HEALTH

Legislators decry delays investigating nursing home complaints in Arizona

Stephanie Innes
The Republic | azcentral.com
State Sen. Rebecca Rios, D-Phoenix.

Delays in investigating complaints about nursing home conditions in Arizona are serious enough that three Democratic legislators this week were willing to put the future of the state health department on the line.

Members of a Senate panel conducting a "sunset" review on the Arizona Department of Health Services' future on Thursday recommended the state agency remain in existence through 2028. But at 4-3, the vote was closer than expected for a major state agency that oversees public health for Arizona. 

Sens. Rebecca Rios, D-Phoenix, Victoria Steele, D-Tucson, and Tony Navarrete, D-Phoenix, all voted "no," explaining they first wanted to get satisfactory answers about why the state is not following up on complaints and reports about violations at nursing homes in a timely manner. 

"The reason I'm voting 'no' today isn't because I don't believe in the work the department is doing. It really is about making sure that we are holding the agency accountable and that we are being accountable to our constituents," Navarette said. 

Complaints that went uninvestigated for up to two and a half years were highlighted in a state auditor general's report released in September. Some of the complaints that did not get investigated included allegations of abuse and neglect of nursing home residents, and unsanitary living conditions. The report concluded that the delays may be putting residents at risk.

"I want to get to 'yes' on this, but I really believe the reason that the auditors brought the report to us is so that we can fully examine the issues before moving toward continuation (of the health department)," Steele said. "I hope that my vote is heard."

Inadequate staffing, attempted strangulation

The audit reviewed 70 complaints and reports about Arizona nursing homes from 2017 and 2018 and found that 54 percent had been open between six months and two and a half years without an investigation.

In one unaddressed complaint, there was an allegation that a resident tried to strangle another resident.

Another case reported inadequate staffing levels at a nursing home that caused a resident to be left soaking in their own urine and wearing clothes stained with dried food, Dot Reinhard of the Arizona Attorney General's Office told the Senate committee.

In two other examples:

  • A nursing student on rotation at a long-term care facility reported that residents were being subjected to abuse, neglect, unsanitary conditions and inappropriate care. The complaint had still not been investigated 229 days later.
  • The mother of a nursing home resident who had been hospitalized following a stroke alleged that the resident did not receive proper medical care or medication. The state health department eventually made a finding that the facility had not provided proper medication to the resident, but the investigation did not begin until 121 working days after the complaint was made. By that time, the resident had already moved to a different facility.

Of the complaints and reports that were investigated in the auditor general's review, 75% were not started in a timely manner, Reinhard said.

"If I had my grandmother in one of these facilities, I definitely don't want to wait six months. I definitely don't want to wait two and a half years to get some sort of resolution," Navarette said. "There are so many alarming things in this audit."

Rios said she was voting "no" because the vote felt too rushed.

"Can I in good conscience vote to continue any agency when these glaring issues are staring me in the face? No. Not when I know we do not have to have this vote today. ...This is just far too important," she said. 

Long-term care complaint rates are a national problem

Colby Bower, the state's assistant director for public health licensing, said the investigation delays are part of a larger issue with long-term care.

Long-term care facilities represent less than 1% of all the facilities the Arizona Department of Health Services licenses, yet accounts for 33% of all the complaints the department receives.

"Every single (long-term care) facility has at least one complaint launched against them," he said. "Long-term care is the outlier within licensing in terms of how the department is able to adjudicate those complaints." 

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Nursing homes in 2017 and 2018 received 18 times more complaints than any other type of facility that the state health department licenses, Bower said. He also pointed to national numbers that show Arizona is one of nine states that have the highest rate of complaints in the country — 60 or more per 1,000 nursing home residents. 

"From 2011 to 2015, we've had a slight decrease in the number of long-term care beds nationally, but we've had a 33% increase in the number of complaints," Bower said.

'I think it was all political'

In response to the audit, the state health department has posted an audit tracker dashboard on its website so that the public can monitor its progress in addressing shortcomings the report raised. 

The department agreed to all five specific changes related to long-term care licensing, but has said additional resources will be needed, including $3.3 million from the state general fund.

The department licenses 158 long-term care facilities, which often are referred to as nursing homes, and is responsible for inspecting the facilities and for investigating complaints about them.

State Sen. Kate Brophy McGee, R-Phoenix.

Residents of nursing homes are typically elderly but can also include younger people with serious medical problems. 

Sen. Kate Brophy McGee, R-Phoenix, the committee chairwoman, said she was disappointed by those who voted "no" because the vote was about whether or not the Arizona Department of Health Services should continue to exist as a state agency, and whether a bill and legislation should be produced to ensure it exists through 2028.

"I would like to point out to my colleagues that a vote of 'no' puts public health at risk," she said during the meeting.

"A 'no' vote says we don't think the agency should continue. It creates flux, it causes problems and I think it was all political," she said later in an interview.

Brophy McGee said legislation will be drafted and presented during the next legislative session to keep the agency in existence until 2028. And the conversation about long-term care will continue. 

"Do we continue the agency? Is it needed, is it necessary? Does it perform valuable functions for the citizens of Arizona? I think the answer is undeniably yes," she said.

Reach the reporter at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes

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