Something's not right at the nursing home within the Brandon Woods retirement complex.
Three times last year, state and federal officials suspended the home's Medicaid and Medicare payments. It was fined twice -- once for $5,000, a second time for $1,000.
Kansas Department of Health and Environment inspectors last month confirmed a report that a confused resident who "used two canes for mobility" had wandered outside unsupervised and without a coat. At the time, the temperature with wind chill factor was 37 degrees.
Earlier, inspectors confirmed reports that three residents in the home's dementia unit were taken to Lawrence Memorial Hospital -- two in May, one in August -- after falls. Two suffered broken hips, the third required stitches to close a cut.
Inspectors attributed the falls to the unit's being understaffed -- two, sometimes three workers trying to care for 26 residents.
The findings are significant because three years ago, Brandon Woods, 1501 Inverness Drive, was named one of the state's top nursing homes after passing its annual survey without a single deficiency.
But in May, state inspectors cited Brandon Woods with 12 deficiencies. The year before, it was cited for 11 deficiencies.
"The statewide average is eight deficiencies," said Deanne Bacco, executive director of Kansas Advocates for Better Care, a state association that monitors nursing-home conditions.
"For a facility to go from zero to 11 and then to 12 (deficiencies) in a span of three years means they're erratic," she said. "The level of care is inconsistent -- that's what the surveys say."
Deficiencies cited in other nursing homes' annual surveys:
l Lawrence Presbyterian Manor, 1429 Kasold Drive -- 6
l Pioneer Ridge, 4851 Harvard Road -- 7
l Lakeview Manor, 3015 W. 31st St. -- 20
l Baldwin Care Center, 1223 Orchard Lane -- 3
l Eudora Nursing Center, 1415 Maple -- 3
Lakeview Manor is now under new management.
Contacted by the Journal-World, Brandon Woods executive director Donna Bell confirmed the incidents cited in the KDHE reports.
And it's true, she said, that staffing at Brandon Woods "continues to be one of the most difficult things we deal with on a daily basis."
Growth of in-home health care and increased competition from other nursing homes and Lawrence Memorial Hospital have made it increasingly difficult to recruit, hire and retain workers.
"We're in a tight labor market that was already tight to begin with," she said.
But, Bell said, Brandon Woods is aware of its problems and is doing all it can to address them.
"We have been honest in admitting and reporting our weaknesses, and we've been very aggressive in getting them corrected," she said.
Another factor, she said, is the federal requirement that nursing homes be "restraint free," meaning unstable residents will not be tied in their beds and chairs.
"When you're restraint free -- as we are -- the unfortunate reality is that people are free to be mobile and that we'll see more falls occurring," Bell said.
At the same time, an increasing number of nursing-home admissions involve residents with dementia.
Bell said Brandon Woods had increased its use of personal alarms with residents who are most at risk of falling.
"The alarms will let staff know when someone who's at a risk of falling is trying to get up or move about," she said.
"We still have a lot of people who don't want help -- it's a pride thing -- or who don't want to be a bother or who think, 'Oh, I can do this.'"
Bell said Brandon Woods' troubles are unrelated to its being sold to Life Care Services, a Des Moines, Iowa-based company, in 2001. Until then, it had been owned by its creator, Retirement Management Co. of Lawrence.
Life Care Services operates more than 100 retirement communities in 31 states.
"The issues we're dealing with are really a reflection of what's going on across the state," she said.
Greg Reser, who oversees KDHE's nursing-home inspections, agreed with Bell's assessment.
"We're of the opinion that Brandon Woods is moving in the right direction, more so than they were in the spring and latter part of last year," Reser said.