As executive director at Kansas Advocates for Better Care, Deanne Bacco is supposed to keep track of which nursing homes are in trouble and which are not.

Until about six months ago, it wasn’t hard. Now it is.

“We’re not sure why, but there’s definitely a big gap between the information we used to get and what we get now,” said Bacco, whose office is in Lawrence.

The gap, she said, coincides with Gov. Kathleen Sebelius’ decision to put her Department on Aging in charge of nursing home inspections rather than the Department of Health and Environment.

“We always found the KDHE staff to be forthcoming; there were policy issues we didn’t agree with them on, but when it came to sharing information they were always helpful. They had a system in place and it worked,” Bacco said. “If there’s a system at Aging, I can’t tell what it is; and it doesn’t work.”

Bacco said that until this week, she didn’t know the nursing home within the Brandon Woods Retirement Community, 1501 Inverness Drive, was under a ban on new admissions from Aug. 10 to Sept. 10 after failing inspections in July and August.

“Under the old system, that’s something we would have known about as soon as it was decided. KDHE would have put out a news release,” Bacco said. “But here it is December and this is the first I’ve heard of it.”

Not their job

Karen Sipes, public information officer at the Department on Aging since October, said her office did not put out news releases on fines and admissions bans affecting nursing homes. That’s now left up to the federal Centers for Medicare & Medicaid Services regional office in Kansas City, Mo.

Though the Department on Aging surveyors inspect nursing homes, their findings are forwarded to the Centers for Medicare & Medicaid office, where the fines and bans are imposed.

But the Centers for Medicare & Medicaid Services office doesn’t share its data with Kansas Advocates for Better Care. Instead, Bacco said, she’s been told she must file freedom-of-information requests for each report on each nursing home, a process that, when applied to the state’s 375 nursing homes, is impractical.

“Oh, we don’t get anything from them,” Bacco said.

The Department on Aging is aware of the fines and bans but does not alert the public through either Kansas Advocates for Better Care or media outlets.

When the Department of Health and Environment was in charge of inspecting the state’s nursing homes, it sent weekly updates to Kansas Advocates for Better Care. News releases on fines and bans were routinely sent to the state’s newspapers.

Sipes said she notified the media of bans and fines affecting assisted-living facilities because they are regulated by the state rather than the Centers for Medicare & Medicaid Services. The news releases are posted on the department’s Web site, www.agingkansas.org/kdoa.

But Sipes said she didn’t know why a similar news-release policy wasn’t applied to nursing homes.

“My guess is that in the transition between KDHE and KDoA, this hasn’t been a focus — not yet,” Sipes said.

Department on Aging Secretary Pamela Johnson-Betts was out of the office last week and unavailable for comment.

No surprise

The slowdown in information sharing came as no surprise to Margaret Farley, a Lawrence attorney and a member of the Kansas Advocates for Better Care governing board.

“It’s what the (nursing home) industry has wanted all along,” Farley said.

Farley and Kansas Advocates for Better Care objected to the Department on Aging being put in charge of nursing home inspections, a move endorsed by the state’s nursing home lobby.

“The perception that’s out there (among nursing homes) is that KDHE had become entrenched and was hard to deal with — and that Aging wouldn’t be so harsh and would be easier to deal with,” Farley said.

“Our concern was that enforcement had not been part of the culture at Aging and that a certain amount of soft-pedaling would accompany the transition,” she said. “I think that’s what we’re seeing here. I know of no other reason why the flow of information would be cut off the way it has.”

Cindy Luxem, vice president in charge of operations and legislative affairs at the Kansas Health Care Assn., disagreed.

“We haven’t seen any fewer surveys since the shift to Aging — if Aging is supposed to be more lenient, we haven’t seen that either,” Luxem said.

Kansas Health Care Assn. lobbies on behalf of the state’s for-profit nursing homes.

Luxem blamed the department’s communication shortfalls on the transition process.

“They’re still working through a lot of things,” she said. “We’ve not had any problem working with them.”

No excuse

But there’s no excuse, Farley argued, for the Department on Aging’s not notifying Brandon Woods’ residents, their families and the public about the nursing home’s troubles.

“Let’s be honest, these are not the kinds of things that Brandon Woods wants its residents to know,” Farley said. “And they don’t want prospective residents to know about it, either. The quieter this is kept, the better.”

Upon request, the Department on Aging provided the Journal-World with copies of reports on conditions its surveyors found at Brandon Woods in early July.

“This was not a good survey, not by any stretch of the imagination,” said Patricia Maben, director at the Division of Long-term Care with the Department on Aging.

A sampling of the findings:

l Despite residents’ complaints that meals were often dull and repetitious, a check of meals planned for July 6 through July 12 showed chicken being served five times in six days.

l Nursing staff did not do enough to prevent bedsores.

l Workers did not do enough to help residents maintain a dignified appearance. One resident was seen with food on his or her face for 10 hours.

l A dispute between a resident’s hospice nurse and the resident’s pharmacy resulted in the resident going without his or her medications for “a number of days.”

l Staff were unable to explain why it took 21 days to get a “floating air mattress” ordered by a resident’s doctor on June 18. A surveyor asked about the mattress on July 8; it was on the resident’s bed July 9.

Air mattresses are used to reduce the risk of bedsores.

l A nurse’s aide seen cleaning a male resident “who was incontinent of stool” did not wash his or her hands before reinserting the resident’s catheter. The resident’s medical records showed he’d suffered urinary tract infections in March, April and May.

“All of these things are sure signs of understaffing, poor supervision. I mean, the things with the catheter and the aide not washing her hands; that’s very basic stuff,” Farley said. “As an advocate, it’s my position that consumers ought to know these things.”

Brandon Woods executive director Donna Bell confirmed the findings but said conditions improved after some problem employees were fired and the home applied a “much stricter approach” to its hiring practices.

“We decided we weren’t going to tolerate people who weren’t committed to quality care,” Bell said.

Brandon Woods passed a follow-up inspection in September, after which the ban on new admissions was lifted.

State records show that Brandon Woods is one of 40 nursing homes cited with at least 10 deficiencies each year for the past three years.

In 2000, the year before it was sold to Life Care Services, a for-profit chain based in Des Moines, Iowa, Brandon Woods was named one of the state’s best nursing homes, receiving zero deficiencies.