New Mexico alleges major nursing home chain's skimpy staff hurt residents, overbilled state

New Mexico's attorney general on Friday sued one of the nation's largest nursing home chains over inadequate resident care, alleging that thin staffing made it numerically impossible to provide good care.

The novel approach in the lawsuit filed by outgoing Democratic Attorney General Gary King could be applied in other states if it succeeds. It targets eight nursing homes run by Preferred Care Partners Management Group L.P. of Plano, Texas, a privately held company with operations in at least 10 states: Nevada, Arizona, Colorado, Florida, Iowa, Kansas, Oklahoma, Louisiana, Mississippi and Texas.

Under both the company and a previous owner, Cathedral Rock Management L.P., the attorney general alleged that the nursing homes profited by skimping on staff "at the expense of the physical well-being of vulnerable nursing home residents."

Preferred Care Management Partners said in a statement that it had not yet seen the complaint. The company said it believes the attorney general is targeting practices at its facilities that date to the time before it bought them.

The nursing chain operator is structured as a manager overseeing a series of private partnerships. Its chairman, Thomas Scott, who was named defendant in the lawsuit, is the only listed individual investor in publicly available Medicare data. His company is considered to be the 10th largest nursing home chain in the country.

Since 2008, the company's facilities have collected $229 million in fees — mostly from the state and federal government — for the more than 1 million days residents cumulatively stayed there. To get that money, the nursing homes had to promise to comply with federal and state regulations requiring adequate care.

Traditionally, nursing home allegations have identified lapses in care — such as avoidable deaths, hygiene issues or a pattern of resident injuries from falls — then used whistleblowers to help show that the nursing home's problems stem from inadequate staff.

New Mexico's case includes evidence such as confidential witnesses from the nursing homes' own staffs alleging that managers recognized that nursing assistants were too overwhelmed to change diapers or help residents shower in a timely fashion. Sometimes there weren't enough people working to help incapacitated residents eat and drink, the complaint says, leaving residents "deprived of food and water."

New Mexico's lawsuit relies on an industrial simulation of how long it takes to complete basic care tasks — for example, 3.5 minutes to reposition a resident in order to prevent bedsores.

By calculating the total minutes required to properly care for residents and comparing them to the actual number of hours worked, the state found deficiencies in the total hours worked by nursing assistants of as much as 50 percent. Those numbers are especially useful, New Mexico's complaint says, because the nursing homes regularly boosted the number of nursing assistants who work during state inspections.

The alleged lapses in care took a toll not just on residents but on their families. Cited as Confidential Witness #2, the daughter of one patient at a Santa Fe facility, Casa Real, said she repeatedly found her father unattended, dirty and complaining he was hungry. With the facility's staff saying they didn't have enough time, the woman took over the daily bathing and feeding that the nursing home was being paid by the government to do.

"She would come in every day just after she left work around 5:00 p.m.," the complaint said. "She could not stand to see her father neglected, so providing his basic care became her life."

The allegations in New Mexico's complaint echo some private lawsuits. In a lawsuit filed in Santa Fe County earlier this year, the family of John Conant, a retired Sandia National Laboratories chemist, sued the Santa Fe Care Center for neglect that they say led to his death.

Recovering from a hip fracture in 2010 at the age of 86, Conant was only supposed to spend one month at the Santa Fe Care Center. The facility was then under the control of Cathedral Rock, a nursing home company that sold its facilities to Preferred Care Management Partners in 2012 after settling criminal and civil charges filed in Tennessee.

Though Conant's family had heard about the facility's reputation, "we thought if we were vigilant enough, it would be OK," said Mary Conant, his daughter.

But Conant fell and dislocated his hip, an accident his family said would not have occurred had there been sufficient help to get Conant to and from his bed. Following the reinjury, Conant's family says, he required new surgery and eventually died of complications.

Preferred Care runs four of the seven New Mexico facilities with the worst grades for quality on Nursing Home Compare, a federal website that evaluates nursing homes. One of those facilities, Sagecrest Nursing and Rehabilitation, had more than six times the average number of health and safety violations for nursing homes nationwide. Another, Espanola Valley Nursing and Rehab, reported to Medicare that its certified nurse assistants had just 25 minutes a day to spend on each resident, according to federal data. The average nationwide is just under two and a half hours.

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Horwitz reported from Washington.