By Thomas Goldsmith
When state health officials started naming names last week of North Carolina long-term care facilities with COVID-19 outbreaks and the deaths resulting at these homes, the move opened up reams of information. Along with real-life stories, the names and records of the facilities shed light on the way the complex business works.
State and federal records, for example, show that Ohio-based Saber Healthcare owns six facilities with outbreaks and deaths, the largest number of centers named by the state as having COVID-19 cases. Their properties include Autumn Care of Cornelius, where the state report showed that 53 cases of COVID-19 had been diagnosed and 10 deaths had resulted.
Some of the facility names had been known through media or county reports, but more than half of the 50 facilities had not been made public.
After a long dispute with Saber Healthcare, Andrea Hummel Gorman of Huntersville got emotional when she talked about her father’s recent death from a case of COVID-19 contracted at one of the company’s nursing homes.
Hers is a complicated story of the kind that many North Carolina families have gone through in recent months as the infection riddled more than 50 nursing homes. Gorman’s father, Stanford Hummel, 88 and a Korean War veteran, entered Autumn Care of Cornelius in early March to recuperate after treatment for pneumonia in a Mecklenburg County hospital.
But, Hummel said in a recent telephone interview, Saber Healthcare decided to discharge Hummel from the facility because he wasn’t improving enough for them to keep receiving payment from Medicare under their regulations.
Alternating appeals to the decision flew back and forth from Gorman and Saber, three times in all. Then Saber won the last round, getting approval to oust Hummel.
“They were going to release him because they said that he was good enough to go,“ Gorman said. But, she said, he was still weak and in need of care.
Meanwhile, COVID-19 was sweeping the nursing home. Beaten down, Gorman gave up, she said. Her dad next entered a Charlotte hospital, with COVID symptoms. A little more than a week later, on April 27, he was dead.
“How’d this happen?“ Gorman said. “God, I was so mad, because I listened to his voicemails again yesterday, with him saying that he had no idea what’s going on. Nobody would tell him anything.“
Saber Healthcare attorneys did not respond to a reporter’s several questions about Hummel’s care, lawsuits against the company and affiliates, and its general response to COVID-19. Saber, the owner of more than 100 nursing homes in seven states, did put up a statement on its corporate web site: “With the global outbreak of the Coronavirus (COVID-19), Saber Healthcare Group remains hypervigilant to the health and wellness of our staff, residents and their families.“
DHHS had resisted making official notice of the location and numbers of COVID-related illnesses and death in nursing homes, but changed direction after pushback from open records advocates and a coalition of North Carolina media organizations including North Carolina Health News.
What is really going on?
“As this pandemic continues to evolve, we continually reassess the appropriateness of data reporting to balance transparency, public health and individual privacy,“ DHHS said in a statement with the list of facilities.
Naming the residential centers not only benefited residents and family members who wanted complete information, but also kept facts flowing to local officials, businesses and people who lived near a nursing home touched by the deadly virus.
Just tracking down what’s going on and who’s ultimately in charge can be a family member’s toughest job, or that’s what Gorman found as her father grew sicker by the day. Medicare covered his fees at Autumn Care of Cornelius for an initial period following his hospitalization for pneumonia treatment.
“I got a phone call from them, telling me that he had to go to the hospital because his oxygen levels were down to 60,“ the daughter said. (Oxygen saturation lower than 95 percent is a warning sign.) “And he was having a hard time breathing. So I asked them, ‘Did you guys get his COVID results?’ And they said, ‘What? Nobody called you? It was positive.’“
The next query Gorman got on Hummel’s status was from Novant Health Presbyterian Medical Center in Charlotte.
“They told me that they would have to do another COVID test on him because Autumn Care could not find his test results,” she said.
Between the federal information resource Nursing Home Compare, the assisted-living information at the NC Division of Health Service Regulation, and assorted public court records, there’s plenty of lore around about North Carolina long-term residential care destinations. Saber Healthcare has some positive results behind it, as well as some stretches of rocky road.
Prior legal trouble
One of the rockiest stretches came in April, when Autumn Care of Cornelius was assessed $10,342 in fines by the federal Centers for Medicare and Medicaid Services and was cited for deficiencies that included the center’s “lack of a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.”
On April 14, Saber agreed to pay $10 million to settle allegations that it induced some of its nursing homes, including two in North Carolina, to turn in false claims to Medicare for “rehabilitation therapy services that were not reasonable, necessary, or skilled,” according to the federal Department of Justice.
In the original lawsuit, filed under the False Claims Act, a law which makes it illegal to bill government falsely for services, all of the facilities with COVID-19 outbreaks were cited, along with virtually every Saber Healthcare skilled nursing facility.
“When skilled nursing facilities provide rehabilitation therapy services based on maximizing revenue rather than what is necessary for their patients, we will not hesitate to hold them accountable,” Jody Hunt, assistant attorney general of the department’s Civil Division, said in a statement.
In its own statement, Saber responded in part, “During this critical time for healthcare providers, our resources are better spent in serving our patients’ needs and supporting our employees rather than continuing to litigate these issues.”
No official documents cite any deficiencies by Saber Healthcare in the recent novel coronavirus infections at six of its North Carolina facilities. However, records indicate a previous lack of attention by stressed employees in individual cases and a company-wide effort to make higher profits by overcharging taxpayers for services.
‘My father got no information’
In another North Carolina development, Raleigh attorney Stephen Gugenheim is pursuing a lawsuit on behalf of three older long-term care residents, alleging that named defendants including Saber Holdings, one of many Saber affiliates, maintained low staffing at three state adult care homes and “provided substandard care in order to profit at the expense of their elderly residents.”
Said Gugenheim in a phone interview, “We are moving forward with litigation and hope to go to trial within a year.“
Legal actions, of course, are not proof of any sort of business practice until they are resolved. But there are stories to ponder, like those of Sanford Hummel and his family. Photographs and stories recall him as a laughing man who loved to spend time with his daughter and grandchildren.
“I seen him every day while we could still see him, before the COVID, before they had to shut down. And my father got no information.
“They couldn’t do nothing with him until they got the results. So, Autumn Care, we would call there several times a day. And we left messages and nobody would call us back. The problem with Autumn Care is not the nurses, but the administration.”
After Hummel went into the hospital and was put on a respirator, there was little left to do, Gorman said, still moved to tears a few days after her father died,
“We said our goodbyes and had them take him off the breathing machine,” she said. “That was just this Monday of this week… It was just so hard, because we fought so hard to be able to…”
Then Gorman trailed off in tears, overwhelmed by the way things ended for her dad.
Of the 422 COVID-19-related deaths in North Carolina, 198 have involved residents of federally regulated nursing homes. Among the grim overall total, 87 percent have been among people like Sanford Hummel, older than 65.
“They need to let these patients know what’s going on with them,“ Gorman said. “I’m sure it’s not just happening with my dad.“
State DHHS records preserve a family’s complaint about their relative, known in an investigative report as Resident #34, during her residency at Autumn Care of Cornelius. She had been admitted to the Saber Healthcare facility on July 23, 2018, with conditions including “dementia, osteoporosis, osteoarthritis, hypertension, and others.” The report said in part:
“Resident #34 was resting in bed with her eyes open. She appeared disheveled. Her hair was very shiny and was going in all different directions. Resident #34 was dressed in a black and red buffalo plaid flannel shirt and had no pants on but was covered with a sheet. Resident #34’s family was at bedside assisting her with the lunch meal. The family indicated that they had been “fighting” with the facility to keep pants on Resident #34…
“(Nursing Assistant) #1 stated that the last time she had changed Resident #34 was before lunch and proceeded to pull back the sheet. When the sheet was pulled back a terrible ammonia smell was noted. Resident #34 was rolled to one side and her brief unfastened. The brief was soiled through all the cotton to the edge of the brief. The draw blanket that was under her was wet with a liquid and the blue mattress had a dark ring directly under where Resident #34 was resting. When NA #1 pulled the intact brief off of Resident #34 and threw it in the trash can, it made a loud thump from the weight of the soiled brief.”
Asked about the incident, the nursing assistant told DHHS investigators, “It was my fault; I did not get back in here and kept getting pulled to do different things.”