When state inspectors walked through the front doors of a southeast Colorado Springs nursing home last year, they found elderly and infirm residents being “degraded, dehumanized, demeaned, punished, fearful, angry and intimidated.”
Yet it appears to have been business as usual for multiple nursing homes across Colorado owned by the same Atlanta-based company.
The inclusion of four Colorado nursing homes — including one in Colorado Springs — on a secret federal list of troubled nursing homes earlier this month has raised fresh questions about the owner of those facilities, SavaSeniorCare, and the well-being of residents at the company’s roughly two dozen other nursing homes across the state.
Ombudsmen in Colorado Springs and the Denver metro area said the company and its four newly-scrutinized nursing homes have made improvements over the last year, often under new leadership. But, they added, the facilities’ inclusion on the federal list is a reason for consumers to ask even more questions before placing family members.
“They’ve been doing better within the last year,” said Shannon Gimbel, program manager for the Denver Regional Council of Government’s long-term care ombudsman program, which oversees three of the troubled facilities. “Certainly, Sava is not new to knowing that operations over its facilities at least in Colorado has been a struggle.
“They do well, and they do well in other states. And Colorado has been a challenge for them.”
The revelation of the list’s existence cast a light on the federal government’s key program for improving conditions at problematic nursing homes, which has been ravaged by federal budget cuts in recent years.
The nursing homes were all candidates for the federal Special Focus Facility program, a Centers for Medicare and Medicaid Services program that aims to improve the conditions of troubled nursing homes. Facilities in the program face losing Medicare and Medicaid funding — the lifeblood of most nursing homes — if they don’t improve.
The only Colorado facility currently in the program is Bethany Nursing & Rehab Center in Lakewood.
While participants in the program — like Bethany — have traditionally been public, candidates for the program have been kept secret by the Centers for Medicare and Medicaid Services, also known as CMS. They were only revealed when Pennsylvania’s two senators — one a Democrat, the other a Republican — published a list of nearly 400 candidates on June 3.
By some measures, one of the most troubled of the four listed Colorado nursing homes has been Aspen Living Center in Colorado Springs.
The nursing home, near Circle Drive and Monterey Road on the city’s southeast side, has racked up more than 60 violations during inspections by state regulators over the last three years, according to CMS. In that time, the nursing home has been fined $210,184 by the agency, while receiving a two-star rating for its overall quality.
Its inclusion fits a trend in Colorado. Every other nursing home in the state deemed a candidate for the Special Focus federal program also is owned by SavaSeniorCare
They have each been cited for dozens of deficiencies in recent years. And they’ve been fined repeatedly by federal regulators for those issues.
Alpine Living Center in Thornton has been fined $751,130. Monaco Parkway Health and Rehabilitation Center in Denver has been fined $169,455, and Pearl Street Health and Rehabilitation Center in Englewood has been fined $149,219.
Lowest possible rating
From looking at the websites for the nursing homes, prospective residents and their families would never know about those issues.
Flush with well-lit photographs of empty dining and living rooms alongside carefully-manicured lawns, the websites feature front and center their Google customer review ratings, each ranging from 3.9 to 4.1 out of a possible 5.
Beneath them are five glowing, anonymously posted comments — all punctuated with five-star reviews that praise each nursing home for their cleanliness and, in at least one instance, their “caring and dedicated management staff.”
The laudatory ratings and comments are a far cry from those by the federal Centers for Medicare and Medicaid Services.
All of them have two-star federal quality ratings by CMS, which is par for the course at Sava-owned facilities in Colorado.
Twenty of the 24 Colorado nursing homes listed on SavaSeniorCare’s website received one or two stars for overall quality on the federal agency’s five-star system. Eleven of them received only one star — the lowest possible rating on the agency’s scale.
The problems included not properly developing care plans, not treating residents with dignity when responding to their call lights and, in one instance, not keeping someone from wandering outside without supervision, despite being at very high risk for falling.
Nursing home ombudsmen say the rating system is far from perfect — sometimes penalizing nursing homes more for paperwork issues, than for quality of life concerns.
Still, they say, the rating system is a factor to consider when choosing a facility, along with personal visits and discussions with local ombudsmen.
“It should never be the only source of information to make a decision. It’s one of several,” said Scott Bartlett, who oversees the Pikes Peak Area Agency on Aging’s ombudsman program.
‘Proud of accomplishments’
At Aspen Living Center, the issues and health violations have piled up for years.
During the facility’s most recent state licensure and federal re-certification survey in April 2018, inspectors found a culture of harassment, abuse and degradation — much of it led by the facility’s administrator.
The facility failed to treat residents with respect and dignity, with some reporting feeling “like a zero” and being treated like children while living “in prison,” the inspection report said.
The administrator — whose name was not given in the report — threatened residents during a meeting shortly after taking control of the building, saying “if any resident was unwilling to abide by her rules, she could show them the door,” the report said.
One woman complained of not being able to go on an outing due to an unpaid bill. Another resident said his pain medication was discontinued after the director of nursing — also not named — accused him of using heroin, despite no attempts being made to test him for the illicit opioid or confirm any such drug use.
Aspen staff members said they either didn’t know to whom to raise concerns, or feared being fired if they raised concerns to state regulators. Most of their angst was directed at the nursing home’s administrator and its director of nursing.
In a statement, a company spokeswoman said the company works “diligently every day to improve the quality of care for the residents we serve in Colorado. We will continue with our efforts and we thank our staff for their dedication and loyalty.”
Aspen Living’s administrator and director of nursing were replaced by the company after the April 2018 inspection. The Sava spokeswoman also emphasized that all four facilities on the federal list received four-star ratings for staffing levels — a key indicator for a nursing home’s ability to provide good care. And she added that the company is “proud of the accomplishments” those facilities have made of late.
The nursing home’s administration was forced to draft a plan to fix problems, and a follow-up visit by state regulators two months later found those problems corrected.
State regulators also said that the nursing home’s staff has been responsive and worked quickly to fix issues at the facility.
“They were very engaged in putting together a plan of correction that we found to be adequate in fixing the problem,” said Margaret Mohan, branch chief for acute care and nursing facilities at the Colorado Department of Public Health and Environment.
“Sava’s been very responsive, frankly,” added Randy Kuykendall, director of health facilities and the emergency medical service division at the Colorado Department of Public Health and Environment.
‘We really need … good care’
It remains unclear whether Aspen Living or the other Sava nursing homes will join Bethany as official participants in the federal government’s Special Focus Facility program.
About half as many nursing homes participate in the program as did in 2010 due to budget cuts, according to a CMS memo. The number of nursing homes in the program has dropped from 167 to 88, and the number of possible candidates has fallen from 835 to 440.
Bartlett, the local ombudsman, said Sava has often been responsive to his concerns over the last year. He also gave the company high marks for its community involvement in trying to address elder issues, including its being a member of the Pikes Peak Elder Abuse Coalition.
“We don’t want nursing homes to close — it’s not about that,” Bartlett said. “I mean, ultimately if they don’t make the turn, that’s a possibility. But what we really need is for the homes to be providing good care and a good environment to live in for these individuals.”
“And luckily, I believe that if there have been these kinds of problems in this region before, they’ve been solved. And I’m hoping the same will be true of Aspen Living Center.”