ST. PAUL — Undignified living conditions, holes in walls, a resident found wandering outside confused — those are some of the reasons federal regulators are scrutinizing 11 Minnesota nursing homes.

The focus on those facilities recently came to light after leaders of a select U.S. Senate Committee on Aging released what they characterized as a “secret” list of 400 nursing homes across the nation the Centers for Medicare & Medicaid Services, or CMS, said had patterns of health and safety violations and need tighter oversight.

The new federal information is part of an increased focus in Minnesota and across the nation on the treatment of seniors and vulnerable adults. The state Legislature recently approved sweeping new oversight rules in response to lax investigations of abuse complaints by state officials.

“We believe it is the tip of the iceberg,” Kristine Sundberg, of Elder Voice Family Advocates, said of the federal list. “Light is being shed on it. Consumers are becoming more aware they don’t have to put up with such subpar care.”

Of the 11 Minnesota facilities listed, one is in Moorhead and three are in the Twin Cities metro area. Nine of the listed facilities have not previously been publicly identified by CMS as having problems bad enough to possibly trigger tighter federal scrutiny.

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Two nursing homes — in Rochester and Red Wing — are already considered special focus facilities that receive twice the normal amount of inspections and risk losing access to federal money if problems are not corrected.

U.S. Sens. Patrick Toomey and Bob Casey, who lead the select Senate committee, have been critical of federal regulators for not releasing more information about troubled skilled nursing care facilities. After CMS agreed to provide the broader federal list, they praised the decision but called on the organization to continue to provide as much information as possible to consumers about facilities that were not making the grade.

The senators also recently released a 26-page bipartisan report aimed at improving transparency around poor nursing home care.

“Choosing a nursing home is a difficult, and often painful, decision to make. Individuals and families deserve to have all the information available to choose the facility that is right for them,” said Casey, of Pennsylvania, the top Democrat on the panel.

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Past focus on a few

CMS officials have defended the past practice of only singling out the nursing homes currently receiving special scrutiny by the department — currently a nationwide maximum of 88 nursing homes because of funding constraints. They contend information about the quality of 400 facilities that could qualify for the program, if there was more room, is already available on the agency’s website.

However, it is not as easy to identify a nursing home as a qualifying candidate for increased oversight as it is to see which facilities are already on the list. Those on the list are explicitly labeled.

Sean Burke, policy director for the Minnesota Elder Justice Center, said it was unfortunate that oversight was so underfunded there are hundreds of facilities that should get more oversight, but don’t.

“I don’t think it was ever conceived that (facilities) would make the eligibility for that list, but not get into the program,” Burke said. “I think it is a lack of transparency from the federal government. The Senate was right to call them on it.”

The CMS database gives nursing homes star ratings in four categories — health inspections, staffing, quality measures and overall.

While the Minnesota facilities on the recently released list of candidates considered for more scrutiny had “below average” and “much below average” scores in one or more categories, some scored well in others.

That makes it harder to distinguish between homes that may have had a bad inspection or two and the consistently low performers.

Burke says making inspection information easily accessible and understandable is a constant challenge. “It’s just confusing,” he said of the web of state and federal information that’s available.

Kate Goodrich, CMS chief medical officer, said the agency now plans to continue to release the entire list of facilities being considered for stricter oversight. “CMS welcomes the recent attention on nursing home quality of care that has amplified the important national dialogue,” Goodrich said in a statement.

Details of Minnesota facilities

The 11 facilities eligible for stricter oversight by federal officials represent a small portion, about 3%, of Minnesota’s nursing homes. Statewide, Minnesota has roughly 375 nursing facilities with about 54,000 beds and 40,000 residents.

The facilities that face the threat of tighter oversight have about 1,200 beds and in the past three years were the subject of a total of 14 separate complaints and nearly $472,000 in fines.

These are the facilities on the federal list and their status:

  • Bay View Nursing & Rehabilitation Center, Red Wing, special focus facility.

  • Brookview A Villa Center, Golden Valley, special focus facility candidate.

  • The Emeralds at St. Paul (formerly Bethel Healthcare Community), special focus facility candidate.

  • The Estates at St. Louis Park, special focus facility candidate.

  • Havenwood Care Center, Bemidji, special focus facility candidate.

  • Moorhead Rehabilitation & Healthcare Center, Moorhead, special focus facility candidate.

  • North Ridge Health and Rehab, New Hope, special focus facility candidate.

  • Rochester East Health Services, special focus facility.

  • Southside Care Center, Minneapolis, special focus facility candidate.

  • Victory Health & Rehabilitation Center, Minneapolis, special focus facility candidate.

  • Walker Rehabilitation & Healthcare Center, special focus facility candidate.

Special focus facilities receive twice the inspections and risk losing federal funding. Candidates are being considered for the program.

Moorhead Rehabilitation & Healthcare Center in Moorhead last fall faced the possible suspension of federal payments, but that penalty was lifted after the home addressed deficiencies.

In a March 2018 inspection, the home was cited for a resident’s “self administration of his own medications.” He had been “self medicating” with narcotics and antibiotics, which were removed from his room.

The Moorhead home also was cited for allowing a resident to develop a painful pressure ulcer on a heel and failing to inform the resident’s doctor of the worsening ulcer. In another case, a resident with an untreated fungal infection told an inspector, “I don’t think they communicate with the doctor, as I think it’s because they don’t care,” according to the inspection report.

Moorhead Rehabilitation & Healthcare Center did not return phone calls asking for comment.

Improving oversight

At an elder abuse awareness conference June 5, Gov. Tim Walz signed into law new protections for seniors and vulnerable adults in Minnesota. They include raising standards for assisted-living facilities closer to those for nursing homes — requiring licensing by 2021, creating a bill of rights for residents, improving consumer protections and allowing residents to have a camera in their rooms.

Few of the changes will have broad impact on skilled nursing homes that are already regulated by the state and federal government.

Nevertheless, the changes are important.

State lawmakers championed the overhaul after learning in 2017 that many complaints to the state of abuse of seniors and vulnerable adults were not investigated. Families came forward to tell stories of how their loved ones were mistreated and even died because of poor care in facilities the state was supposed to oversee.

Jan Malcolm, who returned to her post as health commissioner to help address the state’s oversight failings, called the legislation “historic.” She also noted the state has more work to do.

“This is certainly a big move for our state,” Malcolm said. “We certainly know this bill is not the complete answer to the broader challenge of elder abuse.”

Forum reporter Patrick Springer contributed to this story.