Sherry Cooke's brother, Dennis, died during a stint in a nursing home in Louisville. Years ago, Dennis fell from a ladder and sustained serious brain injuries. He was only in his 40s, and spent the next several years bouncing from one nursing home to another.
Cooke, who lives in Pewee Valley, said she kept her brother company and checked on him practically every day. Despite her vigilance, she said he starved to death within seven months of entering a nursing home.
“Time after time I went in and the tube feeding was not running,” said Cooke, who is now a nursing home reform advocate.
Making sure her brother was getting proper care from the nursing home staff was a constant battle, Cooke said. She said she sometimes saw Dennis’ feeding tubes tied in knots and his body covered in bed sores.
She kept records of his time there and eventually took some final pictures of him right before he died. Her brother had entered the nursing home at a healthy weight and died an emaciated man. Dennis—who was 5-foot-7 –died weighing 106 pounds.
The federal government recently updated how it ranks the quality of nursing homes in the U.S.
And nursing homes around Kentucky are plagued by problems that have plummeted the state to the bottom of national rankings, according to the new information from the Centers for Medicare and Medicaid Services.
The rankings have nursing home advocates clamoring for stronger regulations, though industry representatives claim the rankings are unfair.
A recent Newsweek analysis found more than 40 percent of Kentucky’s nursing homes got just one or two stars, out of the federal five-star ranking system. This puts the state in the bottom tier nationwide, tied with five other states for the sixth worst in the country.
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The ranking is based on state and federal inspection surveys, as well as staffing levels and incident reports, among other things. The federal government added some other quality measures this year, which made many states slip in the rankings. That includes Kentucky.
"Thank goodness for the five-star system and thank goodness it’s been upgraded,” said Nancy Trentham, co-founder of the Kentucky Initiative for Quality Nursing Home standards.
Trentham said she’s been trying to get the state to improve staffing standards for more than a decade now. But she said a lack of political will and entrenched industry interests in the state legislature have kept any change from making it to the governor’s desk.
“If we can address staffing levels in the state legislature, that’s going to improve the care,” she said. “If you don’t have enough staff to care for people, there are going to be incidents to happen and some deadly.”
Trentham said inconsistent quality of staff training is also a problem—and then there is the issue of background checks.
Many homes don’t fingerprint medical and nonmedical staff before they hire them, which can put residents in danger.
“John Brown can come in and say his name is Richard Smith. And John Brown just committed a multitude of crimes,” Trentham pointed out.
With elder abuse on the rise, Trentham said nursing facilities need to make that a priority.
Only 11 percent of licensed nursing homes participate in a voluntary fingerprinting program for elder care facilities, according to the state agency that runs it.
Betsey Johnson, president of the Kentucky Association of Health Care Facilities, said access to fingerprint scanners is currently a barrier for many facilities. She said state agencies are currently working to fix that.
Johnson also takes issue with the way these surveys are conducted.
“There is a lot of subjectivity that’s involved,” Johnson said.
“I mean you have state employees who go into facilities and although they have some guidance they are allowed a lot of discretion. And for some reason in Kentucky we tend to see more deficiencies—higher more significant deficiencies and definitely higher fines. And that’s something that should concern all of us.”
In fact, a ProPublica analysis of some of the new data released by the federal government shows that Kentucky actually leads the nation in the rate of serious deficiencies per nursing home.
Jan Scherrer, who has been fighting for more regulations in Kentucky for years, said it’s not a mystery to her why these numbers are so bad.
After years of unsuccessfully fighting to improve staffing standards, she’s now focusing her efforts on getting state officials to spend more money on homecare.
In Kentucky, she said, nursing homes should only be considered “an absolute last resort.”