Concerns regarding medical and nursing neglect for residents residing in one of our state’s intermediate care facilities has led me to ask many more questions. Questions that I should have asked long ago before harm and permanent damage occurred and quality of life diminished.
But on the other hand, the fact that my allegations were dismissed as “unfounded” when I knew that neglect had occurred, prompted me to do my own investigation.
In Washington State we refer to the state operated institutions (both skilled nursing facilities (SNF) and intermediate care facilities for people with intellectual and developmental disabilities) as Residential Habilitation Centers or RHCs. This presents several problems – the first one being that the SNF and ICF have different federal and state rules and regulations. When both the SNF and ICF are combined in one campus, residents, community members and legislators fail to understand there are two distinct entities involved with different regulations to abide by.
There is also confusion regarding “long term care facility” and “healthcare facility” and which state agency should provide oversight and licensing. In Washington State, the ICF is not included in the definition of “long term care facility” but does fit under the definition of “healthcare facility” by the services provided at the ICF.
This issue is particularly troubling when the state ensures that those who reside in the ICF receive all their healthcare needs on campus by state employed medical providers and nurses.
The Federal Regulations are clear with these issues but Washington State is confused.
Here is just one example of an issue that at this point is unsolvable given the system that Washington State has in place for oversight, surveys and investigations.
There are allegations of multiple medication errors over several years – medications documented as being administered but the pharmacy did not dispense enough medication to account for all the documented (by licenses nurses) administrations. The pharmacy only dispensed 12-46% of the medication the nurses documented. There was harm done by not administering the prescribed medication. This was the practice at the ICF for 9 medications over 5 years time – many, many nurses signed off as administering these medications. If one looked at the medication administration record you would assume that the client received ALL the medication as prescribed –
BUT – there is another story when trying to match the pharmacy records to the nursing administration records. There is a MAJOR problem with the SYSTEM.
The ICF is licensed by DSHS. That means that DSHS is the state agency providing oversight and investigations. When the state investigator goes in to look at these allegations they see the medications were documented as given, meaning that the allegations are unfounded – no medication errors and the nurses provided the care.
There are clear violations of some state nursing standards (State Nurse Practice Act),
- Willfully or repeatedly failing to make entries, altering entries, destroying entries, making incorrect or illegible entries and/or making false entries in employer or employee records or client records pertaining to the giving of medication, treatments, or other nursing care;
- Willfully or repeatedly failing to administer medications and/or treatments in accordance with nursing standards
Failing to meet these standards could lead to disciplinary actions but DHSH does not consider these violations because the nurse documented administration and an error was not observed.
Unfortunately, in this situation, the State Department of Health and the Nursing Care Quality Assurance Commission are unable to do anything since they are not the licensing agency for the ICF and the error is not attributed to one identified nurse. The licensing agency needs to address these violations but DSHS (the licensing agency) does not see these medication errors as violations or errors.
So – how do we as advocates, healthcare providers, parents and legislators ensure that these standards are met?
As stated in the Code of Federal Regulations and the Social Security Act Section 1905 (d) the “primary purpose of the ICF/IID is to furnish health or rehabilitative services to persons with Intellectual Disability or person with related conditions”.
Given that the ICF is a healthcare facility and its purpose is to furnish health services, we need to have healthcare professionals involved in the oversight, surveys and investigations of the healthcare provided – Washington State is not providing the needed oversight of healthcare to this vulnerable population.