Pursuant to the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997, the Civil Rights Division of the U.S. Department of Justice ("DOJ") conducted an investigation of conditions at the Baxter Manor Nursing Home ("Baxter"), a county-operated skilled nursing facility in Arkansas. The investigation resulted in a findings letter being sent to Baxter County's judge on July 14, 2004. The letter stated that in April 2004, DOJ and certain of its expert consultants toured the facility, interviewed residents and staff, and reviewed policies, procedures, and records. The DOJ's investigation led it to conclude that certain conditions at Baxter violated residents' federal constitutional and statutory rights. According to the DOJ, residents at Baxter suffered from deficiencies in the following areas: 1) restraint practices, 2) assessment and resident care, 3) physical environment, and 4) mealtime practices. Additionally, the DOJ found that Baxter's practices did not comply with the Americans with Disabilities Act ("ADA"), 42 U.S.C. § 12132 et seq.
The findings letter described that the DOJ investigators observed a significant number of Baxter residents with restraints whose medical charts in no way justified their use. Both mechanical and chemical restraints were utilized at Baxter Manor in ways that were a substantial departure from generally accepted professional standards. Overuse of full side rails without consideration of suitable alternatives for residents' beds and unchecked use on residents of psychotropic medications for restraint purposes were among the examples the letter cited of inappropriate restraint practices at Baxter.
Baxter's assessment process and care plans often did not meet generally accepted professional standards, whether considering resident rehabilitative, restorative, or medical care needs, according to the findings letter. Physicians and care teams did not operate under clinical practice guidelines and failed to address factors associated with loss of resident function. Baxter leadership and staff lacked training and education regarding federal nursing home regulations, facility policies, geriatric care issues, individual care plans for residents, and discharge planning.
Mealtime use at Baxter of semi-circular feeder tables presented risks of harm to residents, according to the DOJ, as positioning of staff and residents at these tables prompted some residents to hyper-extend their necks to eat, predisposing them to choking, discomfort, and aspiration pneumonia. Regarding discharge planning, the DOJ found that Baxter's staff did not adequately evaluate or assess (1) residents for their discharge potential, (2) barriers to discharge, and (3) placement factors such as a resident's functional status, medical acuity, support requirements, and individual placement preferences. Baxter did not adequately consider discharge planning issues as part of the interdisciplinary care and treatment process. The facility had no effective process for discharge planning, and resident care teams were not educated on discharge planning methodologies. These deficiencies violated the ADA-imposed obligation to treat residents in the most integrated setting appropriate to their individual needs.
The DOJ findings letter proposed remedial actions to remedy the deficiencies, invited the county to address the issues, and alerted the county to the possibility of a CRIPA lawsuit brought by the United States to compel remedial action. We have no post-findings letter information about this matter.Mike Fagan - 06/19/2008