Editorial: State unfair in handling of Sevierville nursing home violations

Jun. 20, 2013 @ 11:04 PM

Fort Sanders Sevier Nursing Home is, by nearly all accounts, a well-run facility, with top ratings from independent firms, a dedicated staff and a commitment to serve the needs of the residents. Its past surveys and inspections were all fine.

So imagine the shock when, during the June recertification inspection, state inspectors found two cases of residents at one time being in immediate jeopardy, ruled the nursing home provided substandard quality of care and set in motion a process that could lead to hefty fines and even loss of Medicare/Medicaid approval.

And to top it off, the findings relate to the use of beds that, in all prior inspections, never were found to be a violation. The nursing home, like so many others, had always used siderail beds. The side rails, when raised, keep residents from getting out of bed easily or without assistance, to protect those who might be hurt if they leave a bed unassisted.

The rules and regulations of the nursing home industry frowned on the use of such beds, but never enforced that rule, according to local nursing home officials. Until now. The two cases of immediate jeopardy were the result of residents trying to get out of beds with side rails raised, one of them with a leg over the rail. The nursing home was told the siderail beds were in violation of the rules because they serve as restraints and could harm residents who try to escape the bed with the rails up.

Immediately, Administrator Ellen Wilhoit and the staff set out to resolve that issue and within three days had replaced the siderail beds with quarter-rail beds, which have rails at each corner of the bed but not along the sides. That may be enough to avoid losing Medicare and Medicaid certification, but it may not be enough to avoid a fine of up to $10,000 a day from the time the violation was found until the state approves the plan of action. It could be a month or two. Or three. The meter doesn't stop. Fines levied against businesses when workers die on the job often are less than one or two days of fines the nursing home faces, and nobody was hurt at the nursing home.

A commitment to safety and resident comfort is a hallmark of a well-run nursing home like the one in Sevierville. Any good care facility has that as the cornerstone of service. But how do you punch your way out of a paper bag filled with what seems to be an arbitrary and unprecedented enforcement of a rule that, when pointed out, was resolved?

If the nursing home has to pay six-figure fines, it will take away money that was to be used for renovations and improvements to the facility, Wilhoit said. It will be money paid to government coffers instead of to help the people living in the nursing home.

Fort Sanders Sevier Nursing Home apparently has no history of improper and substandard care, or of ignoring rules that are routinely and consistently enforced by the inspectors. If it did, the punishment it faces would be deserved. To suddenly crack down on a regulation that had been largely ignored is unfair and punitive.There was no mention made of the beds during two 2012 inspections.

The right thing to do would have been to notify all nursing homes in Tennessee that the use of siderail beds would no longer be allowed or tolerated, then give the facilities proper notice of when the rule would been enforced, thus giving the facilities time to take corrective action.

Fort Sanders Sevier Nursing Home, which is owned by Covenant Health in Knoxville, says it has never had a problem with siderail beds. It made the switch quickly. Those in authority should be fair in administering punishment and in assessing fines. And in enforcing the rules.