Medicaid threatens to pull $29 million from state care home


For the third time in 14 months, Austin’s state institution for people with intellectual disabilities is in danger of losing millions of dollars in Medicaid money after a string of incidents left one resident dead and two severely injured.

The facility has until June 17 to make significant improvements or it could lose its eligibility for Medicaid funding, which amounts to nearly $29 million of its $50 million annual budget. The superintendent hired last year to overhaul the 300-resident Austin State Supported Living Center resigned under pressure May 17.

The financial threat comes after state investigators reported in both annual inspections and complaint investigations that a patient died at the living center in February as staff members ignored his worsening medical condition. Another man suffered severe burns when staffers bathed him. A third was seriously hurt after his roommate attacked him; investigators determined staffers had not done enough to protect him as the aggressive behavior escalated.

“It’s extremely sad,” said Dennis Borel, executive director of the Coalition for Texans with Disabilities, which advocates moving most people out of the living centers. “I’m no longer surprised by anything I hear.”

Earlier this month, Austin living center superintendent Charles Bratcher quit in lieu of termination after barely a year in the top job. Bratcher, who could not be reached for comment, immediately vacated the on-campus house he was leasing. He has been replaced by Matt McCue, a national consultant on disability services.

McCue is the facility’s third leader since March 2012. At that time, former superintendent Vira Benson was removed because of ongoing problems with safety, medical care and treatment services. Bratcher, who earned $95,000 a year, was hired to improve care.

That didn’t happen, said Aging and Disability Services spokeswoman Cecilia Cavuto.

“We have not seen the improvements that were expected and that are needed in the facility,” she said. “We had to make some changes.”

Now the state is scrambling to fix the problems that have put it in jeopardy. Losing the federal money would be a hard hit to the center. Without it, the state would have to find the money somewhere in its $560 million budget for all 13 of its living centers across Texas, Cavuto said.

Despite the leadership changes and continuing struggles, some people with relatives at the Austin center praise the services and social opportunities it offers. They say that investigations and inspections are biased, only highlight problems and don’t capture the positive things.

“There is a wonderful staff, and I’m very happy to have good doctors, good dentists and good nurses,” said Charleen Searight, whose daughter lives there. “It’s her home. I really dislike the fact that people keep trying to tear it down.”

Four years of trouble

The Austin State Supported Living Center is one of 13 taxpayer-funded institutions for 3,600 people with intellectual disabilities, such as autism and cerebral palsy. It is operated by the Department of Aging and Disability Services. Complaint investigations and yearly quality inspections are conducted by the agency’s regulatory arm, a separate division that ensures state and federal standards are met.

If conditions don’t measure up, investigators can put the center on 90-day Medicaid termination status, meaning that its federal money can be withheld if problems are not resolved in that three-month time period. The Austin center was last on notice in October but eventually made enough progress to satisfy officials.

Despite that, investigators have continued to spot severe problems at the 35th Street center. Those troubles are documented in several reports: an annual inspection that scrutinizes overall operations and several investigations into specific incidents involving residents.

Among the findings:

In November 2012, caretakers were regularly failing to measure water temperature before bathing residents. The man who was injured suffered severe burns after being bathed in excessively hot water.

In February, a resident with a history of aggression assaulted his roommate, seriously injuring the man’s ear. Staffers knew the attacker’s violent behavior had been escalating but didn’t do enough to prevent problems, reviewers concluded.

 

Austin’s problems come as all of the centers are under scrutiny by the U.S. Department of Justice. In May 2009, after a federal investigation concluded that residents were living in substandard conditions, the state agreed to make substantial improvements.

Four years after that deal was struck, the centers throughout the state are making slow progress with safety, medical care, treatment plans and other services, Cavuto said. In a November inspection of the Austin center, state investigators wrote that some residents spend most of their time sleeping, watching television or looking out the window. One woman spent hours rolling on the floor, chewing on a plastic apple. Another patient continuously paced from room to room while holding a white sock. A male resident regularly slept naked on the living room recliner.

Staffers frequently failed to teach residents important life skills, such as how to eat or dress themselves independently, the inspection report states.

Part of the reason people are just sitting around is there aren’t always enough employees on duty to focus on the residents, the report states. Such shortages led to one resident wandering from his designated area 74 times in four months and several others sitting in urine-soaked pants for at least an hour.

Employees also told investigators that they worry about their ability to handle emergencies when they were short-staffed. One woman said that she “puts her trust in God that nothing would happen when there are only two staff in the home.”

Nona Rogers, whose brother lives at the Austin center, says that investigators can misinterpret the quality of residents’ lives because reviewers see only a fraction of what goes on. While residents may spend a lot of time watching television one day, they might be very active the next, walking to the chapel or canteen or other areas of the campus, she said.

The intense focus on making every moment a learning opportunity is counterproductive, she said.

“The layer upon layer upon layer of trying to make our family members something they are not can be frustrating,” Rogers said.

Death underscores lapses

The most serious issue was detailed in a March investigation report that described the death of a man with profound intellectual disabilities who had lived in the center for 50 years.

For more than 27 years, the man had suffered from severe gastrointestinal problems, the report states. In the two months before his death, he had been hospitalized twice and treated at the center infirmary three times.

As part of the man’s care, his nurses were supposed to regularly measure his abdomen, the investigation records state. Direct care staffers who worked with him closely were supposed to document his bowel movements. But no one did either task consistently.

As part of its review, investigators watched a surveillance video that captured the man’s death on Feb. 13.

That evening, the man was eating dinner at the center when he began moaning and making noises, the report states. He was obviously in distress, and his stomach “appeared extremely distended,” the report says. The man was taken to the living room, seated on a rocking recliner and left alone for about 10 minutes, investigators wrote.

Four minutes after he was left alone, the man began “kicking his legs out in a forceful manner,” the report states. One minute later, he stopped moving. About five minutes later, an employee noticed the man had turned blue. Staffers began CPR and called an ambulance. The man was declared dead about an hour later.

A nurse later told investigators that he believed the man “went peacefully.”



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