State oversight

Inside a nursing home: cartoons, tunes and tears

 

A recent inspection at one nursing home caring for children found significant shortcomings.

cmarbin@MiamiHerald.com

A day in the life of a children’s nursing home:

•  8:15 a.m.: Resident 2 is parked in the hallway in a stroller. The 3-year-old’s head is in a “slightly arched” position, and his eyes roam the hallway. His lips are chapped.

•  8:45 a.m.: A baby is wheeled into the hallway in an infant carrier next to Resident 2. A mobile is strapped to the baby’s carrier, but no one turns it on.

•  10 a.m.: Resident 1, a teenager, screams “out” from his room, and he is wheeled into the hallway and parked next to Resident 2 and the baby. He reaches over to touch one of them. In what appears to be the children’s first interaction with staff, a caregiver plays nursery rhymes on a CD player.

•  11 a.m.: Residents 1 and 2, the baby and six other youngsters are brought into an activity room. For 30 to 40 minutes, the children are given physical and occupational therapy, watch Dora the Explorer cartoons, and listen to music. A toddler is rocked back and forth by the nursing home’s activities director. Resident 2 cries inconsolably and is sent back to his room.

•  11:35 or 11:40 a.m.: Activities end, a nurse cleans the mats where the children were playing, and the youngsters return to their rooms or a hallway.

Such is the scene described after a recent investigation of Lakeshore Villas Health Care Center, a 179-bed Tampa home with a 15-bed pediatric wing. The March report was the result of a complaint to the state Agency for Health Care Administration.

In response to the inspection, Lakeshore said it had “immediately” revised the activities schedule for Residents 1 and 2, and initiated an audit of the pediatric wing, in general, “to ensure that each resident receives structured activities in which to promote stimulation and learning opportunities.”

The inspection comes at a time when Florida’s practice of raising severely disabled children in geriatric nursing homes already was under a harsh spotlight.

The survey is the most recent of several critical reports by the healthcare agency and others involving nursing homes that also house children. In it, AHCA administrators accuse the home of violating state laws that require nursing homes to provide stimulating activities to frail children, some of whom are physically disabled but intellectually sharp.

The complaint comes six months after AHCA’s top administrator, Liz Dudek, insisted to reporters that pediatric nursing homes were “warm, nurturing” places with a host of enriching activities — and even take children out on field trips, such as excursions to farms to ride horses.

“These reports that they throw somebody in a back room somewhere, where it’s not at all child-based, where they don’t talk to the child, that’s not true at all,” Dudek said.

The Lakeshore Villas report suggests otherwise.

“The facility,” AHCA wrote, “failed to provide meaningful, chronological age and developmentally appropriate structured activities” for two of the three children the agency observed closely on March 7, the day of the inspection.

Entire days went by, the report said, without any documentation of activities staff entering the pediatric ward. One visit lasted less than 30 minutes.

The report suggests the nursing home, which has spent much of the past few years on the state’s “watch list” of marginal homes, largely treats the infants, toddlers and children as if they were small adults.

An “initial activity assessment” done for Resident 2, for example, asked whether the 3-year-old was an “active voter” or a veteran. When offered choices, Resident 2’s activities sheet reportedly checked taking a shower, seeing family members and listening to music. Other choices included reading books, newspapers and magazines. The form was signed by the home’s activities director, who acknowledged to AHCA that she “floated” to the pediatric unit a couple of times each week, and “had no pediatric experience.”

“This form is not age or developmentally appropriate for this child,” AHCA wrote.

As to Resident 1, the teenager, a schedule said he was given “vision activities” — though the schedule didn’t provide a time, or define was a vision activity was, the record said. The schedule also listed the word “buttons,” but failed to explain that, as well. Before he was badly injured in a car accident, records say, Resident 1 was a high school honors student and soccer player. The boy’s chart said he was suffering from “decreased motivation.”

Resident 1’s activities chart also raised questions with the AHCA inspectors: Though the youth ate only through a feeding tube, the log said he liked having snacks between meals. And although the nursing home said he enjoyed having one-to-one interaction with staff, “there was no evidence of the 1:1 interactions with activity staff.”

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