The state Department of Public Health is wading through a backlog of 2,400 unaddressed complaints from nursing home residents, their families or others, and another 1,300 complaints related to incidents at hospitals, some which are now five years old, agency data shows.
The pandemic and a wave of retirements in the agency’s Facility Licensing and Investigations Section has contributed to the complaint pileup. At one point, FLIS was more than 40% understaffed, but through “aggressively” recruiting, its leaders said, the vacancy rate is down to 14%.
The backlog caught the attention of health care advocates and lawmakers who say it is chipping away at public trust in the system.
“By not responding, we’re telling the public they don’t matter,” said Rep. Toni Walker, a New Haven Democrat who is co-chair of the Appropriations Committee. “That should never be in our discussion, nor should it be any of our conclusions.
“This is a dramatic issue we should take seriously.”
Lisa Freeman, executive director of the Connecticut Center for Patient Safety, said the slow process of handling complaints sends a message that patients’ grievances aren’t important.
“When patients, their families and the public are ignored, especially in a nursing home, where many people cannot adequately speak up for themselves, it’s dismissive,” she said. “This is a flat-out way to minimize their involvement and respect for their input.”
The unaddressed complaints date back as far as 2019, said Chris Boyle, a spokesman for the health department. At the height of the pandemic, survey and complaint inspections were put on hold while the health officials carried out infection control visits.
The Centers for Medicare and Medicaid Services “halted our investigations for all complaints other than the most serious in early 2020, meaning that we had some complaints from 2019 on the books when the pandemic hit,” Boyle said.
As the department deals with the backlog, surveyors handle serious “immediate jeopardy” and “high-priority events” quickly, while complaints that are considered “medium” or “low” priority can take longer to resolve. Immediate jeopardy cases — findings that indicate violations in a nursing home caused or were likely to cause harm or death to residents — are responded to within three business days. For high-priority events, the state must initiate an on-site survey within 18 business days, and for medium-priority incidents, within 45 calendar days. Low-priority events are typically dealt with during the facility’s next routine inspection.
“Every single complaint that comes to the agency is important to us, because it’s impacting someone’s life,” said Barbara Cass, the health commissioner’s senior advisor for long-term care.
Medium- and low-priority grievances are “important to us, but they are not suggesting an imminent threat to life or safety or an immediate negative outcome,” she said.
A high-priority event could be a door falling off its hinges and hitting a resident, injuring them, or a staff member humiliating or speaking rudely to a resident. A medium-priority incident could be a resident receiving cold coffee, a resident missing a recreational activity, or that soiled clothes were left on the bathroom floor. Low-priority events, which officials say happen rarely in Connecticut, could be an issue with coding in someone’s medical record that did not impact care.
Even as the department is trying to catch up on complaint inspections, Dr. Manisha Juthani, the state’s public health commissioner, said her department is getting about 75 new grievances from nursing homes each month that are non-emergent.
“Every day we go and do more, but we also get 75 complaints every month,” she told lawmakers at a public hearing in March. “So, we get ahead, but then we also get more.”
Members of the legislature’s Aging Committee asked Juthani if she had a timeline for when the agency might get caught up, but she was reluctant to provide one.
She acknowledged the department needs to do a better job of giving people feedback on the status of their complaints.
“I do understand the frustration that people have with not knowing,” Juthani said. “I’m working very hard with my team to make sure the public that is entrusting us with providing this service to their loved ones have information.”
Complaints increasing
Complaints may be sent directly to the health department by patients, their families, staff or others, but they also are referred by other state offices, including the long-term care ombudsman’s office and the health care advocate’s office.
Mairead Painter, the long-term care ombudsman, estimated she refers more than 100 grievances to the health department on an annual basis. Her office also handles complaints, some of which are not referred to the health department.
Sean King, the state’s interim health care advocate, said his office forwards roughly eight or nine complaints per month.
The number of grievances sent to Painter’s office have increased in recent years. From Oct. 1, 2022 to Sept. 30, 2023, her office received 4,285. From Oct. 1, 2023 to April 5, 2024 — the most recent fiscal year — the office so far has received 1,939.
While health officials say non-emergency complaints are on the rise, immediate jeopardy orders have also increased.
The health department issued 17 such orders in 2018, nine in 2019, 15 in 2020 and 16 in 2021. By 2022, the number jumped to 24, and the state reported 25 in 2023.
During the second half of 2023, five of the orders were issued after residents walked out of a facility, either completely unnoticed or by mistaken identity, and were found in some cases hours later, miles from the nursing home grounds.
There also were at least two cases of residents roaming the halls inside the facility unattended. In one instance at the St. John Paul II Center in Danbury, a male patient in the dementia unit with a history of “sexual predatory” behavior walked out his room and was later found in bed with another resident.
In two cases — one at Apple Rehab Mystic and another at Autumn Lake Healthcare in West Hartford — staff were cited for failing to determine whether a resident was to be administered CPR. In both instances, staff mistakenly believed a resident had a “do not resuscitate” order and failed to provide CPR. Both residents died.
Painter said health officials have recently been responding to complaints more quickly. But the long delays for some grievances can be problematic.
“The hard part is, when you’re this far out, getting findings,” she said. “Are they going to see [the issue]? Because they have to see the conditions the way we saw them when we submitted the complaint. If you’re talking two, three or four years later — is the resident even still there? Is the same roommate there? Can you even replicate the situation? That part is frustrating to residents and family members and my team members.”
Freeman said she is glad the health department is prioritizing the most serious cases, but “no event is necessarily a small event. They’re all important.”
She worries surveyors are missing opportunities to identify repeat errors in nursing homes and hospitals.
“You’re not going to see a pattern if it’s one or two years later,” she said. “Part of determining the cause involves talking to people, and memories slip. You’re losing the opportunity to learn from the mistakes, and that’s going to make them more likely to recur.”
‘These are people’s lives’
Nursing home and hospital industry leaders said they understood the challenges facing the health department and were hopeful the backlog would be resolved.
“It is not ideal. After a number of years, nurses move, doctors change, memories fade. It becomes harder to do an investigation,” said Jim Iacobellis, senior vice president of government and regulatory affairs for the Connecticut Hospital Association. “But we also know every investigation that is logged into the department is done. … And if anybody understands what the last several years were like, the long tail of what has happened, it is the people at the hospitals.”
“We’ve been getting reports from our nursing facilities that during complaint investigations, there’s any number of trainees attending these surveys on-site, which is signaling to the sector there are new hires being made by the regulatory agency and more are on the horizon,” said Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, which represents more than 100 for-profit nursing homes.
But some legislators say more oversight is needed to ensure the complaint backlog is addressed and more resources should be directed to the health department to help surveyors catch up.
“It’s obviously concerning that the number seems to keep going up even after they have added more staff,” said Rep. Lisa Seminara, a ranking Republican on the Aging Committee. “It is something we will be watching to see if communication with families improves and the numbers go down. If not, it’s something we may have to address.”
Rep. Jane Garibay, D-Windsor, a co-chair of the Aging Committee, suggested lawmakers set aside $750,000 to allow some surveyors who work 35 hours a week to go to 40 if they want to.
“I feel frustrated. I feel outraged,” Garibay said. “We need many things in the state budget, but these are people’s lives. I’d like to work with [the health department] on a plan to catch up.
“What we’re asking for is very little. It’s like pennies within our multibillion-dollar budget.”
Lawmakers have until May 8 to vote on bills or approve additional funding.
Walker called on health department leaders to update key legislators at least every two months about the status of the backlog and progress in tackling it.
“This is not information or data that should be held quiet,” she said. “It should be brought out and discussed with vigor amongst the legislators who have responsibility to oversee these agencies.”