The V.I. Government might temporarily take over Sea View Nursing Home to delay its financially disastrous decertification by the Centers for Medicare and Medicaid Services, acting Human Services Commissioner Vivian Ebbesen-Fludd told the Legislature Friday.
CMS Associate Regional Administrator J. William Roberson gave public notice earlier this month that Sea View Nursing Home "has failed to maintain compliance with Medicare requirements," and as a result CMS will no longer reimburse it for care for patients on Medicare or Medicaid after June 30. (See: CMS Notice of Sea View Decertification in Related Links below)
Sea View had been the only CMS accredited nursing home in the Virgin Islands. Medicare/Medicaid distinguishes between nursing homes, like Sea View where patients need skilled care for most of their needs, and assisted-living facilities, where patients live on their own with some help for daily needs. The Lucinda Millin, Herbert Grigg and Queen Louise homes for the aged are assisted-living facilities, which are not rated by the federal entity.
The territory, like the nation as a whole, has an aging population and V.I. Human Services officials have testified many times to the Legislature that the need for long-term care beds is greater than the supply and steadily increasing. Losing funding as a result of decertification of Sea View makes that pressing concern more severe.
Sen. Kurt Vialet on Friday asked Ebbesen-Fludd to update the Senate Committee on Health, Hospitals and Human Services on what was happening at the territory’s sole nursing home.
Ebbesen-Fludd, the governor, agency heads and Sea View owner Dr. Al Heath have met and formed a steering committee to work out how to move forward. The top priorities are regaining certification and preventing local patients from being transferred out of the territory, she said. And taking over the facility may help, she suggested.
"There is a stipulation within the (CMS) regulations that allows the state to operate the facility for an interim, which will allow us to extend the decertification process," she said. "Our biggest concern, and for myself, is there is no move to remove those clients off-island. We made it very clear to CMS that is not an option. Not primarily because of the cost, although that is a factor, but the social issues and that it would not be in the best interests of our patients.”
If CMS approves the request, "that provision gives us 90 more days," before decertification, to try to work out a longer-term agreement with CMS, she said.
"Whatever we have to put in place to keep Sea View open is the plan," she said.
In 2009, CMS rated the Sea View facility five out of five stars — meaning “much above average” — in the categories of quality and staffing, and received three out of five stars — or “average” — for their health inspections, giving Sea View an overall rating of five stars.
But in its most recent report, CMS gives the whole facility two stars, meaning "below average," with its health inspection scoring "much below average," while staffing was "above average," and quality of care measures were "average." (See: Medicare Nursing Home Comparison Tool in Related Links below)
The most severe "patient harm" incidents cited in the report were an incident in which a patient developed a bed sore on his or her leg due to a booty being put on too tightly, and a physical altercation between two employees that resulted in a resident getting hit in the head with a telephone, causing bruising and a cut to the forehead.
Other concerns included unanimous resident complaints that food was usually both very late and cold, and there were no late snacks, causing problems for those with diabetes. Also, one patient suffered weight loss that may be related to the scheduling and quality of meals, according to the report. (CMS Sea View Report)
The Gov. Juan F. Luis Hospital faced similar decertification in 2014, after an inspection unearthed a litany of patient harm incidents. Since then, CMS put JFL on a probationary status and allowed JFL to continue to receive payments in the interim. (See Related Links below)