Legacy still on watch list

HOLLYN JOHNSON/Tribune-Herald Legacy Hilo Rehabilitation and Nursing Center.

Legacy Hilo Rehabilitation and Nursing Center has shown improvement since being named a special focus facility nearly two years ago, according to a list of such facilities provided by the Centers for Medicare and Medicaid Services that was updated in May.

“Special focus facilities” are nursing homes with a history of consistent quality issues that are under increased scrutiny by the CMS.


More than two years ago, Legacy Hilo was in jeopardy of losing its Medicare certification after a September 2016 inspection found widespread problems with “substandard quality of care and harm” at Legacy.

Legacy Hilo has worked to improve in the intervening years, and administrator Tammy H. Silva, who took the helm April 27, 2018, said Legacy has made “great changes since I’ve been in this role.”

A written press release from Legacy Hilo said the facility’s last two standard inspections by the state — conducted in August 2018 and February 2019 — “resulted in only minor tags that show no deficiencies in which there was actual harm to any resident, and no deficiency in which there was systemic potential for harm. Minor tags of this nature are commonplace in skilled nursing facilities nationwide and do not endanger Legacy Hilo’s quality of care, operations, licensure or certification.”

The Feb. 8 inspection found 20 deficiencies, the harm levels of which were minimal and affected few residents, the inspection report said.

Incidents cited in the inspection report include the facility failing to ensure one resident had communication equipment accessible to call for help when needed, failing to maintain current and accurate advanced directives for two residents, and failing to maintain comfortable sound levels, among others.

While news reports from other media outlets last week used old footage from a former administrator, the press release said Legacy Hilo is not in danger of closing.

“Legacy Hilo is absolutely committed to continuously improving and providing outstanding care to its residents, the new release stated. “Legacy Hilo will serve as a critical member of Hawaii’s health care community for years to come.”

The facility’s SFF designation was in place before Silva arrived.

“We are doing our best as a team to get past this and we’re not going to give up,” she said. “We know what we’re doing and we’re doing good by our community, our residents and our staff.”

At Legacy Hilo, Silva said family members are considered part of the health care team.

“My phone number is given to every family member,” she said. “If there is a concern, I make myself readily available, because their concerns are my concerns.”

Keith Ridley, chief of the Department of Health’s Office of Health Care Assurance said his office inspects care facilities on behalf of the federal government.

His office has been conducting unannounced inspections at Legacy Hilo just as they would at other facilities, he said, but as a special focus facility, two full, unannounced inspections are required each year, rather than one.

“In addition, if there are complaints, we will conduct complaint investigations, as well,” Ridley said.

Ridley said that in order for Legacy Hilo to be removed from the special focus facility list, they must have two consecutive inspections without any serious citations and not have any complaint investigations.

“We have seen improvements in conducting the complete re-certification surveys done every six months,” but Ridley said they have had complaint investigations.

“We have found issues with them from time to time,” he said. “At this time, (Legacy Hilo) continues to be on the special focus facility list until such time they are able to satisfy federal requirements.”

Some families are pleased with the care they receive at Legacy Hilo.

Yolanda Keehne of Hilo, whose mother has lived there for a little over two years, is one.

Keehne said said she tried to care for her mother, who has multiple medical problems, at her home before her mother’s health dramatically declined.

She applied for long-term care, and “when it was approved, the only facility that had an opening was Legacy,” she said.

Keehne had read about Legacy, and its past problems, but she was no longer able care for her mother at home.

Always a “vigilant advocate” for her mother, Keehne said at the beginning, communication was not great and at times there wasn’t follow up.

But since Silva joined the facility, “she has immensely, immensely implemented many improvements to boost the quality of care and has kept open lines of communication,” she said. “… I have never experienced or observed my mom receive poor care.”

Her mother is bathed, fed and treated with dignity and respect, said Keehne, adding that she would have taken measures to find an alternative if there was anything she was doubtful about.

Scrutiny on special focus facilities increased last week with the release of a report on care in nursing homes from Pennsylvania Sens. Bob Casey and Pat Toomey.

The report listed participants of the SFF program, as well as potential candidates for that status.

While the identities of facilities that make it onto the participant list are made public, the Casey-Toomey report said the identities of those on the candidate list aren’t made public, “despite being indistinguishable from participants in terms of their qualifications for enhanced oversight.”

The report goes on to say that since 2005, more than 900 facilities have been put on the candidate list, and candidates only move onto the actual list of participating facilities when a space opens up.

Legacy Hilo is the only SFF in Hawaii, but Kohala Hospital was named as an SFF candidate on the list released last week.

A spokesperson for the Kapaau facility said a recent visit by state surveyors suggests conditions there have been improving.

“It’s very island-style. It’s an older building, but it has a very family feel,” said Judy Donovan, West Hawaii regional director of marketing and strategic planning for Hawaii Health Systems Corp. “And, yeah, I would be confident to have a parent or an aunt or an uncle there, absolutely.”

She said representatives from the state Office of Health Care Assurance just finished their long-term care and critical access hospital surveys last week and found no substantial issues that posed “immediate jeopardy” to residents’ safety or health.

Donovan said they hope it will pull the Kohala facility out of the pool of candidates.

“I would hope so,” she said. “In looking at the candidacy ranking, it’s not clear how you get off of it. But I would assume that a good survey which puts you back into the average ranking would release that status.”

Candidates for participation in the initiative are identified based on the results of facilities’ three most recent surveys, and don’t include community input, state investigations or other information, according to the Casey-Toomey report. CMS provides each state with a list of candidates, and states select participants to fill any vacant slots in the program.

The number of slots, though, is limited by the availability of resources at CMS, and there are far more candidates qualifying for increased scrutiny than there are available slots.

The Casey-Toomey report said there are 88 participants in the initiative and 435 candidates.

Email Stephanie Salmons at ssalmons@hawaiitribune-herald.com.

West Hawaii Today reporter Cameron Miculka contributed.

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