An article by Dean Mosiman as it appeared in the Wisconsin State Journal on February 13, 2008.

A facility gets listed by having more problems than others, more serious problems and a pattern of serious problems over time. To get off, a facility must show sustained significant improvement for about a year -- two semi-annual inspections -- and have no serious citations.

Four of the state 's 400 nursing homes are on the list:

Middleton Village and Nursing Rehabilitation, 6201 Elmwood Ave., and Willows Nursing and Rehabilitation, 41 Rickel Road in Sun Prairie, are listed as facilities that have "not improved " after being placed on the list and having at least one follow-up inspection.

Columbus Nursing and Rehabilitation Center is new to the list.

Luther Home in Marinette, which has "shown improvement " after 37 weeks on the list, tied for longest of any of those named.

CMS began the special focus facility program a decade ago to identify places that need more oversight. The issues usually include mishandling medications, abuse and neglect, residents with bedsores or overuse of restraints. States do inspections at these facilities at least every six months rather than within the usual 15 months.

Help for consumers

The announcement Tuesday by CMS and Sen. Herb Kohl, D-Wis., chairman of the Senate Special Committee on Aging, builds on efforts to make it easier for consumers to identify poor-performing nursing homes. CMS released a partial list, which included Willows, late last year.

"I want to applaud CMS for moving toward increased transparency in a responsible, methodical way, " Kohl said in a telephone briefing with reporters.

CMS data shows about half of the facilities identified under the program significantly improve care in 24 to 30 months, while 16 percent are terminated from Medicare and Medicaid.

The industry supports better quality of care but believes the special focus process is flawed because it 's hard to get off the list even if improvements are made, said Brian Purtell, director of legal services for the Wisconsin Health Care Association, which represents 190 nursing homes.

The list announced Tuesday "does not represent the four worst facilities in the state, " he said.

Also Tuesday, Kohl said he is teaming with Sen. Charles Grassley, R-Iowa, to introduce legislation that would increase reporting requirements and raise penalties for serious problems.

Purtell wouldn 't comment because he has not seen the proposal.

Elder abuse

In November, the State Journal 's series on elder abuse, "Silent Shame, " named Middleton Village, Willows and Columbus as among five facilities in or around Dane County cited for actual harm or immediate jeopardy and having at least double the U.S. average of eight citations in the latest inspections.

Actual jeopardy means a resident can 't maintain the highest practical quality of life. Immediate jeopardy, the most severe citation, demands instant action because it has caused or will cause serious harm, impairment or death.

CMS on Tuesday said Middleton Village was last inspected on Jan. 31 and has been on the special focus list for two months. In the most recent published inspections from September 2006 through November 2007, the facility had a state-high 47 citations.

The nursing home administrator couldn 't be reached Tuesday, but Purtell said the facility 's most recent inspection showed "tremendous improvement. "

Willows, CMS said, was last inspected in September and has been on the list for 11 months. The facility had 12 citations in the latest published inspections.

"Our staff and leadership team has been proactive in addressing the inconsistencies in our regulatory history, " administrator Kathleen Dilbeck said in a statement. "We have invested resources to improve the care and services provided at our facility, including extensive retraining and educating staff on polices, protocols and procedures. "

CMS didn 't list the most recent inspection at Columbus, which has been on the list for seven months. The facility had 21 citations in the latest published inspections.

The administrator could not be reached for comment.

Four need improvement

Four other nursing homes in the region were named on another new CMS list this month as places needing improvement for preventing bedsores or overusing physical restraints.

They are:

Badger Prairie Health Care Center, 1100 E. Verona Ave., Verona, (restraints).

Sunny Hill Health Care Center, 4325 Nakoma Road, Madison, (bedsores).

Clearview North, Juneau, (restraints).

Mineral Point Care Center, Mineral Point, (bedsores). A total of 37 state facilities are on that list.

Proposed Legislation

U.S. Sen. Herb Kohl is proposing legislation to make nursing home ownership and operations more transparent, stiffen enforcement and improve staff training. Kohl, D-Wis., chairman of the Senate 's Special Committee on Aging, will formally announce the proposal with Sen. Chuck Grassley, R-Iowa, on Thursday.

The proposal calls for:

More accountability and information about who owns nursing homes, including annual independent audits of chains.

Adding information to the Center for Medicare and Medicaid Web site.

Strengthening penalties. The current maximum of $10,000 for a citation would change to a maximum $100,000 for a deficiency resulting in death, $25,000 for those that cause actual harm or immediate jeopardy, and $3,000 for minor infractions.

Tools to address corporate-level problems in nursing home chains.

A study of the role financial problems play in poor-performing facilities.

Improved staff training to include dementia management and abuse prevention training as part of pre-employment training.

A study on increased training requirements in content or hours for supervisors and nursing aids.

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