Friday, November 16, 2012

Closing Hainkel Home?

Posted By on Fri, Nov 16, 2012 at 4:17 PM

Hainkel Home, in Uptown New Orleans, was opened to the public in 1895 as a home for incurables. Today it's a refuge for Medicaid and Veterans Administration patients, but the state Department of Health & Hospitals has tried to revoke its nursing home license.
  • CHERYL GERBER
  • Hainkel Home, in Uptown New Orleans, was opened to the public in 1895 as a home for "incurables." Today it's a refuge for Medicaid and Veterans Administration patients, but the state Department of Health & Hospitals has tried to revoke its nursing home license.
After being chartered in 1891 and opened to the public four years later, the institution on the corner of Henry Clay Avenue and Patton Street in Uptown New Orleans quickly became the kind of place where baskets containing babies would be left on the doorstep in the dead of night.

Over time, it offered refuge to not only abandoned babies but also to individuals afflicted with terminal illnesses. That it was originally named the New Orleans Home for the Incurables was no accident, even if the sound of it today causes health professionals to cringe.

The home initially had an all-female board — 29 years before women secured the right to vote — and their leadership defined the New Orleans Home for the Incurables as a private, nonprofit, nondenominational facility of last resort. It remained that until 1978, when the state of Louisiana bought the home.

The state quickly dropped the “incurables” label and renamed it the New Orleans Home and Rehabilitation Center. The institution’s honeymoon with the state didn’t last long. Practically every governor since has tried to sell off or transfer the home. The task of pushing back fell upon former Sen. John Hainkel, in whose district the home sits. Thanks to Hainkel’s longevity in the Legislature, he kept the center open during his lifetime and protected it from deep budget cuts.

When Hainkel died in 2005, state lawmakers renamed the facility the John J. Hainkel Jr. Home and Rehab Center, known more commonly around the city as Hainkel Home. At the same time, Bobby Jindal, then a congressman from Jefferson Parish, also convinced Congress to rename the Hammond post office in Hainkel's honor.

Today, the Hainkel Home is one of the few remaining options for Medicaid and Veterans Administration patients in the New Orleans area — but it has no champion with Hainkel’s legendary clout. Jindal, now in his second term as Louisiana’s governor, wants to shutter the facility.

In June, the state Department of Health and Hospitals cited a number of violations at the home and moved to terminate the institution’s Medicaid provider agreement and revoke its nursing home license.

The alleged violations, however, only went back to 2011, which is when the Legislature voted to lease the home to a nonprofit. James Cobb, an attorney for the Hainkel Home, says many of the deficiencies the state cited at the home were attributable to the transition process — and they have since been corrected. Cobb adds that prior to the lease agreement “the state had neglected the facility for years.”

Without the home, 135 local jobs will be lost and 85 patients will have nowhere to go in the city. “These patients are disabled, sick, mentally challenged,” Cobb says. “No one else wants them.” The patients, mostly Medicaid funded, are difficult to place because of low Medicaid reimbursement rates. He adds that such patients also are challenging to discharge.

James Cobb, an attorney representing Hainkel Home, says its patients are mostly disabled, sick and on Medicaid. No one else wants them, Cobb says.
  • CHERYL GERBER
  • James Cobb, an attorney representing Hainkel Home, says its patients are mostly disabled, sick and on Medicaid. "No one else wants them," Cobb says.
So why would the state want to shut down Hainkel Home?

There are whispers of a land grab, but that’s unsubstantiated chatter. Some say it’s part of an ongoing effort by the Jindal Administration to privatize state health care services, but the facility already is operated by a private nonprofit. Moreover, closure would cost the state $400,000 a year in rent from that operator.

On the other hand, the home’s Medicaid patients could be transferred to the state-run facility in Jackson, La., 115 miles north of New Orleans in East Feliciana Parish. The Jackson facility is among the closest that could take the home’s patients. Under this scenario, the state could capture a Medicaid revenue stream of $4.8 million a year — $155 per day for every patient — even though the Jindal Administration has made refusing additional Medicaid dollars a political badge of honor for the governor, who staunchly opposes President Barack Obama’s Affordable Care Act.

Asked about possible relocations plans, DHH public information officer Ken Pastorick says that process would start with a meeting with residents [and] family members to provide information about the transfer process, other area nursing homes with available Medicaid beds, and eligibility questions.

Pastorick says that during a transfer, DHH assigns staff to monitor the relocation of residents and to “substantiate compliance with applicable federal and state regulations.” He offered no other information.
Meanwhile, state officials are quick to cite recent complaints and inspections when explaining why the home needs to be shuttered. The record, however, shows relatively minor deficiencies and no life-threatening problems. Consider the following timeline:

• May 11, 2011: The Hainkel Home underwent a complaint inspection by DHH. No deficient practices were identified.

• June 13, 2011: The home was cited with 21 minor deficiencies, including incidents related to personal care, grooming and medicine orders. Home officials say some of the deficiencies were inherited from the state during the recent leasing process, all of them were easily corrected, and no residents were harmed in any way. The deficiencies were eventually cleared from the home’s record.

• Oct. 19, 2011: One deficiency was noted because of a lack of content in the clinical record. Staff say it occurred when a nurse contacted a physician to pass along a complaint from a patient and did not record the physician’s response. Home officials say a plan of correction was implemented. The deficiency was eventually cleared from the home’s record.

• Oct. 28, 2011: Deficiencies were noted but later cleared by the state for restricting hours for bathing and “failing to request clarification of a physician’s order for therapy.” Home officials say they made patients aware that bathing could take place at any time and they identified the error in communications that led to the complaint. The violation has not occurred again.

• Dec. 2, 2011: Home officials admit to an “isolated incident” of a bath burn. They say training helped correct he error, as did a new boiler, which they say the state “refused” to replace prior to 2011. The related deficiencies were eventually cleared from the home’s record.

• Dec. 9, 2011: The Hainkel Home underwent a complaint inspection by DHH. No deficient practices were identified.

• Dec. 21, 2011: The home was cited for a violation for “failure to report an investigation of alleged neglect.” The deficiency was later cleared and home officials say the alleged violation did not occur the way DHH was initially led to believe.

• March 6, 2012: The home was cited with two deficiencies related to weight and nutrition. Officials say base weights of certain patients were not timely taken; new policies were implemented and the deficiencies have been cleared.

• April 18, 2012: The Hainkel Home underwent a complaint inspection by DHH. No deficient practices were identified.

• June 8, 2012: A deficiency was noted after a complaint of theft from a resident. The home’s business office manager was terminated and the deficiency was cleared.

• Aug. 10, 2012: The Hainkel Home underwent a complaint inspection by DHH. No deficient practices were identified.

• Sept. 9, 2012: The Hainkel Home underwent a complaint inspection by DHH. No deficient practices were identified.

Officials with the home’s private operator say DHH has more or less been picking on the home and unfairly targeting its operations. They contend the state’s efforts culminated when officials tried to close the home last June without due process, which is how the parties ended up in court.

Supporters likewise point to other facilities, such as Plaquemine Manor Nursing Home in Iberville Parish, which had deficiencies this year, in 2010 and in 2009. Those deficiencies allegedly put residents in “immediate jeopardy to their health or safety,” Hainkel Home attorney Cobb wrote in a federal court brief. The state has made no attempt to close the Plaquemine facility. Then there’s Chateau Terrebonne in Houma, which “has an overall rating, a health inspection rating and a staffing rating of ‘much below average,’” according to court documents.

On Nov. 10, DHH was supposed to move forward with terminating the home’s Medicaid provider agreement and revoking its nursing home license. But that date came and went with no action against the home. That’s because, as last week, a federal judge in New Orleans had not yet decided whether the home should be granted an injunction barring the state from shutting it down. “We’re just in a holding pattern over here,” says Cobb, the home’s attorney.

On the other side of the issue, Pastorick says, “DHH is awaiting the judge’s decision and would be in a better position to discuss following the judge’s ruling.”

Until the federal court hands down a decision, the future of the Hainkel Home will remain as precarious as the former patients of the Home for the Incurables.

The son of the home’s namesake, attorney John J. Hainkel III, says his family is holding out hope that the home will remain open. An attorney at the Frilot law firm in New Orleans, Hainkel III says the facility is part of the neighborhood and provides an important service not found in many other areas.

“We’re concerned and trying to keep track of what happens,” he adds. “We’d like to see it remain open for the purposes it was originally created. A lot of people depend on it.”

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