Two years ago, police were called to the Andover Subacute and Rehabilitation Center in a quiet corner of Sussex County to make a grim discovery on Easter Sunday weekend.
As the pandemic then raged through one of the state’s largest nursing homes, the death toll had swiftly and tragically soared out of control. The unclaimed bodies of 17 residents — so many that some had to be stored in a makeshift morgue — became a national story amid complaints by workers of chronic staffing shortages and mounting anger by families over the facility’s failure to take proper care of their loved ones, even after they were dead.
The owners of the long-term care facility in what is a remote and still rural part of New Jersey soon changed its name to Woodland Behavioral Health and Nursing Center at Andover, as if to erase the memory of its handling of the COVID crisis.
Yet little seems to have changed since the nursing home was hit with $220,235 in federal fines and penalties by the U.S. Centers for Medicare & Medicaid Services, just a month after the April 2020 discovery of bodies.
It has garnered the lowest ratings a nursing home can earn for staffing and quality of care. On any given day, there are not enough people to care for its residents, state inspectors say.
Earlier this month, the New Jersey State Comptroller identified it as one the state’s 15 worst nursing homes, based on its continuing “one-star” ratings by federal regulators that the watchdog agency said had led to few, if any, serious consequences.
And the number of lives lost to the deadly virus continues to climb, even after the May 2020 federal enforcement action that found major lapses in patient care and failures in infection control practices amid the deadly pandemic that by then had claimed at least 66 lives there.
State Health Department officials say there have been 109 confirmed COVID-19 deaths among residents at Woodland and its sister adjacent facility, Limecrest Subacute and Rehabilitation Center since the pandemic began. COVID is suspected, but was not lab-confirmed, in the deaths of another 26 people.
Now state and federal regulators have slammed the nursing home over shocking new allegations of widespread abuse and neglect, issuing a declaration of “imminent jeopardy” over health care failures they say threaten the lives and safety of the more than 450 residents who live there.
Once again, members of the New Jersey National Guard are on site to help out. The Department of Health has announced it would appoint a monitor to serve in an oversight role, while threatening Woodland with possible closure through a suspension or revocation of its license. All new admissions have been barred.
Even harsher were the actions of the Centers for Medicare & Medicaid Services.
In a Feb. 9 letter to nursing home administrators, CMS officials said the facility was not in compliance with federal requirements to continue to participate in the Medicare and Medicaid program. Woodland was given until March 3 to correct what has become a critical situation, or CMS said it may pull all its federal funding.
If that were to happen, it could effectively shut down the facility, which is heavily dependent on Medicaid as well as Medicare reimbursement.
Closing any long-term care facility is a fraught decision that is never a first option. For most residents, other than those receiving rehabilitation or post-operative care, a nursing home is not like a hospital where a stay may be temporary. It is their home.
New Jersey has not revoked the license of a long-term care facility since 2018, when the state ordered the shutdown of a dementia care home in Warren County over continuing abuse allegations that the Department of Health found posed a serious risk of harm to the health, safety and welfare of residents.
“Make no mistake, the process of transferring medically vulnerable people from one facility to another can be very traumatic for that resident. It is not something the state of New Jersey is taking lightly, said Laurie Facciarossa Brewer, New Jersey’s Long-Term Care Ombudsman, who serves as the state’s advocate for nursing home residents and their families.
Woodland officials say they are working to ensure the facility is in compliance with state and federal mandates.
But many advocates, elected officials and others all too familiar with the continuing crises at the nursing home have just about lost their patience with Woodland.
They say time has run out.
“There’s no coming back,” said state Sen. Joseph Vitale, D-Middlesex, chairman of the Senate Health, Human Services and Senior Citizens Committee. Noting the penalties and enforcement actions that have come, he added, “it doesn’t seem there is anything the state can do to encourage them to be a better player. Find another place for residents and yank their license.”
The failure of Woodland’s ownership over the years also strikes Rep. Josh Gottheimer as a breaking point.
“What’s clear is the ownership and management are not up to taking care of their fellow Americans here. They’re just not up to it,” said the Democratic congressman, whose district includes Andover. “They apparently don’t have the will, or ability, to fix it. It’s unacceptable.”
Those owners include Chaim “Mutty” Scheinbaum of Lakewood and Louis Schwartz, a former vice president with Skyline Healthcare and the eldest son of Joseph Schwartz who was charged last month in a multi-million dollar federal tax fraud scheme in connection with Skyline, his failed multi-state nursing home chain that had once sought to purchase the long-term care facility in Andover.
Even before the news of the unclaimed bodies in a makeshift morgue thrust the nursing home into the spotlight, there were serious problems in Andover.
In 2017, then under different ownership, the facility agreed to pay $888,000 to resolve allegations it provided substandard or worthless nursing services to some patients, federal authorities said. The nursing home allegedly billed New York Medicaid “for materially substandard or worthless nursing services provided to certain patients that failed to meet federal standards of care and federal statutory and regulatory requirements” between July 1, 2010, and Dec. 31, 2012, according to the U.S. Attorney’s Office in New Jersey.
The case was settled without any admission of liability with the payment of $395,508 to the United States and $492,492 to the state of New York, and Andover entered into a five-year corporate integrity agreement.
Its former owners entered into a sales contract with Skyline Healthcare. But before the deal closed, Skyline collapsed as it ran into financial troubles, failing to make payrolls and meet other financial obligations. The facility was instead acquired by Scheinbaum and Louis Schwartz.
But the issues did not go away.
In 2019, a state investigation found staff members failed to respond to a door alarm after a 76-year-old resident deemed at risk of leaving the building walked out undetected in minus 4-degree temperatures. In a lawsuit, attorneys for the woman, who suffered from advanced dementia, said the facility failed to provide sufficient staff and services to meet the needs or her and other residents of Andover. They alleged and the nursing home “actively sought residents with similar medical and nursing needs “in order to fill their empty beds and increase their rate of occupancy and overall revenue.”
A former employee in another lawsuit also complained of staffing issues, alleging that unsafe understaffing of both nurses and certified nurse aides had “put patients at risk.”
More recently, Woodland continues to report new cases of COVID-19 amid the ongoing omicron wave, with the worst new outbreak of any nursing home in the state. As of this week, 250 residents, or more than half the nursing home’s population, have tested positive with COVID since the latest outbreak began in December, according to data compiled by the state Health Department. The facility reported 16 of them had died. There were also 145 staff members who had tested positive for the virus.
The percentage of residents and staff vaccinated against COVID, meanwhile, is far below state average in nursing homes across New Jersey, according to Department of Health data.
But what might be the final straw for regulators is the litany of charges that has shaken many, in a blistering violations notice issued by state surveyors after spending two weeks at Woodland in early January. In a report, which Vitale said left him “stunned,” were findings of widespread abuse and neglect — including failures to attempt resuscitation of several residents in cardiac arrest.
In one incident, a resident on Oct. 8 was found without a pulse or respirations. While classified as a “full code,” with the family requesting aggressive life-saving treatment despite medical decline, there was no call for cardiopulmonary resuscitation, or CPR, a standard practice for emergency resuscitation. The nursing home’s automated external defibrillator was not used, nor was 911 called.
Surveyors said the nurse assigned to the resident told them that CPR was not implemented because the resident “was visibly blue” and had a “locked jaw,” and believed that the unnamed individual was “too far expired” after entering “a state of irreversible death.”
Also cited were the failures of a nurse and an aide to respond to a resident who called for help when a suprapubic catheter got stuck in a motorized wheelchair. Pleas and complaints of pain were ignored for over 40 minutes, said the state.
At times, the nursing home operated with only half the staff mandated by the state. During a two-week period from late December into January, not a single day went by when there were enough certified nurse aides on duty to care for more than 450 residents, regulators found. On some days, the nursing home operated with only half the staff mandated by the state.
Last week, the leader of a federally funded legal group that advocates for the human, civil, and legal rights of those with disabilities also charged that Woodland Behavioral was operating like an “unlicensed psychiatric hospital.”
Gwen Orlowski, executive director for Disability Rights New Jersey, said the nursing home confines nearly 200 residents diagnosed with traumatic brain injuries, mental illness, developmental disabilities, or recovering from strokes on a locked floor. They live three to a room, she said, in a space that is visibly dirty and smells like urine and feces.
Urging the state to take immediate action, she said some residents should be moved out and receive supervised care in a group home.
As it has in the past, CMS in response to the latest findings may impose hefty fines and penalties.
It will have little effect, predicted attorney Paul da Costa of Snyder Sarno D’Aniello Maceri & da Costa in Roseland — who represented a number of families in a lawsuit charging New Jersey with gross negligence incompetence over its handling of the COVID outbreak in the state’s veterans homes. He said the fines that Woodland may face “are nothing but a blip on the radar for the ownership” and had zero deterrence value.
“Money talks with the owners of these for-profit facilities and six-figure fines are not going to make them even blink,” da Costa said. “A facility like this should not be allowed to accept new patients and get paid Medicaid.”
Last year, New Jersey’s Medicaid program paid Woodland and Limecrest $19.8 million, according to the Department of Human Services. New York, which has 151 fee-for-service Medicaid members at Woodland, representing about a third of the nursing home’s current resident population, paid the facility $8.7 million last year, according to state officials there.
The New Jersey Health Department, meanwhile, said the state took immediate action upon learning of the allegations in the report.
“Our first responsibility is to protect the more than 400 residents living in the facility, which required mandating that it address the violations deemed the most serious,” said department spokeswoman Donna Leusner. “We then issued an order curtailing admissions and required the facility to retain a nursing administrator, an certified infection control practioner and a facility administrator.”
On Jan. 10, the first of two teams of National Guard troops were deployed to the facility. A second team was added on Jan. 28, bringing the total of Guard personnel on site to 18, she said. There are currently between 18 and 20 Guard personnel on site and they are expected to remain there through March 11.
Leusner said the department and CMS are in the process of reviewing the facility’s plan of correction and began the process of installing a state monitor.
And while the state has yet to move toward a shutdown of Woodland, a doomsday scenario may already be taking shape. The monitor was tasked to come up with a closure plan for the safe and effective care of the residents “in the event of a change of ownership, or in the event the department summarily suspends or revokes the facility’s license based upon the facility’s failure to correct the violations.”
Asked specifically about a possible closure, Leusner said only “the Department wants to ensure planning for all options.”
Woodland has said little about the situation and did not respond to specific questions regarding pressure that might force its closure.
“Woodland Behavioral is in close communication with the New Jersey Department of Health and the Centers for Medicare & Medicaid Services to ensure that the facility is in substantial compliance with all applicable standards. Patient health and safety remain our top priority,” the facility said in a statement this past week.
Given the chronic staffing shortages that Woodland has been experiencing, Facciarossa Brewer, the state’s Long-Term Care Ombudsman, said reducing the facility’s census and maintaining the existing staff is probably the quickest way to bring it into compliance. But while cautious about shutting down a place that is the home of so many people, even she wondered if Woodland had reached the end of the road.
“I do have concerns about how a decertification would impact the residents living in Woodland. But this facility cannot be permitted to continue to provide substandard care to the people living there, year after year after year,” she said.
Pointing to the multiple enforcement actions taken by the state against Woodland over the last few years, Facciarossa Brewer said those moves have almost always resulted in a short-term improvement of conditions in the facility. But inevitably, she added, conditions worsen again, and quality of care deteriorates.
“The enforcement actions are like dropping a dime in a bucket of water. Any gains or improvements that are achieved as a result of enforcement actions are erased pretty quickly,” she remarked.
She believes the latest issues at Woodland now, though, are far more grave.
“Some of the problems identified in this facility are absolutely stunning and resulted in real harm to residents. So I think there is a very real chance that the federal government could decertify this facility, which would basically close it down because they would not receive any Medicaid or Medicare funding,” Facciarossa Brewer said.
Clearly, the advocate said, massive institutions like Woodland — where they pack three people into a room — are unsustainable. And she questioned how it ever received a license for 543 beds.
“Huge changes are needed,” she said. “This place needs to be smaller, needs more staff and needs to provide better health care and a better quality of life for the people who live there. Or it needs to close.”
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