Fire ants, an amputated ear and a mouse eaten: Problems at NC nursing homes highlight concerns over annual inspection backlog

For months, WRAL Investigates covered the devastating impact the COVID pandemic had on the state’s nursing homes with the sick and elderly most at-risk to the virus. Months after the latest virus peak, nursing homes are still feeling the lasting impacts.

State and local health departments are struggling to catch up on annual health inspections, something they couldn’t do for much of 2020 due to nursing home visitor restrictions. Now, those same health departments are trying to erase the inspection backlog with fewer inspectors, many of whom quit because of the pandemic or they found much better paying jobs.

The inspection backlog is also impacting families dealing with the difficult decision of finding the right long-term care for loved ones. Those inspections and star ratings are an important tool in picking a nursing home. History shows us, finding the right home can be life-saving choice.

WRAL Investigates went through years of inspections, including many nursing homes that haven’t had a standard health inspection since 2019. The most common problems included medication errors, violations of infectious disease protocols, staffing certifications and basic patient care like showering and help getting to the bathroom.

WRAL Investigates also found several nightmarish situations that show it’s important to do your research before choosing a long-term care facility.

At the Accordius facility in Salisbury, inspection reports detailed a nursing home resident suspected of swallowing a mouse. A staff member saw what looked like a tail hanging out of the resident’s mouth before swallowing it. A doctor wasn’t immediately notified. The facility was hit with a fine of more than $100,000 and placed in immediate jeopardy, meaning it could lose federal reimbursements. The immediate jeopardy was lifted after the facility fixed the inspector’s concerns.

Earlier this year at the Durham Nursing and Rehabilitation Center, a resident’s ear had to be partially amputated because staff failed to quickly notice and treat an infection caused by the strap of a face mask behind the resident’s ear. The facility was fined more than $200,000. A federal database on nursing homes still has the Durham Nursing and Rehabilitation flagged as a facility with potential patient abuse.

Months before the pandemic hit, the Carolina Rehab Center of Cumberland, in Fayetteville, was fined more than $500,000 after a resident was found in her bed covered in fire ants. The patient suffered multiple bites and died. A doctor at the hospital noted the venom from the fire ants likely contributed to the patient’s cardiac-related death.

They are extreme examples of recent issues inside North Carolina nursing homes. But in some cases, much more common issues, like falls, can be devastating.

"They knew she was a high-fall risk patient," Mary Barnhill told WRAL Investigates about her mother, Karen. She was a resident at Accordius Greensboro for just two days for what was supposed to be a short rehab stay.

After asking for help to go to the restroom and waiting too long, Barnhill says her mother tried on her own, "She got up on her own to go, she fell, she hit her head."

Barnhill claims staff put her mother back in bed without a thorough examination. She also blames staff for not routinely checking on her mom after the fall to detect an unseen, deadly problem.

"She could have still been here if they got her to the emergency room in time," Mary Barnhill said. "They could have stopped the brain bleed."

About 13 hours after being found on the floor of her room, Karen Barnhill died from her head injury. Her daughter told WRAL Investigates she has no question what killed her mom.

"The fall at the nursing home, it’s what led to it," Mary Barnhill said of her late mother. "It was negligence."

Mary Barnhill is now suing Accordius Greensboro, but it’s far from the only Accordius facility with issues. Accordius Health is the biggest nursing home company in North Carolina with 24 facilities spanning the state. Federal records show they’re also among the worst performing, averaging just 1.4 stars out of 5 in health inspections. Over the past three years, the 24 homes have amassed $3.6 million in fines. That’s more in fines the next five largest nursing home chains in North Carolina combined Things are so bad at some facilities, 12 have been hit with payment denials by Medicaid in the past three years.

WRAL Investigates searched federal records and found Accordius Greensboro went 2.5 years without an "annual" standard health inspection. North Carolina Department of Health and Human Services Secretary Kody Kinsley says the pandemic, funding issues and the worker shortages are all to blame.

"We have a growing vacancy rate in our inspector/regulatory area," Kinsley said. "It’s incredibly hard to maintain the staff that we need to make sure our older North Carolinians are take care of."

WRAL Investigates found the proof in federal data. Of North Carolina’s 414 nursing homes covered by Medicaid/Medicare, 288 received inspection scores of much below average or below average for staff. That’s 70% of the state’s homes with staffing concerns. Only 27 homes in the state received a five-star "much above average" staffing score.

It’s numbers like that which concerns people looking for a nursing home or assisted living center.

"For most folks this can be uncharted territory and it can be very frightening and confusing," Kathryn Lanier said about the search process. Lanier is the Section Chief for Elder Rights at North Carolina Department of Health and Human Services. She helps families deal with the anxiety of putting a loved one in a long-term care facility.

Many of the families Lanier works with are in crisis mode, where their relative needs immediate or unexpected care. She urges families to start the search process before it’s too late. That includes doing your own online research to see facility inspections. However, look at more than just the star rating, Lanier said.

"Just like any rating system, you have to do your own homework and due diligence," Lanier said.

That homework should also include pre-planning and site visits, well ahead of time for placement. Among other things, Lanier says be extra-observant when you take a tour.

"One of the key things is just the basic environment of the facility," Lanier said. "When you enter into that building, what kind of feel do you get?

"Actually utilizing your five senses. What are you seeing? What are you hearing?"

Lanier says look at more than just how the staff interacts with residents. Observe staff dealing with other staff members. Also, see if the facility’s administrator is walking the halls and actively mingling with resident and staff. Lanier says that’s a sign the administrator will likely be more accessible if you’re relative has issues during their stay.

Mary Barnhill, who says she used to work in long-term care, understands the challenges faced by nursing homes right now.

"Mary nursing homes get full, they get understaffed and they do get overwhelmed," Mary Barnhillsaid. "I know they do, but you still have to have care and compassion."

Mary Barnhill hopes her lawsuit will hold the nursing home accountable for her mother’s death. She says the lawsuit is also meant to send a message to all nursing homes.

"They need to care more about their patients than what they do," she said.

WRAL reached out to Accordius Health for comment on the chain’s overall ratings, as well as the pending lawsuit filed by Barnhill. We have not heard back.