Troubled NC nursing home set to lose nearly all its government funding — and patients

The large majority of patients living at a troubled Salisbury nursing home may have to move because the facility is set to lose virtually all of its government funding, The Charlotte Observer has learned.

The Citadel Salisbury, a for-profit home that has repeatedly run afoul of federal health and safety requirements, has been notified that it will lose its Medicaid funding in addition to its Medicare funding, according to the North Carolina Department of Health and Human Services.

In 2020, about 80% of inpatient days at the facility were funded by Medicaid and Medicare, according to figures compiled by snfdata.com, which compiles information about nursing homes from Medicare cost reports and other sources.

The short-staffed nursing home now has about 85 residents.

The Citadel Salisbury will lose its Medicare eligibility on May 19, the federal Centers for Medicare and Medicaid Services (CMS) announced earlier this week. The Medicaid termination will occur simultaneously, DHHS said.

“The facility has been notified that Medicare will cease to pay for services furnished to Medicare and Medicaid beneficiaries admitted after May 19, 2022, although payment may continue for up to 30 calendar days for patients admitted on or before May 19, 2022,” the federal Medicare agency said in a press release.

CMS urged patients and their family members to consult the “Nursing Home Compare” site for information about other nursing homes where they might want to seek care.

A spokesman for Portopiccolo, the New Jersey investment company that owns the Citadel Salisbury, said Friday that the nursing home will ask the federal government to reverse its decision.

“We are shocked and disappointed at this decision,” nursing home administrator Angela Hooper said in a statement. “The progress this nursing home has made to improve the quality of care during a global pandemic is respectable. The staff are heroic.

“The Citadel improved their quality measures to a 4 star rating from a 2 star rating in only 18 months. We love our residents wholeheartedly and our mission was only to ever share in their lives and make them happy.”

In the past 10 years, no North Carolina nursing home has lost its Medicare funding, a DHHS spokesperson said.

Accordius Health at Brevard, another nursing home owned by Portopiccolo, received a similar Medicare termination notice in March. But state inspectors subsequently found the facility was in compliance with Medicare and Medicaid requirements, so the federal government did not ultimately pull its funding.

“Involuntary termination of a provider agreement is generally a last resort after all other attempts to remedy the deficiencies at a facility have been exhausted,” the federal press release states. “In this instance, the CMS has found that The Citadel Salisbury is out of compliance with CMS basic health and safety requirements.”

A recently published state inspection report includes more than two dozen violations at the facility.

One resident was hurt by a caregiver trying to move him. When he cried out, she put her hand over his mouth to muffle the sound. Another resident said no one helped after she complained to staff about a resident who kept offering her money for sexual favors.

A third had to be hospitalized for infections to surgical wounds after nurses failed to change his bandages for a full week.

One Citadel nurse aide said staffing was so “horrible” that she couldn’t help residents out of bed or give them showers some days. A nursing director reported that staffing was so thin that she sometimes worked 22 hours straight — and still “things fell through the crack and she could not keep up.”

“Left Alone,” a recent investigation by The Charlotte Observer, documented how a shortage of caregivers inside North Carolina nursing homes is putting thousands of vulnerable residents at risk.

Unlike most states, North Carolina has set no minimum staffing ratios for nursing homes.

A data analysis by Observer reporters also found that for-profit owners tend to operate with significantly slimmer staffing and more deficiencies than nonprofits.

Portopiccolo owns about three dozen nursing homes in North Carolina, and the large majority of them got just one or two stars for staffing and overall performance on the federal government’s five-star rating system.

The Citadel Salisbury has been hit with more than $370,000 in fines since 2020. For the past two years, the federal government has put the home on its “Special Focus” list, reserved for the nation’s poorest-performing nursing homes.

In a federal class action lawsuit pending against the Citadel Salisbury, families of two residents allege that “systematic understaffing” led to residents frequently not receiving medications, showers and medical attention. Some days at the home, just three nurse aides were on duty to care for the more than 70 residents, according to the lawsuit, filed by the Wallace and Graham law firm last year.

In a court filing, Portopiccolo called the lawsuit’s claim of understaffing “meritless,” saying the nursing home mistakenly under-reported the hours worked by agency nurses.

In 2020, the Citadel Salisbury had more than $13 million in revenue — and a profit margin of about 8%, according to the cost report it submitted to the federal government

This story was originally published May 6, 2022 at 2:49 PM.

Ames Alexander

The Charlotte Observer

Ames Alexander was an Observer investigative reporter for more than 31 years, examining corruption in state prisons, the mistreatment of injured poultry workers and many other subjects. His journalism won dozens of state and national awards. He was a key member of two reporting teams that were named Pulitzer finalists.  Support my work with a digital subscription