Painter, the state’s long term care ombudsman, who works for the state Department of Aging and Disability Services, launched live chat sessions on Facebook that quickly evolved into a real-time information pipeline for families.

“I was trying to think about how we can reach people. Normally, residents and family members are sometimes the last people to get information,” said Painter, whose office is independent of the state Department of Public Health.  “I wasn’t sure anybody would join [the chats]. It was kind of an experiment to see if it would work.”

In mid-March, after the first cases of COVID-19 were reported among nursing home residents, the state barred all visitors except emergency personnel. Families became more anxious as the number of cases and deaths rose in these facilities.

Contributed Photo.

Mairead Painter, the state’s long term care ombudsman, hosts weekly live chats to answer questions about nursing home care.

To date, nursing home deaths account for about 60% of all COVID-19 deaths. As of May 20, nursing home cases total 7,875 and deaths 2,190.  Although the weekly number of deaths rose by 263, that was fewer deaths than the prior week.

Nursing homes are “playing catch-up,” trying to keep pace with the day-to-day changes the pandemic brings, Painter said. Some now are making stronger efforts than others to communicate with families, she said.

Painter, who has been ombudsman since May 2018, hosts hour-long Facebook Live sessions at 5:30 p.m. every Monday, Wednesday and Friday on the Connecticut Long Term Care Ombudsman Program Facebook page.

“It’s a blessing, a lifesaver and calming voice during a trying time,” said Carol Zenczak of Enfield, who heard from Painter when she posted a social media comment concerned that her mother’s nursing home was becoming a COVID-19 recovery home.  As it turned out, the facility did not become a COVID-19 recovery facility.

The questions posed to Painter run the gamut. In recent sessions, family members have asked: how and when more widespread COVID-19 testing will be available, when facilities might reopen to visitors, whether facilities can add cameras to allow family members to virtually check in on residents, why some facilities are allowing outside “window” visits and others aren’t, whether residents can receive flower deliveries, and how they can get summer clothes to their loved ones.

The chats usually draw between 400 and 600 participants, with one generating close to 1,000 views. They have created a new dynamic, Painter says, where family members sometimes get information from the state even before it’s trickled down to nursing home administrators. A recent chat featured Barbara Cass, who oversees inspections and quality control measures at nursing homes as chief of DPH’s health care quality and safety branch.

The sessions provide more than just a venting session for family members; they have generated some results. After Painter and DPH officials received complaints that family members couldn’t communicate with nursing home residents via video chat, the state distributed 800 iPads to nursing homes May 9. DPH ordered facilities to devise schedules so residents can have 20-minute video chats once a week.

Typically, the ombudsman’s office focuses largely on responding to and investigating complaints by residents, family members and others against long-term care facilities.

Zenczak said, “I have always known about the ombudsman program, but thought you came to use them only in cases of abuse or neglect. Little did I know. With very little communication, although it is getting better, between my mother’s nursing home and those of us on the outside, we are now able to ask for things like window visits, virtual visits, sending care packages through the mail–things I don’t think we would have known we could do if not for people like Mairead.”

Karen Foley of Waterford says she feels lucky that during the 10 years her mother has been at Bayview Health Care Center, she’s never felt the need to contact the ombudsman’s office. “However, I have discovered that this office provides much more than problem resolution,” she said.

“It is a great source of information and support,” she said. “There is a great deal of good collaboration happening, and knowing this has made a difficult situation easier. Mairead’s dedication is so appreciated.”

Liz O. Stern of Stonington, whose mother is in a nursing home, agrees. She spearheads a council that supports families at her mother’s facility.

“She’s a gift,” Stern said of Painter. “What she is doing is beyond what I can put into words, the fact that she can build trust in this climate.  I watch her demonstrate genuine empathy but also laced with a lot of realism. She understands what she can do and what she can’t do, and she is not apologetic about what she can’t do. To know her is to have a friend.”

The chats also let family members learn from and exchange information with each other, Painter said. Many are realizing, for instance, that policies can vary widely from facility to facility. Painter hopes her office is giving families knowledge that empower them and hold nursing homes accountable.

“You have to be part of the solution,” she said of her work.

The two Connecticut nursing homes with reported cases of COVID-19 – Evergreen Health Center in Stafford Springs and Sharon Health Care Center – are operated by Farmington-based Athena Health Care Systems, which also owns facilities in Massachusetts and Rhode Island. Two residents at Evergreen Health Center have died from the infection; and the number of residents with the COVID-19 rose to eight this week. At Sharon Health Care Center, one resident contracted the virus and is quarantined along with the resident’s roommate, as of mid-week.

About once a year, nursing facilities are inspected and rated on staffing levels and the quality of care provided to residents, including how well they prevent infections. Of the 22 Connecticut nursing homes Athena owns, 10 were cited for infection-control violations between 2017 and 2019, according to a Conn. Health I-Team analysis of data from the Centers for Medicare & Medicaid Services (CMS).

Evergreen Health Center in Stafford Springs has a cluster of residents diagnosed with COVID-19.

Most of the citations were classified as causing “potential for harm,” the most common type of violation. In each of the cases, the Athena facilities took corrective measures to fix problems, according to CMS. Neither Evergreen Health Center nor Sharon Health Care Center were cited for infection-control practices between 2017 and 2019.

All Athena facilities have extensive policies and procedures related to airborne and infection diseases and are practicing social distancing whenever possible – holding activities, but in smaller groups.

“At the start of this pandemic, we initiated a series of protections aimed at mitigating the threat of coronavirus at our centers. These include restricting visitors from Evergreen, taking the temperature of anyone who enters the facility, requiring anyone who enters the facility to complete a health questionnaire, and increasing monitoring of all residents every day,” Athena Health Care spokesman Tim Brown said, adding those precautions have been adopted at all Athena facilities.

“These protections are in addition to the rigorous health and safety precautions we practice on a routine basis. We also take the temperatures of all of our patients at every shift,” he said.

“There is no greater priority for us than the health and safety of our resident and staff,” Brown said. “We understand this is a difficult time for the residents and hard-working staff of any nursing facility in Connecticut, or even the country. We want our residents, staff and their families to know that we are doing everything in our control to provide a safe environment at all our centers. We also want to thank our incredible staff for their commitment to the health of all our residents.”

Seniors are particularly vulnerable to the virus, and social distancing – one way to curb the spread of the virus – is impossible in nursing homes, given the type of care residents need to receive.

“I am concerned. We know that nursing homes can be a petri dish and they are spreading the virus to the most vulnerable,” said Gov. Ned Lamont during a briefing this week. “We are staying ahead of it as much as we can.”

Nursing homes are becoming hotbeds for the virus throughout the country. In Washington state, the Life Care Center of Kirkland has been linked to 35 deaths. Several nursing homes in Louisiana have been deemed by the state as COVID-19 clusters, and Vermont’s largest-known outbreak is in the Burlington Health & Rehab Center, where four residents have died as of mid-week.

In Connecticut nursing homes employees are doing what they can to prevent the spread of the virus, but they fear for the safety of residents and themselves as they grapple with supply shortages, said Pedro Zayas, spokesman for the SEIU Healthcare 1199 NE union, which represents roughly 19,000 health care workers in Connecticut, about 6,000 working in nursing homes.

“Workers are very worried about exposure to COVID-19. They want to continue providing health care services with the appropriate protective equipment so they can protect nursing home residents and keep showing up to work,” Zayas said. “Workers are also concerned to bring the virus into their homes, families and communities.”

Having access to personal protective equipment (PPEs), cleaning products and effective protocols is crucial, he added.

“Workers are washing their hands more often. Some workers are using the protective equipment available during their whole shifts,” he said. “But due to the PPEs shortage, sometimes workers are having to reuse protective equipment beyond its’ listed terms of use and expiration.”

With the situation poised to get worse before it improves, nursing homes likely will be strained even further.

“Some nursing homes have decent supply inventories; others are struggling with gloves, masks and hand sanitizers,” Zayas said. “There is definitely a lot of concern around each nursing home operator’s capacity to provide sufficient supplies and keep the nursing home adequately staffed.”

Amid this outbreak, CMS has suspended routine, non-emergency inspections of nursing homes and ordered health inspectors to increase oversight of infection-control compliance. The state Department of Public Health (DPH) has restricted all nursing home visitors except first-responders.

Nursing homes in Connecticut have grappled with infection-control practices since well before COVID-19 came along. A recent C-HIT analysis of data from CMS found that between 2017 and 2019, 145 of Connecticut’s 217 nursing homes were cited for infection-control violations. Those 145 facilities had a total of 225 violations.

Of the 22 nursing homes Athena owns in CT, 10 were cited for infection-control violations between 2017 and 2019.   The information below includes the level of violation, the number of violations and the overall star rating given by CMS.

Home health workers assist clients with daily tasks like bathing, dressing, toileting, walking and transferring out of bed; all things that require them to be extremely close to those they serve. In many cases, they also shop for groceries and pick up prescriptions and other necessities.

It’s a challenging time, but home health workers are committed to delivering quality care, said Pedro Zayas, spokesman for the SEIU Healthcare 1199 NE, which represents more than 5,000 independent personal care attendants.

“Our providers are people who went into this field because they like caring for others,” he said, adding that caregivers are diligent about self-monitoring for fever and other symptoms.

Cases of the highly contagious coronavirus continue to spike in Connecticut and nationally, with elderly people being particularly susceptible. To prevent the spread of the virus, health care experts recommend that people practice social distancing, staying 6 feet apart.

Dr. Mary Tinetti, chief of geriatrics at the Yale School of Medicine, said seniors using home health care should consider whether they can temporarily go without some services.

“There’s no question prevention is all about social distancing and washing. Both those things are a little difficult when you have home health aides coming in. This might be a time to look into what direct care is needed. For instance, people may not need to bathe every day. That’s going to be very direct contact. Maybe they can go down to a couple of times a week.”

— Dr. Mary Tinetti

Lynette Dockery of Meriden, a home health aide who works six days a week, is diligent about washing her hands, wearing gloves and masks, and using hand sanitizer. She says, however, supplies are getting low.

“We don’t have supplies. I have a few masks. We’re asking the state for more supplies,” said Dockery, a home health aide for nearly 20 years. “I don’t know what else we can do. It’s a really hard situation right now. It’s getting worse and worse every day.”

She worries about getting her client sick or becoming sick herself, as social distancing is impossible in her work. One of her clients is on dialysis and has a stent in her chest.

“We can’t stay 6 feet away from our consumers,” she said. “I have to bathe her. I have to do all her personal care. I make her dinner, get her dressed.”

Nationwide, there were about 12,200 home health agencies, employing the equivalent of 145,000 full-time workers in 2016, the most recent year for which data is available. In addition to daily care, about 96% provided some therapeutic services, while 83% provided social work services, according to a 2019 study by the National Center for Health Statistics.

An increasing number of Connecticut residents receiving Medicaid rely on in-home care, according to a 2019 Department of Social Services study that projected 82% of long-term care enrollees will use home care by 2040, up from 68% in 2017.

Linda Grigerek, president of Companions & Homemakers, which has 11 Connecticut locations, said, “Our caregivers have really stepped up. Caregivers are self-reporting any potential exposure to the virus and other illnesses, and self-quarantining to protect clients,” she said. Some who provide live-in care have sacrificed previously planned time off to instead stay with clients.

Grigerek’s agency has directed all caregivers to adhere to Centers for Disease Control and Prevention (CDC) guidelines during the pandemic.

Nonessential Care Sidelined

Home health care workers have already started to see decreased demand for their services as worried seniors forego services.

“A lot of our clients who receive nonessential care, most of those people are just canceling,” Grigerek said, predicting business likely will dwindle to only serving clients who need essential services. “Those are the people that we’re worried about.”

As elderly clients scale back on services, home health workers, who make minimum wage or close to it, could have trouble making ends meet, Zayas said.

“These workers don’t have sick leave. If you don’t show up, you don’t get paid. And if you get sick, you don’t have sick pay.” As income dries up, more aides could struggle to pay for hand sanitizer, masks and other supplies. “Inventory is not even available. Those are huge concerns.”

— Pedro Zayas

About 80% of home health aides are women, Zayas said. Some are single parents who are trying to balance work with caring for their out-of-school children and now face the possibility of reduced or no income.

Dockery, who lives with her 20-year-old son, is the sole breadwinner in her home.

Tinetti said seniors who have aides in their homes should remind them to wash their hands before and after each encounter and to disinfect surfaces repeatedly.

“We all need reminders to do it,” she said. “Older adults should feel empowered to remind them.”

Seniors also can ask care workers for suggestions to creatively engage with them from a safe distance, Tinetti said. For example, taking a walk outside, singing or dancing. Also, those who receive care from multiple aides can ask if just one aide can serve them for now.

“If it’s scary for us [aides], I can only imagine what it’s like for them,” Dockery said of seniors receiving in-home care. “When you’re in a home setting, they depend on you to lift their spirits and take care of them.”

Dockery said her job is “God’s work.”

“If I don’t go [to work], how’s she going to get to dialysis?” she said. “That’s life-saving; that has to get done.”

In 2017 alone, the state Department of Social Services (DSS) received 11,123 reports of elder abuse and decided that 7,196 warranted an investigation. That year, self-neglect—when adults are unable to provide for their own basic care—was the most common type of elder abuse reported to DSS, at 30 percent, followed by neglect by others, financial exploitation, emotional abuse, physical abuse, sexual abuse and abandonment.

“It’s all trending up,” Dorian Long, DSS director of social work services, said.

Some of the recent cases investigated by DSS Protective Services for the Elderly are chilling. A 74-year-old man who was frail, thin and prone to falling was living alone in a home infested with cockroaches and mice. The in-home care of a woman over 90 was stopped for nonpayment because her niece had spent her aunt’s money on her own household. An 87-year-old man confused about his finances had his utilities shut off after his son had spent his money instead of paying the bills.

Long’s 68 social workers helped all the seniors find in-home care, a new conservator or better housing—whatever they needed to escape the neglect or abuse.

Sexual abuse of the elderly is also on the rise, Long said. In the past, DSS would investigate three or four cases a year, working with police, and now it typically handles 40 cases a year. Scams targeting the elderly are also increasing, she said. Seniors can avoid becoming victims by staying involved in their communities. “The more you are isolated, the more vulnerable you are,” Long said.

The Justice Department estimates that 1 in 10 American seniors are abused, and state officials say the problem is likely to grow as the population in Connecticut—already the sixth oldest state—rapidly continues to age.

Complaints about abuse in Connecticut nursing homes, residential care homes and assisted living facilities rose by nearly 15 percent between 2015 and 2017, said Mairead Painter, the state Long Term Care Ombudsman.

Experts say the numbers of elder abuse complaints may be rising due, in part, to greater awareness, but still, many cases are never reported.

“Sometimes individuals are too embarrassed to report it,” Painter said. “Sometimes people are fearful that if they report abuse, they may have to stay longer at a nursing home.”

From Physical Abuse To Romance Scams

The cases of elder abuse seem to be all over the news. In January 2018, the live-in caregiver of an 81-year-old man with dementia was arrested after going on a rampage, breaking a TV and burning papers on a stove, in the man’s apartment in the Rockville section of Vernon.

This January, a Rockville couple in their 70s had several thousand dollars in cash and jewelry stolen when they let in their home men posing as utility workers.

Sometimes the abuse is physical. When she was 69 and living in Meriden, Rita Pompano said, she endured seven months of physical abuse from her husband, Ralph Pompano.

Each day when he told his wife to grab a pillow, the pain would soon follow.

“I knew that was time for my daily beating,” said Pompano, now 76 and living in West Haven. “He’d have me put my face into the pillow so nobody would hear me screaming.”

She escaped with her son Anthony’s help in 2011, only to have her husband threaten him three months later to find out where she was hiding. Ralph Pompano, 74, pulled a gun and fired a shot at Anthony that day before fleeing to Virginia. Two years later, he died in prison.

Bonnie Brandl, director of the National Clearinghouse on Abuse in Later Life, said she has encountered cases like the Pompanos’.

“The abuser may decide their life is being cut short and will become threatening,” Brandl said. “It’s the ultimate act of power and control.”

State Sen. Tony Hwang, R-Fairfield, and four state representatives have proposed legislation to create an elder abuse registry. Similar to the state sex offender registry, it could keep people convicted of such crimes from doing it again, he said.

“We need to be sure our seniors are protected,’’ he said. The bill has been approved by the state legislature’s Committee on Aging and referred to the Senate.

The AARP Connecticut holds workshops across the state to alert seniors about scams, ranging from IRS and sweepstake scams to fake Nigerian princes, said Erica Michalowski, the organization’s associate state director for community outreach.

“We say that the scam artists have gotten the senior into their ether,” she said. “They’re keeping the senior off-balance in a heightened emotional state.”

Betty Bajek, 66, of Prospect, volunteered to educate seniors about fraud for AARP after someone stole her credit card number and charged $1,200. She said romance scams are on the rise as criminals befriend seniors, show a romantic interest in them and then ask for money.

“These con artists prey on lonely people,” she said.

Nationally, financial exploitation and neglect are the most common types of elder abuse. Some states, including Connecticut, count self-neglect as abuse. Julie Schoen, deputy director of the National Center on Elder Abuse, said that is appropriate so those seniors get help. Brandl, of the national clearinghouse, agrees that they need help, but said, “For me, it’s not elder abuse when there’s no perpetrator.”

Unlike children who are abused, seniors can decline help. Long said DSS social workers do encounter some elderly people living in squalor who refuse their services.

“We put on the charm and try to convince them, but as an adult, you have a right to make choices—even bad choices,” Long said. The caseworkers may go back a few weeks later to try again. If the person says no, they have to close the case.

Help Is Available

One of several agencies in Connecticut assisting elders is the CHERISH program in Ansonia, which counseled Rita Pompano after she left her husband. It provides a hotline, court advocacy, safe housing and counseling for victims of domestic violence who are over 60 statewide.

Its coordinator, Mary Jane Liddel, stayed close by as Pompano recounted her story of her husband’s violence. Tearing up briefly, Rita said CHERISH helped her heal. Now, she enjoys freelance writing, cooking for friends and taking road trips with friends.

“I’m just happy that I’m free,” she said.

CHERISH’S 24-hour hotline: 203-736-9944 or 203-789-8104.

To report cases of suspected elder abuse, neglect or exploitation in Connecticut, call the toll-free referral line at 1-888-385-4225; after business hours, or weekends, or state holidays, call 211.

For information about Protective Services for the Elderly, click here.

Masonicare Health Center in Wallingford was fined $3,900 after a resident developed a severe pressure ulcer.

On June 12, 2017, a resident who suffered incontinence and was a risk for skin breakdown was diagnosed with an unstageable deep tissue injury in the lower back. An advanced practice registered nurse determined the resident had the wrong type of mattress and recommended the use of a pressure-reducing cushion, according to DPH.

Once the resident received the cushion, it was under-inflated on multiple occasions and documentation from May through August failed to show staff were monitoring its inflation, according to the citation.

Margaret Steeves, vice president of marketing and communications at Masonicare, said patient safety is the facility’s top priority.

“Regarding this particular incident, Masonicare conducted an extensive review of practice and care delivered,” she said. “While we disagree with the findings, we will comply with the fine.”

Arden House in Hamden was fined $3,660 for four incidents in which residents were harmed.

On May 8, 2017, a resident suffered a hematoma on the left arm after a nurse aide pulled a call bell away from the resident, according to DPH. The resident hit the call button due to difficulty breathing. When the nurse aide tried to calm the resident, the resident began swinging the call bell, which led to the injury. The nurse aide was fired following an investigation, DPH said.

Another resident suffered a stage two pressure ulcer, which healed and then re-opened, according to DPH. The initial wound was diagnosed on Feb. 2, 2017, healed by Feb. 17, then later reappeared and worsened. Staff failed to notify other staff and the resident’s family when the wound worsened, according to the citation.

On May 22, 2017 a resident who required two-staff assistance for mobility fell to the floor after trying to stand up from a wheelchair without help, according to DPH. The resident was bleeding from the mouth and taken to an emergency department for evaluation.

On March 16, 2017, a resident was admitted to a local hospital with twitching, hypothermia, hypotension and septic shock due to multifocal pneumonia, according to DPH. An investigation found the resident’s fluid intake and output weren’t monitored from March 9 to March 16.

Officials at the facility didn’t return a call seeking comment.

The Mary Wade Home in New Haven was fined $3,060 after a resident fell out of bed and suffered a femur fracture.

On June 1, 2017, one nurse aide was providing morning care to the resident, who required two-staff assistance for all care, and was rolling the resident over to the opposite side of the bed when the resident fell to the floor, according to DPH.

The resident was taken to a hospital and diagnosed with a right femur fracture. After being readmitted to the facility on June 2, it was discovered on June 9 that an immobilizer provided by the hospital was not on the resident properly, according to the citation.

“Following an incident which resulted in the injury of a resident last June, we took immediate disciplinary and corrective action to prevent any similar incident from occurring,” administrator Stanley DeCosta Jr. said. “Our entire staff was re-educated and trained on proper procedures for this type of resident care. The resident affected is fully recovered and continues to reside with us at Mary Wade Home.”

Chestelm Health & Rehabilitation Center in East Haddam was fined $3,060 after a resident was hurt in a fall.

On Sept. 15, 2017, a resident with severe cognitive impairment, who was required to have staff nearby when using the bathroom, fell while left unattended, according to DPH.

X-rays at the facility of the hips and pelvic area showed no fractures, but the resident was taken to a hospital three days later and x-rays there revealed several rib fractures and a hemothorax, or collection of blood in between the chest wall and the lung, according to the citation.

An investigation found the nurse aide left the resident alone to answer other residents’ call bells, according to DPH.

“There are times split decisions have to be made when caring for multiple residents,” administrator Brenda Marinan said. “Our staff are very dedicated, loving and compassionate people who were also upset over the resident injury. We support our staff and residents like family members. The resident has recovered and is happily residing with us.”

Rose Haven Ltd. in Litchfield was fined $3,000 after a resident suffered a skin tear on the back while being moved incorrectly by a nurse aide.

On April 9, 2017, one nurse aide tried to move the resident from a wheelchair to a recliner chair manually, despite a physician’s order that the resident required the help of two staff and a mechanical stand lift for all transfers, DPH said. The nurse aide didn’t know the resident required the help of two staff and was reassigned to another facility unit.

Officials at the facility didn’t return a call seeking comment.

Douglas Manor in Windham was fined $1 after a resident, who was supposed to be checked for incontinence every two hours, was inadvertently left on a bedpan for five hours on Oct. 13, 2017.  The $1 fine is because the facility is in receivership, DPH said.

Officials at the facility didn’t return a call seeking comment

That’s an improvement from the 2014 data, when six dialysis centers in the state scored low in quality-of-care ratings.

iStock Photo.

Overall, dialysis centers score higher on most quality measures, compared to national averages.

Dialysis helps those with kidney failure remove waste from the body, regulate chemicals and control blood pressure. Most often, patients have their blood removed and cleaned in a machine called a dialyzer before it’s returned to the body. Another form of dialysis uses a cleaning fluid and the stomach as a filter.

Medicare ranks its participating dialysis facilities on a one- to five-star scale based on nine quality-of-care and best treatment practices that range from death and hospitalization rates to whether patients were catheterized for more than 90 days. Other factors include whether dialysis removed enough wastes from a patient’s bloodstream, rates of infection and if patients experienced elevated calcium levels in their blood.

The state has 48 dialysis centers that participate in the federal Medicare program. Just four are nonprofit. Two chains own most of the for-profit dialysis centers in Connecticut: DaVita, with 25, and Fresenius Medical Care, with 13.

The most recent quality-of-care ratings show that the Fresenius-owned Dialysis Center of Newington scored lowest among Medicare-participating facilities in Connecticut, with a two-star rating. The data show the facility exceeded state and national averages of adult patients who had a catheter left in a vein for more than 90 days, had higher rates of hypercalcemia and lower rates of direct access between veins and arteries. Its rates of hospitalization, readmission and death were “as expected,” or average.

Fresenius Medical Care North America said in a statement that “key” outcome measures—such as hospitalization, infections and death—for the Dialysis Center of Newington “were in line with other facilities in the state.” While the facility did not meet state and national averages in three measures, “the center has taken efforts to improve these areas to better reflect the overall high quality of care delivered,” Fresenius said, adding that it expects the next Medicare ratings to reflect those efforts.

Fresenius also owns the single facility that in 2014 received just one star: Fresenius Medical Care of Fairfield. That facility improved its rating to three stars, though Medicare scores its rate of hospital readmission as “higher than expected.” The Fairfield facility joins four two-star facilities in 2014 that improved to three stars in the most recent ratings: East Hartford Dialysis Center, FMC of Western Hartford, New Britain General Hospital and UConn Dialysis Center.

Those centers rated at five stars are: Black Rock Dialysis in Fairfield, Branford Dialysis, Central Connecticut Dialysis Center in Meriden, Danbury Dialysis Center, DaVita Waterbury Heights Dialysis, Farmington Dialysis, Greater Waterbury DaVita Dialysis, Middlesex Dialysis Center in Middletown, Milford Dialysis, New London Dialysis, South Norwalk Dialysis and U.S. Renal Care Branford Dialysis.

Overall, Connecticut scores higher on most quality measures when compared with national averages. It lags in just one area: Children who had enough waste removed from the blood during dialysis that uses the stomach as a filter. The state’s average was 37 percent, compared with 60 percent nationally.

The Medicare data is from 2015 and 2016.

Some groups, including the National Kidney Foundation, warn that patients shouldn’t use the star system as the sole consideration in determining the level of care a facility gives. Many factors, including a patient’s overall health, can affect scores, the foundation writes on its website. The foundation also notes that Medicare used a bell curve in setting its rankings, which means even those centers that score low on the scale might provide good care. Under Medicare’s ratings system, facilities that score in the lowest 10 percent receive one star, while those in the top 10 percent receive five.

C-HIT’s searchable database on dialysis centers can be viewed here.

The Nathaniel Witherell in Greenwich was fined $1,940 for two instances, the state Department of Public Health (DPH) said.

On March 24, a resident with Parkinson’s disease, dementia and other diagnoses suffered a broken collarbone and broken right hip after falling onto the floor in a bathroom. The resident required supervision for standing and transfers, but a nurse aide left the resident alone for privacy, according to DPH. The resident was treated at local hospital.

On Sept. 22, a resident with hypertension was hospitalized for dehydration and severe renal failure, according to DPH. Investigators found the resident, who was at risk for dehydration, wasn’t properly monitored for warning signs.

“We’ve replied with a corrective action plan, which was accepted” by DPH, said Allen Brown, Witherell’s executive director. “They consider us now in full compliance.”

Chelsea Place Care Center in Hartford was fined $1,920 for an incident in which a resident reported abuse.

On Feb. 7, the resident, who suffers from bipolar and post-traumatic stress disorders, sustained cuts and abrasions to the mouth and forehead and a broken tooth after being struck “six to seven times” by a licensed practical nurse, according to DPH.

The LPN admitted to punching the resident and reported being choked by the resident who refused to leave another resident’s room. The LPN later denied hitting the resident, but the facility determined abuse occurred and the LPN was terminated, according to the citation.

The resident was taken to a hospital for evaluation, admitted for psychiatric treatment, and ultimately discharged to another facility on March 1.

“We take this matter very seriously. The health, safety and well-being of our resident community remain Chelsea Place Care Center’s utmost priority,” said Michael Landi, chief operating officer of parent company iCare. “The events in question were isolated in nature and are not representative of the high standards of care and service we demand from our employees.”

Apple Rehab Saybrook in Old Saybrook was fined $1,750 after a resident fell and suffered a broken femur that required surgery.

The resident, who was at risk for falls, fell on Oct. 26, 2016, while being helped by a nurse aide to the bathroom, according to DPH. An investigation found the aide failed to use a gait belt when helping the resident to the bathroom, as required by facility policy. According to DPH, the aide was aware of the policy but wouldn’t answer specific questions about the incident.

“Each resident is unique and important to us and our goal at Apple Rehab Saybrook and Apple Inc. is to continually provide our residents with individualized care and services,” said John Anantharaj, vice president of clinical services. “Our policies and procedures that uphold residents’ dignity, safe transfers, prevention of falls and general well-being remain our highest priority and are reviewed regularly with staff for compliance and competency.”

Westside Care Center in Manchester was fined $1,740 after a nurse aide offered to obtain illegal drugs for a resident in exchange for sexual favors.

On Feb. 26, the aide offered to get the resident illegal substances. The aide asked the resident how payment would be made “and made a gesture consistent with a sexual act,” according to the citation. The aide also asked to exchange cell phone numbers with the resident.

The resident, who was being treated for various injuries from a motor vehicle accident, reported the incident to staff, according to DPH, and the aide was suspended. The aide was fired after an investigation determined the exchange was inappropriate and violated policy. The aide had sent text messages and made phone calls to the resident in an attempt to extort sexual favors, investigators found.

“We strive each day to provide the highest quality care for all resident of our facility. While the facility implemented immediate interventions, all of which were accepted by the Department of Public Health, and took this matter with the highest level of importance, it also successfully contested many aspects of the department’s investigation, findings and conclusions,” said Patrick Neagle, Westside Care administrator, declining further comment.

Connecticut Baptist Homes in Meriden was fined $1,630 for two instances.

On June 15, a resident with dementia suffered a leg laceration after hitting a bracket attached to a wheelchair. According to DPH, a nurse aide tried to move the resident without help, despite a physician’s order calling for two-person assistance. The resident received 14 sutures at a local hospital, according to the citation.

On Aug. 24, two nurse aides were observed transferring another resident with dementia from a wheelchair to a bed by lifting the resident by the legs and under the arm pits, according to DPH. The transfer didn’t comply with facility policies and put the resident at risk for shoulder dislocation and nerve damage, according to the citation.

An aide involved in the August incident was suspended and re-educated on safe patient handling before returning to work and all staff were re-educated on the topic, said Patricia Morse, Connecticut Baptist Homes administrator. Random safety audits have been conducted daily throughout the facility, she added.

Beacon Brooke Health Center in Naugatuck was fined $1,530 after one resident made inappropriate sexual gestures to another. After three incidents, the resident who made the gestures was discharged. Administrator Linda Garcia declined to comment, citing confidentiality reasons.

The state Department of Public Health fined Apple Rehab Rocky Hill $3,000 for seven incidents. One incident on Oct. 27, 2016, involved a resident’s hospitalization for an uncontrolled nosebleed. DPH found staff had mismanaged the resident’s anticoagulant medication prescriptions.

The resident, who suffered from congestive heart failure and other ailments, was supposed to be taken off Coumadin and begin taking Xarelto on Oct. 20, according to the citation. From Oct. 20 to Oct. 23, the resident received neither medication and then was given both medications in error for several days, the citation said.

While hospitalized on Oct. 27 for a nosebleed, the resident experienced “prolonged and vigorous retching” and required the use of a “non-invasive mechanical pressure support ventilation,” according to DPH. The resident was hospitalized until Nov. 15 before returning to the facility.

The other six of incidents involved residents developing pressure bedsores, or being put at risk of developing pressure bedsores. DPH found staff ignored care plans and did not place pillows under residents’ feet to alleviate pressure, according to the citation.

John Anantharaj, the facility’s vice president of clinical services, said Apple Rehab of Rocky Hill “provided immediate education for all staff to improve the quality of care and rectify the [DPH] findings. Apple Rehab of Rocky Hill is committed to working with DPH and other regulatory agencies to ensure that excellence in care is provided to all our residents.”

Westport Rehabilitation Complex was fined $2,330 for five incidents that occurred in 2015 and 2016.

In one case, staff gave incorrect medications to a resident’s family member who took the relative home for an overnight visit on May 29, 2016. The family member was sent home with two drugs, Clozapine, an anti-psychotic drug that the resident’s physician did not order, and Omeprazole, a heartburn medication, which the physician had discontinued two months prior.

After noticing behavior changes, according to DPH, the family member took the resident to the hospital, where the resident had an abnormally slow heartbeat, which can be a side effect of Clozapine. After being monitored in the intensive care unit, the resident was discharged and returned to the facility on June 1.

A nurse failed to check the physician’s medication orders before giving the drugs to the family member, the citation said.

In a separate instance, a resident was found wandering on Post Road on Jan. 24, 2016, and was returned via police escort, the citation said. The resident was seen trying to leave the building several times between Jan. 21 and Jan. 24, getting as far as the facility’s lobby.

According to DPH, the facility failed to document whether an investigation of the incident took place. The resident was wearing a “wanderguard” sensor, and it is unclear how the wanderguard alarms were bypassed, the citation said.

Other violations at the facility involved staff’s failure to investigate the cause of a resident’s bruises and broken finger; failure to investigate a resident’s claim of mistreatment by a nurse’s aide; and failure to follow a care plan, which resulted in a resident falling from a wheelchair.

The facility’s executive director, Anna Durkovic, said, “Our residents’ wellbeing is always our top priority. After addressing the concerns identified by DPH, Westport Rehabilitation Complex is back in compliance.”

Talmadge Park East Haven was fined $1,160 for an incident dating back to 2012 in which a nurse’s aide forcibly pulled a resident into a chair, according to DPH.

The citation said a resident with advanced dementia was yelling on Dec. 15, 2012, while two nurse’s aides were talking to each other nearby. Witnesses told investigators the resident was in a wheelchair and tried to stand up and one of the nurse’s aides forcibly pulled the resident back down into the wheelchair from behind. That nurse’s aide subsequently was fired.

The citation was issued in 2013, but DPH just publicly released the information because the facility recently paid the fine, according to Maura Downes, DPH spokeswoman. Talmadge Park requested a formal hearing to contest the citation, but later withdrew the request and paid the fine.

“The facility strives to provide quality care to all its residents and took appropriate action in 2013 regarding this event,” said Michael Fiore, the facility’s administrator. “All staff receive ongoing education regarding standards of care.”

Fernwood Manor on Girard Avenue has agreed to hire an independent consultant to oversee its fire safety, staffing and resident monitoring policies, under a consent order issued Sept. 30 by the state Department of Public Health. The DPH is requiring the home to tighten its resident supervision policies, train staff in those rules, and ensure that the facility has “sufficient personnel” on duty to monitor residents, the consent order says.

The home also will pay a small fine – $500 – for failing to ensure that the resident who died “was supervised in a manner that prevented injury,” according to the DPH order.

An inspection report in July found that the Fernwood Manor staff failed to properly monitor residents in the overnight hours of June 19. The home has an 11 p.m. curfew, by which time residents are supposed to be settled in their beds, the report says. An overnight attendant is supposed to make rounds to check on the residents overnight, as well as to ensure that all doors are locked.

Instead, a group of six residents was reportedly wandering in and out of the building after midnight and gathering on the front porch to smoke. Sometime after 4 a.m., one of the residents’ clothes caught fire, and other residents called the police. The resident died of injuries related to the fire.

The attendant on duty told DPH inspectors that she was resting in her room and did not make rounds after the curfew. Instead, she was alerted after the police were called.

She told inspectors that the resident who died had “played with a lit cigarette all the time on his clothing and on his skin, and [she] had seen this with her own eyes. .. She identified that other staff knew and did not tell anyone because [the resident] would say he was just playing around.”

Administrators of the home said attendants are supposed to stay awake and make rounds, but that the facility had relied on the “honor system” to make sure that happened.

The DPH report says that after the fire, burn holes were found in some of the clothing that had been worn recently by the resident, including a jacket and shorts.  Administrators said they were not made aware of reports that the resident had previously burned himself with cigarettes.