Case: DOJ investigation of Baxter Manor Nursing Home

Never Filed | No Court

Filed Date: 2004

Clearinghouse coding complete

Case Summary

Pursuant to the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997, the Civil Rights Division of the U.S. Department of Justice ("DOJ") conducted an investigation of conditions at the Baxter Manor Nursing Home ("Baxter"), a county-operated skilled nursing facility in Arkansas. The investigation resulted in a findings letter being sent to Baxter County's judge on July 14, 2004. The letter stated that in April 2004, DOJ and certain of its expert consultants toured the fac…

Pursuant to the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997, the Civil Rights Division of the U.S. Department of Justice ("DOJ") conducted an investigation of conditions at the Baxter Manor Nursing Home ("Baxter"), a county-operated skilled nursing facility in Arkansas. The investigation resulted in a findings letter being sent to Baxter County's judge on July 14, 2004. The letter stated that in April 2004, DOJ and certain of its expert consultants toured the facility, interviewed residents and staff, and reviewed policies, procedures, and records. The DOJ's investigation led it to conclude that certain conditions at Baxter violated residents' federal constitutional and statutory rights. According to the DOJ, residents at Baxter suffered from deficiencies in the following areas: 1) restraint practices, 2) assessment and resident care, 3) physical environment, and 4) mealtime practices. Additionally, the DOJ found that Baxter's practices did not comply with the Americans with Disabilities Act ("ADA"), 42 U.S.C. § 12132 et seq.

The findings letter described that the DOJ investigators observed a significant number of Baxter residents with restraints whose medical charts in no way justified their use. Both mechanical and chemical restraints were utilized at Baxter Manor in ways that were a substantial departure from generally accepted professional standards. Overuse of full side rails without consideration of suitable alternatives for residents' beds and unchecked use on residents of psychotropic medications for restraint purposes were among the examples the letter cited of inappropriate restraint practices at Baxter.

Baxter's assessment process and care plans often did not meet generally accepted professional standards, whether considering resident rehabilitative, restorative, or medical care needs, according to the findings letter. Physicians and care teams did not operate under clinical practice guidelines and failed to address factors associated with loss of resident function. Baxter leadership and staff lacked training and education regarding federal nursing home regulations, facility policies, geriatric care issues, individual care plans for residents, and discharge planning.

Mealtime use at Baxter of semi-circular feeder tables presented risks of harm to residents, according to the DOJ, as positioning of staff and residents at these tables prompted some residents to hyper-extend their necks to eat, predisposing them to choking, discomfort, and aspiration pneumonia. Regarding discharge planning, the DOJ found that Baxter's staff did not adequately evaluate or assess (1) residents for their discharge potential, (2) barriers to discharge, and (3) placement factors such as a resident's functional status, medical acuity, support requirements, and individual placement preferences. Baxter did not adequately consider discharge planning issues as part of the interdisciplinary care and treatment process. The facility had no effective process for discharge planning, and resident care teams were not educated on discharge planning methodologies. These deficiencies violated the ADA-imposed obligation to treat residents in the most integrated setting appropriate to their individual needs.

The DOJ findings letter proposed remedial actions to remedy the deficiencies, invited the county to address the issues, and alerted the county to the possibility of a CRIPA lawsuit brought by the United States to compel remedial action. We have no post-findings letter information about this matter.

Summary Authors

Mike Fagan (6/19/2008)

People


Judge(s)

Newton, Sue (Arkansas)

Attorneys(s) for Plaintiff

Acosta, R. Alexander (District of Columbia)

Cromwell, William M. (Arkansas)

Kincade, Ronald (Arkansas)

Judge(s)

Newton, Sue (Arkansas)

Attorneys(s) for Plaintiff

Acosta, R. Alexander (District of Columbia)

Cromwell, William M. (Arkansas)

Kincade, Ronald (Arkansas)

Documents in the Clearinghouse

Document

Re: Baxter Manor Nursing Home

DOJ investigation of Baxter Manor Nursing Home

July 14, 2004

July 14, 2004

Findings Letter/Report

Resources

Docket

Last updated May 12, 2022, 8 p.m.

Docket sheet not available via the Clearinghouse.

Case Details

State / Territory: Arkansas

Case Type(s):

Nursing Home Conditions

Key Dates

Filing Date: 2004

Case Ongoing: No reason to think so

Plaintiffs

Plaintiff Description:

U.S. Department of Justice

Plaintiff Type(s):

U.S. Dept of Justice plaintiff

Attorney Organizations:

U.S. Dept. of Justice Civil Rights Division

Public Interest Lawyer: Yes

Filed Pro Se: No

Class Action Sought: No

Class Action Outcome: Not sought

Defendants

Baxter County (Baxter), County

Case Details

Causes of Action:

Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. § 1997 et seq.

Special Case Type(s):

Out-of-court

Availably Documents:

None of the above

Outcome

Prevailing Party: Unknown

Nature of Relief:

Unknown

Source of Relief:

Unknown

Issues

General:

Discharge & termination plans

Food service / nutrition / hydration

Reassessment and care planning

Rehabilitation

Restraints : chemical

Restraints : physical

Sanitation / living conditions

Staff (number, training, qualifications, wages)

Disability:

Integrated setting

Medical/Mental Health:

Medical care, general

Type of Facility:

Government-run