Nursing homes with
unblemished records are rare

By LARRY WHEELER
Gannett News Service

ROCKVILLE, Md. — Spring has delivered a perfect day to the National Lutheran Home.

Big clumps of white azaleas and delicate pink dogwoods decorate the landscape like cotton candy. An elderly man wearing a tidy straw hat and leaning on a sturdy cane makes his way through the front doors of the nursing home.

Inside, the comfortable lobby is a crossroads of activity.

A receptionist answers the phones and makes periodic announcements on the public address system. A visitor with an armful of flowers encounters an old friend, and the two hug. A petite woman with white hair dozes softly in an upholstered chair. A bag of lemon drops sits opened in the little cloth carrying case hanging from her walker.

Two women, probably in their 80s, guide their electric scooters past the open chapel doors on their way to an exercise class.

“Good morning ladies,” says a man whose voice rings strong and deep. “It looks like you have quite a parade going.” The women chuckle and glide off toward the activity room.

The voice belongs to the Rev. Richard Reichard, executive director of the National Lutheran Home. Reichard is an unusual man.

He is as comfortable in a pulpit speaking about the Gospel of Matthew as he is behind his broad desk fretting over the minutiae of state and federal nursing home regulations.

The nursing home he directs is even more unusual.

The 300-bed center, located on a quiet two-lane road not far from one of the region’s busiest superhighways, is among a fraction of nursing homes nationwide that has not been cited for a single violation of government patient care standards in the last four years.

In an industry still struggling to overcome a reputation for abuse and neglect, the National Lutheran Home is an oasis.

The key is staff, said Reichard, 65, a tall man who speaks with a powerful preacher’s baritone.

“This is serious stuff,” he said. “Our board of trustees is tuned to the times and knows that excellent and well-trained people don’t come cheaply.”

Of 16,437 Medicare and Medicaid certified nursing homes nationwide, just 314 — fewer than 2 percent — have been violation free for the last four years, according to a Gannett News Service analysis of federal inspection and complaint investigation reports.

To participate in the Medicare and Medicaid programs, nursing homes must submit to periodic surveys about every 12 months. They also must open their doors and records to investigators whenever a patient or family lodges a complaint with the state-run survey and certification agency.

Inspectors can cite hundreds of so-called deficiencies, ranging from making sure that residents have enough food and proper vitamins to performing criminal background checks on staff.

Examples of more severe deficiencies include nursing home-wide patterns that fail to protect residents from mistreatment, abuse or neglect. Among the most common: failing to protect residents from accidents and properly treat pressure sores.

Each year, the number of violation-free nursing homes has ranged from 19 percent in 1998 to 14 percent in 2001, according to a study from the University of California at San Francisco.

The men and women who live at the National Lutheran Home appear content with their surroundings and the level of care.

Howard Lynch, 82 and his wife, Catherine, 78, live in one of the small independent-living cottages that surround the three-story nursing home. They know that when their health deteriorates to the point they need assistance, they have a good place to go.

“When you get older you have to plan for the future,” said Lynch, a former salesman for a trucking company. “This is without a doubt the best move we ever made.”

Lynch’s mother-in-law spent her last years in the home. His brother-in-law and sister-in-law are also residents there.

“Our neighbor’s husband was in the nursing home, and the care he got was just tremendous,” Lynch said. “The patients really come first here. There is nothing that gets shortchanged, and the staff is really interested and caring.”

The National Lutheran Home has been without problems for four years because it can afford to offer its employees better wages, benefits and working conditions than other nursing homes, Reichard said.

“We’re part of a church, and the church cares. And we’re nonprofit, and people send us money and leave us bequests,” Reichard said.

Federal records show that National Lutheran Home provides its residents with 3.03 nursing staff hours per resident per day, slightly below the national average of 3.9 hours a day.

Since 1995, the annual retention rate for the 185-member nursing staff has hovered around 90 percent, said Norma Spinella, the director of nursing.

“People come here, and they want to work here, and they stay for years,” said Spinella, now in her 22nd year at the nursing home founded more than a century ago at a church member’s farm in Washington.

National Lutheran’s retention rate contrasts with many other nursing homes, which have suffered because of chronically low wages.

Yet the nursing home’s perfect record soon will have a blemish.

Reichard said it recently concluded a dispute with the son of a former patient who complained to Maryland’s nursing home survey agency about the treatment his mother received.

The agency, the Maryland Office of Healthcare Quality, cited National Lutheran for failing to follow up on results of a skin cancer test. The low-level deficiency is not yet visible to the public on the federal government’s Nursing Home Compare Web site because the information has not been updated yet.

“We have loved our unblemished record,” Reichard said. “We’re exposed to probably 100,000 potential events or incidents a year here. In the arena in which we function every day, one deficiency is pretty good. We can live with that.”

(Contributing: Robert Benincasa, GNS)