Lawsuits, fines, complaints put pressure on Athena nursing homes

Athena Health Care Systems, one of the biggest long-term care providers in Connecticut, has come under the scrutiny of officials in three New England states after receiving consistent complaints about conditions in its nursing homes.

Athena is also facing multiple lawsuits alleging that the company failed to pay employee health benefits and that it didn’t pay for temporary staffing during the pandemic.

The Farmington, Conn.-based company recently agreed to pay a $1.75 million fine to the Massachusetts Attorney General’s office — the largest nursing home fine ever in that state — for admitting people with substance abuse issues to its nursing homes without being able to provide them with appropriate treatment, leading to “numerous overdoses,” according to the Attorney General’s office.

And it is facing a wrongful death lawsuit from the family of a resident who died in a Massachusetts nursing home after being bludgeoned by his roommate with a walker.

The company operates more than 40 long-term care facilities in Connecticut, Massachusetts and Rhode Island. In Connecticut, it operates 21 facilities from Middletown to Sharon and serves more than 2,500 residents.

Athena’s struggles highlight issues facing many nursing home operators — a lack of staff making it difficult to meet minimum hourly requirements, financial hardship partially caused by inflation, and a smaller pool of residents years into the pandemic.

The Connecticut Mirror reviewed multiple lawsuits against Athena and consent orders issued by public health agencies in Connecticut, Massachusetts and Rhode Island, along with police reports.

The documents show:

• Six temporary employment agencies have filed lawsuits against Athena in Connecticut, alleging that the company has failed to pay them more than $142,000 for employees they provided since 2021 to offset staff shortages.
• Another lawsuit claims Athena owes nearly $2 million for temporary workers provided by a separate company.
• An Iowa-based insurance company has filed a federal lawsuit alleging that Athena, a self-insured company, has failed to pay more than $6 million in health insurance claims from its employees, an issue that prompted state officials to contact the U.S. Department of Labor to investigate.
• A consent order at Athena’s Middlesex Health Care Center in Connecticut required it to hire an independent nurse consultant to review and revise assessments of staffing levels and medication administration and monitor the frequency of bed sores.
• Three consent orders were issued by the Massachusetts Department of Public Health for patient safety issues and staffing shortages, and Rhode Island officials issued a consent order after investigators discovered unsanitary conditions, such as people eating on Styrofoam plates for six months because there was no dishwasher. 
• A wrongful death lawsuit was filed in Massachusetts by the estate of Robert Boucher, who was a resident at the Oxford Rehabilitation and Health Care Center in Haverhill when, in October 2019, his roommate beat him in the head repeatedly with a walker before staff intervened. Boucher died from his injuries.

From October 1, 2021 to Sept. 30, 2022, Connecticut’s Long Term Care Ombudsman’s office received 518 complaints about conditions in Athena nursing homes, including the Middletown facility — a large increase from previous years, officials said.

“We have had ongoing, significant concerns related to this chain,” Long Term Care Ombudsman Mairead Painter told the CT Mirror. “We have reported them to other state agencies due to the level of concern and the number of complaints we’re getting, in particular, related to staffing.”

The Department of Public Health licenses nursing homes and conducts inspections of the facilities that participate in Medicare or Medicaid about once a year on average. State officials may inspect a home more frequently if it is “low-performing,” according to DPH. Medicaid covers more than 70% of nursing home residents in Connecticut.

The state also investigates complaints from families, residents and Painter’s office related to nursing home care.

During a nursing home inspection, a team typically observes resident care processes and staff interaction with residents and reviews clinical and medication records.

Nursing homes in Connecticut are required to provide at least three hours of direct care per resident per day. The legislature voted to raise the minimum care requirement from 1.9 hours to three in 2021.

The Department of Public Health has at least twice in recent years shut down long-term care facilities when officials believed resident safety or care was in jeopardy. But state officials have said previously they are reluctant to take such a drastic step because they must find new homes for residents.

While DPH officials said they are monitoring Athena’s facilities closely, there are no plans to close any of them. The only facility currently overseen by an independent consultant is Middlesex Health Care.

Connecticut Department of Public Health spokesman Christopher Boyle said that DPH and the state Department of Social Services, which oversees the financial side of nursing homes, are aware that Athena has been experiencing financial challenges.

Boyle said DPH officials “have been monitoring the company’s financial status as part of an overall effort to proactively identify potential impacts on resident care.”

“Because Athena also owns and operates skilled nursing facilities in Rhode Island and Massachusetts, DPH and DSS have met with counterparts in those states to generally discuss Athena operations, as company experiences in any one state may impact operations and resident care in the other states,” Boyle added.

In response to a series of questions from the CT Mirror, Athena’s owner, Lawrence Santilli, acknowledged the company has had financial difficulties that have “undermined the quality of care” in some facilities.

“For Athena, which serves thousands of patients daily across its 45 facilities with thousands of employees, these unprecedented challenges and expenses and the resulting severe staffing shortages have resulted in significantly higher expenses and have put a strain on resources,” Santilli said in an emailed statement.

“To meet the discharge needs of the state’s hospital system and existing residents, Athena was forced to resort to using temporary nursing staffing agencies at the highest levels and the highest costs ever experienced by the company, and at times undermining the quality and consistency of care that has always been our goal.”

Santilli said Athena was a “pioneer” when it came to assisting the state during COVID. The company opened COVID recovery facilities in Meriden and Torrington and took others into nursing homes in Bridgeport and Sharon. Athena was hailed by Gov. Ned Lamont at the time as a key part of freeing up hospital beds and helping curb the spread of the virus in nursing homes.

‘We feel so helpless’

Patty Bausch, 62, has lived at the Newtown Rehabilitation and Health Care Center for four years. But in recent years, staffing problems have meant she has had to wait hours to be changed, she said — an uncomfortable ordeal for someone who is prone to urinary tract infections.

“Sometimes you have to wait two, maybe three hours to have your brief changed,” Bausch said in a recent interview. “You’re sitting in a wet brief for that amount of time. It’s terrible. We just feel so helpless.”

Painter, the ombudsman, is concerned about the mounting complaints from families and residents, whether it’s someone stuck in bed, medications not being distributed or meals being missed.

Yehyun Kim

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CT Mirror

Painter said the 518 complaints her office has received since September 2021 is “likely an undercount” and more go unreported. In some cases, a resident may call to report an issue and then change their mind for fear of retribution. Other times, when her office goes to interview someone, other residents may chime in with similar concerns, but it is still recorded as a single complaint.

The Athena facilities that received the most complaints are the Middlesex Health Care Center in Middletown, Newtown Rehabilitation & Health Care Center in Newtown, Valerie Manor in Torrington, Abbott Terrace Health Center in Waterbury and Bayview Health Care in Waterford, Painter said.

In some Athena homes, residents reported seeing 20 residents assigned to one certified nursing aide. A typical ratio to ensure residents are receiving good care is one worker to every eight or 10 residents, depending on the needs of residents, Painter said.

The most common complaint is lack of access to care, typically stemming from understaffing, she said. That might mean a resident is left waiting a long time without assistance to go to the bathroom or is left in bed when the person instead wants to get up for the day.

Bausch said the lack of staff is noticeable. When she first arrived at the facility, she would shower with the help of nursing aides several times a week.

“Now I’m lucky if I get one,” she said.

Meals arrive late and cold, Bausch said. Daily activities are missed if staff are not available to help her get out of bed and into her wheelchair.

In May, family members had arranged to throw a birthday party for Bausch’s son at the nursing home so Bausch could be part of the celebration. But staff weren’t available to help her out of bed, she said, and she missed the party.

“Because of COVID, I’ve had to miss events like that. So one day, they were going to come to the facility and bring the party to me, which I was so excited about,” Bausch said. “But that particular day, there was no help and there was one aide, she said, ‘I’m sorry, you’re not getting up for that. I can’t do it.’”

Painter’s office also frequently hears about environmental concerns, such as trash not being emptied or problems with heating or air conditioning, and issues with meals, like poor quality food, residents not receiving meals in a timely manner and a lack of nutritional support.

Athena has launched an “ambassador program” in its Connecticut facilities to “focus on customer service, communication and most importantly, serve as an advocate to the residents,” Savannah Ragali, director of marketing and communications for Athena, wrote in an email to the CT Mirror. “Part of their responsibilities is to ensure that residents’ concerns are brought to the appropriate department for quick and timely resolution. Newtown Rehabilitation and Health Care Center has an ambassador at their center.”

‘So heartbreaking’

DPH’s investigators made several unannounced visits to the Middlesex Health Care Center from November 2021 through April 2022, and what they uncovered led them to order Athena to hire an independent nursing consultant to oversee the facility.

Athena hired Tami Reilly, a registered nurse, over the summer. She is required to submit periodic reports to DPH for at least six months, according to the consent order.

One of Reilly’s initial reports obtained by the CT Mirror details the extent of the staffing shortage at the facility. In July, the home was without an administrator, an assistant director of nursing and a food service director, and the lack of shift supervisors was so severe that it forced the nursing director to work more than 68 hours a week filling in shifts, Reilly said in her August 2022 report.

The report outlines a range of issues that officials say can happen when a facility is short-staffed: an open bag of potato chips was found next to a urinal tray on a resident’s night stand; residents had waste-stained sheets because they were left in bed for hours; a resident with a “choking hazard designation” was left with alone with a plate of food until Reilly called in staff after the person had eaten half of a sandwich.

It also describes the general lack of upkeep at the facility, with rust stains on bathroom vanities, dirty, dingy floors in need of a waxing, broken closets, and 16 of the 18 customized wheelchairs at the home found out of compliance.

Santilli said Athena voluntarily agreed to the independent nurse arrangement and halted new admissions.

“We took a proactive approach … [deciding] to not accept new admissions at this time and focus on ensuring the safety and high quality of care for our residents and staff,” he said.

“As a long-time leader in the Connecticut nursing home industry with over 38 years of experience, and working in cooperation with relevant state agencies, we are confident that we are on the right path and have no plans to sell or close any Athena facilities.”

For Painter, the independent nurse’s reports confirm the complaints they have been getting at several Athena homes.

“Every story is so heartbreaking to hear,” Painter said. “What’s hard is that the complaints often fall on the person giving the care that day, the CNA or the nurse, and those people are there because they haven’t given up.

“Where we are not seeing accountability and the people showing up is in the ownership and corporate.”

Financial troubles in Connecticut

In Connecticut, records show there are six lawsuits pending against Athena filed by temporary employment agencies, including one filed this summer by Care Given At Home LLC. All told, the companies allege that Athena has failed to pay them more than $142,000 for providing temporary nurses and nurses’ assistants to fill in at facilities that were short-staffed. The practice of hiring temporary employment agencies is common for providers, especially since the pandemic hit and staff have quit.

All of the lawsuits have been filed since July, with several filed late in December, after the announcement of the fine in Massachusetts. All of the cases are still pending.

Boyle said the DPH was aware of one complaint from a temporary staffing agency that said it was owed money by Athena and could not continue to provide services without getting paid.

Athena also is facing a federal lawsuit in Iowa from ClaimDOC LLC, a company that was overseeing its self-insured program for employees. The lawsuit alleges that Athena in 2021 and 2022 failed to pay more than $6 million in health care claims filed by its employees as well as more than $2 million in fees to ClaimDOC.

Boyle said the state has received complaints from former and current Athena employees about health insurance issues, but DPH doesn’t have any jurisdiction over them.

“Both agencies [DPH and DSS] referred the complaints concerning Athena’s failure to pay employee health insurance claims to the Region 1 offices of the U.S. Department of Labor, Employee Benefits Security Administration, which has jurisdiction over self-insured health plans covered by ERISA, and both agencies have likewise conveyed these serious concerns directly to the U.S. Department of Labor,” Boyle said.

Santilli said the company has been working to settle the lawsuits brought by the temporary agencies and is in contact with the Department of Labor about the health insurance claims.

“We have come to agreements with the temporary staffing agencies to resolve past-due amounts and have worked diligently on rebuilding our workforce,” Santilli said. “We have also made significant payments toward health insurance claims and expect to be in compliance by the end of the month. Currently, Athena is working cooperatively with the DOL.”

For Bausch, the frequent staff turnover has made it difficult not only to get care but also to form relationships with the workers she relies on every day.

“They come in and they’re overwhelmed,” she said. “It’s like quicksand in here.”

Administrators who have pledged to bolster staffing have also left.

“We keep hearing that they’re hiring people, but the people who kept telling us that are [now] gone,” Bausch said. “A lot of management has left.”

“Everybody here feels the pain” of the nursing aides, she said. “We know it’s hard work. It’s not an easy job. But when the residents are made to feel guilty that there’s not enough staff here — it’s not good.”

Largest fine ever

In late December, some of Athena’s issues became public when then-Massachusetts Attorney General Maura Healey announced that Athena had agreed to pay a $1.75 million fine.

In a press release, Healey said the settlement resolved a long-running investigation into multiple allegations, including that Athena “failed to meet the needs of nursing home residents experiencing substance abuse disorder.”

She called it the largest settlement with a nursing home in state history. Athena operates 18 nursing homes in Massachusetts.

The investigation showed that Athena admitted a large number of residents with a history of substance abuse, despite not having the facilities or staff trained to care for them. The investigation uncovered numerous overdoses, some of which Athena failed to report to the Massachusetts Department of Public Health as required by law. The attorney general’s office did not reveal how many overdoses there were or how many people died.

“This resolution ensures that Athena facilities will appropriately provide care for individuals with substance use disorder and helps to restore the trust families need when making critical decisions about the care of their loved ones,” said Healey, who is now governor.

While the attorney general’s office was conducting that investigation, the Massachusetts Department of Public Health was also probing several of the same facilities for a variety of allegations, including not having enough staff and failure to follow COVID protocols at a Plymouth, Mass., facility that led to a widespread outbreak, records show.

The COVID outbreak at the Plymouth Rehabilitation and Health Care Center was so dire that the health department suspended Athena’s license to operate the facility in November 2021.

The notice said that a lack of staffing and the facility’s inability to reduce the number of rooms with three residents posed an “imminent health threat.”

The suspension was lifted in February 2022, according to Massachusetts DPH spokesman Omar Cabrera.

Two other Athena homes were designated as “special focus facilities” because they had poor compliance history over a three-year period — Marlborough Hills Rehab and Health Center and Oxford Rehabilitation and Health Care Center in Haverhill, Mass. The designation required the facilities undergo a survey every six months until they passed all health and safety regulations.

Marlborough Hills is still under the order issued in November 2021, Cabrera said.

Oxford, which was designated an SFF in November 2019, “graduated” from the special focus facility program in October 2021, Cabrera said.

Had to kill him

The Oxford facility came under state review because of a homicide.

Shortly after 7:30 p.m. on Oct. 6, 2019, nurse Maria Sanchez was delivering medication to residents when she heard noises coming from room 216, according to police reports. When she entered the room, she saw a resident, Jose Veguilla, holding his walker over the bed of his roommate, Robert Boucher.

Boucher was bleeding profusely from a head wound, and as Sanchez rushed to stop Veguilla, he threatened to hit her with the bloody walker as well. She rushed out of the room to get help, but it was too late for Boucher, a man who suffered from severe depression because his lower right leg had recently been amputated.

When a second staff member, nursing aide Diane Flores, entered the room and tried to speak with Veguilla in Spanish, he told her he “had to kill Boucher.”

When the first police officer arrived, Veguilla was at the entrance to the facility’s day room, swinging his walker wildly at staff members. He dropped it when the officers approached him, the police report states.

Boucher died at the hospital of his head injuries, and Haverhill police charged Veguilla with murder. He was eventually found incompetent to stand trial and committed to the Bridgewater State Mental Hospital.

The DPH investigation of the homicide eventually led to a $15,895 fine of Athena by the Centers for Medicare & Medicaid Services, the federal agency that oversees long-term care facilities.

But Athena’s problems from that homicide are not over.

Boucher’s representatives filed a wrongful death lawsuit against Athena last August, seeking monetary damages for the facility’s failure to protect Boucher from his roommate, who had a “demonstrated history of violent behavior toward patients and staff.”

The lawsuit alleges that Athena failed to heed complaints by Boucher that he “was afraid of Veguilla” and failed to develop a comprehensive care plan for him. Veguilla suffers from dementia and had made threats of violence against several staff members in the seven months Boucher had been at the Oxford facility, the lawsuit states.

The case is pending at Middlesex Superior Court. Because the lawsuit is ongoing, Santilli said, he could not comment on it.