‘We just felt frustrated and ignored’: Family says nursing home complaint went unanswered
By Barry Simms
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BALTIMORE (WBAL) — An unanswered complaint left a Maryland family frustrated with the care their loved one received at a nursing home.
The family of Lynn Lehneis kept seeking answers from the state, but even a year after their loved one died, the relatives said they still didn’t get any response.
What led to the complaint
Lehneis’ family reached out to 11 News Investigates about the impact this has had on them and their continuing concerns about nursing home care in Maryland.
“We visited Lynn a lot,” said Mary Beam, Lehneis’ sister.
From Lehneis’ stay at a Baltimore County nursing home after a debilitating stroke, the family told of struggles to get her better care. Because of the stroke, Lehneis needed help eating, but the family said she wasn’t getting it. Lehneis’ weight loss was one of the family’s many concerns outlined in a complaint filed with the Maryland Office of Health Care Quality.
“It was awkward. It was embarrassing, and she was really starving,” Beam told 11 News Investigates.
Family members said they expected their complaint to be investigated but said it never was.
“I think it’s heartbreaking, and I don’t understand why,” Beam told 11 News Investigates.
“It’s a breakdown in the system, and it should not be a breakdown in the system,” said Irene DeRenzo, Lehneis’ sister.
Sister: Overwhelmed, OHCQ said complaint was pending
Beam filed the complaint in the middle of the COVID-19 pandemic in April 2021. When she didn’t hear back, she called OHCQ and was told the agency was overwhelmed.
“They have so many complaints, they are inundated because of COVID, and COVID hit hard (at) nursing homes and senior facilities,” Beam told 11 News Investigates.
Beam told 11 News Investigates that she tracked her many calls to OHCQ to find out what happened to the complaint. She said she was regularly told it was still pending.
In November 2022 — a year and a half after first contacting the state — an OHCQ representative “pledged to still investigate the complaint,” though she couldn’t commit to a specific date or time.
“If complaints get lost, where is the teeth in the complaint process?” Beam said. “We were given a case number within a week of OHCQ receiving our complaint. How many other cases never got inspected or evaluated?”
“I feel it’s a travesty. It’s not right. It should have been taken care of. It’s still not taken care of,” DeRenzo told 11 News Investigates.
Were there other complaints?
Individual complaints are often lumped in with an annual survey of a facility as part of a federal mandate. But 11 News Investigates could not find any evidence that the complaint involving Lehneis was one of them.
The state did find nutritional deficiencies in regard to another resident in a January 2022 survey. By that time, the nursing home had changed hands.
The state found the facility “failed to ensure that residents dependent on staff for care received assistance with nutrition” and “failed to document the amount of assistance provided to the resident each shift.”
In that survey, the facility responded, saying it would “coordinate education of nursing staff on identifying residents who require assistance with meals and update the care plan,” but doing so was not an admission or agreement with the alleged deficiencies.
State tells 11 News: ‘We are not losing complaints’
WBAL-TV 11 News Investigates asked Dr. Nilesh Kalyanaraman, Maryland’s deputy secretary for public health services, about missing or uninvestigated complaints.
“I want to reassure folks, we didn’t lose complaints. We are not losing complaints,” Kalyanaraman told 11 News Investigates. “We’re logging every single complaint, and we don’t believe we’ve lost any complaints. If we didn’t follow up with a family, we are happy to see what communication there was to correct that if it was an issue.”
According to its 2023 annual report, OHCQ received 4,692 nursing home complaints in fiscal year 2023, of which the agency investigated 2,855.
So, what happened to the other 1,837 complaints?
“There is a little bit of a backlog in terms of complaints. We can’t go into the numbers, that’s considered part of federal protected information,” Kalyanaraman told 11 News Investigates.
The state told 11 News Investigates that some complaints don’t require an investigation. As for the annual facility surveys, only 42 of 225 facilities were surveyed in fiscal year 2023. The state said OHCQ was short-staffed, with only 64 of 75 surveyor positions filled.
What’s being done now
The Maryland Department of Health said there are now only a couple of vacancies, and it is bringing in more staff that Kalyanaraman said would include “additional surveyors and contractors to work through that backlog and get us up to date.”
Lehneis’ family said their sister was moved to a different facility.
“They were wonderful to her,” Beam told 11 News Investigates.
Lehneis died soon after moving to the other facility. Her sisters still want to know what happened to their complaint, saying they have concerns for other nursing home residents and they wonder about their own future.
“What’s going to happen to me? My sisters, we think about what happened to our older sister: Can that happen to me? Hopefully not. Something’s got to be done to prevent that,” DeRenzo told 11 News Investigates.
WBAL-TV 11 News Investigates spoke with Kalyanaraman before a lawsuit was recently filed alleging the state failed to inspect facilities. The lawsuit demands increased enforcement of nursing home violations.
The state said it cannot comment on the litigation, nor will it comment on the Lehneis complaint.
As for the sisters, they still want answers and an apology from the state.
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