After death, oversight up at nursing home

Cathedral Village, a retirement community in Philadelphia's Andorra section, last month reached what experts called a "unique" agreement with the U.S. Attorney's Office in Philadelphia to enhance care in its nursing home, especially for Alzheimer's and dementia patients.

The joint agreement grew out of complaints by Barry Vernick, whose wife, suffering from Parkinson's disease and dementia, died following a brief stay at Cathedral Village in late 2008.

The agreement mentions no allegations of wrongdoing by the nonprofit Cathedral Village.

But for three years it puts Cathedral Village policies and procedures under Department of Justice oversight, requires monitoring by a consultant, and is enforceable in court.

David R. Hoffman, a former assistant U.S. Attorney in Philadelphia who has been a consultant since 2005, said it was understandable to be puzzled by the agreement.

"It appears to be a purely regulatory matter, but you have a law enforcement agency that does not appear to be enforcing any alleged violation of fraud laws," said Hoffman, who in the 1990s pioneered the strategy of using the False Claims Act to hold nursing homeowners accountable for the quality of care.

Representatives of the U.S. Attorney's Office declined to go into specifics on Cathedral Village, but said generally that they were obligated to ensure and improve the quality of federally funded care.

"We do have that responsibility to use the statutes to address concerns that are seen by members of the community," said Margaret L. Hutchinson, civil chief in the U.S. Attorney's office in Philadelphia.

A U.S. Attorney's Office spokeswoman declined to comment when asked whether the investigation discovered other complaints about Cathedral Village.

The agreement was likely termed a joint agreement because of cooperation from Cathedral Village.

"They worked with us from the get-go," said Gerald B. Sullivan, one of the assistant U.S. Attorneys involved in the case.

Dennis Koza, president and chief executive of Cathedral Village, said the agreement advanced nursing home-care standards.

"To try to explain this to anyone is kind of difficult," said Koza, who has been at Cathedral Village for 18 months. "I've been very happy with the outcome. I think it's going to be a real plus to our organization going forward."

When asked why an organization facing no civil claims would agree to significant oversight by the Justice Department, Koza said he was not at Cathedral Village when the course toward the agreement was struck.

Vernick's struggles began in 2005, when his wife, Carmella, got so sick that he had to stop working and devote himself to taking care of her. After three years of caring for her in their Center City apartment, Vernick, 72, was convinced that it was no longer safe. Her first day at Cathedral Village was Nov. 17, 2008.

Vernick said he was thrilled to get his wife, who was on Medicaid, into Cathedral Village's Bishop White Lodge because of its reputation for high quality.

But his feelings turned quickly. "I took her there on a Monday and I knew by Wednesday, just two days later, that it was a mistake. She was going down so fast, I didn't know what to do," Vernick said.

Vernick said Carmella injured her back in a fall the first night and was not eating or drinking. She was transferred to Jefferson University Hospital on Nov. 28, where she was stabilized and then sent home to hospice care. Carmella, 68, died at home on Dec. 12.

Vernick did not complain immediately. As do-it-yourself therapy, he replaced the floor in their apartment in the 1900 block of Chestnut Street.

When needing supplies, "I would walk to Lowe's on Columbus Boulevard and then walk back. It killed a whole day for me," Vernick said. "I just kept processing and processing and processing. What did I do wrong? I cared for her for several years, and then to lose her that way made me feel really guilty."

In April, he turned to letter writing, getting a quick response from the state health department. "As a result of your complaint, we found no regulatory noncompliance," said an April 27 department letter.

But that was not the end of it. The Center for Advocacy for the Rights and Interests of the Elderly, a Philadelphia nonprofit, also got a copy of the letter Vernick had sent far and wide. The group referred the complaint to the U.S. Attorney.

"We don't send a lot of people there, to be honest," said Diane Menio, executive director of the advocacy group. "Often, we're going there when we find that no one else has taken [a complaint] up," she said.

The result more than three years later was what Paula G. Sanders, an attorney in Post & Schell P.C.'s Harrisburg office and chair of its health-care group, said was "not your traditional settlement."

"Cathedral Village appears to have agreed to some standards higher than those required in the industry, such as having their director of nursing and nurse managers professionally certified in gerontological nursing," said Sanders, who is active in industry groups but not involved in this case.

But that's not all that stands out. "It is unusual to see the government requiring pre-approval of policy changes," she said.

Vernick has worked hard to get over his wife's death, biking in Vietnam from Ho Chi Minh City to Hanoi a year after her final weeks and helping to open a juice bar on Sansom Street.

"The agreement stirred everything up," he said of his feelings.

Still, he said he finds the success of the Justice Department heartening: "They think it's going to have a major impact on other nursing homes."

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