A recently-published list of poor-performing nursing homes around the country has identified a Fort Ethan Allen facility as a candidate for heightened oversight.

Green Mountain Nursing and Rehabilitation, a 73-bed facility located at 475 Ethan Allen Ave. in Colchester, was among five Vermont nursing homes selected as candidates for the Special Focus Facilities program, which is run by the Centers for Medicare and Medicaid Services and provides additional oversight to properties with a pattern of health and safety violations.

Traditionally, facilities under SFF oversight are publicized, but the remaining 400 or so nursing homes candidates have not been. That was a problem for Sens. Bob Casey (R-Penn.) and Patrick Toomey (D-Penn.), who requested a list of SFF candidates in March – following a news story that uncovered incidents of patient neglect and understaffing at Pennsylvania nursing homes – and published the names last week.

“When a family makes the hard decision to seek nursing home services for a loved one, they deserve to know if a facility under consideration suffers from systemic shortcomings,” Toomey said in a press release. “While the vast majority of nursing homes provide high-quality care, there are some that are consistently failing to meet objective standards of adequacy.”

Only one Vermont nursing home – Lyndonville’s Pines Rehabilitation and Healthcare Center – is currently enrolled in the SFF program, while the state’s “candidates” include the Gill Odd Fellows Home in Ludlow, the St. Johnsbury Health and Rehab Center, the Newport Health Care Center and the Burlington Health and Rehab Center.

A message left with a Green Mountain Nursing and Rehabilitation administrator went unreturned last week.

The SFF program requires states to survey selected nursing homes at least once every six months instead of the nine-to-15 months required of other centers.

CMS identifies candidate facilities using three cycles of health inspection reports known as the Five-Star Quality Rating System, which compare centers based on information from surveys, quality measures and staffing data. Those results are converted into points, based on the frequency and severity of citations. Facilities with the most points become candidates for the program.

Green Mountain Nursing and Rehabilitation has a one-star rating from the CMS rating system and has been docked for 34 violations over the last three years, resulting in more than $50,000 in fines, according to the federal Medicare website.

Nine of these deficiencies were categorized as “quality of life and care” violations, ranging from a lack of proper supervision during meals for those at risk of choking to a failure to prevent injuries.

One case involved an elderly patient who twice fell out of bed within a three-hour period. Inspectors wrote that the facility didn’t increase supervision for the patient despite the falls, and the patient was found on the floor yet again less than 12 hours later.

The patient was later transferred to the hospital, which advised that the patient had femoral head and hip fractures. The patient’s family elected not to repair the fractures or attempt rehabilitation, and the patient later died at the hospital on comfort care.

Inspectors wrote that while individual staff members took appropriate actions during the series of three falls, they “clearly lacked the capacity to provide sufficient supervision of the ill and agitated resident to prevent further accidents.”

In another case, nursing home staff failed to maintain ongoing rehabilitative services after a company contracted to provide these therapies stopped working with the facility. This resulted in the emergency discharge of seven residents; two of those patients told inspectors they cried upon hearing the news they needed to leave the home if they wanted to continue therapies.

One of those women told inspectors weeks later that the ordeal still made her cry. The other woman said she had to start her physical therapy over due to missing four days of it.

The SFF program has shrunk over the recent decade due to federal budget restrictions – from 167 slots in 2010 to 88 today – while the CMS can now maintain 440 candidates, according to the agency. Vermont has one SFF slot and five candidates.

CMS sends a list each month of candidate to the Vt. Division of Licensing and Protection, which then recommends a facility from the candidate list. It’s unclear how long Green Mountain Nursing and Rehabilitation has been a candidate for the program; CMS updates its list each month based on the most recent state surveys, and facilities typically remain candidates for about 18 months.

CMS says regardless of a facility’s status in the SFF program, any facility that performs poorly on surveys and “continues to jeopardize residents’ health and safety” will face enforcement remedies like fines, denials of new admissions or even termination.

Pam Cota, licensing chief for the Vt. Division of Licensing and Protection, said the SFF list isn’t a reason to disqualify the facility as a potential home for oneself or family. “It’s looking at a few years, so it really does reflect a bigger history, and the facility may have improved or declined since then,” she said.

She recommended visiting any facility in-person to observe the environment and take note of things like how staff treat the residents. For homes on the list, she added, potential clients should ask the facility’s leadership how they’re working to improve the quality.

“This is just another piece of the puzzle,” Cota said.