P.O. BOX 2018
SALISBURY, MD 21802
- Located in Wicomico County, Maryland
- State government organization
- Certified beds: 80
- Last Medicare rating: 5 stars
Deer's Head Center is a facility within the Maryland Department of Health and Mental Hygiene. Located in Salisbury, Maryland, this facility provides chronic care, kidney dialysis, and therapy. With 80 certified beds, Deer's Head Center is a bit smaller than the Maryland and U.S. averages in terms of capacity.
For several distinct reasons, Deer's Head Center is an unusual facility. First, it is owned and operated not by some private corporation or nonprofit, but by the state of Maryland. Second, at the last official count, it was only about half-full. Third, it got a top-notch 5-star rating from Medicare even though it had some care-related statistics that were simply awful. This facility's statistical portrait, courtesy of Medicare, suggests that numbers may not lie, but, as we explain below, they can be weird.Deer's Head Competitors
Before we get into the weeds of Deer's Head, let's look at the local rivals to Deer's Head.
- Wicomico Nursing Home: Based on the Medicare ratings, Wicomico and Deer's Head could be arch-rivals. Located 3.1 miles from one another in Salisbury (down W. Isabella and N. Salisbury), both got an overall 5-star rating from Medicare. Deer's Head scored high for its health inspection and staff rating, but Wicomico beat Deer's Head by a lot in terms of quality measures: 5 stars to 2 stars. This is the metric that measures levels of care.
- Anchorage Nursing and Rehabilitation Center: This Salisbury facility is 2.4 miles away from Deer's Head geographically, a lot more than a mile apart in terms of Medicare scores. It got a lower rating than Deer's Head in every main Medicare category, including, most notably, its below-average 2-star rating overall.
- Salisbury Center: This facility's main Medicare ratings were identical to those of Anchorage Nursing and Rehabilitation Center, so it likely poses no greater an amount of competition to Deer's Head.
"Deer's Head Hospital Center has been providing services for over 60 years to the citizens of Maryland and is accredited by the Joint Commission and licensed by the Office of Health Care Quality." This is self-description coming from the Deer's Head website. (The letters "DHMH" stand for Maryland Department of Health and Mental Hygiene.)
This facility, which goes by the names "Deer's Head Hospital Center" or simply "Deer's Head Center," continues its self-description: "This facility provides outcome oriented, comprehensive management of complex medical conditions. Our focus on providing excellence in every patient experience is evident in the services we provide in the specialty hospital, inpatient and outpatient dialysis, and skilled/long-term-care."
"Our quality driven and committed staff is dedicated to meeting the needs of the community and producing desired outcomes for all of our patients."
Many nursing facilities make lofty promises on their websites. In addition to announcing its official status, Deer's Head claims to focus on "providing excellence in every patient experience," and "producing desired outcomes for all of our patients."
But what about the fact that over one-third of the short-term residents at Deer's Head reported having moderate to severe pain? (That's about twice the Maryland and U.S. averages.) What about the fact that about one in eight of these Deer's Head residents had a pressure ulcer? (That's about five times the state and national averages.) And these are not the only bad numbers coming out of this state-run facility.Higher Standard
In its last standard inspection of this facility, in January of 2016, Medicare gave Deer's Head the impressive overall rating of 5 stars - its highest score. (Then again, shouldn't a state-run facility be expected to achieve a high standard?) The Medicare inspectors found only four deficiencies here, versus the average of 11 found at Maryland (mostly private) nursing homes in general, and the 7.1 deficiencies, on average, found in homes across the U.S. Deer's Head got four stars for the health inspection.
However, that January 2016 standard inspection also doubled as a complaint inspection, to investigate four separate complaints. The issues of concern were along the lines of failing to use the right form, or schedule a meeting within a week, or fully document a resident's symptoms, or throw away a few meds that were past their expiration dates. We are not experts, but these complaints sound mostly trivial; and Medicare decided that at worst, these issues presented only "Potential for minimal harm." Still - should a state-run facility have any such complaints?
Deer's Head was excellent for its record on fire safety, with only one fire safety deficiency, compared with the Maryland state average of 4, and the national average of 3.4. But again, this state-run facility is being compared mostly with private facilities: it ought to meet a higher standard.Half-Empty
Deer's Head may focus on "providing excellence in every patient experience," but it doesn't do so for a great many patients. This facility has 80 certified beds; but at the last official count, it had only 43 residents. That makes it half or less, in terms of resident population, than either the Maryland or U.S. averages (107.5 and 86.2, respectively). What's odd here, however, is not this facility's total resident count, but the fact that this facility is filled only to about half-capacity.
One thing is clear regarding those 43 residents: they got a seriously large amount of time with nurses. Medicare, which sticks to the numbers in its standard inspections, gave Deer's Head the top 5-star rating for staffing - if for no other reason than the fact that the amount of nursing time per resident was phenomenal.
The total amount of daily nursing time per Deer's Head resident was 4 hours, 51 minutes. To put that in perspective, compare it to the Maryland average of 1 hour, 51 minutes, and the U.S. average of 1 hour, 42 minutes. Deer's Head residents got more than two hours' more attention than average - more than twice as much.
The breakdown by individual discipline tells much the same story. Daily RN time per resident at Deer's Head: 3 hours, 38 minutes; the Maryland average, 59 minutes; the U.S. average, 51 minutes. Deer's Head residents got over three times as much RN time as the state and national averages -- and Deer's Head got five stars for RN staffing. This facility's residents got about three or four times as much time per day with physical therapists (24 minutes, versus the 8-minute Maryland average, 6 minutes on average nationally). Certified nursing assistants at Deer's Head saw residents for 4 hours, 42 minutes per day, versus the Maryland average of 2 hours, 24 minutes, and the U.S. average of 2 hours, 28 minutes. If the sheer amount of time spent is the guiding criterion, then Deer's Head ought to get at least six stars for staffing.Low on Quality
So with all of that nurse-staffing time per resident, how in the world did Deer's Head get only a 2-star Medicare rating for quality measures? These measures are numerical means of tracking the amount of care residents receive. How many residents have bed sores? How many have lost a lot of weight? How many got flu shots?
Considering the vast amount of nursing time that each person was receiving, this facility's stats for short-stay residents are nearly incomprehensible. For seven measured categories measured, Deer's Head scored better than average in three categories, and worse (even much worse) in four. What were all those nursing staffers doing all day? For one thing, they were giving flu and pneumonia shots. Deer's Head was perfect (100 percent) in giving flu and pneumonia vaccinations to short-stay residents,
But in three Medicare categories for short-stay residents, this facility's scores were simply awful. Deer's Head was more than four times as likely to administer antipsychotic drugs (9.5 percent, versus 2.2 percent on average both for Maryland and the U.S.). Short-stayers at this facility were more than twice as likely to report having moderate to severe pain: 36.4 percent here, versus 14.2 percent average for Maryland, 16.9 percent average nationally.
Perhaps the most egregious stat was for pressure ulcers, or bed sores. The exact wording of the Medicare report for pressure ulcers (bed sores): "Percentage of short-stay residents with pressure ulcers that are new or worsened." The incidence rate of pressure ulcers among Deer's Head short-termers was a staggering 12.7 percent -- versus 1.3 percent on average for both Maryland and the U.S. Wow. That's five times higher than average. And these were either new or worsening cases.
The incidence of pressure ulcers is a good metric for gauging the amount of care residents receive. A pressure ulcer can start if you lie or sit in one position for too long. If you move, you're okay. If you can't move, you need someone to move you. That's where the care comes in. A high incidence of pressure ulcers, especially among vulnerable residents who have health problems, suggests that some caregivers are not doing their jobs.Not Available
For reasons entirely unexplained, Medicare said that data were "NOT AVAILABLE" for two measured categories at Deer's Head: residents' rate of improved functionality, and their discharge rates. Obviously, residents were being discharged, since Medicare could state how many of them were being rehospitalized or making ER visits, so why couldn't Medicare find out the discharge rate? Why didn't the Medicare folks ask the Maryland Department of Health and Mental Hygiene? Or why not put in a call to the "Comptroller of Maryland Central Payroll Bureau," which is the legal business name of this facility?
Medicare did manage to collect its full set of data for Deer's Head long-stay residents. For these metrics, Deer's Head was above average in seven categories, worse in five categories, and about equal to the state and national averages in three. Overall, it appears that this facility's scores for long-stay residents were better than those for its short-stayers - which seems to be exactly the reverse of the norm.
For long-stay residents, Deer's Head was "perfect" with zero percent of its long-stayers suffering falls with injury; it also was "perfect" in its zero usage of physical restraints on these residents. It was exceptionally good on the measure of long-termers who needed help in performing their daily activities: its percentage was 7.4, less than half the Maryland and U.S. averages of 18.7 percent and 15.4 percent, respectively. The rate of depression among its long-stayers was significantly less than average: 2.8 percent, versus 4.8 percent for Maryland, 7.1 percent for the U.S. Deer's Head long-stayers were less likely than average to experience serious weight loss. And again, this facility beat the state and national averages for flu and pneumonia vaccinations, giving these preventive shots to nearly all of its long-term residents.
Although its stats for pressure ulcers among short-stay residents were exceptionally terrible, Deer's Head was comparable to the state and U.S. averages for pressure ulcers among long-stayers. It also came in very close to the norms in using anxiety meds and catheterization.
This facility was somewhat below average in maintaining long-term residents' mobility, and it was a bit more likely to resort to giving antipsychotic meds to these residents. The incontinence rate here among long-stayers was significantly higher than average (69.2 percent, versus 58 percent for Maryland, 46.6 percent nationally). Long-stayers here were more than twice as likely as average to report having moderate to serious pain (17.8 percent, versus 6.4 percent for Maryland, 8.2 percent nationally). They also were about twice as likely to have a urinary tract infection (9.1 percent, versus 4.5 percent for Maryland, 4.8 percent for the U.S.).
Deer's Head Center presents a bizarre statistical picture. Its overall 5-star Medicare rating would seem predicated, almost more than anything, on its 5-star rating for staffing. Perhaps that rating could be due to this facility's having too much staff - far more than needed to serve a facility that's only halfway occupied. Yet despite having all those staffers, Deer's Head still had some very negative stats - calling into doubt whether the state of Maryland truly has been "providing excellence in every patient experience."Salisbury Nursing Home Lawyer
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