The Cambridge Rehabilitation & Nursing Center in Mid-Cambridge, seen Tuesday. (Photo: Marc Levy)

A blanket stuffed into a wall opening that exposed the outdoors. Torn bed coverings and a dirty sheet. A resident sitting in a wheelchair that had wheels covered in grime and dirt. Gouged walls, a loose electrical wall plate in a bathroom. Broken window shades, with one window covered by a towel.

Those were just some of the faults that greeted a surveyor from the state Department of Public Health who inspected the Cambridge Rehabilitation & Nursing Center at 8 Dana St., Mid-Cambridge, in April. The annual inspection was unannounced and lasted for three days, like most recertification surveys that determine whether a nursing home continues to qualify for Medicare payments. Facilities must meet a long list of requirements including treating residents with respect as well as providing a safe and “comfortable” environment and necessary medical care.

Despite the presence of the inspector, the blanket remained stuffed into the wall opening for all three days of the visit. The filthy wheelchair remained in use for two days, until the inspector pointed it out to a supervisor. The inspector saw the damaged walls and broken window shades on the third day of the inspection, when visiting that section of the nursing home.

The surveyor also found medical lapses: a resident with swollen feet and no treatment plan for the problem; another with open leg sores and bruises that weren’t being treated as a doctor had ordered. As the surveyor looked on, a nurse gave a resident a much lower dose of vitamin D than prescribed and omitted applying a medicated patch for pain relief.

One resident needed help with eating and didn’t get any despite orders for assistance.  Several had not had a shower or bath in at least a month. One told the surveyor that “he/she hadn’t received a shower in a very long time and would love to have one,” the inspection report said. The manager for that unit “was unable to provide the surveyor with a shower schedule for the unit,” the report said.

The 83-bed nursing home scored 115 out of 132 on the state’s rating scale based on performance over the last three years. Eighty percent of Massachusetts nursing homes scored higher. Cambridge Rehabilitation is owned by a for-profit partnership based in Tarrytown, New York; the two other nursing homes in Cambridge are nonprofit. The partnership also owns four facilities in New York and two other nursing homes in Massachusetts, in Everett and Medford.

The administrator of Cambridge Rehabilitation didn’t return a call Monday seeking comment on the 2022 inspection findings and a reason why the facility has paid 11 federal fines since 2021, totaling $24,563. The nursing home said it would correct all the violations within a month of the inspection; all have been corrected, a state health department spokesperson said.

Lingering problems, exacerbated

The pandemic with its staff shortages undoubtedly contributed to lapses such as these in nursing homes – none of them considered serious in the government’s rating system despite the obvious impact on residents. Yet health care experts say nursing-home quality has suffered for years and Covid-19 merely worsened and exposed deficiencies that already existed.

“Covid-19 has brought into clear view many problems that have lingered under the surface for years, including low quality of care, a broken payment model, ineffective regulation and a lack of transparency related to nursing-home residents’ health outcomes and experiences,” Harvard Medical School health care policy professor David C. Grabowski wrote in an article for the Commonwealth Fund in August 2020. Grabowski, an expert on nursing homes, suggested that higher Medicare and Medicaid reimbursement, more pay to employees, regulation more in line with what residents and families want, and more investment in home- and community-based programs that keep people out of nursing homes could strengthen care.

Little-seen data

The public rarely sees reports of state inspections of nursing homes, though the Medicare program has started posting the documents on the Medicare.gov website, where viewers can compare facilities. The investigative news site ProPublica also publishes inspection reports, along with analysis.

The ProPublica data showed that among the states, Massachusetts had the next-to-lowest percentage of “immediate jeopardy” violations in nursing homes over the past three years, deficiencies so serious that they put residents and staff under immediate threat of death or injury and the government threatens to bar admissions of Medicare patients. That action could put a nursing home out of business. Though few Massachusetts facilities had immediate jeopardy citations, the state’s nursing homes paid an average fine of $18,600 for violations, 10th-highest among the states.

One of the Massachusetts nursing homes that was hit with an immediate jeopardy violation was Medford Rehabilitation & Nursing Center, which is owned by the same New York partners as Cambridge Rehabilitation & Nursing Center. The Medford facility was cited after a nurse didn’t immediately perform CPR on a resident who stopped breathing and had no pulse. The nurse went to call for help, leaving a nursing aide in the room, instead of starting CPR and sending the aide to seek help.

The nurse’s decision “significantly delay[ed] resuscitation” and the resident died, an inspection report said. The government later accepted a correction plan and removed the immediate jeopardy threat, but the Medford nursing home paid a $79,248 fine.

At other nursing homes

The state also cited Cambridge’s two other nursing homes for violations in inspections in 2021 and 2022. Neither had signs of the significant physical neglect found at Cambridge Rehabilitation, yet some findings at the other homes showed a different kind of neglect.

One resident at Sancta Maria Nursing Facility couldn’t see well enough to discern the utensils and food on his or her meal tray, so aides were supposed to help by showing the resident where items were. Instead, a worker bringing breakfast left the room after opening a milk carton and putting a straw in it, at the resident’s request. On three mornings in August 2021, the surveyor watched the resident scramble with his or her hands to find utensils and food, on one day forced to use his or her hands to eat. The aide insisted to the surveyor, incorrectly, that the resident wasn’t identified as needing help.

At Neville Center at Fresh Pond, a surveyor inspecting the nursing home last May found a resident lying in bed who asked the inspector why he or she never got to leave the room.

“Resident #79 said that he/she has been in bed for days and is bored,” the inspection report said. “Resident #79 said he/she doesn’t understand why he/she has to stay in bed with nothing to do.” Records showed that the resident had only four one-to-one staff visits during April and May; the person had twice refused to attend outside activities in April but “the rest of the activity log was blank,” the report said.

During the surveyor’s visit, the television in the resident’s room was turned on but the resident couldn’t see or hear it because of vision and hearing deficits, the inspection report said.

Representatives of both nursing homes didn’t respond to a request for comment. Sancta Maria’s state score of 110 was lower than 90 percent of Massachusetts facilities. Neville Center scored 122, lower than 52 percent of Massachusetts nursing homes. It was a better grade than at the other two Cambridge facilities, but Neville Center paid a $33,911 fine last May 19, the date of the most recent inspection.

Like Cambridge Rehabilitation, Neville Center and Sancta Maria promised to correct all the violations quickly, and all have been corrected, said a spokesperson for the state health department. The state usually conducts certification surveys such as the ones at the three nursing homes once a year.