Wisconsin Nursing Home Ratings & Safety Violation Information

According to Medicare.gov, Wisconsin has 375 nursing homes. While 270 (72%) of these facilities rank average or above on the level of care they provide, the remaining 105 (28%) homes have below average and much below average ratings. This substandard level of care falls below the acceptable rating allowed by Medicaid and Medicare.

All too often the standard operating procedures in nursing homes throughout Wisconsin are violated by the staff and administration. These failures to follow the Nursing Home Reform Law can be extremely harmful or life-threatening to patients. By law, the nursing home must follow the rules established by Medicare and Medicaid programs that serve as a cornerstone to ensuring that the resident’s needs are met.

In some situations, when the resident is neglected, mistreated or abused, they fail to speak up from fear of retaliation that could make their life worse. The resident’s family members must serve as their legal and health advocate to ensure that they are receiving the best care to treat their conditions to overcome serious problems.

Upon admission to a nursing facility, the staff must prepare a Comprehensive Care Plan based off multiple assessments that must be reviewed and revised as necessary. Care planning must be taken seriously to ensure the resident’s safety and well-being. The plan is designed to be an invaluable tool designed to improve the resident’s care and ensure a successful stay at the home.

Unfortunately, many nursing staff review the comprehensive Care Plan as a hollow formality and create a one for a new patient based on the Care Plan of another patient that might have nearly identical problems. Sadly, this method could be detrimental or fatal to the newly admitted resident whose individual preferences and needs might never be met.

Below are common problems associated with Wisconsin nursing facilities that have been cited for severe problems that could have been avoided had the staff follow protocols.

Failure to Protect Residents from All Forms of Abuse

Many families are unaware that their loved one has been physically abused unless they express fear, suffer depression, have untreated injuries or unexplained bruises and cuts. Some of the less common indicators of mistreatment might involve malnourishment, dehydration, avoidable bedsores, unsanitary conditions, and bad personal hygiene.

The signs of physical abuse are usually obvious when the patient expresses fear, depression, unexplained cuts and bruises, and untreated injuries. Problems at Wisconsin nursing homes include:

  • The nursing home did not protect residents from verbal or sexual abuse (Birchwood Healthcare and Rehab Center)
  • A resident’s legal guardian was not notified that they had wandered away from the facility and were found and returned hours later by the local police (Crossroads Care of Mayville)
  • All residents in the nursing facility could have been potentially harmed by a patient who developed an increase in verbally and physically aggressive behavior (Crossroads Care Center of Kenosha)

Failure to Protect Residents from Accident Hazards

Every member of a nursing home team is legally obligated to provide ongoing supervision and monitoring of all residents to prevent hazardous and dangerous problems. Common situations associated with unsafe conditions in Wisconsin nursing homes include:

  • The nursing staff did not follow the resident’s Care Plan to eliminate the potential for a fall (Bay at Sheridan Health and Rehab Center)
  • A patient was not provided services to prevent a fall (Bay at Maple Ridge Health and Rehab Center)

Failure to Implement and Follow Infection Protection Protocols

Without proper controls, infections and other contagious diseases are easily transferred among patients, visitors and employees. The nursing staff is required to follow established procedures and protocols to avoid serious problems. Common issues associated with the spread of infection in Wisconsin nursing homes include:

  • A resident did not receive adequate supervision and assistive devices to prevent an accident (Bay at Burlington Health and Rehab Center)
  • A patient was not provided follow-up care after the nursing staff had a care conference (Bridges of Milwaukee Rehabilitation and Care Center)

Failure to Ensure Residents Receive Proper Treatment to Prevent Bedsores

Nurses and Nurse’s Aides must be educated on established bedsore prevention protocols and monitor the integrity of all residents’ skin. These efforts help to minimize the development of life-threatening bedsores (pressure wounds, pressure sores, decubitus ulcers, pressure ulcers). Common issues involving pressure wounds that occurred at Wisconsin nursing facilities include:

  • A resident did not receive the necessary care and services to treat their pressure ulcers (Ashland Health Services Nursing Center, Bay at Water’s Health and Rehab, Bria of Trinity Village Nursing Center, Cedarburg Health Services, Edenbrook Lakeside Nursing Center)

Failure to Follow Protocols to Manage Communicable Infections

Without infection protection controls in place, the spread of infection can occur throughout the nursing facility or recur to the patient suffering from the communicable disease. To avoid causing common problems, the nursing staff must develop and enforce an infection prevention program that includes following established protocols when providing wound care and keeping track of contagious patients in the nursing home. Common problems associated with infections in Wisconsin nursing homes include:

  • The nursing facility did not develop an infection control and prevention program to manage infectious outbreaks (Ashland Health Services Nursing Center, Bay at Burlington Health and Rehab Center, Bridges of Milwaukee Rehabilitation and Care Center)
  • Other Safety Concerns

    A specific safety concern at Wisconsin nursing homes involved a failure to allow a resident to create an advance directive to receive cardiopulmonary resuscitation (CPR) when needed. Many nursing homes did not notify the resident’s responsible party when the resident had a change in their condition including a decline in their health. Another concern involved a resident who wandered away from the nursing home unnoticed.

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