Maryland residents with severe mobility issues suffered bedsores, infections and falls, as well as emotional trauma from isolation and lack of sunlight, because state health officials failed to properly oversee their nursing homes, a new lawsuit alleges.

They have been “left without a lifeline to the agency responsible for investigating allegations of abuse, neglect and other serious rights violations,” said Ashley Woolard, an attorney from the Public Justice Center that filed the suit last week in U.S. District Court.

The lawsuit, filed along with the advocacy group Justice in Aging and the law firm Arnold & Porter, names five residents and was filed as a class action for a pool of some 9,000 mobility-impaired residents.

But the lawyers, along with lawmakers and advocates not associated with the lawsuit, see a much broader issue. Woolard and others said improper oversight of nursing facilities is a nationwide problem, and some states such as Maryland struggled to restart inspections after the coronavirus pandemic. The facilities, like many health care providers, tend to be chronically understaffed. But Maryland’s may be among the worst.

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There are more than 51,000 nursing home residents in Maryland and they are some of the most vulnerable and marginalized people in the state. A third of the nursing home residents are Black and end up in the in facilities with the lowest federal ratings, the lawsuit says.

The state, according to the lawsuit, has been failing many of them for years.

Among those named in the lawsuit is Irene Connor, a 54-year-old Black woman diagnosed with muscular dystrophy, among other ailments. She relies on a wheelchair and a ventilator and entered a nursing home in 2023 for rehabilitation following a fall.

The lawsuit says she’s waited hours for incontinence care and has at times been left in soiled garments. There’s sometimes no hot water for washing. Her complaint to the state has gone unaddressed since September. The facility was last inspected in 2022.

Michael Nevin, a 61-year-old Black man diagnosed with quadriplegia and other disorders, entered a nursing facility in 2012. The lawsuit says his basic needs for hygiene, dressing and repositioning in bed have often not been met. A social man, he’s been secluded from all but his roommate in his room since March 2023, outside of medical appointments.

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He filed a complaint in April. The facility has not been inspected since 2020.

About 80% of the approximately 225 privately operated nursing homes have not had a required annual inspection that would uncover any neglect, abuse or inequity, the lawsuit found.

The state also received more than 13,000 complaints from residents and their families during the past three years — some alleging serious harms, and fewer than half have been investigated, the lawsuit says.

A recently released report from KFF, formerly the Kaiser Family Foundation, found that in 45 states, fewer than half of nursing facilities had enough staff to meet a new federal rule announced in April. It found rural facilities may struggle to find staff because there are fewer available workers and urban facilities can’t fill jobs because workers have other options.

A federal health department inspector general report found Maryland among 10 states failing to meet a “timeliness threshold” for nursing home complaint investigations each year from 2011 through 2018. Another federal assessment found only Kentucky more delinquent.

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As of May, more than 100 Maryland facilities had not been surveyed in the past four years, the lawsuit found.

The nursing homes themselves also do not fare well, with 44% of the facilities receiving only one or two stars on a federal five-star rating system.

Chase Cook, health department spokesman, didn’t address questions about what led to backlogs in inspections and complaint investigations generally, but said, “The Maryland Department of Health is committed to providing the best care to Maryland residents. We do not have any further comment on active litigation.”

Joseph DeMattos, president and CEO of the Health Facilities Association of Maryland, a trade association, acknowledged annual inspections are “slow and lacking,” though that doesn’t mean residents have been harmed.

“I don’t believe that the lack of annual inspections resulted in the abuse of residents and patients in nursing homes, but nursing homes, patients, residents, and families rely on timely, focused, and collaborative inspections, which have been lacking,” he said. But he added, “The lawsuit is troubling.”

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He expressed support for the new administration of Gov. Wes Moore and the state’s health secretary, Dr. Laura Herrera Scott, who was named in the lawsuit. He put blame on the previous administration of Gov. Larry Hogan and the Office of Health Care Quality, the agency within the health department responsible for the inspections and complaint investigations.

Anna Palmisano, director of the advocacy group Marylanders for Patient Rights, also pointed a finger at “gross inadequacies” in that agency and called for creation of a new regulatory body.

“Maryland desperately needs a competent and responsive health care regulatory agency to implement, proactively monitor and enforce our state and federal health care laws, which are designed to protect vulnerable patients in both nursing homes and hospitals,” she said.

There have been legislative efforts to address nursing home oversight and staffing.

This year, state Sen. Ben Kramer, a Montgomery County Democrat, said the county had been seeking approval from the health department to continue a yearslong arrangement where the county did its own inspections. That agreement ended in 2021, and since then just four nursing homes out of about three dozen in the county have been inspected.

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When officials got no response, Kramer introduced legislation. He later expanded it to allow other counties to do their own inspections, sharing the costs with the state. With health department opposition, he said the bill failed in the General Assembly session that ended earlier this year.

“The message we heard from the state is that they don’t have the people, and this would be a win-win,” said Kramer.

Kramer also noted the health department was required to increase staffing to investigate nursing home complaints by 2018 legislation. The lawsuit, however, found the state failed to add the 20 new positions planned by 2024. A state legislative report estimated the department left unspent $3.2 million budgeted for inspectors.

Kramer is now hoping the lawsuit will spur action to protect all nursing home residents, in addition to those with mobility issues.

“I plan to keep pursuing this,” he said. “There is a danger in leaving our most vulnerable [residents] without state assistance and protection.”

Liam McGivern, a senior attorney at Justice in Aging, said he hoped the lawsuit would bring short-term relief for residents like Nevin and Kramer, and long-term changes to the system.

“There needs to be state surveyors on site assessing these facilities, reviewing the records and talking to residents,” he said. “Everything we found is what the surveyors would have found if they’d gone out there.”