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North Carolina nursing home loses Medicare funds

The vast majority of patients living in a troubled nursing home in Salisbury may have to relocate because the facility will lose virtually all of its government funding.

According to the North Carolina Department of Health and Human Services, Salisbury Citadel, a for-profit house that has repeatedly failed to meet federal health and safety requirements, has been notified that it will lose its Medicaid funding in addition to your Medicare funding.

In 2020, about 80% of hospitalization days at the facility were funded by Medicaid and Medicare, according to figures compiled by, which collects information on nursing homes based on reports from Medicare costs and other sources.

The low-income nursing home now has about 85 residents.

Salisbury Citadel will lose its Medicare eligibility on May 19, the Federal Centers for Medicare and Medicaid Services (CMS) announced earlier this week. Medicaid termination will occur simultaneously, DHHS said.

“The facility has been notified that Medicare will stop paying for services provided to Medicare and Medicaid recipients admitted after May 19, 2022, although payment may continue for up to 30 calendar days for patients admitted on May 19, 2022 or earlier, “the federal Medicare agency said in a news release.

CMS urged patients and their families to consult the “Compare Nursing Homes” site for information on other nursing homes where they may want to seek care.

A spokesman for Portopiccolo, the New Jersey investment firm that owns the Salisbury Citadel, said Friday that the residence will ask the federal government to reverse its decision.

“We are surprised and disappointed by this decision,” nursing home administrator Angela Hooper said in a statement. “The progress this residence has made in improving the quality of care during a global pandemic is respectable. The staff is heroic.

“The Citadel improved its quality measures to a 4-star rating of 2 stars in just 18 months. We love our residents wholeheartedly and our mission was just to share their lives and make them happy.”

In the last 10 years, no nursing home in North Carolina has lost its Medicare funding, a DHHS spokesman said.

Accordius Health at Brevard, another Portopiccolo-owned nursing home, received a similar Medicare termination notice in March. But state inspectors later found that the facility complied with Medicare and Medicaid requirements, so the federal government did not withdraw its funding.

“Involuntary termination of an agreement with the supplier is usually a last resort after all other attempts to correct a facility’s deficiencies have been exhausted,” the federal press release said. “In this case, the CMS has found that The Citadel Salisbury does not meet the basic health and safety requirements of the CMS.”

A recently published state inspection report includes more than two dozen offenses at the facility.

One resident was injured by a caregiver trying to move him. When she screamed, she put her hand to her mouth to attenuate the sound. Another resident said no one helped after she complained to the staff of a resident who continued to offer her money for sexual favors.

A third had to be hospitalized for surgical wound infections after nurses did not change his bandages for an entire week.

A Citadel nurse said the staff were so “horrible” that they couldn’t help residents get out of bed or shower them for a few days. A nursing director reported that the workforce was so scarce that she sometimes worked 22 hours straight, and still “things fell by the wayside and she couldn’t keep up.”

“Left Alone,” a recent investigation by The Charlotte Observer, documented how the shortage of caregivers in North Carolina nursing homes is putting thousands of vulnerable residents at risk.

Unlike most states, North Carolina has not set minimum staffing ratios for nursing homes.

A data analysis by Observer reporters also found that for-profit owners tend to operate with a significantly slimmer and more deficient workforce than non-profit organizations.

Portopiccolo owns about three dozen nursing homes in North Carolina, and the vast majority of them only got one or two stars for staffing and the overall performance of the five-star nursing home system. federal government.

Salisbury Citadel has been fined more than $ 370,000 since 2020. For the past two years, the federal government has put the house on its “Special Focus” list, reserved for lower-performing nursing homes. of the country.

In a pending federal class action lawsuit against Salisbury Citadel, the families of two residents allege that the “systematic lack of staff” meant that residents often did not receive medication, showers, and medical care. A few days at home, only three nursing assistants were on duty to care for the more than 70 residents, according to the lawsuit filed by law firm Wallace and Graham last year.

In a court filing, Portopiccolo described the claim for staff incapacity claim as “unprecedented,” and said the nursing home did not misreport the hours worked by the agency’s nurses.

In 2020, Salisbury Citadel had more than $ 13 million in revenue and a profit margin of approximately 8%, according to the cost report it submitted to the federal government.

A nationwide struggle to hire and retain caregivers is bringing North Carolina nursing homes to a point of crisis, a trend that is endangering thousands of residents, according to our research. An influx of for-profit nursing homes and fewer regulations during the pandemic exacerbate the crisis. So what should families do to protect their loved ones?

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