A Growing Threat to Nursing Home Safety

A Newsweek investigation reveals nearly a third of the nation’s 15,000 facilities are overdue for inspection, putting the lives and care of residents at risk

- By Michael Scott Davidson

BY THE TIME JOE NAEGELE LEFT HILLCREEK Rehabilitation and Care, he appeared a shell of the man who entered. The 87-year-old's face was gaunt and his hair disheveled. Speaking exhausted him. It took three women to hoist his body out of a wheelchair and onto the pillows his niece, Theresa Hutchins, had laid across the passenger seat of her SUV. "He looked like a corpse," she said.

Hutchins pulled her uncle from the Louisville, Kentucky, nursing home less than a month after he was admitted in December 2020. The octogenarian had checked into the facility for physical therapy following a COVID-19 hospitalization, she said. Instead, his stay was a veritable death sentence, according to a lawsuit filed on Hutchins' behalf in 2022.

Naegele's weight plummeted at Hillcreek, his niece said. Barred from visiting him because of the pandemic, the 58-year-old accountant said she did not receive regular updates on her uncle's eating habits. The lawsuit says he suffered from malnutrition and dehydration.

A day after leaving the nursing home, Naegele was back at Robley Rex VA Medical Center. Hospital records state he looked "emaciated" and was 23 pounds lighter than when he arrived at Hillcreek, a weight loss 10 times greater than the nursing home logged, according to documents Hutchins provided Newsweek. He died in March 2021 in hospice care from complications related to Alzheimer's disease; his death certificate listed malnutrition as a contributing condition. "There was no way he could come back, because it was just too much trauma on his body," Hutchins said.