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Wisconsin’s Worst Nursing Homes – (Nursing Home Neglect)

Wisconsin’s Worst Nursing Homes – (Nursing Home Neglect)

Sooner or later, many families will face the difficult decision of placing a loved one in a skilled nursing facility. Some folks are able to remain in their home or in the home of a close family member. For others, however, they need the services only found in a nursing home.

Many of these facilities are wonderful places with cheerful staff that provide great care. Look at the websites of most nursing homes and all will make these claims. Unfortunately, some of these facilities are horrible. Poor training, understaffed, terrible care, poor sanitation and high accident rates. In this post we look at the worst nursing homes in Wisconsin.

ProPublica published a survey of 364 Wisconsin nursing homes, 98 had serious deficiencies. That more than 25%!

Researching nursing homes is easy. Government inspection reports are available on line. To learn more about a particular nursing home, view the free Nursing Home Compare tool from Medicare.

Here are the worst nursing homes in Wisconsin as reported by Medicare and ProPublica (and why they made the list). The list is not in rank order.

Maplewood Center – West Allis

This nursing home is tied for first place based on the number of serious deficiencies found by inspectors in recent years. At 6 such serious infractions, Maplewood Center has dropped the ball on patient care. That is especially surprising since it is a faith based, non profit.

In 2018, one inspection revealed the following:

Based on interview and record review, the facility did not consult with the resident's physician when 1 of 1 resident (R4) had a significant change in her medical condition. On [DATE] at 3:30 PM, R4 had a significant change in her condition when her oxygen saturation level dropped to 80% on room air and she complained of being Short of Breath (SOB). Although facility staff attempted to page the on-call physician, the physician did not return the facility's calls.

The patient suffered before being taken to the hospital. No excuse.

Medicare gives the facility an overall rating of one star (“much below average”).

Chi Franciscan Villa – South Milwaukee

Another Medicare rated “much below average” facility, Chi Franciscan Villa is also a non profit and tied for worst place with 6 serious deficiencies

A 2016 report noted the following [WARNING – This is disturbing]:

Resident #24 was admitted to the facility from an assisted living facility for rehab without any pressure injuries. [After admission] a ruptured blister was observed on Resident #24's left heel when his shoe was removed. Five days later the scab appeared to be coming off and the treatment was not done. The Facility did not consult with the physician that the treatment was not done… There was no follow up with consulting with the physician. On [DATE], [DATE], [DATE] & [DATE] Resident #24's pressure injury presented with an odor but the Facility did not consult with the physician. On [DATE] Resident #24 saw the Physician-LLL, a podiatrist at a wound clinic. Physician-LLL noted a 4 x 5 necrotic heel with obvious signs of infection. The ulcer was gangrenous and Physician-LLL could feel the bone. Resident #24 was transferred to the hospital and was started on IV [MEDICATION NAME] for a stage 4 pressure injury. Resident#24 was placed on hospice and died a week later on [DATE].

Editor’s note: There is absolutely no excuse for a pressure sore (sometimes called a bedsore). With proper care these are preventable. If a loved one in a nursing home has a stage 3 or stage 4 bedsore, call us. One of our Wisconsin nursing home abuse lawyers may be able to get compensation for the pain, suffering and medical expenses associated with bed sores. See our special post on nursing home bedsore injuries here.

Kensington Care and Rehab Center – Waukesha

The third tie vote for most serious deficiencies goes to Kensington Care and Rehab. This 150 bed for profit also has six major deficiencies according to ProPublica. It also earned Medicare one star “much below average” rating.

In the most recent rating period, which just ended in July, the facility had a staggering five deficiencies for “Freedom from Abuse, Neglect, and Exploitation.”

Bridges of Milwaukee Rehab and Care Center – Milwaukee

Another for profit nursing home, this facility earned a spot on the government’s watch list, one of just a very few in Wisconsin. That means the facility has been flagged by the government for having a history of serious quality issues. By being a “special focus facility,” it doesn’t get any stars.

Karmenta Center – Madison

We wish we could say that Bridges of Milwaukee was the only nursing home bad enough to make it on the government’s watch list. It isn’t. It shares those honors with Karmenta Center, a 105 bed non profit nursing home in Madison.

Earlier this summer the facility shut its doors. The Wisconsin State Journal noted it had 51 citations in recent years. The national average for the same time period is 8. The citations included bed sore violations.

ProPublica says that there 8 facilities that meet the criteria for the government’s special watch list but simply have not been placed on the list. Two of those we already covered, Maplewood and Kensington Care and Rehab Center. Keep reading for the rest of the honorable mentions.

Maplewood of Sauk Prairie – Sauk City

This 120 bed for profit has its fair share of serious deficiencies.  Here is an example [WARNING – once again, disturbing material.]:

Based on interview and record review, the facility failed to prevent sexual abuse affecting 1 resident (R3) of a total 105 in the facility. R1 is a registered sex offender. R1 was observed going in and out of female residents'rooms independently throughout his stay at the facility. On 5/9/18, R3 informed staff that R1 had touched her between her legs inappropriately. R1's whereabouts within the facility and his visits in other resident rooms were not monitored during his entire 12 month stay.

In fairness to Maplewood, the facility earned a mere “below average” instead of “much below” average. It also got four stars (above average) for staffing and quality measures.

Crossroads Care Center – Mayville

Crossroads Care Center is a 133 bed, for profit facility. Like the others on this list, it has a long list of deficiencies. Actually one of the longest (76 compared to the national average of 8).

Here is a gruesome example:

“Based on interview and record review, the facility did not consult with the resident's physician when there was a change in the resident's physical condition or a need to alter treatment for 1 resident (R23)... R23 was on Hospice services when she experienced severe pain, gasping for air to breathe, and actively dying when the facility received a stat (immediate) order for [MEDICATION NAME] and [MEDICATION NAME]. The facility knew their pharmacy would take up to 4 hours to deliver the stat medication and did not notify a physician of the delay in medication arrival or request a different form of treatment. Prompt notification to the MD (Medical Doctor) to alter the course of treatment could have lessened R23's pain and air hunger at the end of life.”

Cedarburg Health Services – Cedarburg

This facility is one of the smaller ones on our list, just 78 beds. And it rates an overall “much below “average from Medicare.

Autumn Lake Healthcare at Greenfield – Milwaukee

Next on our list of substandard Wisconsin nursing homes that meets the criteria for the government’s watchlist is the for profit Autumn Lake Healthcare at Greenfield.

According to a June 2018 inspection report, the facility’s substandard care may have caused a patient’s death:

On 1/8/18 at approximately 6:00 pm R1's family complained to facility nursing staff that R1 was experiencing a change in condition including staring to the left side, non-verbal, left hand grasp weak and right arm and hand flaccid. A Licensed Practical Nurse (LPN) assessed R1 and noted the changes in a progress note dated 1/8/18 at 6:41 pm. There is no indication that a Registered Nurse (RN) assessed R1 following the LPN's findings. There is no indication that R1's attending physician was contacted and consulted with regarding the changes in R1's condition. At the continued insistence of the family members, at approximately 9:00 pm, R1's physician was contacted and consulted with regarding R1's ongoing change in condition. At the time of contact with the physician R1 was now unresponsive. The physician gave orders to send R1 to the emergency department however, R1 was not transferred to the hospital until approximately 10:15 pm. Once at the hospital, it was determined R1 had sustained a stroke. The hospital record states: (R1) was brought to the emergency room with a window period of more than 4 and 0.5 hours, felt not a candidate of tPA (tissue plasminogen activator). R1 passed away on 1/14/18.”

Would this patient have survived her stroke? We will never know in large part because the nursing home failed to immediately notify her physician of the apparent stroke and further failed to get her to the hospital within the magic 4 hour stroke treatment window.

It should come as no surprise that Autumn Lake Healthcare at Greenfield has a much below average rating from Medicare.

Brookfield Rehab and Specialty Care Center - Brookfield

Brookfield Rehab is a big facility. For profit and 224 beds. It also earned just one star from Medicare. According to a 2018 inspection, the facility hid evidence of elder abuse by a caregiver:

Based upon interview and record review, the facility did not ensure 1 of 1 substantiated allegations of abuse that includes a suspicion of a crime involving R1 was reported timely to law enforcement. Police were not notified on the allegation of abuse by a Certified Nursing Assistant (CNA) against R1 until 6 days after the abuse occurred.”

Alden Estates of Countryside – Jefferson

Last on our list of honorable mentions is Alden Estates of Countryside. This 120 bed for profit nursing home gets some weird ratings from Medicare. Below average overall with a much below average on health inspections yet a perfect 5 star rating on quality measures. (And ProPublica still says it is eligible for Medicare’s watch list, probably because of its 48 deficiencies in recent years.)

Wisconsin Nursing Home Abuse Lawyers

No one in a nursing facility should ever have to suffer sexual assault, caregiver abuse, denied emergency care, bed sores or catastrophic falls. Yet these events happen daily (and far more than are reported). The Wisconsin nursing home abuse lawyers at Mahany law and our national network can help patients and their families anywhere in United States.  Although we are now a national boutique law firm with cases in 40 states, our home remains here in Wisconsin. That means we know “the Good, the Bad and the Ugly” of Wisconsin’s nursing home cases.

Whether you or a loved one was abused or neglected in a Wisconsin nursing home, adult day care, assisted living facility or a group home, we can help.

How Long Do I Have to Sue a Nursing Home?

We get asked that question often. Wisconsin law generally gives personal injury and medical malpractice victims 3 years to sue. That time periods is a just a few months, however, if the nursing home is owned by the state, county or municipality.

Even though one has 3 years to sue, we recommend that if you or a loved one are injured in a Wisconsin nursing home you contact us immediately.

Why? It’s a sad reality that many folks in nursing homes are nearing the end of life. Memories fade, witnesses die and staff turnover is often high. An experienced Wisconsin nursing home abuse lawyer can immediately begin to investigate and nail down important evidence and witnesses.

Damages in Wisconsin Nursing Home Abuse Cases

Bringing a claim for personal injuries or other abuse does two things. It helps put a stop to bad behavior and can result in an award of significant monetary damages. Compensation is available for:

  • Medical Expenses (current and future)
  • Pain and Suffering
  • Emotional Distress and Mental Anguish
  • Disability
  • Disfigurement
  • Loss of Enjoyment of Life
  • Loss of Companionship

In certain egregious cases punitive damages may also be available. In Wisconsin, punitive damages are limited to the greater of $200,000 or twice actual damages. One of our Wisconsin nursing home abuse lawyers can help you determine what your case is worth.

For more information, visit or nursing home abuse page. Ready to see if you have a case? Contact us online, by email [hidden email] or by phone 414-258-2375. All inquiries are protected by the attorney – client privilege. Cases handled anywhere in Wisconsin and nationwide.

[Our nursing home abuse cases are limited to serious bodily injury, death and bedsore cases. If we can’t help someone in our network probably can.]

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