Injuryboard Commentary - Nursing Home & Elder Abuse

Nursing Homes Still Profitable during the Recession

Beth Janicek — Wed, 18 Nov 2009 15:13:43 GMT

To many people our recent recession is old news. By now, everyone is used to the downturn in the economy, the rising unemployment rate, foreclosures, and the stock market falling. Despite the weekly news of corporations declaring bankruptcy, some businesses are actually still showing nice profits. For instance, large Nursing home ownership companies are still profitable.

The Ensign Group, Inc. which is in the business of skilled nursing, rehabilitation care services, hospice care and assisted living companies recently reported record results for the third quarter of the fiscal year 2009. The company recorded total revenue of $132.9 million, which is up 14.3% from the $116.3 million recorded last year at this time.

Kindred Healthcare, the Louisville long-term care company recorded revenue growth in each of its three divisions – hospitals, nursing homes, and rehabilitation. The company recorded revenue for the July-to-September period of $1.06 billion, which is a 6% raise. Shares went down to about 4% in after-hours trading.

Five Star Quality Care, Inc. announced its total revenues for the third quarter of 2009 to be $297.2 million, a 5.9% increase from the same period last year.

It is great that these large companies are still profitable. However, I believe that they need to take these profits and put them back into the long-term care facilities. The extra funds could help improve living and safety conditions for residents by better staffing the facilities and by doing a better job of training the employees.

Originally posted at InjuryBoard by Beth Janicek

Officials Find "Total Collapse" of Care at Local Assisted Living Facility

Sandy Grinnell — Tue, 17 Nov 2009 17:21:15 GMT

According to the Orlando Sentinel, after seven complaints, officials from the Florida Agency for Health Care Administration inspected an Emeritus Properties' assisted living facility called Emeritius at Crossing Pointe. As a result of the inspection, they placed an immediate stop to any and all new admissions at this facility.

Inspectors found dozens of violations over a two week period and reported conditions such as:

A patient who died of heart failure after staff members failed for four days to give her the heart medicine she had been prescribed.

Another patient who was given a blood thinner — a medicine she had not been prescribed — that made her so sick, she went to the hospital for an emergency blood transfusion.

An employee who had falsified medication and nurse's orders.

Three Alzheimer's patients with toenails so long they curled around their toes.

Managers who, over several days, could not give an accurate resident count. One day, they were off by more than 30 people.

Emeritus owns four other facilities in Orange County and have fully complied with the Agency's requests, submitting a corrective action plan in writing to address the current problems as well as preventative measures so these conditions will not occur in the future.

It is because of horror stories like these that it is imperative that caregivers fully inspect facilities prior to placing their loved ones in a facility, make unannounced visits, and visit often. Do not let this happen to your loved one!

Originally posted at InjuryBoard by Sandy Grinnell

New Website to Help Families Learn About Nursing Homes

Billy Cunningham — Sat, 14 Nov 2009 08:40:00 GMT

The National Citizens for Nursing Home Reform (http://www.nccnhr.org/ ), a consumer advocacy group for nursing home residents and caregivers in nursing, homes, announced that the Brown University Center for Gerontology and Healthcare Research has introduced a website designed for nursing home researchers that provides data on nursing home care in the US. The website states that its goal is to allow researchers to trace relationships between state policies, local market forces and the quality of long-term care and enable policymakers to craft state and local guidelines that promote high-quality, cost-effective, equitable care for older Americans. NCCNHR believes the site will also be enthusiastically received by many consumer advocates looking for detailed data and more sophisticated comparison tools than provided on other website such as Nursing Home Compare.

The interactive database, www.LTCfocUS.org, incorporates information from a number of government sources-Medicare reimbursement claims, OSCAR (CMS's Online Survey, Certification and Reporting system), the MDS (Minimum Data Set), and Brown's own survey of state Medicaid policies Users can interact with the website by creating interactive maps and tables with comparative information about states, counties, or individual nursing homes. All data provided on the website are also available to download.

The website provides the type information that users can employ to choose up to five variables. It allows the user to create a chart comparing all nursing homes in a state. The broad range of variables from which to choose includes number of beds; for-profit and chain status; percent of Medicare and Medicaid beds; Alzheimer's units; occupancy rates; age ranges, gender and race of residents; direct care staffing (RN, LPN, CNA); acuity of care; certain MDS quality measures; source of admissions (hospital or home); and 30-day rehospitalization rates (a potential indicator of quality not found on Nursing Home Compare).

The website is sponsored by the National Institute on Aging-funded Shaping Long-Term Care in America project housed at the Brown center. While its stated purposes are to "allow researchers to trace clear relationships between state policies and local market forces and the quality of long-term care" and to allow policymakers "to craft state and local guidelines that promote high-quality, cost-effective, equitable care to older Americans," NCCNHR recommends that consumer go to this site to perform their researches about nursing homes in their areas before placing a loved one there. The more you can know about your options for placing loved one in a nursing home , the better equipped you'sll be to help prevent any nursing home negligence or abuse.

Originally posted at InjuryBoard by Billy Cunningham

Nursing Homes & Felons: A Dangerous Mix

Kristina Labanauskas — Mon, 09 Nov 2009 16:33:00 GMT

Mentally ill criminals and others on society's fringes housed in nursing homes pose a threat to other residents, especially if they are not carefully assessed, treated and monitored.

In January, 21-year-old Christopher Shelton allegedly raped a 69-year-old woman in her own room. Both were residents at Maplewood Care in Elgin, one of 13 nursing facilities in which Bryan Barrish and Michael Giannini, longtime nursing home executives, have either an ownership stake or consulting role.

Those facilities hold just over 2 percent of the state's nursing home population, the most recent state records show, but they include nearly 10 percent of Illinois' mentally ill nursing home patients and, as of June, almost 6 percent of the 3,000 felons living in the state's nursing facilities.

Shelton was diagnosed with bipolar disorder and had been shuttled between jail cells, psychiatric wards and shelters until nursing facilities became home. After being paroled from prison for a 2004 aggravated battery conviction, Shelton continued down a destructive path. He was arrested at least half-dozen times more, and in 2008 he was arrested three more times on alleged offenses including punching a man in the face at a West Chicago nursing home in which he was living. In November of last year, he requested to be readmitted to Maplewood Care in Elgin, where he had lived earlier in 2008 until he was removed and jailed on prior battery charges.

According to a state health department investigation, Maplewood did not adequately check Shelton's criminal background. However, Barrish and Giannini said the facilities assign professionals to thoroughly assess the risks that younger mentally ill criminals may pose to other residents and don't admit anyone considered a danger to others.

In late June, Maplewood Care held 15 felons among its roughly 200 residents.

About half the population was younger than 65, and more than 40 percent had a primary diagnosis of mental illness, according to the most recent figures on the state public health department's Web site.

Shelton now awaits trial on charges of aggravated criminal sexual assault. The woman no longer lives at Maplewood.

Originally posted at InjuryBoard by Kristina Labanauskas

Contact You Congressman to Pass the Fairness in Nursing Home Arbitration Act

Billy Cunningham — Sat, 31 Oct 2009 10:53:09 GMT

Last January I wrote a blog on the Fairness in Nursing Home Arbitration Act (then Senate Bill . 2838 and now Senate Bill 512) The last report from Congress is that the bill was referred to committee in July. I said then that we all need to keep an eye out for the bill and write our Senators. With Congress in the midst of debating and considering the health package now is a good time to ask them to pass this bill to protect our elderly.

The bill would amend the Federal Arbitration Act (FAA) to invalidate mandatory binding arbitration contracts that are unfair to the elderly because they take away their right to be heard in a court of law and increase their vulnerability to neglect and abuse in a care facility.

The bill does not prohibit arbitration. Rather, it would ensure that the resident or his or her representative could voluntarily choose arbitration after a dispute arose. If arbitration is truly fair and efficient, as some have argued, then both sides should be able to voluntarily choose arbitration after - not before - a dispute arises.

I have seen nursing home corporations insert forced arbitration clauses in their contracts and have them signed by residents who have dementia, by family members who are told they have to sign the whole agreement or their loved one will not be admitted and by the nursing homes own employees who forge signatures. Why do the nursing homes want arbitration so badly? Because it means they will never be held publicly accountable for their actions, no matter how egregious their conduct. Then when a decision is made by most likely a hand-picked arbitrator, the patient is denied the opportunity for judicial review.

On the other hand, if allowed to utilize the court system, society benefits from an open legal process that exposes nursing homne neglect and abuse. One of the most important benefits of civil lawsuits is the discovery process, which often discloses shoddy corporate practices, such as staff reductions, that lead to neglect. Forced arbitration, on the other hand, restricts residents’ ability to get information and keeps abusive business practices hidden.

So again I urge you to contact your representatives in Congress and let’s get this bill passed!

Originally posted at InjuryBoard by Billy Cunningham

Elder Abuse on the Rise Due to the Recession

Beth Janicek — Wed, 28 Oct 2009 11:21:01 GMT

Social workers have begun to “flag” some households with the police in the fear that vulnerable elderly people are being abused in their own homes. Age Concern spokeswomen, Sue Herrod said that there has been an increasing trend for children and grandchildren to move in with grandparents to save money.

“Older people are reluctant to complain, but this can be very stressful for them, dealing with loud noise late at night, and drinking…At the extreme end, we’re seeing emotional and physical abuse.”

Age Concern is pushing for the Domestic Violence Act to be amended to include the protection of elderly people. Elder Abuse often goes unrecognized because it falls outside the accepted definition of domestic violence. Ms. Herrod said, if the person refuses to file a complaint, the only option is to ask the police to keep an eye on the place.

“We’ve asked police to flag certain properties so if there is a call about noise, they know to check on the older person, whom we believe could be at risk.”

According to Ms. Herrod, financial abuse is another potential problem.

“You have families who are struggling themselves, and see gran as an easy source of cash because she has a free household and some savings…it’s distressing to me to see adult children teaching their children to exploit grandma.”

Age Concern national elder abuse advisor Jayne McKendry said that the financial exploitation of elderly people has increased during the recession. This year reports of financial abuse have jumped 11 percent.

“People are desperate for money and looking for easy targets. We’ve got many cases of adult children moving in with their parents without paying board.”

In addition, there are a lot of fraudulent trade people who target elderly people. In the last three years suspected abuse and neglect cases have risen by a third, with approximately 1500 notifications of suspected abuse and neglect nationwide just last year.

Last week I blogged (Bruises Can Be a Sign of Elder Abuse) on different ways to detect elder abuse, and also included important numbers needed to report suspected abuse. If you know of any person who may be physically or financially taking advantage of an elderly person, it is important to report it.

Originally posted at InjuryBoard by Beth Janicek

The Consumer's Role in the Nursing Home/Healthcare Reform Battle

Billy Cunningham — Sat, 24 Oct 2009 12:10:28 GMT

Health care reform is the big issue today- as it should be. But how will it affect our elderly in nursing homes? Nursing home owners say they are looking at $16 billion dollars in cuts from Medicare over the next 10 years. Is that so? The Washington, DC-based Center for Medicare Advocacy (http://www.medicareadvocacy.org/ ) reviews reports from the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) and advises that those reports show that Medicare overpays nursing homes billions of dollars a year. MedPAC found that the aggregate profit margins for freestanding nursing facilities exceeded 10 percent for seven years in a row. In 2007, their profit margin was 14.5 percent. Moreover, they didn’t add staff. So the Center for Medicare Advocacy believes that the nursing home operators are pocketing much of the profits, rather than reinvesting them. The reports also cannot account for money paid out to associated groups who own the property, manage the facility etc.

We read every day about Congress wrestling with health care reform. Hand in hand with Congress are the groups we refer to as lobbyist- there to make sure their particular industry is protected. One of those groups, of course, is the nursing home industry, which claims it is facing a $16 billion cut in direct support from Medicare over the next 10 years, as well as Medicaid cuts in many states.

The nursing home operators warn that further cutbacks in Medicare-which are part of the reform legislation– will drive many facilities out of business. Some homes are laying off employees now, and a few have recently closed. We are also seeing the nursing home reduce Registered Nurses with Licensed Practical Nurses in many areas. Meanwhile, the need for these institutions is increasing. As the number of people going into nursing homes increases so does the level of nursing care.

Are the nursing home owners trying to defeat healthcare reform because Medicare benefits reduction will affect care .or their bottom line? Is the advocacy center right that profits are really higher than reported? Nursing home owners have been known to put their own profits before people. There are cuts in Medicaid. We should all be concerned about the care our elderly will receive.

Knowing what is going on in your local nursing homes is probably the best each of us can do on an individual level. Check them out carefully before placing your loved one in a nursing home. The earlier you know what to look for to prevent nursing home neglect or abuse, the better for your loved one. Here are some cites that will give you information about getting good care: the National Coalition for Nursing Home Reform http://www.nccnhr.org/ , a governmental agency, the National Center Elder Abuse Http://ncea.aoa.gov , and Medicare web site http://www.medicare.gov/nursing/overview.asp.

There are warning signs that nursing home abuse or neglect may have occurred. It is not uncommon to hear reports of various forms of violence and irresponsible, inhumane treatment being inflicted upon residents, including: physical assault and battery ; sexual assault and battery; rape; deprivation of food and water; unreasonable or unwarranted physical or chemical restraint; withholding of needed medication ; overmedicating; suspicious injuries; appearance of untreated wounds, cuts, bruises, welts; reports by residents of being slapped, struck, pushed, shaken, beaten or likewise mistreated; improper confinement; serious injuries requiring emergency treatment or hospitalization; and incidents that result in broken bones, especially a fractured hip.

Originally posted at InjuryBoard by Billy Cunningham

Bruises Can Be a Sign of Elder Abuse

Beth Janicek — Wed, 21 Oct 2009 16:45:02 GMT

A new study released this year by the National Institute of Justice regarding bruising can be useful to identify signs of abuse. As people get older they are prone to more falls, so it may be difficult to determine if a bruise is accidental or if it is a case of abuse. The main point of the study was to stress that accidental bruising does not happen on the face, back, neck or torso. They are typically found on the legs and arms.

Another sign of accidental bruising is if they can not remember how they got the bruise. If a person has a story for the bruise, it could be a lie, and someone with an intentional bruise will always have a reason for it being there. A good way to determine if a bruise is from abuse is if the bruise is larger than two inches. The study states that it is no longer safe to judge a bruise by its color, because the color of the bruise does not indicate when the bruise happened.

Susan Sellers, director of Hamlet Senior Center in North Carolina said,

“By law, if we’re aware of anyone being abused we’re supposed to report it to the police and DDS (Department of Social Services). It depends on if it’s self abuse, neglect, abuse by their children or spouse.”

She also said that once in a while, someone will stand out as a potential abuse victim.

“They’re withdrawn, don’t want to get involved, there may even be some drug abuse. We watch, then report if need be.”

In Texas, the Texas Department of Aging and Disability Services (TDADS) was created to administer long-term services and support for people who are aging and who have cognitive and physical disabilities. TDADS can be contacted regarding suspected abuse at 1-800-458-9858, and at 1-800-252-8016 for Nursing Home Information. The Adult Protective Services (APS) Program under the Texas Department of Family and Protective Services, is responsible for investigating abuse, neglect, and exploitation of adults who are elderly or have disabilities in facilities that include: private homes, adult foster homes, unlicensed room and board, state facilities and community centers that provide mental health and mental retardation services, home health agency staff, exploitation in nursing homes when the alleged perpetrator is someone outside the facility. Abuse can be reported at the Abuse Hotline for APS Facility Investigations at 1-800-647-7418.

Originally posted at InjuryBoard by Beth Janicek

Gov. Crist Calls for Investigation into Caregiver Screening

Sandy Grinnell — Wed, 21 Oct 2009 15:49:34 GMT

Kudos to the Sun Sentinel for bringing inadequate employment screening for daycare and senior care workers to light. Their in depth article has apparently caught the attention of Govenor Crist who has called for a statewide investigation.

Crist has asked the eight agencies involved in the screening to come up with recommendations by November 2 so that they can be addressed at the special session in December. The first focus may be electronic fingerprinting which should alleviate the current 8 week turn around.

According to the Governor,

"When it comes to the safety and security of Florida's vulnerable populations, we must make every effort to ensure that their professional caregivers do not have criminal histories," Crist said in a statement.

An earlier blog on this site discussed the problems with the current system in that background checks are only performed in Florida, not nationwide; facilities can allow employees to begin working prior to getting the results of the background check; and there is a lack of state inspection of employee files at most facilities.

Originally posted at InjuryBoard by Sandy Grinnell

97-Year-Old Man Dies After Nursing Home Allegedly Ignored Sore on Penis

David Mittleman — Wed, 21 Oct 2009 10:07:21 GMT

The son of 97-year-old Charles Bradley is suing the Everett Care & Rehabilitation nursing home facility in Everett, Washington after his father’s genitals allegedly disintegrated from penile cancer and ultimately contributed to his death.

According to court documents, Charles Bradley entered the nursing home in 2004 because of the usual ailments associated with old age. He continued to live in the nursing home until two weeks prior to his death on March 31, 2008. He apparently had a sore on his penis, which the hospital staff ignored until he was rushed to the emergency room on March 13, 2008. The injury to his penis was purportedly undiagnosed penile cancer.

The attorney for Bradley’s son argues that Everett Care & Rehabilitation staff allowed Bradley’s injury to worsen for months without care. According to the complaint, staff at the center noticed the wound while changing Bradley’s diaper in November 2007. The staff member who initially noticed the wound notified the care manager, however, that manager failed to notify Bradley’s doctor. Instead, Bradley’s wound continued to fester for the next four months and his genitals continued to disintegrate. Finally, when Bradley arrived at the Providence Medical Center on March 13^th, he was initially diagnosed with pneumonia. However, doctors soon discovered the wound on his penis and determined that he had penile cancer.

The plaintiff’s attorney argues that Everett Care & Rehabilitation violated their promise to care for Charles Bradley. The lawsuit specifically seeks to hold the center accountable for allegedly failing to protect the elderly. Indeed, while the center refuses to discuss specifics on the incident, citing patient privacy concerns, they have not explicitly denied error. In fact, they have already received one citation from the Department of Social and Health investigators for failing to meet quality of care requirements designated by federal laws.

Originally posted at InjuryBoard by David Mittleman