Yourlawyer.com (Nursing Home Sexual Abuse News)

Housing Mentally Ill in Nursing Homes Sometimes Leads to Violence

Tue, 24 Mar 2009 00:00:00 -0700

Sadly, it seems that nursing homes are increasingly housing the elderly alongside patients with mental illness. The problem is that, in some cases—said U.S. News & World Report, citing the Associated Press (AP)—violence, sometimes with deadly consequences, has been reported.

U.S. News noted that there is insufficient housing in psychiatric units, mental institutions are closing, and nursing homes have more room now that the emerging elder population is healthier or remaining in their own homes longer. Because of these logistical and health changes, younger, seriously mentally ill residents—some suffering from depression, schizophrenia, or bipolar disorder, said the AP—can be found in nursing homes along with the frail and defenseless elderly.

According to AP reports and based on exclusive information it obtained via the Freedom of Information Act, nearly 125,000 mentally ill young and middle-aged adults were living in U.S. nursing homes last year, versus 89,000 in 2002, an increase of 41 percent, noted MedPageToday, which reported that some states showed increases of 75 percent or greater. The current population of mentally ill patients in nursing homes accounts for nine percent of the total nursing home population, said MedPageToday, citing Center for Medicare and Medicaid Services (CMS) data.

MedPage pointed out that Medicaid pays housing for those with so-called chronic psychiatric disorders assuming the mentally ill population in a facility does not exceed 50 percent; age is not a factor in this case. According to the AP, families have sued to try to change these practices and consumer advocates argue that, with proper care, the mentally ill can live in their own housing.

The AP noted that there is no tracking of killings or serious assaults by mentally ill nursing home residents against the elderly and that nursing home training does not always include what it necessary to treat seriously mentally ill patients, leaving the mentally ill angry and the elderly frightened and reclusive.

The AP pointed to a variety of violent, sometimes-fatal crimes committed against elderly residents by mentally ill patients in nursing homes. These incidents and the CMS data point to the fact that nursing homes have become "dumping grounds" for the mentally ill, the report said, quoted MedPage:

A 77-year-old Alzheimer’s patient died after being hit in the face with a clock radio. The man’s roommate was a mentally ill 50-year-old man with a history of aggression and “altered mental status,” who—after being found covered in blood—was arrested and charged, but found unfit to stand trial. He was committed to a mental institution.
A 23-year-old woman was charged with starting a fire that resulted in the deaths of 16 patients at the nursing home where she resided. The woman suffered from multiple sclerosis, dementia, and depression; was found not competent to stand trial; and was moved to a mental institution.
A 77-year-old patient died 10 days after his 62-year-old roommate beat him with a bathroom towel bar; the roommate was found incompetent to stand trial.
A 69-year-old patient was raped by a 21-year-old man diagnosed with bipolar disorder with aggression; had a history of violence; and was left unsupervised, despite telling staff he was sexually frustrated.

Study: Standards Needed for Nursing Home Social Workers

Thu, 08 Jan 2009 00:00:00 -0800

Low federal standards and inconsistent state laws have caused lapses in nursing home social workers’ qualifications. Although social workers are integral to nursing home residents’ quality of care, there are vast differences among workers backgrounds based on the first national study on nursing home social workers, said The Press Citizen. This, according to the findings of a University of Iowa study that surveyed 1,071 nursing home social service directors.

The study found only half of all nursing home social workers actually have a social work degree; unbelievably, 20 percent do not have a four-year degree of any kind; two-thirds do not belong to any professional organizations; and the vast majority—62 percent—are not licensed in social work said The Press Citizen according to the study.

UI also noted that for-profit nursing homes are 31 percent less likely to hire a degreed social worker. Mercedes Bern-Klug, study lead and assistant professor of social work at UI’s College of Liberal Arts and Sciences expressed concern over the findings noting that nursing home social workers are responsible for a variety of critical areas of care. "Nursing home social workers handle very serious emotional issues affecting residents, family members, and other staff members, and they deserve to be educated on how to handle these issues," Bern-Klug said. "Everyone benefits when nursing homes hire qualified social workers," she added.

UI noted that nursing home residents struggle with serious disorders such as dementia, and pointed out that the highest suicide rates are among the elderly; worse, older patients are often victimized, "Still, many people in charge of social work in nursing homes aren't social workers, and the federal government doesn't require that they be social workers," Bern-Klug said. Bern-Klug said 10 states do not address nursing home social worker qualifications, seven state codes seem to be out of compliance with federal standards, only 21 states require a social work degree, and there are loopholes in some state laws. For instance, in Colorado, if a rurally-located for-profit nursing homes advertises for one week in its local paper for, but is not able to find, a qualified social worker, it is not required to hired such a worker, while in Indiana, a clergy member who completes a 48-hour course and consults with a social worker can deliver social services.

Also, UI said nursing homes with over 120 beds must meet federal regulations requiring one full-time social worker be employed; however, a bachelor degree in any human service area—not specifically in social work—and a year of supervised field experience is considered sufficient. Because most nursing homes—70 percent—do not meet the 120-bed standard, they are not required to employ a social worker and despite that most do employ one such worker, there are insufficient social workers to provide the individualized care patients need and, often, said, Bern-Klug, social workers are consumed with marketing and activity planning. "I asked 1,000 social workers, 'How many residents can you handle? Federal guidelines say you can do 120.’ An overwhelming majority said fewer than 60,” she said. "We need legislation to demand well-prepared social workers and to set reasonable social worker-to-resident ratios…. Decades of research has documented the negative consequences of having too few nurses in a nursing home, and still we don't have strong laws demanding a realistic nursing ratio," Bern-Klug said.

Nursing Homes Rated on New Government Website

Mon, 22 Dec 2008 00:00:00 -0800

The Centers for Medicare and Medicaid Services (CMS) has launched a Website ranking nearly 16,000 nursing homes. Reuters Health reports that this is the first-ever federally-managed Website that ranks nursing home facilities for quality.

"Around three million Americans depend on nursing homes at some point during each year to provide life-saving care," CMS administrator Kerry Weems said in a statement announcing the website launch. "Most of those individuals are enrolled in Medicaid or Medicare and we all bear a special responsibility to protect their health and welfare."

The CMS oversees the Medicare and Medicaid insurance programs, explained Reuters Health. The 15,800 nursing homes rated by CMS participate in the public insurance system. According to CMS, in the first round of ratings, about 12 percent of the nation's nursing homes received a full five-star rating while 22 percent scored at the low end with one star. The remaining 66 percent of facilities were distributed fairly evenly among the two, three, and four star rankings, Reuters said.

Looked at were the incidence of bed sores, resident mobility, and if recommended medical care was received, said Reuters Health, which said the site—www.medicare.gov—will receive monthly updates and will include staffing levels and if the facility is for- or not-for-profit. "The new Website improvements also include links to information for community-based alternatives to nursing homes that may be of great interest to families," Thomas Hamilton, who helped develop the new system, told Reuters Health.

Nursing homes must meet federal residents' rights requirements to participate in Medicare or Medicaid. Some states have residents' rights in state law or regulation for nursing homes, licensed assisted living, adult care homes, and other board and care facilities. A person living in a long-term care facility maintains the same rights as an individual in the larger community.

In spite of the law, nursing home abuse continues to be a serious problem. The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of negligence and or abuse, noting the number is likely higher. According to the National Center’s study, 57% of nurses’ aides in long-term care facilities admitted to having witnessed, and even participating in, acts of negligence and abuse.

Earlier this month, Business First of Buffalo reported that New York State Attorney General Andrew Cuomo announced the arrests of nursing home employees over charges of resident neglect and abuse. According to Business First, three employees were arrested and charged and a fourth was convicted for “abusing elderly and ill patients.”

The arrests followed a New York state-wide investigation into institutional care abuse and neglect said Buffalo First. A prepared release stated that the acts involved “physically attacking and using racial slurs against an 86-year-old Alzheimer’s patient, slapping a 100-year-old patient in the face, and tying an elderly patient with dementia to a chair for two consecutive nights.”

Nursing Home Workers Charged by Attorney General

Wed, 08 Oct 2008 00:00:00 -0700

Four nursing home workers caught on tape mistreating a patient were charged yesterday with falsifying records and endangering a resident at a Suffolk County facility familiar with such problems, according to Attorney General Andrew Cuomo. This case represents the fourth recent nursing home abuse case in the state, it is the first to originate out of the New York City area in which hidden camera technology was used to obtain evidence against nursing home employees, Cuomo says.

Cuomo said the hidden camera technology has been used upstate, producing 26 convictions and forcing one nursing home into receivership. Cuomo also said that small cameras are installed at facilities across Long Island. "We're going to be using this technology aggressively," he said. "It gives us a whole new avenue for making these cases," Cuomo added. In the recent case, the tiny camera was placed in the room of an 84-year-old man at Long Island’s Medford Multicare Center for Living. Investigators monitored the camera feed from January to March in 2007, officials said.

The charging documents state that the camera revealed that Betty Cheslak, 52, of Rocky Point, a certified nursing aide, was talking on a cell phone while using a machine to transfer the patient from a wheelchair to the bed. Cheslak roughly bumped the patient’s head against the railing and did not turn him to prevent pressure sores nor help him with exercises. Also, Jacqueline Francis, 45, of Jamaica, Queens, a certified nursing aide, changed the man's underwear only once during an eight-hour shift, despite that she was required to change him once every two hours; Francis neglected to shower him and did not turn him in bed.   Rima Chaudhry, 46, of Smithtown, and Toni Miller, 37, of Middle Island, who are both licensed practical nurses, failed to take the man's heart rate before giving him heart medication and failed to give him water through his gastronomy tube. Apparently, Chaudhry did not give the patient his medication at times because the facility had run out; however, she later marked records indicating
that the medications had been withheld by doctors.

All four healthcare workers were arraigned in First District Court in Central Islip and were charged with endangering the welfare of a physically disabled person, a misdemeanor. They were also charged with falsifying records for changing documents to show they provided treatment when they actually did not, a felony. All four workers pleaded not guilty and were released without bail. Cuomo declined to release video evidence, but at a Mineola news conference yesterday, he showed another hidden camera video that led to criminal charges at a Rochester facility.

Meanwhile, the 320-bed Medford facility has faced accusations of patient mistreatment previously and was fined $6,000 by the state Department of Health in 2003 for care lapses that included not hydrating patients. In 2004, it was fined $2,000 for pressure sores, and had 47 violations in its latest inspections, which is nearly double the state average. Mordechai Klein, of Brooklyn, the facility’s majority owner according to Health Department records, was in Israel Tuesday and could not be reached.   Cuomo said the investigation was ongoing. The facility could face civil charges, officials said.

Majority of Nursing Homes Cited For Safety and Health Violations

Tue, 30 Sep 2008 00:00:00 -0700

Nursing home abuse and neglect continues to be a serious problem in the U.S. According to a new report conducted by the inspector general of the Department of Health and Human Services, a whopping 94 percent of all for-profit nursing homes were cited last year for violations of federal health and safety standards. In total, 90 percent of all nursing homes – including those owned by non-profit groups and government agencies - were cited last year for violations of health and safety standards.

The violations cited by the inspector general’s report included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients. The inspector general also said on Monday that some nursing homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.” In other cases, nursing homes billed Medicare and Medicaid for services that “were not provided, or were so wholly deficient that they amounted to no care at all,” the inspector general said.

According to The New York Times, more than 1.5 million people live in the nation’s 15,000 nursing homes. To participate in Medicare and Medicaid, facilities must meet federal health and safety standards. These programs cover more than two-thirds of nursing home residents, and cost taxpayers more than $75 billion per year.

About two-thirds of the nation’s nursing homes are owned and operated by for-profit companies. Non- profit organizations own 27 percent, while government entities own and operate 6 percent.

According to the inspector general’s report, in the past year, poor nursing home conditions were the subject of 37,150 complaints. Of those, 39 percent were later substantiated by inspectors, and at least 20 percent involved the abuse and neglect of patients. What’s more, 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, the report said.

While the report said privately-owned nursing homes were the most likely to have safety and health violations, others did not fare much better. Of the facilities owned by non-profits, 88 percent were cited for violations, while 91 percent of government-run institutions received citations. According to the report for-profit nursing homes averaged 7.6 deficiencies per facility, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.

It is not surprising that privately-run nursing homes have some of the highest rates of deficiencies. Over the past several years, private equity firms have been actively working to acquire nursing homes, and have taken over large chains like of HCR Manor Car, Genesis Healthcare Corp. and Beverly Enterprises. These firms buy facilities and then drastically reduce their costs – usually by cutting staff – with the goal of eventually selling the facilities at huge profits.

According to a New York Times investigation published last year, facilities owned by private investment firms score worse than national rates in 12 of 14 indicators regulators used to track ailments of nursing home residents. And the Centers for Medicare and Medicaid Services says that residents of such nursing homes suffer more from depression, loss of mobility and the loss of the ability to dress and bath themselves. And both federal and state regulators told the New York Times that citations for quality-of-care deficiencies, like moldy food and restraining residents for long periods of time, rose at every large nursing home chain that was acquired by a private investment group,

Study: Over 10 Percent Of Older Americans Suffer Abuse

Wed, 20 Aug 2008 00:00:00 -0700

A new University of Chicago study—the first such comprehensive review of elder mistreatment in the United States—has found that approximately 13 percent of elderly Americans are subject to abuse. Worse, such elders are most commonly abused by a person who either verbally or financially abuses them. "The population of the country is aging, and people now live with chronic diseases longer. So it's important to understand, from a health perspective, how people are being treated as they age," said lead author Edward Laumann, the George Herbert Mead Distinguished Service Professor in Sociology at the University of Chicago. While other studies have been conducted, they were based on small, non-representative samples of the population or on data gathered from the criminal justice system or welfare agencies. As such, those studies were not considered as comprehensive as this new study, which was conducted in response to a National Research Council report calling for scientific study of elder mistreatment.

Laumann and his research team found nine percent of adults reported verbal, 3.5 percent reported financial, and 0.2 percent reported physical mistreatment. The study also found physical impairment plays a role in mistreatment. "Older people with any physical vulnerability are about 13 percent more likely than those without one to report verbal mistreatment but are not more likely to report financial mistreatment," said co-author Linda Waite, the Lucy Flower Professor in Sociology at the University. The study revealed adults in their late 50s-60s are more likely to report verbal or financial mistreatment than older patients. "Perhaps the respondents are including fairly routine arguments, perhaps about money, with their spouse, sibling or child in their reports or perhaps older adults are more reticent to report negative behavior," Laumann said. The findings found wide variations in mistreatment depending on age and ethnicity and were reported in "Elder Mistreatment in the U.S.: Prevalence Estimates from a
Nationally-Representative Study," published in the current issue of the Journal of Gerontology: Social Sciences.

In addition to other findings, the study found that females were about twice as likely to report verbal mistreatment, but no higher level of financial mistreatment, than men; Latinos were about half as likely as nonLatinos to report verbal mistreatment and 78 percent less likely to report financial mistreatment; and blacks were 77 percent more likely to report financial mistreatment than whites. Respondents were questioned about the past 12 months, as follows: "Is there anyone who insults you or puts you down?" (verbal); "Is there anyone who has taken your money or belongings without your okay or prevented you from getting them, even when you ask?" (financial); and "Is there anyone who hits, kicks, slaps, or throws things at you?" (physical). Twenty-six percent reported verbal mistreatment, 26 percent identified a spouse or romantic partner as responsible, 15 percent said their children mistreated them verbally, while the remainder said a friend, neighbor, co-worker, or boss was responsible.

Among people who reported financial mistreatment, 57 percent reported someone other than a spouse, parent or child, usually another relative, was taking advantage of them.

Shameful Conditions Continue in Adult Homes

Tue, 19 Aug 2008 00:00:00 -0700

We have long been reporting on the horrendous conditions in some of this country’s nursing homes as well as some of the abuses suffered by nursing home residents. In one such case, 54-year-old resident Karen Preston left the Roscoe Manor Adult Home in uptate New York; stumbled into the woods about a mile away; fell repeatedly; wandered in circles; curled up under a tree; and was found by police, two days later, frozen. Her socks were nearby and she was not wearing shoes. The medical examiner ruled that she died of hypothermia. Preston suffered from severe schizophrenia and lived in Roscoe Manor because she needed help with daily activities and self-care.

In many of this country’s worst adult homes, residents are routinely subjected to neglect, filth, and indifference according to a Times Herald-Record investigation found. A year after the Preston disappearance, another Roscoe Manor resident—Ella Maye—left the home. Maye, 78, suffered from dementia and heart disease and state police believe she suffered a fatal heart arrhythmia as she was trying to crawl back to Roscoe Manor when she collapsed on a neighbor's front lawn and died. Roscoe Manor is supposed to conduct hourly bed checks; however, owner Charles Benson said an employee had failed to do so. No one noticed Ella Maye was missing.

Adult home inspection reports and history documented by state agencies reveal that residents of some New York's Hudson Valley adult homes are at a significant risk of illness, injury, or even death due to carelessness or negligence on the part of the homes' operators and staff. Inspections at 22 licensed adult homes in Ulster, Sullivan, and Orange counties from 2001-2007 revealed 846 violations were found to directly affect the safety or well being of its residents. State documents indicate that in some cases, residents are left to sit in soiled clothing, are subject to physically or verbally abusive staffers, and suffer repeated cases of mismanaged medications.

Further, state oversight has been ineffective in regulating these homes. For instance, in 2005, a Narrowsburg Adult Home resident with a long history of substance abuse and mental illness set three fires in the home in one day. In the first two events, staff told the alarm company there was no fire; emergency services were not notified. The third fire so badly damaged a wing of the building that 20 residents required relocation. Inspectors found the building’s sprinkler system had not been properly maintained or repaired and was rendered inoperable. Also, staff was not supervising residents’ medication doses. In 2006, inspectors reported that a 16-year-old was routinely assigned to work a shift on Fridays and Saturdays. Another inspection found no staffers present and residents were roaming about. Residents complained that workers routinely locked themselves in the kitchen at night.

In 2006, the Jeffersonville Adult Home neglected to seek help for a resident who waded into a creek after threatening to jump in, and who slashed her wrists soon after in a suicide attempt; a resident who repeatedly injured herself and threatened suicide; and a resident who assaulted staff and punched an elderly resident in the face. A 2002 inspection of Monticello Manor found a staffer in a room shouting at a naked resident with the door open and the resident's roommate present. A state inspector noted that an employee put new bed sheets on top of a wet, urine-stained mattress.

Laws Still Not in Place to Protect Nursing Home Residents from Sexual Assaults

Wed, 23 Jul 2008 00:00:00 -0700

A 58-time sexual offender was placed in a Florida nursing home in 2002 at the order of a district court judge. Ivy Edwards, 83, sexually assaulted a 77-year-old female resident suffering from dementia. Exactly six years ago tonight, Edwards wheeled himself into the patient’s unlocked room, used his cane to block the door, and assaulted Virginia Thurston. Staff making rounds found Thurston’s door locked. They found Edwards in the patient’s bed.

Thurston’s daughter, Sandy Banning, was told nothing occurred; however, a social worker told Banning her mother had been sexually assaulted. Edwards was arrested for the 59th time. “She didn’t remember,” Banning said, “I had to take her to be examined and watch her cry.” Meanwhile, Banning has been waiting six years for Florida lawmakers to protect vulnerable nursing home residents from sexual abuse by known predators.

Unbelievably, the Florida state Legislature considered legislation—only this past spring—to require criminal background checks of prospective nursing home residents, and to deny admission to those with a history of sexual offenses or other violent crimes. This legislation is still not in place, which means predators, regardless of how nefarious their histories, are able to gain access to untold numbers of victims who are not in a position to protect themselves. Florida Senator Durell Peaden Jr., Republican-Crestview, co-sponsored the Florida bill, which was passed by the Senate but failed in the House. “The House will be put on notice to pass this,” Peaden said of next year’s session when he and co-sponsors will bring the Florida bill back next session.

Banning says she will push again for the bill next year and today is in Washington, D.C., testifying before the House Subcommittee on Investigations and Oversight. “I’m mad. I’m mad because nothing has been done,” Banning said. And Banning has every right to be angry. No one in the nursing home knew of Edward’s history because his 58 known sexual crimes occurred before sexual predator registration laws were enacted.

Without mandatory background checks, there is no telling how many sexual predators are living in nursing homes, said Wes Bledsoe, whose grandmother died after being victimized in an Oklahoma nursing home in 2000 and who is founder of the non-profit organization A Perfect Cause, formed to crusade for frail elders in long-term care facilities from sexual offenders. The group is pushing for state laws and federal legislation for required background checks and separate nursing homes for sexual offenders. Bledsoe found that from 2002-2006, there were 60 murders and 1,600 registered sex offenders living in US nursing homes. Figures do not include non-registered offenders at high risk—such as 59-time offender Edwards—parolees, and assaults occurring inside facilities.

Oklahoma just passed legislation requiring background checks and a separate nursing home for sex offenders and is planning—via a separate entity--to build and manage an offenders’ nursing home, Bledsoe said. “My hope is Florida will follow Oklahoma’s lead and not just look at background checks but also separate and secure facilities,” he said.

Fairness in Nursing Home Arbitration Act Approved

Thu, 17 Jul 2008 00:00:00 -0700

The House Judiciary Subcommittee on Commercial Law and Administrative Law just approved the Fairness in Nursing Home Arbitration Act of 2008, moving the Act one step closer to becoming law. The Act prohibits the signing of an arbitration agreement as a prerequisite to nursing home admission. Critics of such agreements say they only help shield the owners of long-term care facilities from the consequences of allowing nursing home abuse and neglect to occur on their premises.

This means that a pre-dispute arbitration agreement between a long-term care facility and a resident—or those acting on a resident’s behalf—are not valid nor are these pre-dispute agreements specifically enforceable. Republicans on the subcommittee voted against the measure and some members tried to add amendments to make the Act easier on nursing homes, for example, Representative Chris Cannon (Republican-Utah) tried to add language to exclude nursing home physicians and providers and ensure the bill would not be retroactive, to name a couple. These amendments were shouted down in voice votes.

U.S. Senators Mel Martinez—Republican-Florida—and Herb Kohl—Democrat-Wisconsin—introduced the legislation to protect dispute resolution options for nursing home residents in response to the growing number of facilities that required patients to agree to arbitration as the only method for dispute resolution prior to admittance. "When a family makes the difficult decision to help a loved one enter a nursing home, among the primary considerations is quality care. Forcing a family to choose between quality care and forgoing their rights within the judicial system is unfair and beyond the scope of the intent of arbitration laws," said Senator Martinez. "This effort restores the original intent and tells families that they don't have to sign away their rights in order to access quality care."

"Nursing home residents, one of our nation's most vulnerable populations, must not lose their right to hold nursing homes accountable in the event of abuse or neglect," Senator Kohl said. "This bipartisan legislation protects senior long-term care residents who unwittingly sign away their constitutional right to have their case heard by an impartial judge or jury. I am proud to work with Senator Martinez in introducing this bill, and urge my colleagues in the Senate to pass it without delay."

In 1925, the Federal Arbitration Act (FAA) was enacted by Congress with the intention of “allowing parties an alternative forum to efficiently resolve business disputes.” Since the FAA was enacted, arbitration has expanded to now include non-business disputes. Also, nursing homes often require patients to sign mandatory pre-dispute arbitration clauses upon admittance. Many have long felt this requirement is an “unwarranted intrusion into a vulnerable population's right to access the civil justice system” to resolve potential claims.

The Fairness in Nursing Home Arbitration Act reflects the FAA's original intent and requires that agreements to arbitrate nursing home disputes be made after the dispute has arisen and not at the time of admittance into the home. While the new Act does not prohibit arbitration in nursing home disputes, it does prevent a nursing home corporation—which typically has greater bargaining power--from forcing residents and their families into arbitration via a non-negotiable contract that was forced on the resident prior to the dispute. The Act also ensures arbitration occurs on a voluntary basis and is not forced.

Elder Abuse by In-Home Aids a Growing Problem

Wed, 16 Jul 2008 00:00:00 -0700

Elderly people who want to avoid nursing homes often employ in-home aids to help meet their day-to-day needs. However, in many cases, the in-home aid industry is unregulated, and advocates for the elderly say that this situation has led to a growing number of cases of elder abuse, neglect or fraud in which home caregivers take advantage of the elderly.

A district attorney in San Diego County, Calif. told The Wall Street Journal that he prosecuted at least 25 home caregivers in the past year, mostly for stealing from elderly clients. Another, from Lake County, Calif., told the Journal that about 80 percent of his office's 74 prosecutions of elder abuse in the past year involved home aides.

In-home care has been touted as a way to keep older people happier and healthier, and at a lower cost, than they would be in a nursing home. According to The Wall Street Journal, it costs Medicaid program about $6,000 per person per year for home care, versus about $20,000 for care in a nursing home. About 1.6 million people are employed in home care, split about equally between those who provide basic health services, and those who provide housekeeping, cooking and nonmedical help.

Of the two types of aids, health aids are often certified nursing assistants who face licensing requirements and other regulations. However, most in-home elder abuse cases involve non-medical aids, who require no special licensing, and are loosely regulated.

According to The Wall Street Journal, in California, Florida, Connecticut and at least 19 other states, nonmedical aides don't have to be licensed or pass a criminal background check to get a job. In other states where employment agencies are required to do some type of checks, applicants with criminal records can slip through the cracks, some research has found.

The problem goes deep. A recent study sponsored by the Centers for Medicare & Medicaid Services conducted at Michigan State University screened 214,167 people who held or sought jobs working with the elderly, including home care, in that state between April 2006 and November 2007. Of those, 5,462 had criminal histories that should have disqualified them. Michigan is one of the states that does require background checks of caregivers for the elderly, but as the study shows, that requirement clearly doesn't go far enough.

Consumers seeking in-home help for an elderly loved should ask an employment agency exactly what a prospective caregiver has been screened for, and require at a minimum a state police criminal background check. Those hiring on their own can also request a background check from state police, and references should always be checked.

Aggression Among Nursing Home Residents Not That Uncommon

Wed, 09 Jul 2008 00:00:00 -0700

A recent Cornell University study reports aggression among nursing home residents—verbal and physical abuse--is more common than once believed. In an online report with McKnight's Long Term Care News, the study claims that many observations made at a city-based nursing home found at least 35 different types of abuse, with screaming being the most popular. Physical violence included pushing, punching, and fighting.

The report also discussed another two-week study wherein researchers found that 2.4 percent of nursing home residents claimed to have been victims of physical aggression; 7.3 percent claimed they were verbally abused. A third report discussed an investigation in which 12 nurse observers found 30 incidents of aggression between residents in one eight-hour shift. Victims were most commonly male and often had “wandering cognitive processing problems.”

A report released earlier this year by the Congressional Government Accountability Office (GAO) revealed a widespread “understatement of deficiencies,” that included malnutrition, severe bedsores, overuse of prescription medications, and nursing home resident abuse in the nation’s nursing home inspection reports. The report stated that nursing home inspectors routinely ignore or minimize problems that pose serious, immediate patient threats. "Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem," said Karl Pillemer, director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology.

Facilities are generally inspected once yearly by state employees who work under contract with the federal government. Federal officials attempt to validate state inspector work by joining them on visits or conducting follow-ups. It was in a follow-up that the GAO discovered the state missed at least one serious deficiency in 15 percent of all inspections. Worse, in nine states, inspectors missed serious problems in over 25 percent from 2002 to 2007.

There are 16,400 nursing homes with over 1.5 million residents nationwide; approximately one-fifth of the homes were cited for serious deficiencies last year. “Poor quality of care—worsening pressure sores or untreated weight loss—in a small, but unacceptably high number of nursing homes, continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said. Taxpayers spend about $72.5 billion annually to subsidize nursing home care and facilities must meet federal standards to participate in Medicaid and Medicare, which covers over two-thirds of its residents, at a cost of over $75 billion annually.

Although laws vary by state, most states do have laws—which include criminal penalties—in place to protect senior citizens from elder abuse; nursing homes are not exempt from these laws. Unfortunately, nursing home abuse tends to be underreported because individual homes do not take elder abuse seriously and residents fear embarrassment, injury, even incapacitation for speaking up.

In February, the Bush administration finally published the names of 131 of the nation’s worst nursing homes.

Nursing Home Ratings System to be Online By Year's End

Thu, 19 Jun 2008 00:00:00 -0700

A new nursing home rating system should be up and running on the Medicare Website by the end of this year. The new site will employ a 5-star system to rate nursing homes based on government inspection results, staffing data and quality measures. It is hoped that the new ratings systems will act as an incentive to encourage nursing homes to improve quality, and to stem the high rate of nursing home abuse and neglect that endangers so many residents.

There are 16,400 nursing homes with over 1.5 million residents nationwide. Unfortunately, the quality of many nursing homes is questionable - according to a recent report by the General Accounting Office, approximately one-fifth of all nursing homes were cited for serious deficiencies last year. The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of negligence and or abuse, though it concedes that the number is probably higher. According to the National Center’s study, 57% of nurses’ aides in long-term care facilities admitted to having witnessed, and even participating in, acts of negligence and abuse. Data from the U.S. Centers for Disease Control and Prevention show that nursing home neglect played role in the deaths of nearly 14,000 nursing home patients between 1999 and 2002. Even when the consequences are not fatal, nursing home negligence robs victims of a sense of security and their dignity.

Information on nursing home quality can be tough to come by for families in the process of selecting a facility for a loved one. The new ratings use information on a facility's staffing level, the number of patients with bed sores, violations and other data that shed light on the quality of care. It may also include information such as whether a nursing home provides care to patients with dementia or those on ventilators.

Earlier this year, the Centers for Medicaid and Medicare Services added the identities of so-called Special Focus Facilities — nursing homes that rank in the worst 5% to 10% for inspection results in a given state - to the Nursing Home Compare database on its website. These homes were selected for stepped-up scrutiny by regulators. The list includes about 130 facilities.

Consumer advocates are pleased that Medicare has committed to providing families with a tool they can use to find a quality nursing home, but stress that the site will only be useful if it is easy to use. Ease of use is one of Medicare's major goals for the site, and the agency will be accepting public comments in July and August on the site and its contents.

One patient advocate also told The Wall Street Journal that the new nursing home ratings will rely too much on information furnished by the facilities themselves, which may make them inaccurate. " Too often, nursing facilities report that residents are doing much better than they really are and that they have more staff than they really have," Toby S. Edelman, senior policy attorney with the Center for Medicare Advocacy said. "Relying on nursing homes to describe accurately how well they are doing -- and reporting that information as fact -- just doesn't make sense."

Nursing Home Arbitration Agreements Unfair to Residents

Wed, 18 Jun 2008 00:00:00 -0700

Nursing home abuse and neglect has reached epidemic levels. Unfortunately, many nursing home patients and their family are signing away one of the most important tools in the fight against abuse and neglect - their right to sue.

The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of negligence and or abuse, though it concedes that the number is probably higher. According to the National Center’s study, 57% of nurses’ aides in long-term care facilities admitted to having witnessed, and even participating in, acts of negligence and abuse. Data from the U.S. Centers for Disease Control and Prevention show that nursing home neglect played role in the deaths of nearly 14,000 nursing home patients between 1999 and 2002. Even when the consequences are not fatal, nursing home negligence robs victims of a sense of security and their dignity.

When abuse or negligence occurs, a lawsuit can be one of the most effective ways to force a nursing home to change its ways. Often, the conditions that lead to nursing home abuse and negligence - such as understaffing, inadequate meals, etc. - are the result of management's attempts to cut costs. Sometimes, it is only after the nursing home is forced to pay a hefty lawsuit settlement or judgment that conditions at a facility will change for the better.

Unfortunately, rather than maintain safe facilities for their residents, many nursing homes would rather find other ways to avoid lawsuits. To that end, some nursing homes have started requiring new residents and their families to sign documents that take away their rights to file a lawsuit, and must agree to submit any complaints to binding arbitration. These arbitration agreement are becoming more common, as more and more nursing homes are acquired by giant corporations.

The arbitrators in these nursing home abuse cases are usually corporations themselves, and they are generally paid by the company that owns the nursing home named in the complaint. While the arbitrator is supposed to be an independent party, critics of these agreements say they serve as a shield to for nursing home companies to avoid the consequences of budget and staffing cutbacks.

The nursing home industry defends itself by pointing out that arbitration is voluntarily agreed to and not a condition for admission. But the process of admitting a loved one to a nursing home is often stressful, and accompanied by a slew of paperwork. Many families who have complained about the arbitration process claim they were not really aware of the ramifications of signing an such an agreement.

The confusion over nursing home arbitration agreements has led to the filing of more than 100 lawsuits challenging them. And the controversy has gotten the attention of Congress, where a Senate committee is holding hearings on the issue this week. Both the House and Senate are also considering bills that would make nursing home arbitration agreements unenforceable.

Sen. Herb Kohl, D-Wis., who heads up the Senate Committee on Aging, told the Associated Press that the proposed legislation is not seeking to ban arbitration agreements entirely. Rather, it would require that the decision to go to arbitration would need to be made by both parties after a dispute occurs, not at the time a resident is first admitted to a facility.

Nursing Home Problems Missed in Inspections, GAO Says

Thu, 15 May 2008 00:00:00 -0700

In a report scheduled for release today, the Congressional Government Accountability Office (GAO) reveals a widespread “understatement of deficiencies,” that include malnutrition, severe bedsores, overuse of prescription medications, and nursing home resident abuse in the nation’s nursing home inspection reports. The report states that nursing home inspectors routinely ignore or minimize problems that pose serious, immediate patient threats.

Facilities are generally inspected once yearly by state employees who work under contract with the federal government. Federal officials attempt to validate state inspector work by joining them on visits or conducting follow-ups. It was in a follow-up that the GAO discovered the state missed at least one serious deficiency in 15 percent of all inspections. Worse, in nine states—Alabama, Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee, and Wyoming—inspectors missed serious problems in over 25 percent from 2002 to 2007.

There are 16,400 nursing homes with over 1.5 million residents nationwide; approximately one-fifth of the homes were cited for serious deficiencies last year. “Poor quality of care—worsening pressure sores or untreated weight loss—in a small, but unacceptably high number of nursing homes, continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said. Taxpayers spend about $72.5 billion annually to subsidize nursing home care and facilities must meet federal standards to participate in Medicaid and Medicare, which cover over two-thirds of their residents, at a cost of more than $75 billion a year.

Senators Charles E. Grassley (Republican—Iowa) and Herb Kohl (Democrat—Wisconsin and Senate Special Committee on Aging Chairman), requested the study and introduced a bill to upgrade nursing home care and increase penalties for federal standards violations. The maximum fine, now about $10,000, would be increased to $25,000 for a serious deficiency and $100,000 for deficiency resulting in patient death. The senators are pushing their bill for inclusion in a package of Medicare changes Congress is expected to pass in June.

The American Health Care Association, a nursing home trade group, opposes the bill. “We should not be increasing fines, adding auditors, and encouraging a ‘gotcha’ mentality. We should be testing new, less punitive ways to measure and improve the quality of care,” said Bruce A. Yarwood, association’s president. But, David P. Sloane, senior vice president of AARP, the lobby for older Americans, said it was “one of the most significant nursing home reform initiatives” in two decades. Under the bill, nursing homes must provide consumers and the government with more information about their owners and “affiliated or related parties,” including any individual or company with a role in managing operations. Lewis Morris, chief counsel to the inspector general of the Department of Health and Human Services, said he has been frustrated in identifying nursing home owners for facilities providing substandard care. “We have found nursing home residents who were grossly dehydrated or malnourished. We’ve found patients with maggot infestations in wounds and dead flesh. We’ve found residents with broken bones that went unmended,” he said. After discovering such problems, the federal government now requires some companies to sign compliance agreements, which are monitored by outside experts.

Reporting Suspected Nursing Home Abuse

Wed, 07 May 2008 00:00:00 -0700

Nursing home abuse, though despicable, is hardly uncommon. Although laws vary by state, most states do have laws—which include criminal penalties—in place to protect senior citizens from elder abuse; nursing homes are not exempt from these laws.

Unfortunately, nursing home abuse tends to be underreported because individual homes do not take elder abuse seriously and residents fear embarrassment, injury, even incapacitation for speaking up. As with any abuse, the only way to prevent more instances is to stop it immediately as soon as abuse is suspected.

Thoroughly investigate any nursing home being considered. Undervalued, underpaid, and untrained employees tend to render more abuse. Ask about and watch for high employee turnover rates. Employees who are not properly trained or paid may not be concerned with the residents in their charge and even less concerned about challenging authority if they suspect abuse. In many cases, employees who have been charged with multiple incidents of abuse do not receive punishment and remain employed at the nursing home.

If someone is in life-threatening danger, call 911 immediately. If danger is not immediate, but abuse is suspected, tell someone trustworthy. Contact local adult protective services by speaking with the Eldercare Locator at 1-800-677-1116 between 9:00 am and 8:00 pm Monday-Friday Eastern Time. When making a call to report abuse, be able to provide the elder victim’s address and contact information; known medical problems, including confusion or memory loss; family or other social support system; types of abuse and if any incidents of hitting, yelling, or other abusive behavior have been witnessed; and the caller’s name, address, phone number, and contact method to discuss the abuse. When reporting abuse and not related to the victim, a nursing home abuse hotline is the best option and each state has organizations that monitor these hotlines and can offer assistance. If making a formal complaint against a specific nursing home or staff member, find a sitter to monitor the victim or remove the victim from the facility. Abuse sometimes increases following complaint initiation.

In a harrowing example of widespread elder abuse and negligence, in February, the family of a deceased Norwich, Connecticut man filed what is believed to be the first wrongful death lawsuit against officials at Connecticut’s largest nursing home chain: Haven Healthcare. The suit claimed that misappropriation of Haven funds by Chief Executive Officer Raymond Termini contributed to "deplorable conditions.” The family also sought permission to sue the state departments of public health and social services and Nancy Shaffer, the state's long-term care ombudsman, for failing to investigate and act on complaints lodged by the family. The deceased family member was a patient at Haven homes for over two years when he was rushed to a hospital after his wife found him in excruciating pain and his legs gangrenous and in early rigor mortis, allegedly due to an untreated and infected pressure sore on his hip and physical restraints that immobilized him. The man died two days later.

Also in February, the Bush administration finally published the names of 131 of the nation’s worst nursing homes. There are about 16,400 nursing homes nationwide and taxpayers spend about $72.5 billion annually to subsidize nursing home care. The document containing the nursing homes cited can be accessed at: http://www.cms.hhs.gov/CertificationandComplianc/Downloads/SFFList.pdf

Nursing Home Negligence Lawsuit Says Misappropriation of Funds for

Fri, 22 Feb 2008 00:00:00 -0800

Nursing home negligence by Connecticut's largest nursing home chain was the result of fraud committed by a Haven Healthcare official. Those claims are made in a wrong death lawsuit filed by the family of Robert Wininger, a resident of one of Haven Healthcare's nursing homes who the lawsuit claims died as a result of the nursing home negligence. The suit claims misappropriation of Haven funds by Chief Executive Officer Raymond Termini contributed to "deplorable conditions" at Connecticut’s largest nursing home chain.  The family is also seeking permission to sue the state departments of public health and social services and Nancy Shaffer, the state's long-term care ombudsman, for failing to investigate and act on complaints lodged by Wininger's family.

Wininger was a patient at Haven homes for nearly 2 1/2 years when he was rushed from Haven Health Center of Norwich to Backus Hospital on June 5, 2007 after his wife found him in excruciating pain and his legs gangrenous and in early rigor mortis, allegedly due to an untreated and infected pressure sore on his hip and physical restraints that immobilized him. Wininger died two days later. The lawsuit names Termini; Dr. Cornelio Hong, former medical director at several Haven nursing homes; and Dr. Joselito Endaya, Wininger's treating physician and a partner in Hong's private medical practice as defendants. Endaya does not appear to have been on Haven's payroll.

Wininger was admitted to Haven for short-term rehabilitation on January 25, 2005, after a fall at home. Records indicate that on February 12, 2007 nursing staff noticed a Stage II pressure sore on Wininger's right hip. The suit claims Wininger's family was not notified about the wound and Wininger received no treatment. Later that month, staff noted Wininger's right leg was "purplish,” but there was no indication of follow-up care.  Wininger was transferred to another Haven Center on March 14, 2007 to be closer to family. There, staff noted an open wound on his hip/buttock area on March 19, but a nursing note a week later indicates the skin was intact, a fact the suit claims is "medically impossible…and demonstrates the inadequate care and poor record-keeping characteristic of the Haven homes."

The suit alleges that both doctors failed to adequately examine and treat Wininger and contributed to a standard of care "that was so bad as to constitute physical abuse of patients"; they violated the state's Patients' Bill of Rights by their inadequate care and restraining Wininger; staff did not perform medically necessary physical therapy, keeping Wininger; Haven entities filed for bankruptcy when their dire financial straits and numerous fines for inadequate patient care were exposed in a newspaper series; and Termini "knowingly drained and misappropriated the assets of Haven homes…and used the assets to furnish a lavish lifestyle and launch a Nashville record company known as Category Five Records, resulting in deplorable conditions in the Haven homes and numerous preventable injuries and deaths of residents, including [Wininger]."

Hong left Haven the week after Wininger died and has since sued Haven for $13,000 for back pay.  Attorney General Richard Blumenthal is investigating whether Termini misappropriated federal funding intended for patient care to underwrite his own business and personal investments. Haven Healthcare—through its attorney—denied Haven's financial problems had any bearing on patient care.

Nursing Home Abuse Concerns Rise in Florida Amid Manor Care Purchase, Publication of Nursing Home "Watch List"

Wed, 02 Jan 2008 00:00:00 -0800

The issue of nursing home abuse is making news in Florida, where the Service Employees International Union (SEIU) and some state lawmakers are urging regulators to examine the issues of nursing home abuse and neglect as they consider granting a nursing home license to a private equity firm that recently purchased facilities in Florida and around the country. The Carlyle Group purchased HCR Manor Care for $4.9 million, and now owns 29 nursing throughout Florida. The SEIU and other nursing home advocates fear that the Carlyle Group will move to cut costs at the nursing homes it owns, something that could put nursing home residents at risk for abuse and neglect. Those concerns have only been heightened by the Florida nursing home “watch list” which already cites some Manor Care properties for providing inadequate care to nursing home patients.

Recently, private investment firms have looked to nursing homes as a possible route to easy money. These firms buy facilities, drastically reduce their costs, then turn around and sell them at huge profits. Private investment groups have been targeting some of the biggest nursing home concerns, in turn affecting the care of millions of patients. In addition to Carlyle’s purchases of HCR Manor Car, Genesis Healthcare Corp. agreed to be bought by private equity in January, and Beverly Enterprises went private in 2005.

But these acquisitions could be coming at a great cost to nursing home patients. According to a New York Times investigation, facilities owned by private investment firms score worse than national rates in 12 of 14 indicators regulators used to track ailments of nursing home residents. And the Centers for Medicare and Medicaid Services says that residents of such nursing homes suffer more from depression, loss of mobility and the loss of the ability to dress and bath themselves. And both federal and state regulators told the New York Times that citations for quality-of-care deficiencies, like moldy food and restraining residents for long periods of time, rose at every large nursing home chain that was acquired by a private investment group. While the Manor Care sale has been approved by shareholders, Florida is one of several states still deciding whether to give Carlyle a license to run the nursing homes.

Meanwhile, a Florida nursing home “watch list” indicates that many nursing homes in the state are problematic, and two of Manor Care’s nursing homes are already on that list. According to inspection records, staff at Manor Care Health Services in Boca Raton served residents cold food, failed to wash their hands before administering medicines and did not follow doctors' orders to remove catheters and treat patients' wounds. In all, 139 of the state's 650 nursing homes are on the watch list. The watch list is part of the state Agency for Health Care Administration's nursing home guide, which grades facilities based on inspection results and is updated every three months. The nursing homes are ranked relative to each other with the best homes getting five stars and the worst getting one star. In addition to Manor Care, some of the homes on the list were also owned by major chains including Classic Residence by Hyatt, which owns 76 nursing homes in the United States.

Nursing Home Abuse Law Could Stiffen Penalties, Change Rules Regarding Private Equity Firms

Fri, 16 Nov 2007 00:00:00 -0800

Nursing home abuse is finally getting some attention from Congress, where two separate hearings were held yesterday to discuss the problem. Committees from both the House of Representatives and the Senate took up the nursing home abuse issue, and now Congress will consider legislation to deal with this serious problem.

Nursing home abuse is one of the most serious problems facing this country’s elderly. Though it concedes that the true number is probably much higher, The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of abuse. According to the National Center’s study, 57% of nurses’ aides working in long-term care facilities admitted to having witnessed, and even participating in, acts of abuse. The report sites systemic problems within the nursing home industry, like inadequate pay for workers and chronic understaffing, as contributing to the epidemic of abuse. There are nearly 1.4 million Americans living in nursing homes right now, and that number is expected to more than double in the next decade. As it does, advocates for the elderly and disabled fear that incidences of abuse will continue to climb as well.

As a result of yesterday’s hearings, two Senators, Charles Grassley (R-Iowa) and Herb Kohl (D-Wisconsin), are working on legislation that would stiffen penalties for nursing home abuse. The bipartisan legislation would give more enforcement power to the U.S. Centers for Medicare and Medicaid Services, which oversees state inspections of the nation's 16,400 nursing homes and also pays for the care of many poor and elderly residents.

The bill would also address growing concern about increased ownership of nursing homes by private equity firms, amid media reports that such ownership leads to poor quality care. Private equity firms generally buy nursing facilities, cut costs and resell them for a profit. But these acquisitions could be coming at a great cost to nursing home patients. According to a New York Times investigation, facilities owned by private investment firms score worse than national rates in 12 of 14 indicators regulators used to track ailments of nursing home residents. And the Centers for Medicare and Medicaid Services says that residents of such nursing homes suffer more from depression, loss of mobility and the loss of the ability to dress and bath themselves. Unfortunately, private investment firms have created complex corporate structures that obscure nursing home ownership, making it difficult to hold them accountable for nursing home abuse. The complex ownership structure also means that sometimes managers can even legally bypass Medicare and Medicaid reporting requirements. The proposed nursing home abuse legislation would require public reporting of ownership information, including affiliates, and deny payments for new residents until problems are fixed.

Advocates for nursing home residents can only hope that the legislation proposed by Grassley and Kohl will soon become law, although similar legislation has languished in Congress before.

Nursing Home Abuse Bill Sits in Congress, as Elder Abuse Reaches Epidemic Proportions

Thu, 01 Nov 2007 00:00:00 -0700

A nursing home abuse bill, the Elder Justice Act, has been under consideration in Congress for the past five years but has received scant attention and has yet to be passed. Although nursing home and elder abuse are serious and growing problems in this country, the nursing home abuse bill has never even been voted on. While no one in Congress opposes the nursing home abuse legislation, few are trying to push it through the legislative process.

Congressional critics say that the Elder Justice Act has not been passed for a number of reasons that have little to nothing to do with the bill itself. For one thing, Congress has been distracted by the war in Iraq and partisan bickering. But for the most part, they say the Elder Justice Act has been allowed to collect dust because the issue of nursing home abuse has not garnered the kind of media attention it deserves. This past summer, while much of the media was focused on the problems of Paris Hilton and Brittany Spears, Congress held hearings on nursing home abuse. Those hearings were not covered by one major TV news network.

But the issue of nursing home abuse should be getting more attention, just based on the shear numbers of elderly affected by this crime. Though it concedes that the true number is probably much higher, The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of abuse. According to the National Center’s study, 57% of nurses’ aides working in long-term care facilities admitted to having witnessed, and even participating in, acts of abuse. The report sites systemic problems within the nursing home industry, like inadequate pay for workers and chronic understaffing, as contributing to the epidemic of abuse. There are nearly 1.4 million Americans living in nursing homes right now, and that number is expected to more than double in the next decade. As it does, advocates for the elderly and disabled fear that incidences of abuse will continue to climb as well.

The Elder Justice Act, while not a cure for nursing home abuse, would bolster efforts to combat this crime. The Elder Justice Act would set up separate elderly justice offices in the U.S. Departments of Justice and Health and Human Services, provide $400 million for state adult protective services over four years and create a federal coordinating committee among agencies to monitor and direct the government's efforts. The bill would also establish forensic centers around the country to probe elderly abuse cases and give local prosecutors more support in bringing cases. And it would penalize nursing homes if they did not report crimes swiftly.

Last year, the Elder Justice Act was finally passed by the Senate Finance Committee, but it was never voted on by the full Senate. Now byzantine Senate rules mean that the nursing home abuse bill will have to go through several more committees before it is up for a vote. And some Senate watchers fear that, with a public more focused on the escapades of Brittany than the problems of the elderly, the Elder Justice Act will never be voted on.

Nursing Home Abuse at Privately-Held Facilities Should be Investigated, Say Senators Clinton and Grassley

Wed, 03 Oct 2007 00:00:00 -0700

To US Senators want to know if nursing home abuse and neglect are more prevalent in facilities owned by private Wall Street equity firms, and they are asking the Government Accountability Office (GAO) to find out.   Their requests come on the heels of a New York Times investigation that found that the quality of care at nursing homes dropped sharply after they were acquired by private investment concerns.

Senators Hilary Clinton (D-NY) and Charles Grassley (R-Iowa) based their requests on the report in the New York Times that said drastic cost cutting measures imposed on nursing homes once they were purchased by private equity firms made nursing home neglect and abuse far more likely.   Recently, private investment firms have looked to nursing homes as a possible route to easy money.   These firms buy facilities, drastically reduce their costs, then turn around and sell them at huge profits.

Private investment groups have been targeting some of the biggest nursing home concerns, in turn affecting the care of millions of patients. Just this August, the private equity firm Carlyle Group won antitrust clearance to buy Manor Care Inc, the largest U.S. nursing home owner for $4.9 billion. Another chain, Genesis Healthcare Corp. agreed to be bought by private equity in January, and Beverly Enterprises went private in 2005.

But these acquisitions could be coming at a great cost to nursing home patients. According to the New York Times investigation, facilities owned by private investment firms score worse than national rates in 12 of 14 indicators regulators used to track ailments of nursing home residents.   And the Centers for Medicare and Medicaid Services says that residents of such nursing homes suffer more from depression, loss of mobility and the loss of the ability to dress and bath themselves.   And both federal and state regulators told the New York Times that citations for quality-of-care deficiencies, like moldy food and restraining residents for long periods of time, rose at every large nursing home chain that was acquired by a private investment group.

Unfortunately, these privately-owned nursing homes are not always subject to the same legal consequences that other facilities would face for providing inadequate care to nursing home patients. Normally, the family of a resident suffering from nursing home abuse or neglect might sue the home’s owners, and regulators could impose stiff fines if conditions weren’t up to standard.   But private investment firms have created complex corporate structures that obscure exactly who owns a nursing home, making lawsuits more difficult. And the complex ownership structure also means that sometimes managers can even legally bypass Medicare and Medicaid reporting requirements.

In making his request to the GAO, Grassley asked that the agency analyze the number of private equity deals involving nursing homes, and quality and safety issues before and after changes in ownership. Clinton asked for an assessment of 63 firms in particular that the GAO cited in March as having a troubled history.

Advocates for nursing home residents can only hope that the Senators’ requests will eventually lead Congress to take action that will make private equity firms responsible for the nursing home abuse and neglect that occurs at the facilities they own.

Nursing Home Abuse, Neglect More Common in Facilities Owned by Private Investment Firms

Mon, 24 Sep 2007 00:00:00 -0700

Nursing homes are big business, and some private Wall Street investment firms have taken notice. In recent years, large groups have been gobbling up nursing homes, which they use to rake in millions of dollars in profits.   But often, those profits come at a devastating price to nursing home residents, who must bear the brunt of an investment firm’s cost-cutting efforts.

According to a report published in Monday’s New York Times, private equity firms like the Carlyle Group and Warburg Pincus, have been buying nursing homes by the hundreds. Once they have acquired a home, these private companies often employ aggressive cost cutting measures to increase profits.   Often, this means reducing nursing staff, and cutting budgets for supplies, activities and even meals.   As a result, an environment is created that is ripe for nursing home neglect.

Take the case of Habana Health Care, a 150-bed facility in Tampa, Florida.   According to the New York Times, Habana was struggling to make ends meet when it was purchased by a group of private investment firms.   Immediately after taking it over, the new management cut costs, including reducing Habana’s staff of registered nurses by half.   Soon, the new investors were reaping large financial rewards.

But Habana’s residents weren’t doing nearly as well.   The New York Times reports that over three years, 15 Habana nursing home residents died from what their families termed negligent care.   During inspections, regulators found staffing below minimum levels, as well as malfunctioning fire doors, unhygienic kitchens and one resident forced to use a broken leg brace.

Unfortunately, Habana is not an isolated incident.   According to the New York Times, facilities owned by private investment firms score worse than national rates in 12 of 14 indicators regulators used to track ailments of nursing home residents.   And the Centers for Medicare and Medicaid Services says that residents of such nursing homes suffer more from depression, loss of mobility and the loss of the ability to dress and bath themselves.   And both federal and state regulators told the New York Times that citations for quality-of-care deficiencies, like moldy food and restraining residents for long periods of time, rose at every large nursing home chain that was acquired by a private investment group.

Normally, the family of a nursing home resident suffering from substandard care might sue the home’s owners, and regulators could impose stiff fines if conditions weren’t up to standard.   But private investment firms have created complex corporate structures that obscure exactly who own a nursing home, making lawsuits more difficult. And the complex ownership structure also means that sometimes managers can legally bypass Medicare and Medicaid reporting requirements.

Several groups are pushing to make such complex corporate structures illegal, but private equity firms are lobbying hard against such laws.   Meanwhile, these companies continue to see huge profits from their nursing home acquisitions, even as the nursing home residents suffer from neglect. According to the New York Times, the investment group that purchased the Habana Health Care Center recently sold it, along with 185 other facilities, for a whopping $1.4 billion.

Nursing Home Abuse: Neglect, Physical and Even Sexual Abuse are the Harsh Realities Facing Today's Elderly

Thu, 21 Jun 2007 00:00:00 -0700

The revolting reality of Nursing Home Abuse is on the rise. Though it concedes that the true number is probably much higher, The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of abuse. There are nearly 1.4 million Americans that are living in nursing homes right now, and that number expected to more than double in the next decade. As it does, advocates for the elderly and disabled fear that incidences of abuse will continue to climb as well.

Unfortunately, a nursing home is not always the place of respite and healing it should be. According to the National Center’s study, 57% of nurses’ aides working in long-term care facilities admitted to witness, and even participating in, acts of nursing home abuse. The report sites systemic problems within the nursing home industry, like inadequate pay for workers and chronic understaffing, as contributing to the epidemic of abuse.

Anyone with a loved one in a nursing home needs to be aware of the signs of abuse. Neglect is the most common form, and is easily recognizable if family members know what to look for. Patients in soiled beds and clothes, or those suffering from bedsores and frozen joints could be victims of neglect. Indications that a patient is over or under medicated can also signal neglect.

Neglect is most often caused by understaffing at nursing homes. However, this does not mean that neglect is more benign than other forms of abuse. In fact it can be deadly, as it was for an Alzheimer’s patient living at the Atrium I Nursing Home in Pennsylvania. The 88-year-old woman was allowed to wander away from the facility and died from exposure. The nursing home administrator was later charged and convicted of involuntary manslaughter in the patient’s death.

About 2500 cases of physical abuse by nursing home staff are being reported each year. Because this type of abuse can easily be covered up by staff, the true number is not really known. Elderly people can often be victims of falls, so sometimes, bruises, sprains or factures do not alarm a patient’s loved one. However, if these injuries cannot be fully explained, or if they are occurring frequently, further investigation is probably needed.

One of the most insidious forms of nursing home abuse is sexual abuse. According to a 1996 Medicaid Fraud Report, 10% of all physical abuse cases in nursing homes are of a sexual nature. Sexual predators will usually take advantage of disabled patients who are physically unable to tell anyone about their assaults. Often, this type of abuse is only discovered when a patient shows evidence of sexual contact, perhaps in the form of a sexually transmitted disease. In Illinois the repeated rape of a mentally disabled woman wasn’t discovered until she became pregnant. A nurses’ aid was charged and plead guilty to sexual assault in that case last month.

Because its victims are so helpless, nursing home abuse is one of the most underreported crimes in our nation Families of nursing home patients must become aware of the signs of abuse, and they must be willing to advocate for their loved one. Often, family members are the only people who can prevent a tragic outcome for a long-term care patient.

Many Nursing Home Residents Fail to Receive Adequate Pain Control Due to Deficiencies in Medication Prescribing Practices Study

Sun, 05 Mar 2006 00:00:00 -0800

A new study conducted by an interdisciplinary team of researchers, and published in the Journal of the American Geriatrics Society, has found that the medication prescribing practices in place at many nursing homes results in poor pain management in residents.

As reported in Medical News Today (3/4/06), the researchers “designed and tested a Nursing Home Pain Medication Appropriateness Scale (PMAS) to screen the overall suitability of prescribing practices for pain in a nursing home setting.”

The team then compared pain assessments performed by trained assistants to the actual medications being prescribed to the residents being evaluated.

The results of the analysis were disappointing in that the “mean” total PMAS was only 64% of optimal and less than 50% of the residents who had “predictably recurrent pain” were actually receiving pain medication. Prescribing of pain medication on the PMAS was found to be better in situations where residents were not in recurrent pain.

Pain is a significant problem in older people and nursing home residents are certainly no exception. The American Geriatrics Society estimates that between 45% and 80% of nursing home residents experience significant pain (Panel on Persistent Pain in Older Persons).

Living in pain, as a result of inadequate pain management, tends to lower a persons overall quality of life and leads to other consequences such as sleep deprivation, poor nutrition, depression, anxiety, agitation, decreased activity, and delayed healing.

According to the researchers: "The inclusion of pain as a quality measure for both short-term and long-term residents is intended to provide an incentive for nursing homes to improve their practices in this area. The use of evidence-based process measures will permit an organization to begin addressing persistent problems in pain management."

Jury awards $160 million in nursing home suit

Thu, 23 Feb 2006 00:00:00 -0800

After hearing claims that a nursing home knowingly paired a frail 81-year-old man with a violent, mentally ill roommate who viciously pummeled him, a jury responded Wednesday with one of the largest civil judgments ever awarded in San Antonio.

Finding that Summit Care Corp., its Texas affiliate and two nursing home employees shared the blame for the beating and its after effects, the jury awarded a total of $160 million to the estate of Tranquilino Mendoza, who died less than three years after the attack, from unrelated causes.

Mendoza's daughter was overcome with emotion upon hearing the verdict.

"I wish my daddy was here," said a sobbing Rosamarie Paradez, who as administrator of Mendoza's estate pursued the case after his death.

"I'm glad I had the opportunity to finish what he started."

An attorney for the defendants, said members of Mendoza's family agreed during trial that he received excellent care at the Comanche Trail Nursing Center until the attack. She said medical records demon-strated that Mendoza recovered quickly and fully from his injuries.

"It has been our desire to fairly and reasonably compensate Mr. Mendoza and his family for the injuries he sustained," the defendants attorney said. "Because of the enormity of the jury's verdict, we intend to pursue available legal remedies."

During a trial that ran nearly two weeks before 73rd District Judge Andy Mireles, attorneys for the plaintiffs offered evidence that Mendoza's roommate was involved in 30 assaults before he was paired with Mendoza.

On Sept. 28, 1997, two days after they were assigned to live together, the roommate beat Mendoza with a water pitcher, a glass and his fists. Attorneys said Mendoza was seriously injured and never recovered from the trauma.

There is no definitive list of the largest civil judgments awarded in Bexar County, but the nursing-home case easily ranks among them. In recent memory, three juries in San Antonio's county and federal courts awarded larger sums.

In 1992, a jury awarded $1.3 billion to two men and an Australian firm in a breach of contract lawsuit in a purported con involving 1.75 million ounces of gold.

Mexican-based grocery wholesaler Valores Corp. won a 1999 breach-of-contract lawsuit against Wal-Mart Stores. The jury awarded $624 million in actual damages; the case was settled before punitive damages were awarded.

In 2002, a jury ordered Hillenbrand Industries to pay nearly $174 million to San Antonio-based Kinetic Concepts in a federal antitrust lawsuit.

Texas Jury Returns $160 Million Verdict for Vicious Beating of 81-Year-Old Nursing Home Resident by Violent Roommate

Thu, 23 Feb 2006 00:00:00 -0800

Although the award will likely be substantially reduced by the trial judge or a Texas appellate court, a San Antonio jury has returned a verdict $160 million in favor of the family of Tranquilino Mendoza, an 81-year-old man who was viciously beaten by a mentally disturbed roommate at the Comanche Trail Nursing Center in 1997.

The jury found that Summit Care Corp., its Texas affiliate, and two of its employees shared responsibility for this particularly brutal beating and its aftermath. Mr. Mendoza survived the attack but died less than three years later from unrelated causes.

"I wish my daddy was here. "I'm glad I had the opportunity to finish what he started.” said an emotional Rosamarie Paradez, who brought the action on behalf of Mr. Mendoza’s estate as his administratrix.

The attorney for the defendants said members Mendoza's family had testified that he had received excellent care the Mr. Mendoza received at the Comanche Trail Nursing Center before the attack. Moreover, defendants argued that, despite the severity of the beating he received, Mendoza made a full and speedy recovery from his injuries.

Defense counsel claimed that, while defendants always wanted “to reasonably compensate Mr. Mendoza and his family for the injuries he sustained," the “enormity of the jury's verdict” makes it necessary for defendants “to pursue available legal remedies."

The evidence at trial showed that Mendoza's roommate had been involved in some 30 assaults prior to his being moved in with the elderly Mendoza on September 26, 1997.

Only two days later, the violent roommate brutally attacked Mendoza with a water pitcher, a glass, and his fists. Although he lived for almost three years after the attack, the jury was convinced that Mendoza never recovered from the severe trauma he suffered as a result of the beating.

(Source: Express-News [San Antonio] 2/23/06)

Class-Action Lawsuit Seeks $600 Million in Connection with Outbreak of Legionnaires' Disease in Toronto Nursing Home that Has Already Killed 21

Thu, 27 Oct 2005 00:00:00 -0700

In the aftermath of one of the deadliest outbreaks of legionnaires’ disease ever, a 58-year-old Toronto resident, who contracted the illness, has commenced a $600 million class-action lawsuit according to a report by CTV News.

That report states in part: “Gerald Glover, 58, was infected with legionnaires' disease earlier this month during the outbreak at the Seven Oaks Home for the Aged in Scarborough. His family is baffled because Glover lives in a building across the parking lot from the home, and they say he hasn't even been in Seven Oaks.

Glover collapsed on Oct. 5 and was admitted to hospital with kidney failure, pneumonia, and temporary loss of memory and hearing. Glover’s daughter Cheryl Glover told CTV News that the suit is aimed at addressing her family's suffering.

‘It's never been about the money,’ she said. ‘We've been to the hospital and seen what they go through my dad has been hooked up to IVs in his arms and a huge one in his neck because of kidney failure, his stomach is all bruised up from being a pin cushion, and we still have no answers.’

The Glover family's lawyer, Glyn Hotz, said he has received phone calls from others interested in joining the class action suit. He said residents should have been better protected.”

According to Hotz: “Toronto Public Health should have taken measures to protect people in the home. They should have had preventative antibiotics and maybe even have moved people. They certainly should have shut the ventilation off, and instead they warned nobody."

After autopsy results confirmed at least three of the deaths at the Seven Oaks Home for the Aged in Toronto were directly linked to legionnaires’ the disease, the search intensified to find the source of the outbreak.

Although health officials had been stressing the fact that all of the dead have been elderly and infirm and that there is no danger to the general public, 30 employees, 26 visitors to the home, one hospital worker, and four people who live or work in the area (including Glover) had also been affected. Including residents of the facility, 127 cases of the disease have been diagnosed.

The search for the source of the disease was conducted by the Public Health Agency of Canada. Plumbing and air conditionaing systems at Seven Oakes were checked and a scan of a one-mile radius around the facility was conducted.

Three scientists and two technicians from the agency’s National Microbiology Laboratory were also sent to Toronto to conduct numerous tests aimed at locating the point of origin of the bacterium known as legionella pneumophilus bacterium. Environmental specialists were also called in to help identify possible sources of the bacteria.

Finally, last Friday, it was announced that the source of the outbreak was traced to the cooling tower on the roof of the nursing home. The bacteria samples from the cooling unit were found to be the same as those taken from the infected residents.

The cooling tower had been shut down on October 6, the day that legionnaires’ disease was identified as the probably cause of the outbreak.

Health officials concluded that an air intake for the home's ventilation system located next to the cooling tower allowed droplets of water containing the bacteria to be spread through the home by the ventilation system. There was no immediate evidence that the cooling tower had been improperly maintained.

Airborne droplets from the tower were blamed for spreading the illness to the four people in the vicinity of the nursing home who were also infected.

Shortly before Friday’s press conference, the 20th death among the home’s residents was announced. That number has since risen to 21 with the death of an 89-year-old resident of the home. Presently, eight victims of the disease remain hospitalized.

Indiana Nursing Home Investigated in Series of Abuse Incidents

Sat, 22 Oct 2005 00:00:00 -0700

State officials in Indiana (U.S.) have banned the Hanover Nursing Center from admitting any new residents as the result of an investigation into a series of incidents involving the abuse of several elderly inhabitants.

One such incident involved a 79-year-old woman who was severely beaten and left with a bloody face.

The Indiana Department of Health has released a report indicating that four Hanover residents were physically or verbally abused since August of 2005. The agency issued an emergency order banning the admission of new residents to the facility. A daily fine of $4,050, which began at the end of August, was also recommended.

Two former Hanover aides are facing charges in relation to the abuse allegations. One is facing a felony battery charge for an attack on a female Alzheimer’s patient and the other is facing a misdemeanor charge for failing to report the event. Both aides pleaded not guilty but are now facing trial on January 12, 2006.

The former aide charged with felony battery is Amy Johnson, who is accused of attacking a female resident in the center’s Alzheimer's unit on August 30.

According to the state's report, Johnson, 28, wrapped her left arm around the resident's neck, punched her in the face, and then asked her "how she liked it." Following the assault, the elderly woman had blackened eyes and blood gushing from her mouth and nose.

Seven other employees were fired because of claims of abuse, including an incident where a male resident was choked "so hard he was turning blue." He also had his thumbs bent back by two aides when he refused to go to bed.

Hanover is managed by Medical Rehabilitation Centers Inc., of Lexington, Kentucky. Executives of the company have called these abuse claims isolated incidents and said that they are enforcing a zero-tolerance policy on abuse like many other nursing homes. The Hanover nursing home is one of 15 such facilities in Indiana, Illinois, and Wisconsin managed by Medical Rehabilitation Centers.

Medical Rehabilitation Centers claims that the rest of the employees at Hanover are angered and outraged about the alleged abuse. The company has also established an anonymous abuse hotline.

A state monitor and two consultants are currently working at the nursing home to effect changes designed to prevent such incidents in the future. The Department of Health plans to conduct a follow-up inspection within the next 45 days to determine if remedial measures have been implemented at the center.

Nursing Home Lawyer Sexual Abuse Lawsuit Attorney

Sat, 22 Oct 2005 00:00:00 -0700

Nursing Home Sexual Abuse

Keywords: Lawyer | Nursing Home | Sexual | Abuse | Lawsuit

The nursing home abuse lawyers at Parker Waichman Alonso LLP have seen how nursing home sexual abuse devastates its victims. This shocking crime is far more common than some might think, and is becoming more frequent. Our nursing home abuse attorneys have worked for over 15 years to insure that nursing homes that fail to protect residents from sexual predators are held accountable for the terrible injuries these criminals inflict on nursing home patients.

Our Dedicated Lawyers and Attorneys Have Years of Experience
Handling Nursing Home Sexual Abuse Lawsuits!

Nursing Home Sexual Abuse a Growing Problem

As the corporations that own nursing homes look to cut costs, they have reduced wages and staff at their facilities. Understaffing makes it far easier for the activities of sexual predators to go unnoticed. Low pay means that in some cases, nursing homes end up attracting unscrupulous individuals. Very often, nursing home management won’t perform background checks on prospective employees unless they are required by law to do so. The nursing home abuse lawyers at our firm have seen how the lack of background checks, understaffing and poor pay offered to nursing home staffs have allowed sexual predators to gain employment in nursing homes and other long term care facilities.

According to a 1996 Medicaid Fraud Report, 10% of all physical abuse cases in nursing homes are of a sexual nature. Sexual elder abuse is defined as non-consensual sexual contact of any kind with a nursing home resident. Sexual contact with any person incapable of giving consent is also considered sexual elder abuse.

Nursing home residents are known to have been sexually victimized by both staff and other residents. Sexual abuse of nursing home victims nearly always occurs along side other forms of abuse. Sexual abuse is often a sign that nursing home management is neglecting its residents in many other ways. The nursing home abuse attorneys at Parker Waichman Alonso LLP are dedicated to insuring that nursing homes that do not provide a safe environment for residents are held accountable.

Signs of Nursing Home Sexual Abuse

Often, nursing home sexual abuse goes undetected. Sadly, the physical and cognitive impairments common among nursing home patients make it impossible for them to fight off sexual assailants or report sexual abuse. In other cases, sexual predators are able to intimidate their vulnerable victims into silence. In still other instances, nursing home sexual abuse victims are too embarrassed to come forward with details of what they have been forced to endure. For this reason, the families of nursing home victims must become educated about sexual abuse that occurs in nursing home. The nursing home abuse lawyers at Parker Waichman Alonso LLP have dedicated themselves to providing the families of nursing home victims with the resources they need to protect their loved ones.

Nursing home abuse can take many forms. Forced nudity, or forcing a nursing home resident to engage in taking pornographic pictures or looking at pornography is a form of sexual abuse. Forcing a nursing home resident to listen to inappropriate jokes or stories – especially if the intent is to humiliate the resident – is also abusive. Unwanted sexual touching (including whipping, pinching, and punching or kissing) on the part of staff is sexual abuse, as is forcing one resident to inappropriately touch or kiss another’s body. Obviously any form of rape or forced sexual intercourse is sexual abuse.

There are some physical signs of sexual abuse that anyone with a loved one in a nursing home should be aware of. Bruising around breasts, upper abdomen, or inner thigh is often evidence of inappropriate touching or worse. Signs that a nursing home resident has been the victim of a sexual assault include bleeding from the vagina or anus; the presence of a sexually transmitted disease; troubles walking or discomfort when sitting; and irritation or itching in genitals. The nursing home abuse attorneys at Parker Waichman Alonso LLP are very aware of all the signs of nursing home sexual abuse, and can help families determine if their loved one has become a victim of this crime.

Legal Help

Nursing home sexual abuse is a disgusting crime, and the victims of nursing home sexual abuse need to be treated with sensitivity, dignity and compassion. The nursing home abuse attorneys at Parker Waichman Alonso LLP will always treat the victims of nursing home abuse with the respect they deserve. If you suspect a loved one has been the victim of nursing home sexual abuse, they have valuable legal rights. Please fill out our online form for a free consultation from a qualified nursing home abuse attorney.