Freelance Contribution by Jessica Walter

Childhood is a carefree time, during which the parents make sure their little ones are happy, healthy, and content. However, as the years go by, the roles get switched, and it is now the grown up children who have to ensure their elderly parents’ or grandparents’ welfare. It’s estimated that by 2029, there will more than 1 million people aged 65 or over residing in South Carolina. Watching your parents and grandparents age and their health and mental capacity decline is a difficult thing for any child or grandchild to witness, but it’s even harder to make the decision to withdraw them from the place they’ve called home for decades, to  put it on the market and choose a high rated nursing home for them to move into.

Making the decision

The annual cost of a private room in a nursing home in the US is $92,378 which is a big expense for anyone, so making the decision to move a relative to one is a big decision to make; both financially and emotionally.

It can be extremely difficult to admit to yourself that your relative is no longer the person they once were and that they don’t have the mental capacity to stay in their own home and look after themselves as they once could. When you’ve made the decision you may feel guilty and a sense of grief knowing the changes that are to come to both you and your loved one. However, it’s important to recognise that you’ve made the best decision for your relative and that their new home will provide around the clock care and amenities which they don’t have in their own home.

Selling up

You’ll likely need to sell your relative’s home to fund the costly sum of a care home. If you’re looking for a quick house sale so that you can arrange for your relative to be placed into care sooner rather than later, there are a few things you can do to speed up the process.

If you’re not comfortable leaving your relative in their own home during the selling process, then it’s advisable they move in with you temporarily. This will allow you to get their house in top condition ready for any possible viewings. It’s important that the house is clean, tidy and inviting, so be sure to repair any damaged areas, remove any clutter and personal items and give the property some curb appeal by giving the front yard a tidy and the front door a lick of paint.

Choosing the right home

When moving your loved one into a care home, you want to ensure that they will receive the best quality care and attention and that all their needs will be met, day and night. Therefore, it’s vital you take the time to research any potential care home you are considering selecting. A good care home won’t mind you asking lots of questions, visiting multiple times and speaking to existing residents and their family to discuss their experiences and feelings of the home.

It’s a hard decision to make to sell a relative’s home and to move them to a care home but deep down you’ll know when the time is right and that it’s the best thing to do.

The State Journal-Register reported on the latest attempts to prevent “patient dumping” through illegal (and immoral) evictions.  Statewide patient advocates say improper involuntary discharges are the top complaint filed against nursing homes. There were 911 such complaints received by ombudsmen in the fiscal year ending June 30.  Advocates will push again this year to enact stricter legislation that guards against improper discharges affecting patients.

Nursing homes and assisted-living centers in Illinois are allowed to discharge people against their will for reasons that include mental and physical health, behavior and lack of payment.  Long-term care facilities are required by federal law to give 30 days’ notice before evicting someone. That time period allows residents, their families and advocates such as ombudsmen the opportunity to trigger appeals that can lead to hearings decided by a third party.  But notice often isn’t given, leaving nursing home residents stranded in hospitals while nursing homes immediately evict them or give no reason or inadequate reasons for not taking them back.

“The legislation updates the Illinois Nursing Home Act to reflect the newly revised federal nursing home regulations in relationship with involuntary transfers and discharges,” she said. “The legislation also closes loopholes that currently allow facilities to circumvent regulations making it far too easy to be non-compliant.”

Last year, officials from the nursing home industry opposed the legislation, which would have put into place new monetary penalties when nursing homes fail to give the required 30-day notice for an involuntary discharge.

 

 

The Star-Tribune reported the tragic and preventable death of Gary A. Schmidt from reckless administration of medications at North Ridge Health and Rehabilitation nursing home.  Schmidt was given a dose of oxycodone that was 20 times too strong and caused the death of the short-term resident.  He was only 53 years old.

Schmidt was found on the floor at North Ridge Health and Rehabilitation and was dead by the time paramedics arrived the morning of April 2, 2017, according to results of the state Health Department’s investigation.  North Ridge Health and Rehabilitation is owned and operated by Mission Health, a for profit chain from Florida.

Investigators found that a nurse administered 30 milliliters instead of 30 milligrams which is at least 20 times too much of the narcotic. In an interview with a state investigator five days after the overdose, the nurse said “she did not verify the concentration and dose of the oxycodone administered because she was very busy with multiple patients.”

SCNow reported in 2013 that Richard C. Cooke pleaded guilty to several crimes connected to fraudulent activity in his operation of six nursing homes, including three in the Pee Dee.  Cooke pleaded guilty to two indictments charging him with forgery and four indictments charging him with medical assistance provider fraud.  Cooke was sentenced to 10 years on the two forgery indictments, suspended to five years probation and three years each on the Medicaid fraud charges, all suspended to probation. Cooke’s probation conditions include house arrest for one year and 500 hours of community service, plus the full restitution.  So Cooke steals more than a million dollars from the taxpayers and only gets probation?

“Fraud committed against the Medicaid program deprives funds needed to pay for medical services, including nursing home care for elderly citizens who can’t afford it otherwise,” S.C. Attorney General Alan Wilson said after the sentencing.

Indictments show Cooke submitted fraudulent cost reports to the South Carolina Medicaid program in his role in Cooke Management Company Inc. of Lake View, which operated six nursing homes across the state. Those nursing homes included Florence Rehab and Nursing Center in Florence, Sunny Acres in Fork and Kingstree Nursing Facility in Kingstree.

Under South Carolina Medicaid regulations, nursing homes are required to submit annual operational cost reports for their facilities. The Medicaid program pays the nursing home based on that and on the number of Medicaid residents. From 2009 through 2011, the six nursing homes Cooke oversaw were overpaid more than $1 million as a result of fraudulent items listed on cost reports submitted to Medicaid.

Under the terms of the plea agreement, Cooke was required to plead guilty to all charges, to make full restitution to the S.C. Medicaid program, to be excluded from the Medicaid program for life and to cooperate with the ongoing investigation by the S.C. Attorney General’s Office.

WSBT reported that marijuana was found in the Oreos at an Indiana nursing home.  Officers were called to the Golden Living Center to investigate where an elderly resident got Oreo cookies tainted with THC, the active ingredient in Marijuana.

According to the resident, the cookies were from Michigan and used for medicinal purposes. He says they helped manage his pain. The resident would not reveal who brought the cookies to him. About 20 cookies were seized and destroyed, police said.

11Alive wrote another article about the SavaSeniorCare facility in Atlanta where a decorated World War II veteran died while gasping for air and begging for help as the SavaSeniorCare caregivers were seen on a hidden video, laughing.  The DeKalb County District Attorney may file criminal charges against nursing home staff for not responding appropriately while one of their residents slowly died in front of them.

Dempsey died while begging for assistance inside the Northeast Atlanta Health and Rehabilitation Center. Video shows he yelled “help” numerous times and pressed his call button half a dozen times. It took nursing home staff about an hour to call 911.

In November, the Brookhaven Police Department launched a criminal investigation into 89-year-old James Dempsey’s death after an 11Alive Investigation uncovered hidden camera video and court depositions of nursing home staff who responded to the World War II veteran.

The SavaSeniorCare facility is Northeast Atlanta Health and Rehabilitation. 11Alive obtained both videos in 2017 through public records requests after the family filed a lawsuit.  Police say 11Alive’s story was key to re-opening the investigation. “It was very instrumental…because there was information in the news report that you guys aired that our detectives had not seen yet,” said Gurley.

One of the nurses seen in the video is Wanda Nuckles, who worked the night Dempsey died. In a court deposition, the nursing supervisor testified under oath that she rushed to the room and started CPR on Dempsey and did not stop until paramedics arrived.  That is clearly not true.  The video shows she did not start CPR immediately. The video also shows her starting and stopping CPR numerous times, only picking up right just before paramedics arrived.

At one point, the hidden camera video caught nursing home staff laughing while they tried to fix his oxygen machine when Dempsey had already stopped breathing.  Last year, operators of the nursing home, Sava Senior Care, took 11Alive to court in an attempt to stop the video from getting released. Attorneys for Sava even attempted to appeal to the Georgia State Supreme Court, but withdrew its appeal after a lower court already released the video to 11Alive.

The Atlanta Journal Constitution confirmed that arrest warrants have been issued for three nursing home employees accused of repeatedly ignoring a World War II veteran’s pleas for help. A grand jury indicted the women — Loyce Pickquet Agyeman, Wanda Nuckles and Mable Turman — four years after James Dempsey was found dead in his room at the SavaSeniorCare facility.

Agyeman, a former licensed nurse, was charged with murder and neglect to an elder person, Jones said. Nuckles, also a former licensed nurse, was charged with depriving an elder person of essential services. Turman, a certified nurse assistant, was charged with neglect to an elder person. All face concealing a death charges.

WSPA, my hometown local news, reported on the prevalence of physical restraints in South Carolina nursing homes.  South Carolina restrains your loved ones at three times the national average.  Only one state physically restrains patients more often, and some local facilities rank among the worst in the nation.  There are numerous safety devices that can be used for safety that do not place residents in harm’s way.  Under a combination of state regulations and federal law, physical restraints can’t be used unless a doctor specifically authorizes it, and that authorization has to be renewed every 24 hours.

WSPA told the story of Charles “Eddie” Fowler who died from “positional asphyxia” or choked to death, strangled by the medical restraints that bound him to his wheelchair.  “He was all by himself,” Charles’ sister Deborah Cranford said. “Don’t know if he was calling for us, don’t know how he felt…he had to feel so alone.  They think he slid down from what the coroner said and the harness was strangling him the whole time,” she said.

State and federal regulators have tried for decades to eliminate the kinds of restraints that Cranford said killed her brother.

No place in the Upstate restrains a higher percentage of it’s patients than the Ellenburg Nursing Center in Anderson.  On average, about 11 percent of the patients at the nursing center are restrained each year, which is 10 times the state average and 26 times what you’d expect nationwide.  And at times, the numbers are a lot worse than that.

At Woodruff Manor in Spartanburg County, staff physically restrained more than 11 percent of its patients in the last three months of 2016.

Jason Blalock is a certified nursing assistant and up until last month worked at Lake Emory Post Acute Care.  “They would have like a seat belt wrapped around them that’s bolted to the back of the wheelchair, and wrapped around with an alarm on the back.”

Blalock said he was fired from Lake Emory Post Acute Care after he filed abuse complaints with the state.

We asked him, “how long would somebody be restrained like that?”

“For hours at a time,” Blalock said.

“For hours at a time?” we asked. “You saw for hours at a time patients restrained to their wheelchair?”

“Yes,” he said.

Commercial Appeal reported on the lawsuit unsealed in federal court in Memphis alleging that Spring Gate Rehabilitation and Healthcare Center nursing home gave heavy anti-psychotic drugs to residents to keep them “docile.”  The complaint alleging Medicaid and Medicare fraud by the facility argued that the company provided “worthless” services to residents between 2012 and 2015. Now the company will pay a $500,000 settlement, and has entered into an agreement with the Department of Health and Human Services to prevent such conduct in the future, the U.S. Attorney’s Office said.

According to the lawsuit, Spring Gate, operated by Memphis Operator, LLC, prescribed a resident heavy doses of anti-psychotic and anti-anxiety drugs in 2013 “despite the fact that there was never a medically accepted indication justifying such heavy-duty medications.”

“After Spring Gate prescribed these psychoactive drugs, (her) condition quickly deteriorated,” according to the complaint. “Spring Gate internal reports described her as confused and unsteady, prone to staring off into space. She fell multiple times …”

Her nephew raised concerns to Spring Gate and “to his great surprise, the nursing staff openly admitted to (him) that (she) was being prescribed these drugs ‘to keep her in the bed,'” according to the lawsuit.

KPCC reported the latest data from the federal Centers for Medicare & Medicaid Services, known as CMS, regarding the percentage of long-term nursing home residents being given antipsychotic drugs dropped from about 24 percent in late 2011 to under 16 percent last year. Decreases were reported in all 50 states, with the biggest in Tennessee, California and Arkansas.  However, 16 percent is still way too high.

“Given the dire consequences, it should be zero,” said attorney Kelly Bagby of the AARP foundation, which has engaged in several court cases challenging nursing home medication practices. Bagby contends that the drugs are frequently used for their sedative effect, not because they have any benefit to the recipients.

Experts and advocacy groups — including the Washington-based Center for Medicare Advocacy and AARP Foundation Litigation — say even the lower rate of antipsychotic usage is excessive, given federal warnings that elderly people with dementia face a higher risk of death when treated with such drugs. Some nursing homes are finding other medications that sedate their patients into passivity without drawing the same level of scrutiny as antipsychotics.

Analyzing the latest government data, Human Rights Watch estimates there are now about 179,000 people in nursing homes who get antipsychotics every week without having a diagnosis for which the drugs are approved.

“Antipsychotic drugs alter consciousness and can adversely affect an individual’s ability to interact with others,” the new report says. “They can also make it easier for understaffed facilities, with direct care workers inadequately trained in dementia care, to manage the people who live there.”

The report also says that nursing homes, in violation of government regulations, often administer antipsychotic drugs without obtaining consent from residents or the relatives who represent them.

Hannah Flamm, the report’s lead author, said the recent data showing a decline in antipsychotic usage demonstrated how extensive the overmedication problem had been. In an interview, she said the lower numbers don’t impress her.

Would you want to go into nursing home if there’s a one in six chance you’d be given a drug that robs you of your ability to communicate?” she asked. “It’s hard for me to applaud the reduction when it’s inexcusable to ever misuse these drugs.”

Advocacy groups contend that federal enforcement of medication regulations has been too lax and will only grow more lenient as President Donald Trump’s administration pursues an agenda of deregulation.

“They’re helping the industry, not the patients,” said attorney Toby Edelman of the Center for Medicare Advocacy:

 

CNN had a great article on the new Human Rights Watch report, “‘They want docile:’ How Nursing Homes in the United States Overmedicate People with Dementia.”  “Children complained about parents who were robbed of their personalities and turned into zombies. Residents remembered slurring their words and being unable to think or stay awake. Former administrators admitted doling out drugs without having appropriate diagnoses, securing informed consent or divulging risks.”  The under-staffing of nursing homes is a major factor of such over-medication.

The 157-page report estimates that each week more than 179,000 people living in US nursing facilities are given antipsychotic medications, even though they don’t have the approved psychiatric diagnoses — like schizophrenia — to warrant use of the drugs. Most of these residents are older and have dementia, and researchers say the antipsychotic medications are administered as a cost-effective “chemical restraint” to suppress behaviors and ease the load on overwhelmed staff.
What’s revealed in this report echoes the findings of a CNN investigation published in October. The CNN story described how one little red pill, Nuedexta, was being misused and overprescribed in nursing homes. What’s more, CNN learned that this overuse benefited the drugmaker to a tune of hundreds of millions of dollars, largely at the expense of the US government. The CNN report prompted an investigation into a California-based pharmaceutical company.
The Food and Drug Administration has not deemed antipsychotic drugs an effective or safe way to treat symptoms associated with dementia — including dementia-related psychosis, for which there is no approved drug. In fact, the FDA cautions that these drugs pose dangers for elderly patients with dementia, even doubling the risk of death, the report shows. Other possible side effects outlined in the report include an onset of nervous system problems that may cause “severe muscular rigidity” or “jerking movements,” as well as low blood pressure, high blood sugar, blood clots and other problems.
There are plenty of ways to deal with dementia-related symptoms or behaviors that don’t involve pharmaceuticals, the report lays out. Improvements can be achieved through providing activities, reducing loneliness, creating routines, encouraging relationships with familiar staff members, offering exercise and promoting programs like music therapy and pet therapy.
The government has long-recognized the problem of overusing antipsychotic medications and is required to monitor the use of such drugs, the report shows. In fact, in 2012, the Centers for Medicare & Medicaid Services established the National Partnership to Improve Dementia Care in Nursing Homes in acknowledgement of this issue.  “The US government pays nursing homes tens of billions of dollars per year to provide safe and appropriate care for residents,” said Hannah Flamm, a New York University Law fellow at Human Rights Watch. “Officials have a duty to ensure that these often vulnerable people are protected rather than abused.”