I came across an article discussing the trend of Wall Street investment groups buying nursing homes and the effect it is having on residents and litigation.  Check out my summary: 

In recent years the Long Term Care industry has seen thousands of nursing homes across the nation taken over by Wall Street investment groups and unfortunately, this change has not been to the advantage of the residents.  Many of the nursing homes purchased were struggling financially before ownership changed hands and are now returning millions in profits at the expense of the residents who rely on these facilities for their daily needs. 

Take for example Habana Health Care Center in Tampa, Florida.  It was purchased along with 48 other nursing homes in 2002 by Wall Street Investors including Warburg Pincus and The Carlyle Group.  The Carlyle Group bought out Dunkin’ Donuts.  (I’m sure that makes them good health care providers.)  Since these groups have taken over, costs have been cut to pull Habana out of its struggling financial situation.  The Centers for Medicare and Medicaid Services indicate that the number of Registered Nurses employed at the facility has been cut in half.  Florida’s Agency for Health Care Administration reports that budgets for nursing supplies, resident activities and other services have also been cut.  The nursing home was repeatedly  warned by regulators that staffing was below the required levels and inspections revealed several violations.

In just three years 15 Habana residents died resulting in lawsuits claiming neglect.  Vivian Hewitt is one of the family members who filed a lawsuit against Habana when her mother passed away.  Mrs. Hewitt’s mother had a bedsore that became infected with feces.

Data collected by the Centers for Medicare and Medicaid Services indicate that residents at facilities owned by large private investment firms generally do not do as well as  residents in publicly owned facilities.  

There is another problem created when a nursing home is owned by private investment firms.  Typically these companies make litigation difficult for plaintiffs by spreading ownership across many firms, including management, real estate, holding companies, etc.  Some companies are created just to hire staff or purchase equipment.  Many companies have no actual office or staff.  This allows corporations to protect themselves from litigation as well as increase their profits by renting the nursing home from themselves, buying equipment from themselves, and so forth.  Many plaintiffs don’t know who to sue or end up having to name 10 or 15 defendants to cover all companies involved with the facility.

When Mrs. Hewitt filed suit against Habana over her mother’s death, her attorney began investigating the corporate side of the facility.  Three years and $30,000 later and they haven’t made much progress.

Nathan P. Carter, a plaintiffs’ attorney in Florida said he once had to sue 22 companies in a nursing home case.  He also said he believes that about 70 percent of plaintiffs’ attorneys who used to sue nursing homes no longer do because the complicated corporate structures make it so difficult.

There are currently groups who are lobbying to make the corporate structure at nursing homes simpler and smaller in hopes that resident care will get better and litigation will get easier.  One such group is the National Citizens’ Coalition for Nursing Home Reform. 

Check out the full story at :  http://freeinternetpress.com/story.php?sid=13671#more

USA Today recently reported that the numbers of elderly (defined in the article as the population of people 85 and older) living in nursing homes is declining.  The article points out that these numbers don’t include those living in Assisted Living Facilities, which may in fact reflect a good portion of the 85 and older population. 

This is a good thing, as it may mean that people are living better instead of just longer.  I say that for a couple of reasons:  1) you have to be functioning at a certain level to be in assisted living, 2) it is my opinion that it is always better not to be in a nursing home.

The article also points out the sad fact that the decline is most likely in the "upper-income white population" who has the financial ability to take advantage of options other than nursing home placement.  Everyone else will likely have nursing homes as their only option.  The other sad fact is that "the average nursing home patient runs out of money within six months and must go on Medicaid" – so while these individuals will go broke, and eventually the Medicaid system may go broke, the nursing home industry continues to make money.

To read the entire article, click here.

U.S. Senator Barack Obama today released a statement on the report in the New York Times on nursing homes.

"The news that some private equity firms have been boosting profits at the nursing homes they own by cutting essential staff and compromising the quality of care for our seniors is unconscionable and unacceptable. America’s workers and America’s seniors deserve better, and the American public deserves to know exactly what’s going on in these nursing homes."

‘I led the fight in Illinois to pass the Hospital Report Cards Act that required hospitals to disclose details on nurse staffing and the quality of care so that the everyone was aware how well their health care system worked. When I’m President, this kind of transparency will be a part of my universal health care reform that provides every American with affordable, quality health care."

This weekend, the New York Times published an article about the profitability of nursing homes.  The article points out that while profits are rising, quality of care is falling.  This may come as a surprise to the nursing home industry who, as a general rule, seems to constantly repeat their litany about how they aren’t making any money.  I couldn’t be happier to see the New York Times say the same thing that we already know . . . someone’s making money in the nursing home business.  So this is not new news to me.  And I’m sure its not new news to many lawyers across the country.   However, it is good news to see the press pick up on this and put it front page on Sunday morning.

And, once again, the industry focuses not on the care they provide but the trouble they have with lawsuits . . . and their response is  "we made the companies smaller and poorer, and the lawsuits have diminished."  The industry takes no responsibility for lack of quality care that results from making the companies smaller and poorer.  To be fair, the previous quote was taken from an executive with a company called Formation properties – a company who owns the Habana Health Care nursing home which the article focuses on.  However, I’m comfortable that the nursing home industry as a whole would stand behind this quote.  There are no comments in the article defending the qualtiy of care that residents receive.

One day, we may all be facing the decision of whether or not to put a loved one in a nursing home, if we haven’t already.  And one day, we may all be facing the decision of whether or not we will need nursing home care ourselves.  I can only hope that some of the executives that have put this grand money making scheme into practice will have to look into the face of their family members or into their own mirrors and decide if that nursing home, the one they have swept money away from, is somewhere they would feel comfortable placing their mothers, fathers, wives, or husbands in.  Or even better yet, is that nursing home a place they would want to live out their final days . . . Ultimately, justice can come in many forms.

To read the entire article, click here.

Federal and State regulations mandate that a nursing home hire and retain a medical director for nursing homes.  In a recent case, after a lengthy investigation, a nursing home was found guilty of fraud for failing to have a medical director.   It took the jury about two hours to decide.

The state took Billie Anderson to court because investigators say from March 2002 to January 2003 Anderson operated Anderson Health Care in Gray without a medical director.

During that time she still collected about $100,000 dollars a month for her Medicaid patients—that is a violation of Medicaid laws because she didn’t have a medical director.

The guilty verdict means the jury believes Anderson knew there was no medical director and that she concealed or failed to disclose that information to the state.

In Moundsville, W.V.a.,  Police said a mentally handicapped woman was sexually assaulted inside a Moundsville nursing home. The suspect is Roy Reed Sheldon, 22, who was placed into a cruiser and headed to jail after his arraignment Wednesday afternoon. 

He sexually assaulted a 57-year-old mentally handicapped woman who was a resident of Dora Allietta Memorial Home on Eighth Street.   Police got a call over the weekend from an employee after the victim said Sheldon raped her.

A blanket covers the sign at the nursing home — and it turns out Sheldon is no stranger to the place. Police said he lives on the top floor and his wife manages the home. Sheldon’s wife no longer works there.

Sheldon is facing sexual assault, sexual abuse, and indecent exposure charges. Police said he gave a confession, but denies having intercourse with the woman.

Here is an interesting article about an investigation at a nursing home involving a resident who died from suffocation. 

It was Friday, September 7 when authorities say Stephanie Galletti who lived at the Taylor Nursing Home and Rehabilitation Center got tangled in some bed rails and suffocated.   According to a search warrant, it is part of a neglect investigation into Galletti’s death. She was an Alzheimer’s patient with a history of falling out of bed.

Court papers reveal a housekeeper "found Ms. Galletti’s head wedged between her bed rail and her mattress."   Included in the evidence seized from the nursing home Wednesday were medical records and an air mattress from Galletti’s bed.

According to court papers, the elderly woman died at 7:40 a.m., but her death was not reported to police until 9:48 a.m.   No one can explain the two hour delay.

In the affidavit investigators said, "No explanation was given as to the two hour delay in reporting the incident."  Authorities are also investigating a bed alarm that is supposed to sound if a patient falls out of bed. Detectives said Galletti’s bed alarm was turned off.

The bed alarm should not have been off according to the physician’s orders.  Clearly, the home did not have the bed alarm on and did not properly supervise the resdient.

The New York Times has an interesting and scary article about how the elderly are given dangerous and unnecessary medications.   The article relays a story about a 78-year-old woman who was found unconscious on the floor of her apartment by a neighbor.
Her medical history included high blood pressure, coronary artery disease, atrial fibrillation, congestive heart failure and osteoarthritis. She also had a cold with a productive cough. For each condition, she had been prescribed a different drug, and she was taking a few over-the-counter remedies on her own. These were the medications:

¶Lopressor to control high blood pressure.
¶Digitalis to help the heart pump and control its rhythm.
¶Coumadin to prevent a stroke caused by blood clots.
¶Furosemide, a potent diuretic to lower blood pressure.
¶Lipitor to lower serum cholesterol.
¶Baby aspirin to reduce cardiac risk from blood clots.
¶Celebrex for arthritis pain.
¶Paxil for depression and anxiety.
¶Valium, as needed, to help her sleep.
¶Levofloxacin, an antibiotic for the cough.
¶Ibuprofen for body aches.
¶Cough medicine.

This is what doctors call polypharmacy, otherwise known as a “poisonous cocktail” of many drugs that can interact in dangerous ways and cause side effects that can be far worse than the diseases they are treating. Elderly people are especially vulnerable because they often have several medical problems for which they see different doctors, each prescribing drugs, often without knowing what else the patient is taking.

The woman described above passed out because she had a bleeding stomach ulcer from a combination of drugs that irritate the stomach, Celebrex, ibuprofen and aspirin, and thin the blood, coumadin and aspirin, made worse by an antibiotic that raises blood levels of coumadin.

She recovered after a transfusion of two units of packed red blood cells and was sent home with strict instructions to stop the Celebrex, ibuprofen and aspirin and advice to “contact her internist and psychiatrist regarding possible medication changes that might decrease the risk for future adverse events,” Dr. Michael Stern reported in the June issue of Emergency Medicine.

Dr. Stern, a specialist in geriatric emergency medicine at New York Presbyterian Hospital/Weill Cornell Medical Center, noted that the elderly took about 40 percent of prescribed drugs, roughly twice what younger adults take, and that they suffered twice as many adverse drug reactions as younger people.

“The average community-dwelling older adult takes 4.5 prescription drugs and 2.1 over-the-counter medications,” Dr. Stern reported. Polypharmacy is responsible for up to 28 percent of hospital admissions and, he added, if it were classified as such, it would be the fifth leading cause of death in the United States.

The Effects of Aging

Various drugs taken by the elderly can interact dangerously. Some drugs use the same metabolic pathway and, thus, compete with one another, which can result in hazardous blood levels of one or more drugs. Some drugs cause effects like dehydration that reduce kidney function and the ability to eliminate drug metabolites. The combined effects of some drugs can be more potent than the prescriber intended.

Major organ systems function less efficiently in older people. The heart’s ability to pump blood declines with age, as does absorption by the gut, the breakdown of drugs by the liver and the ability of the kidneys to excrete them. With aging, the percentage of lean body mass declines, and body fat increases. Thus, aging affects how much of a drug reaches the bloodstream, how well it is distributed in the body and how effectively it is cleared from the system.

Drugs like digitalis and coumadin, which are primarily distributed in lean tissues, are likely to reach higher blood levels in people older than 65. So the prescribed dosages should be lowered to reduce the risk of toxic side effects. Other drugs, like Valium and barbiturates, that are distributed in fatty tissue can accumulate in the elderly body and remain active longer, increasing side effects like sedation.

Aging also results in fewer protein binding sites for drugs, resulting in a higher blood level of the drug that loses the competition for sites.

Furthermore, aging can affect the responses to certain medications. This is especially true for those that influence blood pressure and the brain. Drugs like Valium, antidepressants and antihistamines can cause effects like delirium, agitation, sleepiness, depression and worsening dementia in older people, Dr. Stern wrote.

Chad Trammel and his team of nursing home lawyers did a great job in a difficult trial.  The multi chain (and infamous) Beverly Enterprises has been found negligent in the death of  resident and ordered to pay $1.4 million in compensatory damages.

After deliberating on Monday, the Ouachita County jury agreed on $875,000 in punitive damages in the case. The company was sued for the April 2005 death of Herman Johnson.

Johnson went into the nursing home March 18, 2005. Two weeks later, he was found unresponsive in his wheelchair in the dining room. Two nurses tried to revive Johnson before an ambulance took him to Ouachita County Medical Center, where he was pronounced dead. An examination of the body found bed sores and evidence of malnutrition and dehydration–clear signs of serious neglect.

The suit claimed the nursing home was insufficiently staffed to provide adequate care for Johnson. Lawyers for Beverly said Johnson’s condition was due to long-term alcohol abuse and other chronic health problems, including anemia, diabetes, high blood pressure and kidney failure. They say Johnson also had a history of refusing to take vitamins and medicine prescribed for him.

The trial began earlier this month, and the jury announced its decision Friday along with the award of compensatory damages. The jury found the defendants also had acted recklessly and had deprived Johnson of his rights as a resident of the home.

Beverly Healthcare is one of the nation’s largest nursing home chains. Over the course of the eight-day trial, the 12-person jury heard testimony from a variety of Beverly representatives, medical experts, and other witnesses. Among the documents displayed during the trial were internal Beverly e-mails referring to the company’s own nursing assistants as “trash” and “misfits” who posed a “hazard” to the residents. According to Beverly’s own officials, the company was not able to retain quality nursing assistants because it refused to raise its wages by $1.00 per hour.

The plaintiffs also introduced evidence showing that the company recently paid its executives $138 million in bonuses. Finally, the jury heard from Beverly Director of Operations David Mills, who took the stand and compared running a nursing home to owning an automobile dealership.

“This jury sent a powerful message to Beverly and all the other nursing-home mega-chains that neglect their residents in order to boost profits,” said Chad Trammell, a partner with Nix, Patterson & Roach and the attorney who represented the plaintiffs. “The people they are abusing are our mothers, our fathers, and our grandparents. These companies have a duty to care for their residents, and that duty is more important than maximizing shareholder return and paying out huge executive bonuses.” 

A new study indicates that segregation is alive and well in America’s nursing homes.  Elderly and ill blacks in the United States are more likely to live in poor-quality nursing homes, researchers said on Tuesday in a study that shows clear patterns of segregation persist.

"This study shows us that racial segregation has a significant impact on the quality of care received by nursing home residents," David Barton Smith of Temple University in Philadelphia, who led the study, said in a statement.

Barton Smith’s team used U.S. government data on 1.5 million patients in 14,374 nursing homes in 2000, covering close to 90 percent of all nursing homes and residents.

"Blacks were nearly twice as likely as whites to be located in a nursing home that was subsequently terminated from Medicare and Medicaid participation because of poor quality," they wrote in their report.

The researchers said their report follows up on some well-established research on disparities in U.S. health care, which shows blacks get poorer care regardless of what kind of health insurance they have.

"Before Medicare and Medicaid were implemented in 1966, nursing homes in the South were totally segregated by Jim Crow laws and in the North almost as much by patterns of use and admission practices," they wrote.