Brian Lee is the executive director of Families for Better Care, a national nursing home watchdog group. He wrote the below editorial about Florida’s Proposal 88.

“Once again, the nursing home lobbyists have strapped up their boots, donned their black hats, and rode out on their trusty steeds to make quick work of Public Enemy No 1.

Just what’s this foreboding menace looming over their horizon? Why it’s none other than Proposal 88.

Proposal 88, now before Florida’s Constitution Revision Commission, would brand an elderly Bill of Rights directly into the DNA of the state’s constitution, guaranteeing the protection of our parents’ and grandparents’ civil and legal rights, especially when they move into a nursing home.

To nursing home owners, shareholders and their lobbyists, Proposal 88 represents everything that is evil in this world, for it poses the most serious, the gravest threat to their empire’s very way of life —  giving nursing home residents equal footing under the law.

You see, if your mom or dad moves into a nursing home right now, your parent immediately becomes an excluded class of citizen, afforded a slate of diminished rights that benefit not your mom or dad, but greedy nursing home companies that put outlandish profits ahead your loved ones’ care and safety.

Now, you have to know, the nursing home lobbyists are highly skilled operatives, who’ve repeatedly taken out similar threatening proposals in the past. A fast draw of their diamond-studded checkbook in one hand, a point and click of their Mont Blanc in the other, and voila, their problems disappear.

But Proposal 88 is different, and they know it.


Because if the 2016 elections proved anything, it’s that Americans are sick and tired of the status quo.

A dust off of Proposal 88’s analysis by The Florida Bar shows a glut of nursing homes that have become awash in “routine violations of rights by facilities, administrators and employees” resulting in a “parade of grim and tragic” cases. Care in some facilities has become so bad that “20 percent of residents in assisted living and nursing home facilities” are now “subject to abuse, neglect and exploitation.” 

 A few of the more “alarming” incidents referenced in the Proposal 88 analysis include “employees videoing themselves assaulting and humiliating vulnerable residents,” theft of the “meager belongings of residents,” residents living in “severely unsanitary conditions,” dismissed “claims of sexual assault despite evidence,” and the “death of 12 residents in the Rehabilitation Center in Hollywood Hills” following Hurricane Irma.

Quite simply, too many nursing homes aren’t a bed of roses.

But the hardened band of nursing home lobbyists, circling wagons to bat down these difficult truths, would argue everything is fine, residents don’t have problems, it’s actually the providers for whom we should feel sorry. Claiming to be underpaid and overburdened with regulations. Right.

The fact is, nursing homes have gotten wealthy off the bedsore-ridden backs of our loved ones. Proposal 88 would change that dynamic by ensuring residents’ constitutional right to safe living in a nursing home.

And with a new poll showing 86 percent of Floridians now supporting the elderly having a nursing home Bill of Rights enumerated in the state’s constitution, nursing home owners and their lobbyists should brace themselves.

Soon, there will be a new sheriff in town.

McKnight’s had an article on how Preferred Care of Plano is using bankruptcy to avoid responsibility for the abuse and neglect suffered by their residents.   Preferred filed for bankruptcy in November claiming in court that lawsuits led to its financial demise.  Consumer advocates and industry experts — including families who allege their loved ones were mistreated in facilities in Texas, Kentucky or New Mexico — say the company is trying to avoid accountability.

“If their quality of care were higher, they wouldn’t be getting sued,” said Dallas lawyer Gabriel Canto, who represents the family of a Preferred Care resident who died after falling twice in the same day.

Preferred Care was incorporated in 1992 by Thomas Scott.   Today it’s a web of corporations that includes technology services, rehabilitation services and nursing homes linked to Scott including Preferred Care Partners Management Group, Preferred Care Inc., Preferred Care Partners, Pinnacle Health Management and Pincomputing.   The company has annual revenue estimated at $750 million, it is one of the country’s largest senior care providers, with more than 100 skilled nursing, assisted and independent living centers in 12 states, including 38 locations across Texas.

A Dallas Morning News investigation published last week strung together state and federal inspection reports and dozens of lawsuits to illustrate the nursing home operator’s horrific track record and history of abuse and neglect. Allegations of neglect, injury and wrongful death included the beating death of two residents at the hands of a mentally ill roommate, a resident found dead with his wheelchair on top of his body and a state attorney general’s allegation that residents were left for hours in soiled clothes and sheets.

An unusually large share of Preferred Care facilities have poor ratings, based on federal inspection data. About a third of Preferred Care homes in Texas received 1 star overall in the Five-Star Quality Rating System, compared to a quarter of all nursing homes statewide.

State health departments, lawyers and the hundreds of families they represent say that the company is using bankruptcy as a way to escape the consequences of a long-standing pattern of substandard care.

Scott and his wife live on a 155-acre property in Celina that’s valued at $3.7 million, records show. Scott owns several other properties in Collin and Grayson counties, as well as a home in Fort Lauderdale, property records show.

The Macon Telegraph reported on the abuse allegations against two nursing home employees caught on camera assaulting a resident.  Hidden camera footage in an elderly man’s nursing home room led to the two women being arrested on elder abuse charges.

The family of William John Parks, 89, who lives at Lynn Haven Health & Rehabilitation nursing home in Gray, became concerned earlier this year and put a “nanny cam” in his room, said Jones County sheriff’s Maj. Earl Humphries.

Footage recorded Jan. 31 showed both physical and mental abuse of Parks, who was recovering from pneumonia and needed extra care with feeding and personal hygiene, Humphries said.

“The two attendants in the room were just really frustrated with Mr. Parks and were treating him pretty roughly, … manhandling him too much,” he said.

The Times Herald-Record had an article on Sapphire Nursing and Rehab at Goshen.  The residents’ experience includes being “caked in excrement for hours, waiting 30 minutes or more for aides to respond to call bells, getting meals an hour late, receiving the wrong food, and wandering off unattended for extended periods.”  The allegations come after the state Health Department’s recently launched investigation into complaints at the 120-bed home following significant staff cuts by its new owners.

A renowned nursing home researcher said the home’s staffing levels appear to be potentially hazardous and below safe industry standards.  “They have very bad, dangerous staffing,” said Charlene Harrington, an emeritus professor of nursing at the University of California San Francisco, who helped the Record analyze the home’s staffing data. “They’re going to have a lot of bad things happen with those staffing levels.”

“The care of my mother by the new owners has made me sick,” said Majorie Fox of the Town of Wallkill, whose mother, Florence, is a Sapphire resident. “I have been to the doctor with high blood pressure. I’ve spoken about the cuts to everyone at Sapphire and the Department of Health when they were there.”

Sapphire Regional Administrator Jay Pepper acknowledged the home’s new owner, Goshen Operations, LLC – which bought the former Elant home and its three sister facilities in the fall – had “hit some bumps in the road” with staff resignations and “slight” staff cuts.

Between layoffs and resignations from September to December, Sapphire’s nurse tally plummeted 54 percent to 15 licensed practical nurses and two registered nurses, who are supervisors, according to 1199 SEIU United Healthcare Workers East, the employees’ union. Before the cuts, there had been 12 RNs and 25 LPNs, the union said.  In addition, more than a half-dozen of the home’s leaders and staff members, from administrators to kitchen help, have either resigned or been laid off since mid-December, and the home’s certified nursing assistant total is down 10 to 59, according to the union.

In recent weeks, the Record has communicated with about a dozen current and former staff members, relatives of residents and one former patient. The consensus: The home has skidded far and fast downhill since new owners took over in September.  Goshen Operations, LLC, promised “no significant changes to staffing levels” to the state Department of Health when it bought the four facilities in the fall.

Based on a full home, in a typical day, Sapphire’s Goshen location provides 1.87 hours of care per patient per day from CNAs, 0.73
from LPNs and no dedicated non-supervisor RN hours. The home should provide 2.58 from CNAs, 0.71 from LPNs and 1.32 from RNs based on the home’s federally reported acuity level, Harrington said.   Harrington said “the facility appears to have over-reported its staffing by a lot” to the federal government, based on Sapphire’s Medicare filings. “You can compare what the union reports as actual staffing with what they should have and see that they only have a small percent of what they should have.”



The Orlando Sentinel had an article about the need for enforceable Resident Rights in Florida (and elsewhere!).  Because of facilities with track records of putting their patients in danger, some advocates and industry experts want to change the Florida Constitution, adding a nursing home and assisted-living facility residents’ bill of rights. Doing so, they say, would not only add more protections, but it also would shield residents from state legislators and presidential administrations that might roll back existing regulations under pressure from the nursing home industry.

The public is completely in the dark about what happens in some of these facilities,” said Brian Lee, a former nursing-home watchdog for the state who now heads the national advocacy group Families for Better Care. “Even the tragedy of 12 nursing home residents dying from neglect after Hurricane Irma — deaths that were categorized as homicides — has not been enough to shame the industry into making changes.”

The Rehabilitation Center at Hollywood Hills in South Florida was evacuated Sept. 13 after power was knocked out by the storm and temperatures inside soared. A dozen elderly residents ultimately succumbed to heat exposure; one had a body temperature of 109.9 degrees. That facility is still fighting to keep its license.

It also prompted the governor to ask the state’s Constitution Revision Commission — which examines the Florida Constitution every 20 years for possible changes — to look at whether there are ways that the document could offer better protection for residents of long-term care facilities.

Proposal 88 establishes the right for residents to be treated “courteously, fairly and with the fullest measure of dignity,” given “adequate and appropriate health care” and live in “a safe, clean, comfortable and homelike environment” with “reasonable precautions” against natural disasters and extreme climatic conditions. , which is now being aired in public hearings throughout the state. If approved by the commission, it would go before voters in November.

It also says residents have the right to access courts, have speedy trials and sue without limitations for damages, that they can’t be asked to waive those rights, and that the facilities must carry liability insurance sufficient to ensure that residents and their families are “justly compensated.”

The industry as a whole is adamantly opposed to any such language in the state’s Constitution — even though some of the rights are already part of laws previously enacted by the Florida Legislature and the proposal doesn’t spell out the consequences for nursing homes that don’t comply.

Record-setting bed valuations, billions in guaranteed revenues and robust profit margins have pushed the senior care market to become one of the fastest growing, most highly profitable health care sectors.

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.”

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.

The Duluth News Tribune and Twin Cities Pioneer Press had articles on the tragic death of a resident at Bethel Care Center. When a St. Paul nursing home resident’s ventilator tube became detached and sounded an alarm during a worship service at the facility last summer, there weren’t any nursing staff around to help, according to a report by the Minnesota Department of Health.  Staff didn’t notice the detached tube for an hour, at which point it was too late to save the resident, the report said.

According to the Health Department:

Around 2 p.m. on July 16, 2017, the resident was brought to a church service in the nursing home. His ventilator was functioning properly. Two minutes later, his ventilator alarm sounded. A pastoral staff member claimed to hear the alarm, but he or she had previously been instructed to ignore it. About an hour later, the same staff member noted poor color in the resident and called for help.

Nursing staff arrived, reconnected the tubing and called emergency services. At 3:36 p.m., emergency medical services pronounced the resident dead.  The resident’s cause of death was listed as asphyxia due to disconnection of the ventilator tubing. The resident physician said he had recently examined the man and thought it unlikely he would have died otherwise, the report said.