The Washington Post reported on a nursing home resident Rebecca Zeni who was “eaten alive” by scabies. Parasitic mites had burrowed under her skin, living and laying eggs all over her body. By the time she died, vesicles and thick crusts had formed on her skin. Her right hand had turned nearly black, and her fingers were about to fall off.  The scabies that infected Zeni’s body had become so severe that bacteria seeped into her bloodstream causing her wrongful death.  Zeni died June 2, 2015. An autopsy found that she died of Staphylococcus aureus septicemia due to Norwegian crusted scabies, a severe form of scabies that affects people with weak immune systems, such as the elderly.

Zeni’s death is now the subject of a lawsuit filed against PruittHealth, a for-profit company that owns dozens of nursing homes, including Shepherd Hills in LaFayette, Ga., where Zeni lived for five years until she died. Shepherd Hills, a nursing home that had multiple scabies outbreaks in recent years and a history of health violations, failed to follow policies and procedures to prevent the occurrence and spread of the highly contagious disease.  Instead of providing the care that Zeni desperately needed, the lawsuit alleges that the nursing home allowed her to die an agonizing death.

A lawyer for the company, Jeffrey Braintwain, argues that, among other defenses, injuries may have been caused by people PruittHealth cannot control. This includes Puryear and Zeni herself.  The nursing home is blaming the resident!!!

Federal health inspection records paint a troubling picture of the company, which describes itself as the “regional leader” of providing long-term health care to the elderly in the southeast. In August 2013, according to the Georgia Department of Public Health, 10 residents and 10 staff members were affected by scabies. In October 2014, the home’s internal infection log shows, at least six patients were affected. In May 2015, according to the Department of Public Health, 20 residents and another 15 staff members were affected.

Many PruittHealth-owned facilities have similarly dismal records. Nineteen other facilities in Georgia, seven in South Carolina and one in North Carolina received one- and two-star ratings from Medicare.  Of the 56 nursing homes owned by Pruitt in Georgia, nearly half (46%) are rated “below” or “much below average.” In total, Pruitt’s one and two-star facilities collected $221 million from Medicaid in 2016 and 2017.

Zeni’s death raises crucial — and familiar — questions about for-profit nursing homes that have long been accused of sacrificing patient care to minimize costs and maximize bottom lines. Nursing homes owned by big corporations and private investment firms consistently performed poorly in terms of quality of care and are more likely than nonprofit and government facilities to be cited for “serious deficiencies” that harm residents, according to 2011 and 2016 reports by the Government Accountability Office. Staffing levels are usually lower, meaning trained nurses spend less time with residents each day.

Human scabies results when an adult female human itch mite burrows into the top layer of your skin, otherwise known as the epidermis. There the mite can hang out, poop, and lay eggs. The eggs can then produce new mites, leading to more and more mites in your skin. Each mite can live a couple months in your skin. That is the Circle of Mites.

Image result for scabies mites picture

When the infestation is ignored, thousands of mites may be reproduced.  Norwegian or crusted scabies tends to occur when your immune system is weak, allowing the mites to reproduce more. With so many mites, the skin forms crusts that are thick, gray, and crumbly.

The mites are so small that you can’t see them. A simple view from a microscope will allow caregivers to figure out if a resident has scabies.  Tthey can be passed unknowingly from person-to-person via skin-to-skin contact. Transmission only occurs via human-to-human contact.  The contact has to be prolonged and intimate.   This should not happen in a nursing home since caregivers are required 1) to wear sterile gloves before caring for a resident, and 2) wash their hands before caring for a resident.

The mite can survive on objects such as a blanket, other bedding, clothes, and furniture for about 3 to 4 days, so you could catch scabies from such items. Therefore, make sure you thoroughly wash (using the hottest temperature possible) or seal in a bag for at least a week any object that may be affected.

Symptoms can take anywhere from a few days to 4 to 6 weeks to appear. The itching tends to be worse at night and can keep you awake. The classic appearance of the rash is a line of little bumps, as described by the American Academy of Dermatology. The rash can become scaly and look a bit like eczema.

Image result for norwegian scabies crusted

Scratching can convert the rashes into sores. Sores can lead to infection. Infections can potentially lead to death, especially if you are in a weakened condition.  An elderly person’s immune system is weaker and won’t attack the mite as vigorously. If not treated, the mites will multiply indefinitely. A patient can have thousands of mites in his or her body. They form crust on the skin. The crust sheds, carrying mites and eggs with it. The outbreak spreads.  Tomorrow, we will discuss a recent nursing home case involving scabies.


Fox40 had an article about for-profit nursing home chains in California that illegally prioritizes some patients over others based on how much of a payout insurance will pay the individual nursing home for each.  As soon as a resident goes from Medicare (where reimbursements are high) to Medicaid (where the nursing home gets a flat fee), the chain tries to get rid of them.  These chains discharge residents without proper notice or a legal reason.  It’s called patient dumping and it’s illegal.  Under California law, nursing homes need to notify patients 30 days before they’re let go.

“What’s happened is the money’s gotten the best of the providers,” Tony Chicotel, a spokesman with the California Advocates for Nursing Home Reform,  said. He urges consumers to follow the money. “Medicare pays a significantly higher rate per day for nursing home care than [MediCal] or even private pay dollars do,” he said.  According to Chicotel, the problem is Medicare only provides a few months’ worth of nursing home care to patients. When that runs out, he says some nursing homes rush to fill her bed with someone else on Medicare.  “The more you occupy your beds with Medicare residents, the more money you’re going to make. Sometimes three or four times as much.”

He’s working on a class action lawsuit filed against SavaSeniorCare, a national for-profit billion dollar chain.  SavaSeniorCare has over 200 facilities nationwide including 4 in South Carolina.  SavaSeniorCare is also part of a False Claims Act case in Tennessee.  See Hayward doc 59.

“It’s a very widespread problem. It involves dozens of nursing home chains in California, hundreds of individual nursing homes. It’s a problem that’s affected northern, central, southern California. We hear about it everywhere,” Chicotel said.

A representative from Mission Carmichael, a care facility owned and operated by Sava, did respond to the lawsuit, saying only that they’re “aware of the case” and “cannot comment about the specifics”


6ABC reported on the recent audit by the Federal Government which found an alarming number of nursing homes failing to report suspected abuse, including sexual abuse.  Action News Investigative Reporter Chad Pradelli has been investigating the nursing home industry in Pennsylvania for the past year.  Pradelli looked at every state inspection report in the 5 county region for 2016 and 2017.

He found dozens of cases where nursing homes failed to properly investigate and report neglect, abuse or possible abuse both physical and sexual.  The investigation found state inspectors cited nearly half of all nursing homes in the 5 county region for either failing to investigate and/or properly report possible abuse and neglect in 2016 and 2017. 85 facilities in all were cited.

Attorney Sam Brooks of Community Legal Services of Philadelphia said, “It’s not in the nursing homes interest to properly report issues and enforce regulations because it affects their bottom line.

Sam Brooks is a nursing home advocate who’s been investigating nursing home abuse. He says not only are facilities failing to report abuse or possible abuse, they do not adequately investigate.

He blames both nursing home staff and the State Dept. of Health that is responsible for overseeing them. He looked at every inspection report of nursing homes in Philadelphia from 2012-2014.

“We found 9/10 if you filed a complaint against the facility the Department of Health was not substantiating that complaint. So hundreds and hundreds of complaints were dismissed,” said Brooks. “What we were shocked by is over 3 years of complaints in Philadelphia we didn’t find one violation for sexual abuse or purposeful harm,” said Brooks.

Forbes had an article about the difficulty of relying on nursing homes to take care of our loved ones.  “When your loved one is admitted to a nursing facility, you are at their mercy. There is a significant imbalance of power in many ways and many families may find themselves feeling completely lost.”

We expect that the people with the most experience will hold our hands and help us through this difficult period, however, this is not always the case. Unfortunately, the situation for seniors continues to deteriorate and, as family members try to grapple with mounting issues it can take a toll on their relationships.

Poor Organization

One of the first things you should determine is whether there is a clear chain of command at the nursing home. Immediately find out who you should contact with all of your questions. If they rattle off different names in different departments, INSIST that you work with ONE person to avoid confusion. 

Not only are there a lot of moving parts in nursing homes but there may be a high turnover rate among employees. Who you spoke to yesterday may be gone tomorrow. As such, try to maintain contact with the highest level staff member and know who you need to go to as a backup.


In workplaces where employees come and go, you may notice that a lot of people are confused about their own roles. Whether the staff members are new, poorly trained or even disinterested in their job, this is problematic because you are relying on these people for information.

To combat this issue, again, try to discuss things with one person and document every single interaction. To make this easier, consider making email your primary mode of contact. You will have a written record of everything that has been said which may come in handy if a dispute ever arises (and it probably will).

Staffing Issues

Not to sound like a broken record but nursing homes really do struggle to keep employees, especially the good ones. You may quickly discover how much this affects the quality of care at many different levels.

From poorly maintained rooms to poorly maintained records, an understaffed senior residence can be a dangerous place but there may be little that you can do. Sadly, this isn’t an uncommon issue and seniors could be left feeling neglected. Be friendly with the staff and show them you are invested. This will send the message that you are kind but also vigilant.

Medical Malpractice

In the worst-case scenario, a nursing home resident can be physically or mentally harmed by negligent medical care. This, unfortunately, can have permanent consequences and may even result in their death.  As a result, the anger and pain that stem from these situations can tear a family apart. By being proactive, however, you can improve your odds of a better experience.

What You Can Do

I’ve mentioned it once but I’ll say it again – document EVERYTHING. Do your best to keep important conversations restricted to email but, if you do have an in-person discussion, you can always follow-up with that person and recap everything that was said. Again, this provides you with a paper trail.

Do some research and contact every senior resource in your area including the Department of Social Services, Medicaid, Medicare and everything in between. Get the correct information from the source and double-check anything the nursing home tells you.

You can also enlist the help of the local Ombudsman and/or an attorney that specializes in elder law. Not only can they help you navigate this confusing time in your life but they can be especially helpful if anything goes wrong.

No matter what, understand that this is going to be a stressful chapter in your family’s history. Any problems that already existed could easily deepen under these circumstances. Try to always give each other the benefit of the doubt, listen with an open heart and focus your energy on making memories with your aging loved one. Everything can change in an instant so make the most of every moment.

The Tribune reported the tragic consequences of allowing a nursing home resident to smoke without proper supervision and safety attire.

The father of a 55-year-old mentally impaired man living at a nursing home in San Luis Obispo alleges that staff there negligently gave the partially paralyzed and wheelchair-bound man a cigarette and lighter shortly before he was found in a patio area “engulfed in flames.”  Compass Health, Inc., owns and operates Mission View Health Center.

A lawsuit filed by Floyd Lewelling, on behalf of his son Jeffrey Lewelling, says that staff at Mission View  should not have given the man his own lighter nor left him alone in the designated smoking area.  They should also provide a smoking apron.

The Lewelling family seeks an unspecified amount of monetary damages for dependent adult abuse and neglect, negligence and violations of resident rights.

Fox2Now had a sad story about a nursing home resident covered in bruises with no explanation.  Bessie Wamsley is laying in a hospital bed covered in bruises and bumps. She has two black eyes, bruising inside her ear and marks on her face and neck. Doctors tell her family they don’t think she’s going to survive.  Her family is demanding answers as their grandmother lies in a hospital bed covered in bruises. The injuries occurred while she was in the care of Country View Nursing Facility in Bowling Green.

“The doctors kind of have the feeling that whatever happened to her lead up to the seizure and the stroke,” says Bella Avila.  The facility never notified her family that her grandmother was hurt because they don’t have power of attorney.  Staff later told them Bessie fell out of bed.

Police obtained Bessie’s medical records that show she was taken to the hospital for a fall on April 19 and was sent back to the nursing home. She says according to police, 10 days later she was sent back to Pike County Memorial and then flown to DePaul Hospital.

“Then the doctors and nurses came in to talk with us and said that if it happened on April 19, the bruising wouldn’t be that fresh,” she says.

“She can’t move. I don’t see her going out of bed. She can’t walk. She can’t be on her own let alone roll herself up,” says Jennifer Reeves, her other granddaughter.

This isn’t the first time the family has noticed injuries.

“She’s had many bruises before. They said she bumped it on the table or that she’s on blood thinners, so she bruises easily, and they always just kind of blew us off. We went up there before and she was missing a fingernail and we asked how and they said she slammed it in her drawer or something,” says Avila.

“I want my grandma back. I want justice for whatever happened. There’s other families that could be going through this and it’s not fair to them. We need answers,” says Reeves.


Fox4KC reported that Joy Titus is now banned from Redwood of Independence after filing a complaint against the nursing home last month about her husband’s treatment in the dementia unit. The state of Missouri is investigating the company running the nursing home which has a troubled history, including an ongoing wrongful death lawsuit.

Joy was forced to make a painful choice and sent her husband to the rehabilitation center just after Christmas 2016.

“The guilt is so overwhelming. It’s almost impossible to live with — that I’m not taking care of him myself,” she said.

But Joy felt good about the facility, knowing her mom had gotten good care there, as had a few family friends. It was an added bonus the facility was just 5 minutes from her home.  “I had no qualms about taking him there,” Joy said.

But she said things rapidly changed in April 2017 when Redwood Post Acute Network bought the place. In June, her husband escaped from a window and wasn’t found for hours.

“The care, just got to be less and less,” she said.

In November 2017, state and federal inspections and complaints reveal patients repeatedly missing medications. In one case, a diabetic patient didn’t get insulin for four days, and their blood sugar went extremely high. Staff took a “couple hours” before anything was done.

In March 2018, a wrongful death lawsuit was filed against Redwood after an epilepsy patient allegedly failed to get medicine and died.

For Joy, the last straw came two weeks ago when she went to visit Richard.  “I walked in, and he was naked from the waist down. In the middle of the hall. With four women in chairs, sitting there watching him, and he`s covered in feces.  And I hollered and hollered for help, and there was no help,” she said.  “My husband was saying over and over, ‘They hurt me. They hurt me. Get me out of here,’” Joy said.

Richard’s now in a new nursing home, and his outlook is already improving.  “He’s calm.  No anxiety attacks,” Joy said.

She’s now hoping others learn from her ordeal and is encouraging others to check online inspection reports from Medicare and the state before choosing a nursing home for your loved one. Then make regular check-up visits and report any concerns you have.


The L.A. Times reported on a state audit that shows that California health regulators allow poor care at nursing homes around the state, and the number of incidents that could cause serious injury or death has increased significantly in recent years.  The state auditor singled out the California Department of Public Health for specific criticism, saying it had not performed necessary inspections or issued timely citations for substandard care. The audit also found that the department’s nursing home licensing decisions were inconsistent and lacking in transparency.  We have the same problems in South Carolina.

In California, confirmed cases of substandard care at nursing homes statewide increased by 31% from 2006 to 2015, according to the audit. And incidents of nursing home noncompliance that caused or could have caused serious injuries or fatalities rose by 35% in the same period.  Safety and accountability problems at nursing homes across the United States are rampant. Federal inspection reports, for example, show that infection control is routinely ignored. At the same time, the Trump administration has scaled back the use of penalties to punish nursing homes that put residents at risk of injury.

The audit showed that in the vast majority of cases where investigators found problems that could severely harm patients, the public health department failed to cite or fine the facility involved.  The quality of care at nursing homes will be critical as baby boomers age and demand for these services grows.

The state audit also investigated three large private nursing home operators whose net incomes have skyrocketed over the past decade — from less than $10 million each in 2006 to between about $35 million and $54 million in 2015. The report confirmed that the owners of the three companies are increasing their profits by doing business with companies they own or in which they have a financial interest, and siphoning money away from patient care to these “related entities”.  The three companies, Brius Healthcare Services, Plum Healthcare Group and Longwood Management Corp., paid between $37 million and $66 million to related companies from 2007 to 2015, according to the audit.

Kaiser Health News found last year that about three-quarters of nursing facilities in the country outsource services to companies that they control or in which they have an interest.  The obvious and inherent risks of such arrangements are that owners will inflate their prices to increase cross-company profits, and that it is easier for commonly owned companies to engage in fraud and conceal it.

Michael Connors, with California Advocates for Nursing Home Reform, expressed alarm that nursing home operators are making such big profits by doing business with their own companies. Nursing home chains are using these deals to “siphon off money intended for care in order to pad and hide profits” — and that hurts residents, he said.

The Daily Beast had an article about the investigation into the nursing-home death of the father of Trump’s ex-security advisor H.R. McMaster Jr. in Philadelphia last month.  According to the Philadelphia Medical Examiner’s Office, 84-year-old H.R. McMaster died at Cathedral Village nursing home in Pennsylvania and suffered “blunt impact head trauma”. Philadelphia State Police have labeled the death “suspicious.”

The allegations are that McMaster Sr. did not receive proper care, according to 6ABC. McMaster supposedly fell, hit his head and was placed in a chair, then died, 6ABC reported. The senior was admitted to the facility after having a stroke, the station said.

“As soon as we became aware of the alleged incident, we began an internal investigation and contacted the appropriate authorities,” Cathedral Village said in a statement to CNN, adding the “safety” and “welfare” of the patients is the facilities “utmost priority.”

However, over the last two years, Cathedral Village has failed four state inspection reports, according to Pennsylvania Department of Health records.

Last January, an inspection report revealed that four nurses were working despite expired Nursing Assistant Certifications. Nearly six months later, the agency failed to follow a doctor’s requirement of applying daily gauzes on a patient’s surgical incision. According to observation reports, the patient’s sheets were filled with blood and “yellow and brown colored drainage.” A fetid odor was also emitted from the dressing area, records show.

Two years ago, the nursing home failed to provide one-on-one activities for a clinically depressed patient who also had a stroke, state records show. According to the report, the only activity the patient had was a “television in the room.” That year, the facility also failed to keep accurate clinical records, reports show.