WFAA had a troubling investigative report on the care provided at nursing homes in Texas.  Part One is here.  Part Two investigates the nursing home industry hiring criminals to care for our loved ones.  A six-month WFAA investigation found 200 aides certified to work in North Texas nursing homes have serious or violent criminal histories.

The most troubling part is that current regulations in Texas allow many certified nurse aides (CNAs) with criminal histories to work in nursing homes legally.  The WFAA investigation found CNAs who have been “convicted of crimes that should make them ineligible to work, yet slipped through the regulatory cracks — and continue to remain state certified and employable.”

The WFAA review found CNAs with arrests for crimes that include the following: aggravated assault with a deadly weapon; continuous violence against family; injury to a child; abandoning a child; aggravated robbery; aggravated sexual contact with a child; and burglary.

There are three major oversight flaws, according to the WFAA findings.

Loophole 1: Inadequate initial background checks

The first involves the initial certification.

The state requires DPS to conduct a criminal background check prior to an applicant being certified. That’s different from Texas requirements in other industries, for example, like child daycare in which a national background check using fingerprints is required.

The WFAA review found the DPS checks apparently fail to uncover various state convictions. That’s resulted in nurse aide applicants getting certified, though they should be barred for life.

Loophole 2: No background check on re-certification

A second flaw appears in the re-certification process. The state requires a nurse aide to get re-certified every two years, yet does not require regulators to re-check a CNA’s criminal background.  Instead, any further background checks fall to the nursing homes.

WFAA found individuals who commit crimes that should bar them from work – and have their certification pulled – yet remain certified and employable.

Loophole 3: Deferred adjudication probation

The third and most common loophole WFAA found is buried in the state’s regulations. It says if you commit a serious or violent crime, you are eligible to become a CNA as long as you don’t have a “final conviction.”  WFAA found dozens of nurse aides who pleaded guilty to violent crimes. But since they got probation, the law allows the nursing homes to keep hiring them.

That means a nurse aide can commit a serious or violent crime, gain deferred adjudication, and successfully fulfill the terms of their probation, to avoid a “final conviction.” The individual, though often pleading guilty to a serious or violent crime to gain probation, remains eligible to be a CNA.

This can be very dangerous to any resident but especially those with dementia.  At minimum wage, a nurse aide must clean, bathe and feed as many as 30 residents at a time. That’s compounded by Texas’ lack of minimum staffing level requirements.

They have dementia, Alzheimer’s, symptoms that cause them to have a lack of communication,” said Ernest Tosh, an attorney who handles nursing home abuse cases across the United States.

They can’t express exactly what happened, which is why violent offenders should be screened out from working in these facilities,” Tosh said. “They can physically or sexually assault an individual and there be no repercussions because that individual can’t identify them or communicate what happened.”

I think our state needs to recognize that nursing homes are not as poor as they claim to be,” said J.T. Borah, an attorney who specializes in nursing home abuse and neglect. “If the industry were to finance and staff at the level they were supposed to, they could afford better employees. They could have better applicants.”

 

CBS12 Investigates uncovered reports of true horror stories happening at nursing homes across the country that should have been reported to law enforcement.  These cases include life threatening falls, starvation, even sexual assaults that were not reported.

 “We found that CMS, the Centers for Medicare and Medicaid Services didn’t have adequate controls in place to detect these potential instances of abuse or neglect,” said Curtis Roy, Assistant Regional Inspector General for Audit Services, OIG.

“CMS acknowledged that that they are not doing the data match to identify cases of neglect,” added Roy. “They also acknowledged that they have not identified any instances of nursing home staff not reporting cases as required.”

The audit found 38 cases that were so bad, by law the nursing homes were required to contact local law enforcement. But, they didn’t do it.

CMS must initiate protocols to adhere to a long-standing federal statute that requires nursing homes to report abuse cases to police and other state agencies immediately or risk fines of up to $300,000.

“They don’t care about those fines,” explained attorney Joe Landy. “It is business as usual. It is cheaper to pay those fines to keep these facilities understaffed with people that are not properly trained while they make record setting profits.  “It exposed what is a long-standing problem in Florida,” said Landy. “It exposed a nursing home that was making a huge amount of money with no accountability whatsoever.”

The Sun Sentinel had a great article on new reforms to increase safety in Florida nursing homes.  A dozen bills to reform nursing homes are under consideration in the Florida Legislature after 14 people died at a Hollywood, Florida, nursing home that lost power during Hurricane Irma.  Many of the bills require nursing homes and assisted living facilities to have generators capable of powering air conditioning in the event of a power loss.

The latest give new teeth to Florida’s Long-Term Care Ombudsman program, which records show has regularly turned up fewer complaints each year under Gov. Rick Scott.  The Ombudsman program, which is supposed to look out for residents in Florida’s 683 nursing homes and thousands of assisted living facilities, would be allowed to conduct undercover operations inside nursing homes, posing as patients or employees, to look for abuse and neglect.

The big boost to the state Ombudsman program is unique among the many bills. Another novel portion requires facilities to allow residents’ families to monitor them electronically as a safeguard against abuse.

The multitude of other bills includes:

SB 284: Filed by state Sen. Lauren Book, D-Plantation, this bill requires nursing homes and assisted living facilities to have generators that can power air conditioning in the event of a loss of power, and requires the Agency for Health Care Administration to conduct an unannounced inspection at least every 15 months to check and make sure the generator is in working order. The bill requires facilities to have enough fuel to power generators for five days.

HB 479: Filed by state Rep. Patricia Williams, D-Lauderdale Lakes, this bill requires an unannounced inspection by AHCA every four months. It also requires nursing homes and assisted living facilities to have generators to power air conditioning and enough fuel to last for five days.

HB 327: Filed by state Rep. David Richardson, D-Miami Beach, this bill requires AHCA to carry out an announced inspection each May before hurricane season and requires facilities to have generators that can power air conditioning and enough fuel to last four days.

SB 372: Filed by state Sen. Rene Garcia, R-Hialeah, this bill would require generators to power air conditioning and enough fuel for four days. It also requires AHCA to carry out an announced inspection in May before the start of hurricane season. Additionally, it requires the Public Service Commission to ensure that utility companies treat nursing homes and assisted living facilities with at least 50 residents that offer critical medical care as high priorities, similar to hospitals.

HB 443: Filed by state Rep. Emily Slosberg, D-Boca Raton, requires nursing homes and assisted living facilities to have current contact information on file with both residents and the state Long-Term Care Ombudsman. It also mandates that residents be allowed to access personal records on file at the facility.

SB 830: Filed by Farmer, this bill is identical to HB 443.

SB 558: Filed by state Sen. Daphne Campbell, D-Miami, this bill requires all health care facilities that provide overnight care — including nursing homes and assisted living facilities — to have generators that can power air conditioning and enough fuel for four days. The generators must be able to maintain conditions throughout an entire facility.

HB 435: Filed by state Rep. Larry Lee, D-Port St. Lucie, this bill establishes a matching grant program, funded with $5 million every year through 2023, so that facilities buying generators can get a dollar-for-dollar matching grant from the state on a first-come, first-serve basis. The grant is open to both public and private facilities.

HB 437: Filed by Lee as well, this bill requires facilities to have generators and enough fuel for seven days.

HB 331: Filed by Slosberg, this bill adds new language to the state’s patients bill of rights, requiring facilities to send an explanation for any relocation in writing to both a resident and the Long-Term Care Ombudsman.

 

U.S. News reported that fire sprinklers inside a southeastern Idaho nursing home did not activate when a blaze erupted last weekend.  All of the 49 patients were evacuated and several were treated for smoke inhalation.  The fire likely started in the attic of the facility and was possibly sparked by a malfunctioning light fixture, authorities said.  The State Fire Marshal’s Office and the Pocatello Fire Department are investigating the cause of the fire that destroyed the Safe Haven Care Center, the Idaho State Journal reported .

The facility was equipped with sprinklers but none activated during the blaze. “We are investigating why the fire suppression system didn’t operate as expected,” Smith said. “There is a question of whether or not the fire suppression system was turned on, and there are also some questions about whether or not the fire suppression system had some parts of it that were abandoned.”

 Department of Health and Welfare officials inspected the sprinkler system in August 2016, finding the facility did not maintain the system in reliable operating condition.

Nationwide, eviction is the leading complaint about nursing homes. In California last year, more than 1,500 nursing home residents complained that they were discharged involuntarily. That’s an increase of 73 percent since 2011.  NPR reports on AARP’s lawsuit against the illegal practice.  Nursing home residents have a lot of rights guaranteed in state and federal law. For example, they have to be given 30 days’ notice before they’re moved involuntarily. And the nursing home has to hold their bed for a week if they’re in the hospital.

The legal wing of the AARP Foundation asked the federal government to open a civil rights investigation into the way California deals with nursing home evictions. Now, they’re suing Pioneer House and its parent company. It’s the first time the AARP has taken a legal case dealing with nursing home eviction.

The California Long-Term Care Ombudsman Association joined the lawsuit as a co-plaintiff. The organization represents long-term-care ombudsmen. Those are the public officials who track complaints about nursing homes and advocate for residents. But Leza Coleman, the group’s executive director, says the spike in complaints about evictions is so overwhelming, that it’s “impacting our ability to handle other complaints.”

Forbes had an interesting article about nursing homes “dumping” residents.  This problem is only getting worse because it is becoming common corporate policy to evict low-income residents to make room for more lucrative Medicare or private pay residents. In other words, they dump Medicaid people so they can make more money on other residents who are paid by better sources than Medicaid.  Some elders are low income and receive Medicaid. Some live in nursing homes, as they need full time care. Medicaid recipients are vulnerable and can be subject to terrible treatment, including being kicked out of a home just because they have to get temporary treatment at a hospital.

“It is disgusting to think that a nursing home will not only violate the law in refusing to allow its own resident back into the home after going to a hospital, but it will callously separate spouses by doing so. Neither has the luxury of choice. One spouse can stay while the other gets the boot?”

The AARP Foundation, the affiliated charity of AARP, is fighting for the residents to stop this despicable practice.  According to Foundation attorney Kelly Bagby, a clear legal right to return to the place where she lived exists, and should be enforced by the state health agencies. The law prohibits it and the law is ignored.

If your own aging loved one is ever mistreated, threatened with being evicted or dumped from a nursing home, know that he or she has rights that can be enforced. The place to start is with the Office of the State Long Term Care Ombudsman. The ombudsman is assigned the task of being the liaison between the facility and the resident or resident’s family.

The Telegram reported the Aug. 7 death and cover-up of Walter E. Haddad.  State and federal agencies investigated the suspsicious circumstances surrounding the death of Haddad who died after he fell and hit his head, and nursing home staff covered up the fall rather than send him to the hospital.

The report said that after hearing a loud thud about midnight on Aug. 6, a certified nurse assistant and a licensed practical nurse found Mr. Haddad lying on the floor and they put him back in his bed.  No assessment by a registered nurse was done. The CNA told investigators that he did not report the fall, as required by the facility, because the LPN had asked him not to.

“However, staff did not complete a thorough clinical evaluation or neurological assessment on (Mr. Haddad), which resulted in a delay of transfer to the hospital for evaluation of possible injury,” investigators said in the report.

Mr. Haddad’s daughter, Lorna Haddad, took issue with the report. She said staff should have been more careful because they knew that her father, who helped found the nursing home, had a history of falls. The retired accountant had moved into the nursing home last year, after Parkinson’s disease left him prone to falls. She said notification of his fall risk was posted throughout his area of the facility.

“I think the report is meaningless,” she said. “The fact that he didn’t have an alarmed bed or an alarmed chair is alarming.”

The report in general said professional standards of quality were not met because of the actions or inactions of the staff.  Every time a patient falls, injury or not, they’re required to call the physician and the patient’s family.

The morning after he fell, Mr. Haddad told several staff about the incident. The only thing that they did was to give him Tylenol. When Mr. Haddad’s family came to visit, he told them that he had fallen the night before and hit his head. Staff told the family that there was no report of a fall and that Mr. Haddad may have been mistaken or confused. When his speech became slurred and he complained of neck pain, he was taken to the trauma unit at UMass Memorial Medical Center, where he died.

The Santa Fe New Mexican reported that Casa Real nursing home in Santa Fe owned and operated by Preferred Care Partners Management Group has at least temporarily improved persistent quality-of-care problems enough to resume billing Medicare and Medicaid for newly admitted residents.  Casa Real is one of only two homes in Santa Fe that accept Medicare and Medicaid patients.

For more than two months, Casa Real had been barred from charging Medicare or Medicaid for new residents after the Centers for Medicare and Medicaid Services found the nursing home wasn’t in compliance with federal care standards.

Inspections this year turned up a long list of problems, including medication errors, expired food and drugs on shelves, unreported resident injuries and assault, poor care of bed sores, nursing understaffing and inadequate safeguards against the spread of dangerous infections.

The former director of nursing at Casa Real from May to August has accused management of forging patient records in an attempt to show the facility was in compliance with care standards dealing with monitoring of medication effects on residents.  Of course, she was soon fired.

The August inspection found residents weren’t receiving medications as directed by their physicians and that the nursing home wasn’t doing enough to ensure that residents didn’t receive unnecessary drugs, including psychotropic medications.

The federal agency in May designated Casa Real as a “special focus facility” because of its poor record of complying with care standards, and it said the nursing home would be subject to more frequent inspections. The designation is given to the nation’s poorest-performing nursing homes and is meant to address the “yo-yo” problem of facilities routinely falling in and out of compliance with care standards.

The state Attorney General’s Office is suing Preferred Care, alleging it has defrauded Medicaid by having insufficient staff to meet the needs of residents at its Santa Fe nursing homes, as well as its facilities in five other New Mexico communities. Preferred Care has denied the allegations.

The Hill had an article on the False Claims Act.  The FCA authorizes private individuals to sue anyone they think is defrauding the federal government. Individuals filed more than 4,700 FCA actions between 2009 and June 2016. The Act provides for treble damages. The spoils are divided among the person alleging the fraud, his attorneys, and the federal government. In 2014, the Department of Justice reported that FCA “recoveries” totaled $5.79 billion. Health care lawsuits accounted for $2.3 billion of that.

The federal government must investigate the claims in every FCA case. The initial investigation is done under seal. Defendants may be investigated for years, but not know about it until their business documents are subpoenaed. The individual alleging fraud can proceed with a case even if the government decides against it.

Increasingly sophisticated groups of attorneys choose to continue. They sue any entity that receives federal payments, claiming that the failure to comply with administrative standards constitutes fraud. At the time the act was passed, the goal was to prosecute fraud cases in which a contractor billed the United States for nonexistent or worthless goods or services.

 

The Tampa Bay Times reported the omission of information in Florida’s investigations into nursing home abuse and neglect complaints. In the past year, Governor Scott’s Agency for Health Care Administration has purchased and employed new redaction software that removes key words, dates and descriptions from the inspection reports posted online and used by the public to monitor conditions at the 683 nursing homes and more than 3,100 assisted-living facilities in the state.

For family members that want information about what state regulators know about a nursing home, Governor Scott has increasingly made access to that information harder to get, said Brian Lee, the head of a national watchdog group called Families for Better Care.  “There’s no rhyme or reason to it,” Lee said. “They are so indiscernible now, they’re almost useless. If the feds can put this same information on its web site, why can’t the state? It’s a favor to the industry by the Scott administration.”