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.”

Democracy Now had an article blaming deregulation and lack of enforcement on the 9 deaths at Rehabilitation Center at Hollywood Hills in the aftermath of Hurricane Irma.  Florida Governor Rick Scott has now directed the Agency for Health Care Administration to terminate the nursing home as a Medicaid provider.   It is incredible that Rick Scott blames everyone except himself.  See article at Miami Herald stating that Governor Scott deleted the messages from the nursing home begging for his help.

Scott gave out his number to nursing homes and assisted living facilities ahead of the hurricane so administrators could report concerns, according to a timeline released by Scott’s office. In the days following Irma, the staff at the Rehabilitation Center at Hollywood Hills called four times. But the messages they left the governor were ignored and then deleted.

New details about the nursing home include the fact a number of safety violations had already been reported at the facility, including two violations about its backup power capabilities—this was before the storm. However, Scott’s administration did nothing.

Unapproved work was done without city permits to the air conditioning and back-up generator systems.  City building officials say they discovered a temporary generator had been placed outside the facility and wired into the building without the necessary city permits.  The city also says officials discovered the air conditioning cooling tower was replaced without a permit — also a violation of the city’s building code.

Florida Power & Light refused to speed up its response to senior living facilities because Scott never listed nursing homes as critical facilities in power outages.

The main owner of the nursing home, Dr. Jack Michel, also has a history of running afoul of healthcare regulators. In 2006, the Justice Department fined another hospital that Michel runs, the Larkin Community Hospital, $15.4 million over civil fraud allegations.

“And it raises questions and concerns, not just about what happened in this particular situation, but how all nursing homes in Florida are regulated, and whether we’re going to require accountability and transparency, and whether nursing home owners, like the owner of this particular facility, that have a history of abuse should even be allowed to operate healthcare facilities. Certainly, things like putting them higher up on the FPL list and requiring facilities to have standby generators that would run air conditioning systems would make a whole lot of sense in a place like Florida. But there are broader questions about what we’re willing to allow nursing homes to get away with and what kind of accountability we want to have for the billions of dollars in public money that supports this industry.”

“The problem is that nursing homes are funded by our tax dollars; 70, 80 percent of the revenue that supports this industry is our money through Medicaid and Medicare. And it is simply not appropriate to have an industry that’s on the public dole. I mean, I would say we should question whether it’s appropriate to have an industry that takes care of frail elderly people that is run by for-profit corporations. But if we’re going to do that, then we have to have appropriate regulation that makes sure that staffing levels are sufficient to provide quality care and that nursing home operators are accountable for the money they receive and for standards of care. And that’s a problem that, you know, is not—that’s a day-to-day, 365-day-a-year problem, not just in natural disasters like this.”

“Most of the hands-on care that’s done in nursing homes is done by certified nursing assistants. And they, tragically, subsidize this industry through poverty-level wages and poor healthcare and retirement benefits. It’s a labor of love, but it is a crime that we ask our nursing home residents and our nursing home caregivers to subsidize the activities of for-profit corporations.”

The New York Post tabloid had an interesting article by Betsy McCaughey, a senior fellow at the London Center for Policy research and chairman of the Committee to Reduce Infection Deaths, about the  alert issued by the inspector general for the Department of Health and Human Services calls for urgent action. It cites incidents in 33 states where residents were rushed to emergency rooms because of rape, broken bones or severe neglect. The IG warned families to “visit your loved ones often” and “report potential cases of abuse or neglect to your local police.”

One out of every three Baby Boomers will at some point need a nursing home. Not necessarily for permanent living. Many will go for rehab after heart surgery or an orthopedic repair, never thinking the stay could turn deadly.

You can blame the indifference of hospital administrators and government officials for the frequency of these tragedies. When hospital patients are told they need to go to rehab, instead of straight home, the hospital hands them a list of facilities.

Beware. Some facilities have five-star ratings from Medicare, but others have only one or two stars, meaning substandard care. Hospital staff don’t tell you that.

What can families do? Complaining to the facility usually elicits “We’re short-staffed.”

The worst facilities appear on Medicare’s Special Focus probationary list. Still, facilities with numerous complaints stay open, filling beds with unsuspecting patients.

New Jersey enacted Peggy’s Law this month, imposing fines on employees who witness neglect or assault and fail to call police. It will empower caregivers to do the right thing. A similar bill awaits action in the New York Legislature.

Every state should pass such a bill. To spare patients the agony of living with abuse and dying from it.

NPR reported that serious cases of abuse and neglect are never reported to law enforcement.  More than 25% nursing home abuse are not reported according to an alert released by the Office of Inspector General in the Department of Health and Human Services.  The vast majority of the cases involved sexual assault.

That is an incredible stat considering that state and federal law require that serious cases of abuse in nursing homes be turned over to the police.  The alert notes that federal law on this issue was strengthened in 2011. It requires someone who suspects abuse of a nursing home resident causing serious bodily injury, to report their suspicion to local law enforcement in two hours or less.

Government investigators are conducting an ongoing review into nursing home abuse and neglect.  These are cases of abuse severe enough to send someone to the emergency room.  The only explanation for failing to report is that the facility is trying to cover up the abuse and avoid accountability.

The alert from the Inspector General’s office says that the Centers for Medicare and Medicaid Services (CMS), which regulate nursing homes, need to do more to track these cases of abuse. The alert suggests that the agency should do what Curtis Roy’s investigators did: cross-reference Medicare claims from nursing home residents with their claims from the emergency room. Investigators were able to see if an individual on Medicare filed claims for both nursing home care and emergency room services. Investigators could then see if the emergency room diagnosis indicated the patient was a victim of a crime, such as physical or sexual assault.

 

Republican Sen. Chuck Grassley has a long history of nursing home oversight and increasing quality of care for nursing home residents.  After the alert from the Department of Health and Human Services Office of Inspector General finding that 28 percent of 134 potential incidents of abuse or neglect in 33 states may not have been reported to law enforcement, as required, Grassley stated:

“A crime is a crime wherever it takes place. Abusing or neglecting nursing home residents are criminal acts. They have to be reported and investigated by law enforcement. It’s unacceptable for more than one-fourth of potential crimes in nursing homes to apparently go unreported. I intend to follow up with CMS to make sure the agency will take immediate action to fix this problem, as the inspector general recommends. The nursing home industry should do a better job of following the law. Nursing home residents, their families and the taxpayers deserve quality care and justice whenever crimes are committed.

The alert recommends the Centers for Medicare and Medicaid Services take immediate action to ensure incidents are identified and reported.

NJ spotlight reported the passage of “Peggy’s Law” which require nursing homes to notify the police within hours of suspected abuse — or staff must make 911 call if situation is an emergency.  This seems like it should have been required long ago.

Starting soon, elderly residents in New Jersey’s nursing homes and other long-term care facilities will benefit from additional protections designed to ensure law enforcement is looped into possible criminal abuse cases right from the start.

The measure is named for 93-year-old Peggy Marzolla who died several months after being injured while in the care of a nursing home in 2010.  Marzolla was treated for a broken eye-socket, cheekbones, and wrist, among other injuries, which nursing home staff blamed on an accidental slip and fall. Marzolla’s family didn’t accept the excuses she got from staff and was displeased with the state’s follow-up, leading her to lobby lawmakers to better protect seniors — a campaign she has continued ever since.

DHEC officials confirmed the agency is currently taking enforcement action against Brookdale Senior Living Facility in Charleston, where a resident died in July 2016 after wandering away and being killed by an alligator.

The action comes as a result of violations cited during a series of recent inspections and investigations, according to DHEC’s spokesman Robert Yannity.

According to DHEC’s website, when an agency takes enforcement action against a facility, administrative staff are called to attend a conference with DHEC officials to go over the violations and discuss corrective actions.

If DHEC and the violating facility come to terms, a mutually agreed upon “Consent Order” is issued outlining the actions which must be taken, and DHEC’s expectations.