Category Archives: Staffing

 North Carolina has substantiated claims that a nursing home mistreated a resident after a daughter secretly recorded staff insulting her father.  Knapton said she placed a camera in her father’s room after he told her that staff routinely insulted him. She also suspected she wasn’t being told about all the times her father, who had had a stroke, had fallen out of bed.  The hidden camera Rebecca Knapton placed in her father’s room at Universal Health Care/North Raleigh captured staff belittling him after he had fallen out of bed and was calling for help.

ichard Johnson, 68, is recovering from a stroke, and video from the hidden camera shows that he fell out of his bed early on April 10. It took more than an hour for staff to respond, and they berated him when they did.

“Man, you stink,” one worker told Richard Johnson as he lay on the floor. He told them he fell trying to get to the bathroom.  One worker told the 68-year-old that he shouldn’t complain about lying on the cold floor.

“You were on the bed, you decided to go on the floor, so that’s your fault,” one worker said. “You decided to go on the floor, so don’t complain that it’s cold.”

“How old are you? You’re supposed to be enjoying your retirement. Instead, look what you are doing, pooping on yourself. Shame on you,” a staff member says.

At one point a worker told him that his suffering was his own fault. “You must have done something really, really bad,” she said.

Knapton said her father told her, “they talked down to him, they treat him mean, they call him names, they fuss all the time.”

A state investigation triggered by Knapton’s complaint pointed out problems with the care of other patients.

According to documents Knapton received, surveyors for the state Division of Health Service Regulation interviewed staff and residents and reviewed document at the nursing home from April 10-15.

One patient complained of chest pain for two days, but there was no indication that he received nitroglycerin as the doctor ordered, according to the state report. The man was sent to the hospital on the second day. Hospital records show a nurse saw him at 1:30 p.m. in the emergency room, and that he died about four hours later. However, a nurse’s record at the nursing home had the man leaving for the hospital at 7 p.m.

The N.C. Department of Health and Human Services said that the Centers for Medicare & Medicaid Services will initiate enforcement action and notify the facility.

Steven Bryant recorded a recent visit he made to Universal Healthcare of Lillington to see his 82-year-old mother. Sudie Bryant had complained of the care she had been receiving, he said, so he wanted to document what happened while he was there.  Sudie had been lying in a puddle of urine for so long that it had turned brown.

“Sir, I’ll be honest with you. We’ve been doing our best,” an aide said. “It’s just two [aides] in this hall, and honestly, we’re doing the best we can.”

As one aide leaves to get an administrator, the other explains staff cutbacks are the problem.

“I am glad that you are here to see it because we tell them time and time again that it’s too much, too much,” she said. “They don’t listen to us. We need the families to complain. We need families to see how it really is.”

Choice Health Management Services has 16 facilities in North Carolina, most operated under the Universal Healthcare brand. Medicare has levied fines totaling $567,976 for problems at six of the facilities since 2015.

Universal Healthcare Fuquay-Varina topped the list, with $234,260 in fines, followed by Universal Healthcare Lillington, with fines of $151,483. Universal Healthcare North Raleigh was fined $31,186 two years ago, the smallest fine against any of the six facilities.

The Raleigh facility has a history of repeat federal violations for insufficient staffing and failing to answer patients’ call bells in a timely manner.

The fines assessed against the three Universal Healthcare facilities in the Triangle combined to top the $246,000 in fines Medicare levied against 22 other nursing homes within a 25-mile radius of Raleigh in the past three years.

The incident at Universal Healthcare Lillington, where a man recently recorded a video showing improper care for his mother, involved a patient infested with maggots.

A doctor from an outside clinic found “maggots living in a wound on the resident’s foot” when he removed the patient’s shoes, according to a report. An aide at Universal Healthcare told investigators she discovered the maggots the previous day and went “screaming out of the room” without taking further action.

Universal Healthcare of Fuquay-Varina was fined after a resident at risk for wandering walked out the front door and across the parking lot. Inspectors checked all of the bracelets worn by at-risk patients to alert staff if they were about to wander off and found that none of them worked, according to a report.

“That’s ridiculous,” Powell said when he heard about the issues at Universal Healthcare facilities. “I am at a loss for words. I got to find a place to move my mom.”

See more information at WRAL, The News & Observer, and WFMY.

In 2016, the Labor Department sued Bridgeport Health Care Center and Bridgeport Manor and the nursing home’s chief financial officer, Chaim Stern, alleging they funneled $4 million from the facility’s retirement plan to themselves and a religious organization.  The feds alleged Stern diverted at least $4 million in plan assets to Bridgeport Health, himself, and Em Kol Chai, a New York-based Jewish organization that lists Stern as its president and trustee.

Workers accused Stern of failing to pay them on numerous occasions and failing to pay the company that manages their healthcare benefits. The nursing home filed for bankruptcy April 18 leaving many workers high and dry.  The 240-bed facility has a two-star rating on Nursing Home Compare and had been dinged for a high number of days without registered nurse staffing.

A spokesperson for the U.S. Attorney’s Office confirmed to News12 that “federal law enforcement activity” was taking place at the nursing home, but would not say which federal agencies were involved.  A warrant was served and the FBI, Department of Labor staff and others were on the scene raiding the facility’s administrative offices.

Alex Spanko is the Assistant Editor at Aging Media Network and covers the skilled nursing and reverse mortgage industries for Aging Media.  He wrote an interesting article on Georgia’s new law on background checks for Skilled Nursing News.  The new law will subject the owners and management to the same requirements as direct care caregivers and other employees who provide treatment and services to the  residents. But the threshold for who qualifies as an owner remains unclear.

“Employees, owners, and administrators will be required to undergo fingerprint background checks starting October 1, 2019, according to an analysis of the law from the firm of Arnall Golden Gregory, LLP. That check involves a search of the FBI’s registry, and long-term care stakeholders will also be required to submit to a check of Georgia’s sex offender registry — as well as those of states where the applicant or potential owner lived in the previous two years.”

Unfortunately and bizarrely, who the nursing home designates as an owner, however, will be largely up to interpretation.  The law exempts so-called “passive investors” who control the operations but do not admit to directly overseeing the operations at a facility.  For example, an owner is defined as someone with a 10% or greater ownership stake who, among other things, “purports to or exercises authority of a facility,” has an office on site, can directly access the building, or who even agrees to buy a specific facility.

“Most surrounding states use the FBI’s fingerprint-based national background check to screen prospective employees seeking work at long-term care homes,” the government-sponsored group wrote in its report. “This ensures that applicants who are convicted of a crime that makes them ineligible to work in such homes do not move to an adjoining state and obtain employment in a facility.”

But Georgia only used a name-based system that searched for crimes that occurred within the state’s borders, a structure that concerned the members of the council — which include state lawmakers, judges, and the executive counsel to Gov. Nathan Deal.

“In 2017, the council learned that there are approximately 25,000 employees in more than 10 different facility categories that provide care for the elderly and are subject only to the name-based background check,” the members wrote.


WSLS ran an article on the epidemic of bullying in today’s nursing homes.  Around the U.S., caregivers say they’ve seen gossip, exclusion and even incidents of physical violence popping up.  Arizona State University professor Robin Bonifas says for some who see their independence and sense of control disappear late in life, bullying gives them a feeling of regaining lost power.  Bonifas, a social work professor at Arizona State University and author of the book “Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic,” said existing studies suggest about 1 in 5 seniors encounters bullying. She sees it as an outgrowth of frustrations characteristic in communal settings, as well a reflection of issues unique to getting older.

Every month, as many as 20 percent of older Americans who live in nursing homes are subjected to seriously bad behavior from one of their fellow residents, such as physical and verbal abuse, privacy invasions or unwanted sexual attention. “The findings suggest that these altercations are widespread and common in everyday nursing home life,” says study co-author Karl Pillemer, Ph.D., professor of gerontology in medicine at Weill Cornell Medical College in a press release.

Nationwide, that translates to hundreds of thousands of people who endure abuse. Many incidents of name-calling, bossy behavior, loud arguments and, at its most extreme, physical violence go unreported.


The Marietta Daily Journal had an article about the prevention and treatment of scabies in nursing homes.  The article explains that members of the Cobb Elder Abuse Task Force met in May to discuss how and why contagious illnesses like scabies occur at senior homes.

Scabies is caused by microscopic mites that burrow into the skin and lay eggs. It can be spread without precautions in place by prolonged skin-to-skin contact and often manifests as an intensely itchy rash.  According to the Centers for Disease Control and Prevention, nursing homes and extended-care facilities are often the sites of scabies outbreaks because they have a large number of people in close contact.

Scabies should not typically be fatal on its own, however untreated scabies can lead to bacterial infections that can be fatal, especially among the elderly.  Nursing homes can be found negligent in failing to recognize the infestation and by allowing the disease to progress so far that it injures the residents. If properly recognized and diagnosed, it can be treated with a simple prescription lotion or cream, according to the CDC.

MyPalmBeachPost reported that Eva Mae Rhodes died a painful wrongful death at age 98 after caregivers at Lakeside Health Center nursing home left her outside unattended where she blistered and baked in Florida’s sun.  Rhodes was transferred to the hospital with a temperature of 103.2 degrees, suffering from heat stroke, severe dehydration and second-degree burns on her shoulders, arms and mouth. An investigator for the Florida Department of Children and Families concluded inadequate supervision was to blame. After Rhodes died two weeks later, the Palm Beach County Medical Examiner listed her cause of death as “hyperthermia” caused by exposure to the sun and heat.

The family filed a lawsuit to make sure that this doesn’t happen to other vulnerable adults.   “The message I want to send is we will not tolerate the abuse of our elderly,” CandaceMcKinley told reporters. “I’m mortified that nothing more has been done.”

Lakeside Health Center is owned and operated by the national for profit nursing home chain Life Care Centers of America.



New Jersey legislators are introducing a bill that would require nursing homes to increase staffing of certified nurse aides to a safe level. New Jersey requires nursing homes to provide 4.1 hours of care per resident each day, with additional rules for specialty care units. Assembly bill 382 would set a ratio of one CNA for every 8 residents during the day; 1:10 during the evening; and 1:16 overnight.

The proposal was supported by caregivers, consumer advocates, and experts.  The nursing home industry claims that increasing staffing will hurt their profit margins.

The Assembly Human Services Committee advanced a bill to establish specific staff-to-patient ratios. It would enact regulations supporters say are on par with staffing levels already in place in other states. The bill would not affect requirements for LPNs, RNs or other nursing home employees.

In her testimony, SEIU vice president Milly Silva told committee members their state ranks 44th in the nation for staff-to-patient ratios.

“These statistics are alarming and should serve as a wakeup call,” she said.

WFAA had an article about the continued use of dangerous medications to chemically restrain nursing home residents.  See Part 5 (See Parts 123 and 4 of WFAA’s continuing investigation of nursing home abuse and neglect.)  Despite the FDA’s warning to stop using anti-psychotics for dementia patients, the majority of nursing homes still uses them — more than 25 percent of the residents continue to take them for uses not approved by the FDA.

The story begins in 1993. Risperdal had just gained FDA approval for use in treating schizophrenia and bipolar disorder. But that’s a relatively small market. Dementia patients, however, comprise about half of nursing home residents.

Federal and state attorneys argued that Johnson & Johnson “developed a scheme to turn the drug into a blockbuster,” court documents show. In testimony, the attorneys claimed Johnson & Johnson used Texas as the “model state” to promote the drug “locally and nationally.”

The goal, according to federal and Texas attorneys: Get doctors to prescribe Risperdal over other drugs and for conditions – like dementia – for which it was not FDA-approved. It’s known as “off-label use.”

An off-label use of a drug is not illegal,” said Michael Elliott, a former assistant U.S. attorney who specialized in health care fraud. “What is inappropriate is for a drug company to market that drug for off-label uses.”

Texas court records and exhibits show Johnson & Johnson recruited influential doctors like Steven Shon, then medical director of the now defunct Texas Department of Mental Health & Mental Retardation. Texas Attorney General attorneys alleged Johnson & Johnson “made a series of illegal payments to Dr. Shon that effectively turned him into a salesman for Risperdal,” court documents show.

Dr. Shon testified in the case that the money did not influence him.  Sure….

The company also paid lucrative fees to a major pharmacy provider to promote the drug in nursing homes, court documents show.

Despite the FDA’s warning that using Risperdal to treat elderly dementia patients was dangerous, business plans in federal court filings show Johnson & Johnson created a sales force they called “ElderCare.”

The alleged objective? Target dementia patients, federal court records show.

From the late 1990’s to 2004, sales reps made thousands of calls promoting the drug “as safe and effective” for treating “behavior problems” in elderly dementia patients, court documents show.

As a result, court exhibits show, domestic sales of Risperdal increased from $892 million to $2 billion per year.

According to Johnson & Johnson’s own market research, as much as “75 percent of the prescriptions for Risperdal were for off-label uses.”

ABC reported the horrific neglect suffered by Val Simpson, a nursing home resident at The Tinonee Gardens The Multicultural Village, because of cost-cutting and under-staffing in the facility.  To the facility’s credit, it has acknowledged it failed Simpson, who was in its care before she died last year.  The Australian Aged Care Quality Agency said the home’s failures at the time placed, or may have placed, the safety, health or well-being of residents at risk.

Ms Simpson’s daughter Sharon Dodd said remembering her mother’s last days was almost too hard to bear.  “Just the level of neglect and watching mum being in a bed of urine and faeces … the placement certainly didn’t provide her with the care she deserved,” Ms Dodd said.  Staff at Tinonee have told the ABC incontinence pads were limited to three residents per day and nappy rash cream always needed to be on hand.

Ms Simpson’s lack of oral care was also upsetting. Her mouth was at times dry, cracked and shrivelled with filth.

A close-up of an old woman's dehydrated mouth.
“It was really shrivelled up and she had lots of things that looked like warts on her tongue,” Ms Dodd said.  “She could hardly respond to me because her mouth was so dry.”

Her granddaughter, Kelsey Moss said she had been horrified by what she had seen.  “There was food left in her mouth and she was left to try and swallow on her own … the outcome could have been much worse,” Ms Moss said.  “She was thirsty, wanting to go to the toilet, never hungry, but definitely neglected there.”

Ms Dodd said her mother had been in so much agony, staff put her behaviour down to anger management problems, before giving her a sedative.  “If they knew anything about UTIs and how they change your personality, they would have known she had a UTI, instead of the anger issues,” she said.

Simpson also suffered regular falls while she was at Tinonee, which left her family concerned about unexplained bruising.

She also went missing one cold winter’s night, and was discovered hours later on all fours, disoriented in the home’s garbage collection area.

“It wasn’t until the kitchen staff came out and put the garbage away that they knew Mum was out there, not even knowing how to stand up,” Ms Dodd said.



WRAL News has learned the state is investigating allegations of abuse at Universal Healthcare North Raleigh nursing home that wee caught on video.  Rebecca Knapton, the patient’s daughter installed a hidden camera after her father complained about how he was being treated.

Knapton contacted WRAL News after seeing the video that was captured in her father’s room. According to the facility, staff members have been fired, but that doesn’t make the video any easier to stomach.

The video starts at about 4:20 a.m., when Knapton’s 68-year-old father, who is recovering from a stroke, slips off the bed. The volume on the TV is loud, but he can be heard calling for the nurses over and over.  He is on the floor for more than an hour before someone walks in at 5:25 a.m. She looks over the bed and walks out without speaking or checking on the patient.

The patient continues to call out for help.  It takes another 15 minutes for staff members to return. Instead of helping him, they start questioning him.

“What are you doing there,” a staff member says. “What are you doing on the floor?”

“I need help,” Knapton’s father replies.

The patient tells the staff that he had to go to the bathroom, but had an accident while waiting. The staff proceeds to change him on the floor, even though he repeatedly tells them he’s cold.

You were on the bed. You decided to go on the floor, so don’t complain that it’s cold,” a staff member says.

The same staff member even faults the patient for having a stroke.  “You had to do something very wrong with your life. What did you do? You’re suffering so bad, so you’ve done something wrong. Yes, you did,” the staff member says.

At around 5:40 a.m., after nearly two hours on the floor, the nurses finally lift Knapton’s father into the bed, but the berating continues.

“How old are you, one? You’re supposed to be enjoying your retirement. Instead, look what you are doing, pooping on yourself. Shame on you,” a staff member says.

The shaming continues as a staff member pulls the pillow from under his head, and with it more of the patient’s dignity.

“Shame on you. Shame on you,” the staff member says.

Choice Health Management Services, the parent company of Universal Healthcare North Raleigh, released a statement which said, in part:

“As soon as the facility became aware of the family’s allegations, an investigation was initiated. We understand the family’s concern and regret that this occurred. The staff involved were terminated for their inappropriate conduct. The remaining staff received additional in-service training.”