The Conservative Review had an article by Logan Albright, a researcher for Conservative Review and Director of Research for Free the People, on the AARP’s multi-year investigation into the practices of America’s nursing homes. Below are excerpts:

In an alarming number of cases, elderly residents have been given powerful and dangerous drugs without their consent. In addition to the illegality and the moral transgressions against the residents’ autonomy, in some cases this practice has had deadly consequences.

Antipsychotic drugs are routinely used in nursing homes, often without good reason. According to research from the University of California, San Francisco, up to one in five patients in 15,500 nursing homes has been inappropriately prescribed a dangerous drug.

Patients are simply an inconvenience to staff, and keeping them drugged up makes them more manageable.  The pretense of “medical care” is used to give legitimacy to what would otherwise be a crime.

American society is now at a stage in which unproven allegations of mental incompetence can be used to rob our fellow human beings of their liberty and their dignity, with only the opinion of a so-called expert required to do so. And while the legal team of the AARP has won some commendable victories in exposing wrongful death and mistreatment of the elderly, these cases only scratch the surface of the deeper problem.

The elderly do not cease to be human. Their rights are not forfeited when they reach a certain age. That they should be so misused against their wills is a damning indictment of a system that ought not be possible in “the land of the free.”

 

The Dallas News and WISHTV had articles on the malicious treatment of residents at Windsor Nursing and Rehabilitation Center of Duval.  A nursing-home employee recorded an elderly woman being made to rub feces on her face and shared the cruel video on social media. Footage shared on Snapchat shows someone tickling the woman’s nose as she sleeps, causing her to rub her face, KXAN-TV reports. Her hand appears to be smeared with feces. A second photo shows someone tickling the sleeping woman’s nose with a tissue or feather apparently prompting her to reach up and touch her own face with her dirty hand, which a third photo also shows.

Jasmyn Long, who saw the videos Monday, told KVUE-TV that she knew the man who posted them.  “I really can’t believe there are people out there that find that kind of stuff amusing,” Long said. Long said she responded to the man, who told her he wasn’t worried about losing his job.

A fiery online exchange shows someone offended by the pictures writing: “Imagine if that was your parents…”

The employee responded: “Who gone make me loose [sic] my job surely not you!” When KXAN went to the man’s home, his family said they had no comment.

Then a young man came back outside, responding to KXAN’s questions about the man’s whereabouts and if he would answer why the photos were posted.

“He’s sleeping. We don’t have time for that,” the man said.

The Texas Department of Aging and Disability Services said that the center had notified it of the incident.

 

 

 

 

McKnights reported that Centers for Medicare & Medicaid Services (CMS) are directing nursing homes to submit of payroll based journaling data well ahead of the May 15 deadline in order to catch errors. Providers will have until that date to submit data for the fiscal quarter lasting from Jan. 1 to March 31, 2017.

CMS staff told attendees of the Skilled Nursing Facility Open Door Forum call to not hold out until the deadline in order to see if there are “errors and issues” and leave time for corrections if needed.

While providers’ compliance with the program has not been added to their Five-Star rating yet, CMS officials noted the addition of a badge to the Nursing Home Compare website that will show whether or not a facility has submitted staffing data. A green badge indicates that the facility is already participating in the PBJ program; gray means a facility isn’t participating yet.

The badge also includes a note that the staffing reporting program will “be on Nursing Home Compare by early 2018.”

Michigan’s MLive reported that Kathryn Brackett, a dementia patient and resident of Crystal Springs Assisted Living Center was found dead in the early hours of Oct. 27 on the grounds outside the center. She died of hypothermia after being stranded outdoors for more than four hours in mid-30-degree temperatures and rainy conditions.

Yahira Zamora and Denise Filcek are the assisted living center employees facing felony charges which led to the October death of Brackett.

Zamora is accused of resetting an alarmed door designed to keep residents inside without checking whether any residents exited the facility. She faces a charge of second-degree vulnerable adult abuse — a felony punishable by up to four years in prison, or a fine of $5,000.

Filcek was responsible for making bed checks every 30 minutes and failed to check on patients despite falsely indicating she had on records. She faces a charge of intentional inclusion of misleading or inaccurate information in a medical chart — a felony with a maximum sentence of four years in prison, and/or a $5,000 fine.

 

 

A Florida federal jury in U.S. ex rel. Ruckh v. Genoa Healthcare, LLC, found the operators of 53 skilled nursing facilities liable for more than $115 million in damages stemming from false claims they submitted to Medicare and Medicaid after pretending patients needed and received more care than they did.

The jury ruled on False Claims Act allegations brought by whistleblower Angela Ruckh, who worked at two of the facilities as a nurse, and found that the four defendants — CMC II LLC, Salus Rehabilitation LLC, 207 Marshall Drive Operations LLC and 803 Oak Street Operations, LLC were liable for false claims.

Ruckh said she saw years of corporate scheming meant to “bill Medicare and Medicaid” by upcoding therapies.  Angela Ruckh, formerly of La Vie Management, proved that the providers listed in the case presented “false or fraudulent” claims for reimbursement.

The Government has many tools to help it prosecute False Claims Act cases.  One such tool is extrapolation—the act of using a sample of resident files to determine an error rate and applying that error rate to a greater universe of resident files.  After some initial setbacks including having their case dismissed for lack of necessary detail, the plaintiff complained that to show fraud with detail in every instance was not feasible.  The plaintiff instead asked to use the Government’s tool of extrapolation (to be able to have an expert pick out some files, determine an error rate and apply that error rate to a larger universe.)  The Federal Government filed a brief in support of permitting private parties this power.

The Court sided with the whistleblower, allowing her to use extrapolation and statistical sampling to estimate the volume of overpayments allegedly received by the defendants.  In issuing his decision, District Judge Steven Merryday relied on other cases that accepted statistical sampling methods as reliable and acceptable evidence in determining facts related to False Claims Act claims.  Judge Merryday echoed a recent District Court case in Tennessee that considered “the large universe of allegedly false claims” in finding that “it would be impracticable for the Court to review each claim individually” and to do so “would consume an unacceptable portion of the Court’s limited resources.”

Though this case is just the latest in a string of cases upholding the use of statistics and extrapolation to establish liability under the False Claims Act, this decision is unique in that it allows an individual qui tam whistleblower to utilize this powerful tool to demonstrate falsity even where the Government has declined to intervene in the case.

The Tuscaloosa News reported the arrest of Betty Jean Tubbs who was charged with elder abuse for punching a resident in the face while working at Heritage Health Care and Rehab. Tubbs was a certified nursing assistant at the facility.

She is accused of striking a resident, 71, on the head and punching the resident, causing eye swelling and bruising.

A grand jury reviewed evidence and indicted Tubbs on the felony charge on Jan. 24. She was arrested Feb. 16 and later released on bond.

If convicted, Tubbs could be sentenced to two to 20 years in prison and a fine up to $30,000.

 

CNN had a heartbreaking article written by Bobbi Young about the rape her mother suffered at a nursing home.

I scanned my mother’s bed, pulled back the rumpled sheets and uncovered her shivering naked body. I stared at her bruised inner thighs, her sheets wet with urine and blood, her catheter pulled completely out of her. I covered her with a blanket and held her close as she pleaded, “Get me out of here.”

I kissed her forehead, our tears mixing, and promised no one was going to stop me. She would not spend another night in this nursing home.
I pushed the call button. No response. I followed the cord to the wall and found it disconnected. My heart racing, I tracked down an aide and demanded that a nurse come to my mother’s room immediately. At 88, she was examined with nonchalance and covered back up.
I called the manager to her room and told her I was taking Mom home.
The nursing staff gathered in force, attempting to convince me that her release was a long process, that my mother could still benefit from their help. Her stay in the nursing home had been a temporary transition needed after being hospitalized with a stroke.
But I knew my mother had been harmed. I feared the worse. And I feared for her life if she stayed there.
I called her doctor to sign a release form, and I phoned a service for private medical transport. I also called my husband and said, “I need to bring Mom home with us today. Go get Daddy.”
At the front door of the nursing home, the management staff lined up to wish us well. They invited us to come back and visit.
“Thank you,” I told them, “but we will never drive by this road again.”
When we arrived home, the driver unloaded my bundled mother and the rain momentarily stopped. I looked up and saw my father, his hand pressed to the window, tears in his eyes and mouthing the words “Mama … Mama’s home.” Married 69 years, my parents experienced every second apart as an eternity.
Once settled in their own bed, Daddy curled up next to Mother, held her hand, prayed with her, assured her she was OK now, home safe. She was still recovering from her stroke, and even though my father sensed some harm had come to her, he didn’t ask. He didn’t want to stress her more. He never left her side.
Over the weeks that followed, my mother complained of pain in her groin area. Doctors increased the doses of pain medication, but she still awoke in anguish, day after day. I finally had to examine her — and my heart sank.
I knew she needed to be seen by her gynecologist as soon as possible.
A nurse practitioner examined my mother and ran tests to confirm her suspicions: a sexually transmitted disease. Had my mother shown these symptoms before, she asked. The answer was no. Had my mother had any sexual partners besides my father in her lifetime? The answer was no.
When I told her about what had happened in the nursing home, the nurse said my father would need to be tested for the disease. My mother was visibly shaken. I asked the nurse, if my father was negative, what would be the next step? She said, you need to call the California Department of Public Health and file a report.
We drove home silently. My mind struggled with how much my mother had been through; now we were minutes away from devastating my father. I asked if she wanted my help in telling Daddy. The answer was yes.
As I spoke, Daddy didn’t hesitate to agree to be tested. Then he asked what all of this meant. What would proving he was negative for the disease mean?
Mama, her voice choked with sadness, replied: “I was raped.”
My father held my mother, crying, shaking his head in disbelief and apologizing for not being able to keep her safe.
I grew up believing my parents were strong and took comfort trusting I would always be safe. They both worked two or three jobs throughout my childhood to buy me and my siblings encyclopedias to enhance our knowledge of the world long before Google existed.
Witnessing this wound inflicted on my parents cut deeply to the core of my own foundation. The hospital had recommended the nursing home as a transitional step; her own internist was the director of the facility: What could possibly go wrong?
There were no warning flags. We failed to protect her against something we could not even imagine existed. A distress signal is only as good as the person who sees it. When I saw it, I took action. But it was too late.
For months, my parents comforted each other, not wanting to be even a foot apart. Their love never wavered; it only deepened. I would walk past their bedroom and see them snuggled tightly together, whispering. My father later told me they were praying and planning to renew their wedding vows on their 70th anniversary.
Beyond the harm the perpetrator had inflicted on my mother, he took a toll on my father’s remaining strength and stole some of the precious time my parents had left. Still, together they decided to fight for reform, which my husband and I fully supported. We filed a civil lawsuit against the facility, arguing that more should have been done to protect my mother. She was brave enough to appear at the center of a public service video created by a nonprofit calling for nursing home reform.
On the day my father died, my husband was diagnosed with terminal cancer. His painful journey ended 17 months later. But our commitment to choose love and joy enabled Mother and I to embrace our faith and carry on. I promised my husband I would not be sad or bitter. I had promised my father I would care for Mama and keep her safe.
I feared that I would not be able to fulfill those promises.
But there are moments in life that transcend fear. They mend twisted hearts. This became one of those moments.
After my husband’s funeral, all of my mother’s nurturing traits intensified. I had promised to care for her, and now she was providing me with what felt like a second childhood. She took the reins, suggesting remedies such as extra locks on doors and an alarm system to quiet our fears. She reminded me of recipes to help stretch our dollars to survive — such as making “imagination cookies.” When I looked sad, she would talk about funny things my husband did to make her laugh. We prayed together, planned our spring garden, went for drives on hot days with the windows down, hair blowing in the wind, laughing with memories.
I promised my mother I would honor her vow to carry on her courageous battle for justice all the days of my life by telling her story. While her perpetrator will likely never be found, it was one of her last wishes for people to understand that no one is too old to become a victim of rape.
My mother died in January. She was 94. As I walk around my home now, I look at the empty rocking chair in which she soothed her children. I can feel her brushing my long hair. The seedlings she planted in eggshells on Christmas Day are bursting toward spring. I can hear her laughter and her reminder to me: “The gifts God gave you, he did not give to another; respect them and share them wisely. …”
Who was this woman in my life? Why was she made to suffer so?
An answer fills my sorrowful heart:
Suffering can carve two types of people, monsters and angels. I am fortunate to have been raised by angels. And I pray to one day be worthy of that divine fabric that still holds me tightly together — love.

CNN conducted a special investigation into the epidemic of sexual assaults and rapes in nursing homes.  “The unthinkable is happening at facilities throughout the country: Vulnerable seniors are being raped and sexually abused by the very people paid to care for them.”

“It’s impossible to know just how many victims are out there. But through an exclusive analysis of state and federal data and interviews with experts, regulators and the families of victims, CNN has found that this little-discussed issue is more widespread than anyone would imagine.”

“Even more disturbing: In many cases, nursing homes and the government officials who oversee them are doing little — or nothing — to stop it.”

“In cases reviewed by CNN, victims and their families were failed at every stage. Nursing homes were slow to investigate and report allegations because of a reluctance to believe the accusations — or a desire to hide them. Police viewed the claims as unlikely at the outset, dismissing potential victims because of failing memories or jumbled allegations. And because of the high bar set for substantiating abuse, state regulators failed to flag patterns of repeated allegations against a single caregiver.”

It’s these systemic failures that make it especially hard for victims to get justice — and even easier for perpetrators to get away with their crimes.”

“Some accounts of alleged sexual abuse come from civil and criminal court documents filed against nursing homes, assisted living facilities and individuals who work there. Other incidents are buried in detailed reports filed by state health investigators.”

“Most of the cases examined by CNN involved lone actors. But in some cases, a mob mentality fueled the abuse. And it’s not just women who have been victimized.”

“Despite the litany of abuses detailed in government reports, there is no comprehensive, national data on how many cases of sexual abuse have been reported in facilities housing the elderly.”

“More than 16,000 complaints of sexual abuse have been reported since 2000 in long-term care facilities (which include both nursing homes and assisted living facilities),according to federal data housed by the Administration for Community Living. But agency officials warned that this figure doesn’t capture everything — only those cases in which state long-term care ombudsmen (who act as advocates for facility residents) were somehow involved in resolving the complaints.”

“The result: CNN exclusively found that the federal government has cited more than 1,000 nursing homes for mishandling or failing to prevent alleged cases of rape, sexual assault and sexual abuse at their facilities during this period. (This includes some of the cases provided by the Centers for Medicare & Medicaid Services.) And nearly 100 of these facilities have been cited multiple times during the same period.  Complaints and allegations that don’t result in a citation, which the government calls a “deficiency,” aren’t included in these Medicare reports. In addition, national studies have found that a large percentage of rape victims typically never report their assaults. So these numbers likely represent only a fraction of the alleged sexual abuse incidents in nursing homes nationwide.”

“Yet the facilities that currently house more than 1 million senior citizens typically pay low wages to nursing assistants (about $11 or $12 an hour), making it difficult to attract and keep quality workers. And during the most vulnerable hours, the night shift, there are often few supervisors.”

The article discusses numerous horrific examples; I encourage you to read the full article.

Legal advocates, government regulators, criminal investigators and medical experts agree that sexual abuse in nursing homes can be extremely challenging to prevent and detect. But they say many facilities should be doing much more to protect vulnerable residents.

  1. “When you have a sexual assault claim, you shouldn’t go to a conclusion she’s a problem patient. You should investigate as a sexual assault until proven otherwise.” — Dave Young, district attorney for Colorado’s 17th Judicial District
  2. “Preserve evidence! Don’t bathe or change clothing, sheets, etc., when an assault is suspected.” — Sherry Culp, Kentucky long-term care ombudsman
  3. “Most abuse is undetected and never reported mainly because observable signs are missed or misinterpreted. A little training could go a long way.” — Tony Chicotel, staff attorney at California Advocates for Nursing Home Reform
  4. “As with nearly every type of abuse and neglect seen in nursing homes, the better staffed the facility the less likely sexual abuse will occur. This is a crime of opportunity, so the more supervision the better.” — Kirsten Fish, elder abuse attorney
  5. “There needs to be a reporting system. …The system doesn’t keep track of cases that haven’t been substantiated, [and] their rules for substantiating a complaint are just astronomical. It’s virtually impossible to substantiate a complaint.” — Lt. Chris Chandler, Waynesville, North Carolina, Police Department

 

 

WDAY reported on the lack of regulatory oversight in Minnesota. The Minnesota Health Department performed on-site investigations of just 10 percent of the 3,400 complaint allegations it received from the public about nursing home and home-care treatment last year, according to the agency’s statistics. The agency only did on-site inspections of 102 allegations — less than 1 percent — of the nearly 21,000 allegations it received from providers’ reports.

The number of vulnerable adults receiving care and the ease of lodging complaints have both grown in recent years, resulting in an exponential increase in the number of complaints the department takes in.

“Thousands of complaints are not investigated so maltreatment continues, and less severe issues may escalate to more serious harm,” the agency said in a budget request this year. Those uninvestigated complaints in the last year included more than 4,000 falls, nearly 2,000 complaints of emotional or physical abuse by staff and nearly 3,000 “unexplained injuries,” the department said.

KSPR reported on a proposal to keep residents safe, and to deter theft, fraud, and abuse, by allowing video cameras in Missouri nursing homes.  Under the proposed law, families can choose to put a camera in their patient’s room, at their own expense and would be able to view the cameras at any time.

Supportive lawmakers say families could monitor how much and how often medications are given and how their loved one is being taken care of overall. Rep. Andrew McDaniel backs the bill after his staff says they received hundreds of complaints about abuse, neglect, rape and fraud.

Nursing home lobbyists claim they are concerned about patients’ privacy, and their lobbyists have killed similar bills in past legislative sessions. However, McDaniel says the camera can be turned off during baths or if a patient is exposed.