The Santa Fe New Mexican reported the history of neglect at Casa Real.  Inspections and investigations paint a troubling picture of life at the nursing home: medication errors, expired food and drugs on shelves, unreported injuries and assault, poor care of wounds, inadequate safeguards against spread of antibiotic-resistant infection, nurse understaffing and more.

Problems also have occurred at the Santa Fe Care Center, a sister facility of Casa Real, according to inspection reports.  A resident at the Santa Fe Care Center was threatened with eviction last year because his family complained about his care, an inspection found. The inspector also reported seeing staff ignore a woman’s repeated pleas for help as she sat in a wheelchair near a nursing station.

The troubles at Casa Real and the Santa Fe Care Center aren’t new. State inspectors in at least the past 15 years have cited serious deficiencies in resident care. The office of the state long-term care ombudsman, which serves as an advocate for nursing home residents, reported 428 complaints against Casa Real and 105 complaints against the Santa Fe Care Center in the past two years. The top complaints dealt with discharge, administration of medications, staff attitudes and failure to deliver ordered care.

State and federal regulators have allowed the homes to continue to operate and accept Medicare and Medicaid payments, although the facilities have faced substantial fines.  Ownership of the homes, now operated by Preferred Care Partners Management Group of Plano, Texas, has changed several times.

The for-profit facilities are the only skilled-nursing homes in Santa Fe that take Medicare and Medicaid payments, meaning area residents must accept conditions at the homes if they cannot afford private-pay nursing and want to stay in Santa Fe.

Conditions at both nursing homes are the subject of a lawsuit filed against their operators by the state Attorney General’s Office, which alleges the homes received hundreds of millions of dollars from Medicare, Medicaid and private payers without delivering even basic care.

The lawsuit alleges that Preferred Care defrauded Medicaid by having insufficient staff to meet the needs of residents at its Santa Fe nursing homes, as well as at facilities in Gallup, Las Cruces, Bloomfield, Española and Lordsburg. Also named as a defendant is Cathedral Rock, former owner of the homes.

The department conducted its last standard health inspection of the nursing home in April and reported 37 deficiencies, more than three times the average number of health deficiencies found in all New Mexico nursing homes. Among the reported problems:

• Medications were not administered at proper doses or on time. One resident was supposed to be given a medication daily but didn’t receive it on 13 days in March. Also, residents didn’t receive medications because the home didn’t have them available. Expired medications were found in drug storage.

• A female resident who was supposed to receive a shower three times a week hadn’t had a shower for a week. “I got a shower cause I was begging for it,” the resident told an inspector.

• Bathroom pull cords for call lights were unreachable if a resident fell.

• Residents were not receiving the number of physical therapy sessions ordered by physicians. “This deficient practice … is likely to increase falls resulting in bruises, lacerations, broken bones, head trauma and death,” the inspector’s report said.

• Food was not served at the proper temperature, and food in refrigerators was older than its expiration date.

Bangor Daily News published a letter from Phillip Bennett, an administrator at Bangor Nursing and Rehabilitation Center.  See below.

As a nursing home administrator, I read with great interest the BDN report “Worn to the Sole” about the Maine woman who protects the dying and can barely make ends meet. This article accurately and empathetically portrayed the daily life of a dedicated CNA in a Bangor-area nursing home. It highlighted her sincere commitment to the residents for whom she cares and the quality of care that comes from an intimate knowledge of their likes and needs, developed over months or years of daily personal attention. And it reflected her pride and confidence in working as a professional caregiver.

But “Worn to the Sole” is aptly named, reflecting the difficulties faced by CNAs in all nursing homes, where the work is hard, the hours sometimes unexpectedly long, and wages insufficient to pay the bills and provide a satisfactory living.

Maine nursing homes face an intractable CNA shortage with no precedent, and they have been struggling for some time with how to deal with it. The CNA hourly wage, adjusted for inflation, has fallen over the last 10 years — a long time during which every dollar a CNA brings home buys less — and in any case, it has never provided much more than a subsistence wage.

Together with the stress the job entails (both because of reasonable and unreasonable supervisor and family member expectations) and risk of injury (Maine CNAs are injured as often as construction workers), there has been a disincentive for CNAs to remain in the field — and they are either leaving the field altogether or for better pay elsewhere.

 As nursing homes see CNA vacancies appear with greater frequency, they turn to temporary staffing agencies, often paying twice as much to maintain minimum staffing. The agencies fill the vacancies by paying temporary CNAs a higher hourly wage. The work the agencies offer may be less certain, and benefits may or may not be available, but CNAs need a better income. Many CNAs have moved to those agencies for the higher hourly pay they receive. Many end up working in nursing homes in the same area, which are befuddled by their lack of staff and what to do about the matter. Additionally, to reduce the extraordinary and ongoing costs of temporary CNAs, nursing homes require additional hours of work on short notice, a practice all too common in health care but unacceptable in other walks of life.

It seems to me that the answer is fairly clear: CNAs in nursing homes need to be paid more. The CNA shortage is a long-term structural change caused partly by nursing homes not paying enough to attract and retain workers — a problem compounded by requiring additional shifts or weekends to cover staff shortages.

Bangor Nursing and Rehabilitation has done both — significantly increasing CNA wages and eliminating the requirement for them to stay for additional shifts. It makes no business sense to pay exorbitant fees for CNAs from staffing agencies while waiting for MaineCare, the state’s Medicaid program, to increase reimbursement rates. It is ethical and practical to pay better wages. Nursing homes already pay more for temporary CNAs than if they paid a higher wage to recruit or retain their own staff. Not to do so flies in the face of reason, regardless of state legislative action.

Our experiment is early. We still have unexpected turnover, but we do receive more applications for vacancies and fill them faster than before, and have greater employee satisfaction by not mandating additional hours. We also hope to improve our retention by offering better wages and not requiring our employees stay beyond their scheduled shifts.

Perhaps an independent nonprofit can do this easier than a corporate for-profit entity, but this change is inevitable. The sooner CNAs make more and have reliable hours, the more likely nursing homes will be able to reduce their dependency on staffing agencies and reduce their wage expenses. In the process they will likely find satisfaction in caring for their employees as those employees care for their residents. It is the right thing to do.

 

Goupstate reported the arrest of Natalia Mikhailovna Roberts, a caregiver at Lake Emory Post Acute Care in Inman, S.C.  Roberts is accused of taking medications from patients and charged with two counts of violating drug distribution laws and theft of a controlled substance.

Warrants from the Department of Health and Environmental Control accuse her of intentionally taking doses of hydrocodone and oxycodone that were intended for patients.

In one incident on May 27, records reflect that there were 78 doses of oxycodone for a patient when there should have been 96 tablets remaining, according to a warrant.

Another warrant states that on June 17, a page was missing from a controlled medication utilization record for another patient regarding hydrocodone doses.

Until a few months ago, Lake Emory was designated as a Special Focus Facility and was even fined almost $200,000 on Jan. 11, 2017.  Lake Emory is owned and operated by Fundamental Long Term Care now known as Hunt Valley Holdins, a national for-profit chain with hundreds of nursing homes in numerous states.

The Dayton Daily News reported that Pristine Senior Living of Beavercreek sent a letter to their families informing them that their employee, Steven Douglas McDowell, a licensed practical nurse, is facing sex charges involving residents at the facility.  At least, three Pristine Senior Living residents have been identified as possible victims.

McDowell has also been indicted on 11 counts of illegal use of a minor in nudity oriented material, one count of voyeurism and three counts of gross sexual imposition, according to the prosecutor’s office.

The Business Times reported the financial difficulties of one of the major national for-profit nursing home chains.

US healthcare landlord Quality Care Properties Inc said on Friday that it can seek receivership for the country’s second-largest nursing home chain, HCR ManorCare, after it failed to make a US$79.6 million payment for current and past rent.

In a statement, Quality Care said it had delivered a notice of default to HCR ManorCare, its main tenant, regarding the missed payment, which Quality Care said triggers immediate payment of $265 million in additional overdue rent.

Private equity firm Carlyle Group bought HCR ManorCare in a 2007 leveraged buyout for $6.3 billion and sold the properties to HCP for $6.1 billion in 2010.

I guess they are done siphoning funds away from patient care to line their own greedy pockets.

New Mexico Attorney General Hector Balderas is trying to stop elderly abuse in nursing homes.  KFOX TV reported that New Mexico’s attorney general is launching a new campaign to prevent elderly abuse in nursing homes.

He’s ordered the state to review documents and evidence of abuse that would lead to an investigation on any facility.

“We also look at whether or not they are being cared for appropriately, according to their care plan, and we also look at a variety of injuries and things of that nature,” said Richard Chavez, the AG’s special agent supervisor.

Once enough evidence is gathered, the attorney general’s office will try to prosecute offending homes.

Yolanda Monsalvo. a nurse aide was found guilty of falsifying business records at Medford Multicare Center for Living nursing home to cover up patient neglect, prosecutors said, joining other co-workers also convicted of various crimes.

Monsalvo left her dementia patients with no supervision — and one of them broke an arm and suffered head injuries from a fall, officials said. She was convicted partly due to video surveillance footage, which showed she left the building where she was supposed to be monitoring her patients, including the one who then fell.

“Nursing home caregivers are entrusted to provide the highest level of safety and care to our most vulnerable residents,” he said. “There are serious consequences for abandoning nursing home residents and then trying to cover up neglect.”

Last June, the firm and its owners paid $28 million to settle a lawsuit charging them with looting the nursing home, committing fraud and breaking the law in running a business, according to Attorney General Eric T. Schneiderman.

The corporation paid a $10,000 fine after pleading guilty to attempted falsifying business records, part of a coverup in the death of a 72-year-old patient, he said.

Monsalvo, now facing a maximum sentence of 4 years, was indicted in April 2016 for “lying in an investigation report” about another patient’s fall from a wheelchair, Schneiderman said in a statement on Friday.

A New York Court struck the Answer of a nursing home for failure to respond to discovery including providing a complete copy of the resident’s nursing home chart. See Order in Schiller v. Sunharbor.

“In 2011, Georgette Schiller, as executrix of the estate of Bernice A. Schiller, deceased, and individually, commenced this action against, among others, Sunharbor Acquisition I, LLC, doing business as Sunharbor Manor, OG Operator, LLC, as successor to Sunharbor Manor, and Sunharbor Manor, LLC, doing business as Sunharbor Manor (hereinafter collectively the defendants). The plaintiff alleged that the decedent received care and treatment at the defendants’ nursing home, and that the defendants’ negligence caused an infection in the decedent’s left leg, which ultimately required amputation of her leg above the knee and resulted in her death. Almost four years after she commenced the action, the plaintiff moved, inter alia, pursuant to CPLR 3126 to strike the defendants’ answer on the ground that the defendants were willful and contumacious in their failure to respond to the plaintiff’s repeated demands for the decedent’s entire medical record and the Supreme Court’s orders related to the same. The court granted that branch of the plaintiff’s motion which was to strike the defendants’ answer, and the defendants appeal.”

“Here, the defendants’ repeated failures, over a period of years, to respond to the plaintiff’s discovery demands, even after being directed to do so by multiple court orders, without adequate excuses, constitutes willful and contumacious conduct.”

The Miami Herald reported the criminal charges of bribery against Bertha Blanco, a Florida health care administrator in exchange for helping a nursing home owner accused of orchestrating a $1 billion Medicare and Medicaid fraud scheme keep his license.  The wide-ranging investigation that federal authorities are calling the nation’s biggest health fraud case.

Blanco made about $31,300 a year overseeing inspections at nursing facilities owned by Philip Esformes, a wealthy businessman who owns dozens of Miami-Dade nursing facilities as well as homes in Miami, Los Angeles and Chicago.

A criminal complaint filed against Blanco accused her of taking tens of thousands of dollars in cash in exchange for tipping Esformes off about violations so he could address them before state inspections.  Blanco’s aid allowed Esformes to keep his license active and continue billing the federal government for questionable patient services.

Federal authorities say Blanco took the bribes and provided patient and inspection records to intermediaries, who delivered the information to Esformes.  Two of those intermediaries, brothers Gabriel and Guillermo Delgado, have made plea deals and are expected to testify against Esformes. The brothers helped investigators get to Esformes by videotaping a cash transaction that prosecutors said was meant to go for bribes.

Esformes is accused of using his 20 nursing facilities to file false Medicare and Medicaid claims for services that were not necessary for 14,000 patients.

Prosecutors said his health care network and other co-conspirators billed $1 billion for fraudulent services between 2009 and 2016.

The Advocate had a letter explaining why staff turnover is so high in nursing homes.

“As with all nursing homes, there is a poor retention rate for the certified nursing assistants who keep the doors open; no one who owns a nursing home would do what they do. This is a backbreaking job that requires lifting, tugging and pulling to provide the care the residents need. They contend with medical equipment that includes a tracheostomy, feeding tube, ventilator, colostomy bag, Foley catheter, IV’s, oxygen mask/line, etc. They deal with bed sores and bathe, dress and groom the residents. All of this at a starting salary of $8 or less per hour depending on your experience.”

The average unit at a nursing home has at least 30 residents, and most of the time, there are 3 CNAs assigned. If you are assigned 10 residents, and five of them are to be spoon-fed or are incontinent, someone is going to get cold food, be hungry or lay in soiled clothing for some time because the CNA only attended to one resident at a time.