Kentucky Bill Requires Minimum Staffing Ratios

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WYMT reported that Kentucky Rep. Rick Nelson of Middlesboro filed a bill that would require minimum staffing standards in Kentucky nursing homes.  Nursing homes and other long-term care facilities would have to meet minimum staff-to-resident ratios for licensure or re-licensure after July 30 of this year under House Bill 573.

Ratios of one nurse aide to every nine residents and one nurse per 21 residents at all times during the day would be among the requirements.

Additionally, facilities with 75 or more beds would be required to have a registered nurse supervisor during day and evening shifts, in addition to the other required staff.

Larger facilities would carry more requirements, including the need for a full-time assistant nursing director and education director.

Facilities that do not comply with the minimum staffing requirements for two consecutive days would be prohibited from accepting new patients until they have complied for six consecutive days, according to the bill. Fines of up to $1,000 per day could also be assessed against the facility.

 

RN Arrested for Theft of Fentanyl Patches

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The Herald & Review reported the disturbing story of James Rellihan who is accused of removing opioid patches from the bodies of residents at two nursing homes, including one where he worked as a registered nurse.  Rellihan is charged with burglary and theft under $500.

In a statement read in court, Assistant State’s Attorney Jeff Horve detailed two visits Rellihan allegedly made, one on Feb. 24 to Bloomington Rehabilitation and Health Care Center, and another on Feb. 26 to Heritage Health in Normal.

At the Bloomington facility, Rellihan removed three fentanyl patches from a terminally ill man, telling the patient, “It will be OK,” said the prosecutor.   The 31-year-old nurse was seen by co-workers who questioned why he was at the facility on his day off.
On Feb. 26, Rellihan showed up at the Normal nursing home where he had worked. He went to a patient’s room where he removed a fentanyl patch from a man with dementia, according to the charges.
When questioned by police, Rellihan “denied taking, using or selling” the patches, Horve told Associate Judge Amy McFarland.

Blaming the Victim

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The Gephardt Daily reported another sexual assault by a nursing home employee.  Jorge L. Vera was booked into jail on one count of forcible sexual abuse, a second-degree felony.  The alleged victim, a 64-year-old patient at the facility, told investigators female aides would usually prepare her bath, then leave her alone to wash and dress herself.  However, Vera, she told investigators, would remain in the room and use his hands and a washcloth to clean her body.

The woman said Vera would apply extra pressure while cleaning her private areas, and would let his hand “linger” too long.

The alleged victim said she was “very uncomfortable, and pulled away from Vera.”

The court paperwork says that when questioned, Vera initially denied the incident happened at all.  Under further questioning, Vera told investigators the alleged victim grabbed the bathroom rail, positioned herself, then requested he wash her private areas, which he did.  The inconsistency shows why he got arrested.

Trust, Neglect, and Betrayal

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WYMT reported that Mark Dyer is in the hospital fighting for his life because of the neglect he suffered at Knott County Health and Rehabilitation Center.  The family said a nursing home did not take proper care of Mark Dyer, and that it all could have been prevented.

In the last days of February, the family noticed Dyer seemed sick. The family posted pictures of Dyer’s condition on Facebook. They said Dyer smelled like he had not been bathed in days, his tongue was swollen, and his skin was swollen, and his skin was dry and peeling when he brought to the hospital. When he arrived at the hospital, doctors said Dyer had pneumonia and was septic which is life threatening.

“We have always been a very close family,” said Dyer’s niece, Robyn Dyer Shrum.  “When you can’t care for someone at home, you expect excellent care at a nursing home,” said Shrum.  Dyer was taken to the Knott County Health and Rehabilitation Center. The facility is near most of his family. “It’s heartbreaking that we might have to move him from that nursing home because a lot of our family members won’t be able to go visit him like they can now,” said Shrum.

“You are trusting these people to take care of your family and this happens and there is just no trust,” said Shrum’s cousin and Dyer’s niece, Kristy Dyer Johnson.  “This is disgusting. This is neglect at its worst,” said Johnson.  “Pray for Mark, pray for our family. He needs all the prayers he can get. He is a good, Christian man,” said Johnson.

 

Under-staffing Leads to Fatal UTI

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Westchester News 12 reported that new allegations of abuse and neglect arose from a grieving son who claims his mother died due to the lack of care at troubled Sapphire Nursing Home in Goshen.  Joseph Guyt’s mother, Lillian, died month at a hospital after being in the care of staff at Sapphire Nursing Home in Goshen.  Guyt claims he complained about the conditions to both the facility and state over the past year, providing News 12 with documents as proof.

Liilian was immobile and wheelchair-bound due to severe arthritis. He says she developed an avoidable urinary tract infection at Sapphire that spread to her kidneys, proving fatal within days. Guyt believes it was caused by being left daily – sometimes allegedly for hours – in urine and feces by Sapphire staff.

“It’s really a systemic issue. They’re not isolated incidents at all. It’s a horror show at Sapphire,” he says.

The allegations come on the heels of a state probe in which Sapphire was issued multiple violations, accusing the home of understaffing and patient neglect.

 

 

 

Failure to Prosecute

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The Des Moines Register and KRCG reported an obscene travesty of justice.  Prosecutors have dropped felony dependent adult abuse-exploitation charges against nursing home owner and operator Marc Johnson whose company runs the Danville Care Center. In December 2016, Iowa’s Medicaid Fraud Control Unit charged Johnson with two felonies: Fraudulent practices and dependent-adult abuse in the form of financial exploitation. Evidence shows that Johnson stole about $1,700 from a resident to buy a television and other items.

The bizarre decision not to prosecute means Johnson, the president of Cardinal Care Co., will not be tried for an alleged offense that would legally disqualify him from employment as one of his company’s nurse aides, housekeepers or janitors.

“For the county attorney to close her eyes to this and leave this man in a position of authority so the business can remain open just seems absurd to me,” said Dean Lerner, an advocate for seniors who once ran the Iowa agency that inspects nursing homes.

“This doesn’t pass the smell test,” said John Hale, a consultant and advocate for Iowa’s elderly. “A person isn’t prosecuted because of the impact it might have on their business? I was taught that justice is blind. It certainly doesn’t appear so in this case.”

Last fall, a representative of the development company that owns the home contacted prosecutors and warned that if Johnson was convicted, his company would have to sever ties with Cardinal Care, and the home would have to close.  However, the president of the development company, Matthew Hauptman, said this week that while he feels it was unlikely the home would have closed, his company had to guard against that possibility.

The federal Centers for Medicare and Medicaid Services rates the quality of care at the Danville Care Center as “below average.”

Hidden Video Records Abuse

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The 961 reported that a video that was recorded on a hidden camera shows an elderly Lebanese-American man being abused in a nursing home in Michigan.  According to sources, Hussein Younes was admitted to Autumnwood of Livonia in May 2015 to recover from abdominal surgery. A few weeks later, the wheelchair-bound patient started complaining to his children that he was being abused.

The nursing home denied any abuse but Hussein’s children noticed unexplained bruises and cuts on their father’s head. They set up a hidden camera in his room which recorded what their father was going through.  The family gathered more than 100 clips documenting neglectful behavior over two days.  The tapes show two nurses screaming at him, hitting him, and violently throwing him in his wheelchair. They were even using racial slurs.

“I discovered unspeakable horrors,” Salim Younes said. “What I found on these clips is something that blew my mind.”

The video clips show several Autumnwood employees treating Hussein Younes very roughly, allowing him to slide from his wheelchair to the floor, jerking his head back and forth and yelling obscenities directly into his face, among other abusive and negligent behaviors.

“I’m sick of your stupid ass. Get your ass up here,” one nurse’s aide is shown saying to Younis and she jerks him roughly from his wheelchair to his bed.

Hussein was immediately removed from the facility.  Autumnwood of Livonia conducted an investigation and denied responsibility until the video was discovered then the facility fired the employees who were involved in the incident.

The family filed a civil lawsuit in September 2016. His son Salim said that he is shedding light on what happened because what the family went through was unbearable. He also does not “advise anybody to put their family over there.”

“They got all their money out a long time ago”

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The second-largest U.S. nursing home operator, HCR ManorCare, filed for Chapter 11 protection with $7.1 billion of debt, and transfer ownership to its landlord, Quality Care Properties Inc (QCP.N).  The deal includes a settlement agreement for ManorCare’s former chief executive, Paul Ormond, who was owed more than $100 million when he stepped down in September.

The New York Post had an interesting article about the history of Carlyle Group and now bankrupt HCR ManorCare, one of the largest national for-profit chains in the country.   Carlyle paid $6.3 billion in a highly leveraged buyout in 2008 to purchase HCR ManorCare. In 2018, ManorCare collapsed into Chapter 11 bankruptcy, a victim of a $7.1 billion pile of debt created by Carlyle’s greed and mismanagement.

“Ten years ago, angry nursing home workers faced off against private equity mogul David Rubenstein — accusing his Carlyle Group of being interested in nothing but sucking profits from HCR ManorCare, the nursing home behemoth it had purchased the previous year.”  Clearly, they were correct.

Carlyle’s history with ManorCare was troubled almost from the beginning. In 2010, Carlyle sold HCR’s real estate in 338 facilities to HCP, a real estate investment trust, for $6.1 billion — forcing ManorCare to pay rent.  The real estate sale allowed Carlyle to lock in a profit on ManorCare despite the care provided.

“From Carlyle’s perspective, they got all their money out a long time ago,” the investor said.

“It’s really the classic sale-leaseback situation where the PE-owned company loses,” the investor said.

By 2012, ManorCare’s revenue did not cover monthly rent obligations.  HCR ManorCare had owed its landlord more than $300 million in rent.

 

Arbitrary Lifetime Medicaid Limits

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New York Magazine had an interesting article discussing how Trump and the Republicans want to limit the lifetime amount Medicaid will pay for individuals.  This will dramatically affect nursing home residents.  Five states are asking for the power to impose arbitrary lifetime time limits on benefits for politically disfavored categories of recipients.  Given Trump’s inclination to destabilize the individual market segment of Obamacare (and the policies governing it), the Medicaid expansion is now looking like the most successful part of the Affordable Care Act, despite the Supreme Court making the expansion a state-by-state option that still leaves larges portions of the country uncovered.

It’s clear that importing time limits to Medicaid has the intention of indirectly killing off the Affordable Care Act’s Medicaid expansion, by radically curtailing benefits for the low-income childless adults without health insurance.

Medicare Cuts to Nursing Home Industry

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The Republican budget includes a series of cuts to long-term health services. According to an analysis by the Congressional Budget Office, the new legislation reduces direct Medicare funding for nursing homes by $1.9 billion over 10 years – or $140 million starting in October.

Medicare delivers higher payouts, covers a broader range of costs and comes with more certainty. Even though Medicare patients have comparatively relatively short stays – they’re capped by law to 100 days – the overall revenue they bring in can stem the losses incurred by Medicaid patients.