The L.A. Times reported another story about a nursing home fined for allowing a resident to choke to death.  This is the third story about choking deaths in nursing homes in the last couple of weeks.  The nursing home was fined $80,000 after a 54-year-old schizophrenic patient choked on a meatball and died.

Raintree Convalescent Hospital had known the patient had problems swallowing.  The spaghetti meatball served to him needed to be chopped or sliced before being given to him.  Both the cook and the nursing assistant who served the meal failed to grind up the meatballs, as required. The cook failed to follow the directions for the patient’s meal by not mashing up the meatball. He also said the nursing assistant failed to look at the meal card on the patient’s tray — which would have been a second chance to catch the error — before serving the lunch. 

"I just did not think to chop up his meat that day," the nursing assistant told state investigators.   The facility was probably understaffed which did not allow her time to do her job properly.

The man stumbled out of his room, pale and unable to speak. After a nurse unsuccessfully attempted the Heimlich maneuver, paramedics were able to suction the meatball out of the man’s airway, but he was pronounced dead at a hospital emergency room.

Senators Chuck Grassley (R-IA) and Herb Kohl (D-WI) reintroduced the Nursing Home Transparency and Improvement Act, a bill that would give consumers more information about individual nursing homes and their track record of care, give the government better tools for enforcing high quality standards, and encourage homes to improve on their own.

"Improving the quality of care in nursing homes is a constant challenge. More transparency, better enforcement and improved staff training are needed, and this legislation works to make changes in those areas and improve the quality of life of nursing home residents and to empower the family members and loved ones of those residents," Grassley said.

"Twenty-two years have passed since Congress last addressed the safety and quality of America’s nursing homes in a comprehensive way," said Kohl. "As we prepare to debate reforms across our health care system, there has never been a better time to implement critical improvements to our nation’s system of nursing homes. And as the GAO report demonstrates, many of these improvements are past due."

In addition to the bill introduced today, Grassley and Kohl released a U.S. Government Accountability Office (GAO) report entitled "Medicare and Medicaid Participating Facilities: CMS Needs to Reexamine Its Approach for Oversight of Health Care Facilities." This report suggests that the survey and certification system is significantly underfunded relative to the scope of its oversight responsibilities, which have greatly expanded in recent years. The report found that survey frequencies have greatly lengthened due to resource constraints, resulting in some facilities receiving inspections only once every ten years. The Nursing Home Transparency and Improvement Act seeks to bolster the federal government’s survey and certification system.

Grassley is ranking member and former chairman of the Committee on Finance, with jurisdiction over the federal health care programs that cover nursing home care, and former chairman of the Special Committee on Aging. Kohl is chairman of the Special Committee on Aging, a standing committee that conducts oversight of issues related to the health, safety, and financial well-being of older Americans. The Grassley-Kohl bill is the product of their work together on nursing home quality, which has helped to generate some positive results in recent years, including the government’s new five-star nursing home rating system and the release of the Special Focus Facility program participant list, consisting of the 135 worst nursing homes in the country.


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Mark N. Geller is a Memphis attorney with Nahon, Saharovich & Trotz PLC. He leads the firm’s nursing home practice group. He wrote the following column which can be found here:

The federal government’s Medicare program recently released a rating system that ranks the quality of care for residents in nursing homes. Among our nation’s 50 states, Tennessee ranked third from the bottom in its percentage of nursing homes that received the report’s highest five-star rating — ahead of only Louisiana and Georgia.

According to this rating system, Tennessee also had the fourth-highest percentage of poor-performing nursing homes in the nation (those that received the lowest possible rating of one star), behind Louisiana, Georgia and Virginia.

On the surface, these results are bad enough for Tennessee’s elderly population and their families. Unfortunately, though, the Medicare Nursing Home Compare report fails to capture the true extent of how poorly our fellow Tennesseans who live in nursing homes are being cared for right now.

In fairness to the nursing home community, four nursing homes within 50 miles of Memphis were given the highest ranking by Medicare’s report, and they stand out among the best in the country. (To view the full report, go to

As an attorney who practices in the area of nursing home litigation, I witness almost daily the substandard level of care many elderly Tennesseans must endure. I have seen the wide range of poor nursing home care across this state; poor care that sometimes includes leaving people in their own excrement for long periods of time, which results in bed sores and even death. There are cases — and they’re not uncommon — in which elderly nursing home residents have been left begging for food and water, but have been ignored. Or cases — including one recently in Memphis — where elderly residents have wandered out of their nursing facility unsupervised and were severely injured.

Even this bare recitation of facts pales next to actually hearing a family’s story. Family members have spoken about how they begged and pleaded for care that never came. They have talked about the heartrending suffering their loved ones go through in their last days of life.

Despite these stories and the objective data ranking Tennessee among the worst in the nation for nursing home care, Tennessee legislators recently sponsored bills (HB2243 and SB2160) to reform lawsuits against the nursing home industry by putting a monetary value on human life.

The bills set the price of a human life at $300,000. If they become law, that would be the maximum amount of noneconomic damages that could be awarded to plaintiffs in lawsuits against a nursing home. In addition, if a jury concludes that the nursing home’s actions were so wrong that they warrant the award of punitive damages, that amount would be limited as well, by a formula that uses calculations provided by the nursing home itself relating to its level of patient care.

These proposals, which are under review in legislative committees, are bad bills that are primarily focused on limiting the compensation that a family can recover if a jury finds that a nursing home acted improperly. They would protect nursing homes from liability. Nothing in them would protect nursing home residents.

There is no serious measure within these bills that sets out minimum standards for proper care of nursing home residents. The proposals fail to provide measures to protect the residents from negligent or improper care. They have no provisions to require nursing homes to maintain proper staffing levels or even treat their residents well.

Tennessee’s low ranking in the nursing home industry is easy to understand. Typically, nursing homes are operated by multibillion-dollar, multistate corporations whose main purpose is to make as much money as possible for their shareholders. Of course, there’s nothing wrong with making money. What is wrong is that many nursing home chains too often cut operational costs to increase profits. Such cuts are unconscionable when they are done at the expense of their stated business goals: the comfort and well-being of the elderly.

When a nursing home’s budget is cut, the nursing home must function with less supplies, equipment and staff. Less staff means fewer people to provide care to the residents. Eventually, it reaches a point at which the staff, no matter how caring or qualified they may be, are simply unable to meet the needs of the residents.

Life is precious and should be treasured. Every human being deserves to be treated with dignity and respect.

Making money is perfectly acceptable so long as you are doing your job first. Here, the primary job should be to provide skilled and humane care to the residents of Tennessee’s nursing homes and to make sure their needs are being met.

The state should legislate serious standards of care for nursing homes. And nursing home operators should be held accountable if they fail to live up to those standards.

The Franklin News-Post had a story about a nursing home employee–the assistant director of nursing– getting only three years for the distribution of prescription drugs she took from residents at her facility.  Linda Sloan Quick was also sentenced to three years probation, following her prison sentence, and she was ordered to be on good behavior for 25 years.  There was no mention if she would lose her license to practice nursing or if she was reported to the Board of Nursing.

Court records show that the drugs taken from the nursing home by Quick had either expired or had been prescribed for patients who had died or had been transferred to another health facility.  The sheriff’s department received anonymous information that a nursing home employee was selling prescription drugs, and investigators got Quick’s name from a confidential informant.

Quick was sentenced to 10 years for distribution of Fentanyl, but seven years of the sentence were suspended.  Quick was also sentenced to three years on each of the three counts of distribution of Hydrocodone. All nine years were suspended.


The L.A. Times reported that a nursing home was fined only $75,000 for the wrongful death of a resident.  The nursing home was well aware that the resident had a history of swallowing problems but did nothing to prevent him from choking to death on a snadwich that never should have been given to him.  .  In fact, the nursing home failed to immediately treat the resident when he began choking.

The patient had dementia and a known history of having difficulty with swallowing. The patient’s care plan at Anaheim Crest Nursing Center said he should only be given pureed food.  The state investigation documented two incidents Sept. 9 when the patient ate solid food. At dinner, he was fed an incorrect meal and given a spoonful of vegetables and rice. After he started coughing, a nursing assistant performed the Heimlich maneuver and a "tomato-like" material was coughed up.  Later that same evening, the patient got  a sandwich and began to eat it and began choking and turning colors.

According to the state, there was no documented evidence that the patient received emergency treatment for choking.  It is the standard in all nursing homes that if something was not documented then it wasn’t done.  Nurses are trained in school on this principle and every nursing home in the country abides by the principle.  Despite this standard, the nursing home is now claiming that the staff did attempt the Heimlich maneuver, administered cardiopulmonary resuscitation and called 911. 

The nursing home tried to claim that the death was a result of a heart attack, and that they had not been informed the patient had a choking incident just before his death.  If that is true, then why did they allegedly try to do the Heimlich maneuver.  They can’t keep their lies and cover-up straight!

After the coroner determined that the patient had choked on a piece of food found in his larynx, a subsequent internal investigation uncovered the second, and ultimately fatal, choking incident. out of Cleveland had a recent story about a nursing home resident who was left unattended and allowed to leave the facility unsupervised.  The resident ended up walking on the road and getting hit by a car.  She died from injuries sustained in the  "hit and run" accident.  What is amazing about this story is how the article concentrates blame on the driver of the vehicle instead of the nursing home which was responsible for keeping this resident safe and out of harm’s way.  The nursing home should have been watching her and not allow her to leave the premises unsupervised.

Citing declining health, her family recently convinced her to check into the nursing home.   She was very unhappy there and wanted to return home.  This is a clear sign of a risk for wandering.  Her family says she was supposed to be staying in a "locked-down area" when she somehow was allowed to escape.

"There was a security door in her room that she was able to disable at 87 years old. They appear to be very short staffed at night. We were told there was a loud alarm going off but no one went looking to see what was going on," says Meldrum.

According to the Avon Police Department, several 911 calls came in Friday evening alerting them of a car versus pedestrian crash in front of the Good Samaritan Skilled Nursing & Rehabilitation Center on Detroit Road. When officers arrived to the scene, they found Warren lying on the side of the road.  Police say the suspect vehicle did not stop after the accident and drove away from the scene.

Is there any investigation as to why and how she was able to leave the nursing home without being noticed?  how long was she missing?  Why didn’t anyone hear the alarm or respond to it? Was the nursing home short-staffed?

The San Diego Union-Tribune had an article about a nursing home which received the most severe citation and a $90,000 fine after an investigation found that poor treatment and supervision resulted in a resident choking to death last year.   Escondido Care Center, a 180-bed facility, failed to adjust the patient’s meal plan to meet his changing dietary needs. The resident suffocated when food became stuck in his windpipe and the right main bronchial stem. He was eating a lunch of beef with barbecue sauce, mashed potatoes, and steamed cabbage and carrots. During lunch, the patient coughed repeatedly until he became unresponsive and slumped over in his wheelchair. The patient died.

The facility was well aware that the resident had swallowing problems and was at risk for choking.  His physician had ordered a strict diet to avoid problems with chewing and swallowing.
On two occasions in November, the facility’s dietary supervisor, registered dietitian and a nurse wrote in the patient’s file that he was having difficulty chewing and that he was coughing while drinking “thin liquids.”   No records exist to show that any staff member alerted the resident’s doctor or tried to alter the man’s diet or supervise it more closely.


Often when maggotts are found in a resident’s pressure ulcer (normally caused by the lack of proper wound care and cleaning), the nursing home tries to argue to the family that the maggotts are a method of cleaning the wound and that the nursing home intended the maggotts to clean the wound (despite no physician order typically).  Well, that frivolous argument has now been proved wrong.

Reuters had an article about a recent study in the British Medical Journal of the world’s first controlled clinical trial of maggot medicine.  Maggotts may clean wounds quicker than normal treatment but this does not lead to faster healing. Some patients also found so-called "larval therapy" more painful. 

To find out more, researchers at Britain’s University of York recruited 267 patients with venous leg ulcers and treated them either with maggots or hydrogel, a standard wound-cleaning product. They found no significant difference in outcomes or cost.  Larval therapy works because maggots eat only dead and rotting tissue, leaving a clean wound. They do not burrow into healthy flesh, preferring to eat each other when they run out of food. 



The New york Times had an article explaining the Obama administration’s plan to overhaul financial regulation by subjecting hedge funds and traders of exotic financial instruments to potentially strict new government supervision. Many of these hedge funds and financial instruments own or have a financial stake in numerous nursing homes around the country.  It states that the government would have the power to peer into the inner workings of companies that currently escape most federal supervision, and specifically cites "private equity firms like the Carlyle Group."   

The Carlyle Group bought out Manor Care a couple of years ago and have created sham L.L.C.s to protect themselves from liability while cutting the budgets of the nursing homes that they own.  In fact, two men who worked in the New York State comptroller’s office were arrested recently after it was discovered they took millions of dollars in kickbacks from private equity and hedge funds.  David Loglisci, who was the top investment officer of the state’s $122 billion pension fund, along with Henry Morris, who fund-raised for former comptroller Alan Hevesi, were nailed in a 123-count indictment, which included charges of money laundering, securities fraud and bribery. It was discovered that over 20 transactions made by the pension fund involved kickbacks, with five of those coming from the renowned private equity fund The Carlyle Group. Morris, who was released after posting a $1 million cash bail, allegedly received $13 million from The Carlyle Group, from investments that totaled $730 million.

The administration would require that all standardized derivatives be traded through a regulated clearinghouse. Traders would be required to provide documentation on their collateral and borrowings. They would also be subject to new eligibility requirements, and their trading and settlement practices would be subject to new standards. had an article about the sexual abuse allegations at an elderly home in Hot Springs, S.D.  Many family members are appropriately concerned. The DCI is finally looking into reports dating back to January at the Castle Manor Nursing home.  Hospital officials say they know of more victims. Board President of Castle Manor Rich Nelson knows of at least three victims and has received several other complaints. The suspect is a male nursing assistant.  Family members of the alleged victims claim Fall River Health Services tried to cover up the abuse.

When sisters Sharon Deboer and Gwendolyn Ketterer needed a long-term care facility for their mother two-and-a-half years ago, they had no doubts about the care at Castle Manor. That changed when the 84-year-old dementia patient started acting out of character late last year when a male nursing assistant began taking care of her.

"I just felt that there was something with him that I just couldn’t put my finger on. I couldn’t put my finger on it but I suspected that type of thing. It was just a feeling," Deboer said.  On January 17, Deboer’s suspicions were confirmed.  "One of the staff called me and told me she had to talk to me, that she had something to tell me. She told me right when we met that this CNA, this male CNA, had been molesting my mom," Deboer said.

That was the only type of notification the sisters received from Castle Manor, despite an abuse report filed with the Department of Health three days earlier. The suspect stayed on as an employee for weeks before Manor officials say he was finally let go. That was part of Fall River Health Service’s efforts to cover up the abuse.

How many others suffered abuse silently while Manor staff looked the other way.