The Des Moines Register published an editorial (see below) from Iowa Republican Senator Chuck Grassley regarding the importance of government oversight for the health, safety, and well-being of the residents of nursing homes.  As a nursing home abuse and neglect attorney trying to prevent and deter the rampant abuse and neglect at many nursing homes, it is refreshing to hear a politician understand the significance of proper supervision.

“Oversight is often a vehicle for change in the federal government. In order to solve a problem, you need to know what it is, how bad it is and why it’s happening. Oversight is an important tool to find answers to those questions as well as ensure the appropriate steps are taken to solve the problems.

A significant amount of the work I do in the Senate centers on oversight. From health care to the Pentagon, I care deeply about rooting out waste, fraud and abuse in the federal government in order to make it function better for the people of Iowa and the entire country. My oversight team works regularly with whistleblowers to identify problems in the federal government, but often it’s Iowans who contact me with issues they’re facing that begin my most important oversight work. One example of this is elder abuse.

Through letters, phone calls and at my annual 99 county meetings, Iowans with loved ones in nursing homes have approached me about concerns they’ve had regarding the treatment of their family members. Their concerns have ranged from lackluster facility conditions to claims of negligence and abuse. Their concerns have inspired my decades-long work to preserve the dignity of older Americans.

As the former chairman of the Senate Aging and Judiciary committees, as well as earlier in my tenure as Senate Finance Committee chairman, I conducted oversight of the nursing home inspection process and convened hearings focused on enhancing quality standards and compliance across the nursing home industry. I’ve continued that work this Congress as I’ve stepped back into the Senate Finance Committee chairmanship. Part of those oversight efforts have included numerous letters to the Centers for Medicare and Medicaid Services (CMS) requesting information on how the agency is working with facilities to keep these standards high and take action when they fall short.

For example, former Sen. Herb Kohl (D-Wis.) and I released a number of important Government Accountability Office (GAO) reports that exposed serious quality care problems in nursing homes. A 1998 report exposed serious quality of care problems in nursing homes, exacerbated in part by highly predictable annual inspections and few citations for serious deficiencies. Senator Kohl and I held hearings in the Aging Committee about the report and urged action from the Clinton administration, which it later took to improve the inspection process.

In 2009, we released another GAO report on the Special Focus Facility (SFF) Program, which monitors nursing homes that earn the worst quality ratings. The study recommended that SFF be administered by CMS and expanded to accommodate more of the 580 nursing homes GAO found to be the poorest performers. Both in 2010 and 2012, Senator Kohl and I released reports that highlighted under-reporting of serious deficiencies in nursing home care and urged CMS to improve oversight of its system to monitor quality standards.

These ongoing oversight efforts have led to significant positive changes. In 2008, CMS increased the information available on Nursing Home Compare, a government-run website that allows families to compare nursing home facilities as they try to find the right home for their aging loved ones. CMS has also implemented a standard survey methodology across all states for quality care standards, making it easier to identify nursing homes that fall short and quickly work to resolve the problems.

Last year, CMS began publishing rates of hospitalization for long-stay residents on Nursing Home Compare, which factors into facility ratings, and created a new system to monitor nursing home staff levels, which also factors into facility quality ratings because low staff levels often lead to poor care.

After oversight efforts exposed nursing home employees who were taking humiliating and demeaning photos of elderly residents without their knowledge or consent, social media companies moved forward to develop better means of reporting abusive cases and CMS issued additional guidance on social media abuse.

In March of this year, the Finance Committee held a hearing on abuse and neglect occurring in America’s nursing homes. During the hearing, an Iowan testified about her mother’s death due to alleged neglect by staff members at a federally funded nursing home that held a five-star rating on Nursing Home Compare. That same facility had also been the subject of multiple complaint investigations in recent years.

Following the hearing, CMS announced a five-part approach to guide its work to ensure safety and quality in America’s nursing homes. The approach will focus on strengthening oversight, enhancing compliance enforcement, increasing transparency, improving quality and putting patients first – priorities I have advocated for over the past two decades.

Older Americans deserve to maintain their dignity and live in safe, caring environments during their golden years. Oversight of nursing homes and the federal agencies that police them is essential to ensuring that happens.

Pleasant Acres Rehabilitation & Nursing Center was sued because of a woman’s wrongful death. Nancy Young died on Dec. 15, 2018 —only  seven days after her left hip and wrist were fractured from a preventable fall.  Young had entered another resident’s room, and the resident slammed the door on her as she was leaving. Young fell, but no one reportedly witnessed it, according to the lawsuit.

The York County Coroner’s Office ruled the death a homicide because of the action of another person. Young died of blunt force injuries that complicated existing conditions, including heart disease, according to the coroner’s report.

Daughter-in-law Barbara Young, who is executrix of Nancy Young’s estate, filed the wrongful death lawsuit in York County alleging that the nursing home did not provide enough staffing to care for Young as well as other residents.

Pennsylvania requires a minimum of 2.7 hours of care per resident per day. However, the state Department of Health found that the home was providing 2.44 hours of care per resident as of Oct. 26, 2018.  The state put the home on notice again in November about a staffing problem, the lawsuit states. Both times, the home submitted plans for correction. A former employee of Pleasant Acres and loved ones of residents complained earlier this summer to the York County Commissioners about the state of the home. They described it as being short-staffed.

In their efforts to maximize revenues/profits, Defendants negligently, intentionally, and/or recklessly reduced staffing levels below the level necessary to provide adequate care to residents, which demonstrated a failure to comply with the applicable regulations and standards for nursing home facilities,” the lawsuit alleges.

 The facility was well aware that Young was at risk for falls, and “if she fell, there was a likelihood she would be seriously hurt,” the lawsuit states. She needed to use a walker and to wear shoes while walking in the halls. Despite the facility knowing that she was at risk for falls and needed assistance and supervision to maintain her safety, Young fell several times after being admitted. Young’s family repeatedly met with staff, and interventions were planned to prevent falls, such as ensuring that her walker was within reach when nurses checked on her.

The night that Young fell, she was found lying on her back with only slipper socks on. She did not have her walker, the lawsuit states.

Provider Magazine had the below message on their website:

The long term and post-acute care profession is reminding providers that new arbitration regulations released earlier in the summer by the Centers for Medicare & Medicaid Services (CMS) have gone into effect as of Sept. 16, stressing that separate legal actions concerning arbitration issues do not impact the implementation process.

Sources at the American Health Care Association (AHCA) tell Provider that despite some erroneous media coverage of the arbitration implementation date, the Sept. 16 start date has not been impacted. Only specific providers involved in arbitration rule lawsuits are affected by the court order, not all skilled nursing facilities (SNFs), they say.

The final rule (CMS 3342-F) will allow CMS to regulate SNF arbitration agreements effective Sept. 16, but this does not apply to agreements signed before that date.

Further, providers need to make sure that their agreements and practices are in compliance with the new regulations, says an AHCA source.

Besides the effective date, the new regulation includes the following:

–          Arbitration agreements cannot be conditions of admission or continuation of care;

–          Agreements must be presented in form, language, and manner that the resident can understand;

–          Agreements must provide for neutral arbitrator and venue;

–          Residents must have the right to cancel agreements within 30 days of signing;

–          Agreements must not discourage a resident from communicating with federal or local officials; and

–          If the dispute is settled by arbitration, a copy of a signed agreement and arbitration award must be kept for five years and available for inspection by CMS.

When CMS released the final arbitration rule on July 16, AHCA applauded the agency for allowing skilled nursing centers to use pre-dispute arbitration agreements, which were banned by the Obama administration in 2016.

Still, on the new final rule’s release, AHCA President and Chief Executive Officer Mark Parkinson said the skilled nursing profession is “concerned about CMS adding any conditions or administrative requirements when Congress has spoken on the subject.”

Pre-dispute binding arbitration agreements are arrangements in which two parties agree to settle future disputes through an arbitration process rather than through litigation. The agreements also require that both parties accept the arbitration process’ outcome.

KRON4 reported the sad incident of CNA Nshimiyiana Hamzat at Foss Home and Village Nursing Home who was arrested after authorities say he raped a disabled woman in the nursing home where he worked.  According to court documents, Hamzat was caught on a hidden camera sexually assaulting the victim more than once.  The woman’s family says they hid the camera that looks like a phone charger in the room. Hamzat is charged with second-degree rape.

Hamzat owns another adult care home himself in Bothell, Wash. where operations have since been suspended, remains jailed.

According to Seattle media, there is another investigation involving another sexual assault at the same facility.

All hands on deck!

The U.S. House of Representatives will vote Friday on H.R. 1423, the FAIR Act—a bill to end forced arbitration in all its forms.

Help achieve passage of this affirmative, comprehensive legislation to help workers, seniors, and consumers!

Contact your member of Congress today. Your voice matters.

Use AAJ’s Take Justice Back Action Item to send your members of Congress an email (or call) urging the passage of H.R. 1423, the Forced Arbitration Injustice Repeal Act.

For additional information about how forced arbitration devastates Americans, visit AAJ’s Faces of Forced Arbitration website.

The New York Times had a great article on the false promises and the Big Lie of the Assisted Living industry.  They sell themselves as the solution to everyone’s worries about old age built on the unrealistic dream that we will grow old while being self-reliant and live that way until we die.  The irony of assisted living is, it’s great if you don’t need too much assistance. But if you have trouble walking or using the bathroom, or have dementia and sometimes wander off, assisting living facilities aren’t the answer.

The assisted living industry is all about profit and has a financial interest in sustaining a belief in this old-age nirvana. Originally designed for people who were mostly independent, assisted living facilities have nearly tripled in number in the past 20 years to about 30,000 today. It’s a lucrative business: Investors in these facilities have enjoyed annual returns of nearly 15 percent over the past five years — higher than for hotels, office, retail and apartments, according to the National Investment Center for Seniors Housing and Care.

But when it comes to direct care, the facilities are often lacking.  Families and residents don’t realize that these facilities are not designed to provide more than minimal help and monitoring. Even those that advertise “24-hour” monitoring may have someone present round-the-clock on the premises, but may not have sufficient staff to actually monitor and assist the large number of residents.

“People’s defense against something horrible happening is, ‘Well, they have a right to be independent,” she said. “‘Yes, he did walk up the stairs with his walker and fall down and die, but he had a right to do that.’ That’s a horrible defense. You don’t just allow people to do unsafe things.”

Most residents of assisted living need substantially more care than they are getting. Half of those residing in assisted living facilities in the United States are over the age of 85, the Centers for Disease Control reports. The number of people 85 years of age and older in the United States will nearly triple to about 18 million by 2050, according to the Census Bureau.

“When you say nursing home, people say, ‘Yuk,’” said Eric Carlson, the directing attorney for Justice in Aging, a national advocacy group for low-income older Americans. “When you say assisted living, a lot of people say, ‘That sounds good.’ Nobody realizes the system is broken.” When something bad happens to a resident of an assisted living facility, “They just think it was that facility that was horrible,” he says.

Part of the problem is a lack of regulation. The federal government does not license or oversee assisted living facilities, and states set minimal rules.  Not surprisingly, complaints against assisted living facilities are mounting in courts around the country.

Assisted living has a role to play for the fittest among the elderly, as was its original intent. But if it is to be a long-term solution for seniors who need substantial care, then it needs serious reform, including requirements for higher staffing levels and substantial training.

That will raise prices, and assisted living already costs between about $4,800, on average, each month, and nearly $6,500 if dementia care is needed, according to the National Investment Center, a group that analyzes senior housing reports.



Flagler Live had an interesting article about a controversial issue in long term care especially for nursing home abuse and neglect lawyers who emphasize the sanctity and value of life.  The issue is senior suicide or “rational suicide”.  A six-month investigation by Kaiser Health News and PBS NewsHour finds that older Americans are quietly killing themselves in nursing homes, assisted living centers and adult care homes.  Descriptions KHN unearthed in public records shed light on residents’ despair: Some told nursing home staff they were depressed or lonely; some felt that their families had abandoned them or that they had nothing to live for. Others said they had just lived long enough: “I am too old to still be living,” one patient told staff. In some cases, state inspectors found nursing homes to blame for failing to heed suicidal warning signs or evicting patients who tried to kill themselves.

In a nation where suicide continues to climb, claiming more than 47,000 lives in 2017, such deaths among older adults — including the 2.2 million who live in long-term care settings — are often overlooked.  Analysis of new data from the University of Michigan suggests that hundreds of suicides by older adults each year — nearly one per day — are related to long-term care. Thousands more people may be at risk in those settings, where up to a third of residents report suicidal thoughts, research shows.

The fact that vulnerable residents are managing to kill themselves in what are supposed to be safe, supervised places raises questions about whether these facilities pay enough attention to risk factors like mental health, physical decline and disconnectedness — and events such as losing a spouse or leaving one’s home.




McKnight’s had an article about the issues and problems at California Villa in Van Nuys, CA, an assisted living facility.  Staff members were unable to identify a veteran in their care when a case manager from the Department of Veterans Affairs visited, resulting in the case manager reporting that she had visited with the resident — four days after he had died, according to the U.S. Office of Special Council.

The incident is part of a larger issue with the care of veterans in assisted living, according to the office. The alleged incidents are examples of how VA  “compromised patient care” because they “failed to take action on repeated allegations of patient care deficiencies and employee misconduct” at assisted living facilities where veterans live. The VA investigation concluded that because veterans, not the VA, pay assisted living facilities, VA officials did not oversee those facilities as “vigorously” as they did other programs funded directly by the VA.

California Villa was approved to care for veterans by the VA Greater Los Angeles Healthcare System, according to the OSC. When a case manager visited in October 2017 looking to meet with a specific veteran, however, staff members referred her to the wrong resident, a VA investigation found. The resident she had come to see actually had died four days before her visit.

The VA investigation also “confirmed longstanding and well-known” issues at the home, including a general state of disrepair and a disorganized medication room, the OSC said. Between 2015 and 2018, several veteran residents experienced “serious” medication errors, according to investigators.

For instance, staff members did not provide physician-prescribed antibiotics to a 100-year-old veteran with sepsis, the report said. In another case, staff members allegedly did not update records related to physician-canceled prescriptions, resulting in a veteran receiving double doses of medication on two occasions. And in a third case, staff members allegedly did not provide medication to a resident who did not leave his room.

“I am shocked that such lax oversight of facilities providing critical care for vulnerable veterans ever occurred, and I commend these whistleblowers for coming forward to shine a light on this serious issue,” he wrote.

The VA has agreed to begin monitoring more closely the assisted living communities caring for veterans. Also, the VA agreed to make the community care program coordinator a full-time position, and the person in the role now will visit all VA-approved assisted living facilities every month, according to the OSC. All facilities also will be independently reviewed, too, the office said.

Sherry Culp is Kentucky’s state long-term care ombudsman and president of the Nursing Home Ombudsman Agency of the Bluegrass, Inc. Natalie Brown-Radtke is director of the Long-Term Care Ombudsman Program at Catholic Charities and district ombudsman for the Kentuckiana Regional Planning and Development Agency. They wrote the below editorial for the Kentucky Courier Journal.

The unnecessary death of retired Judge Dan Schneider, as reported by Andrew Wolfson in the July 3 Courier Journal, might never have come to light had an unidentified person not written anonymously to Schneider’s widow Joann six weeks after his passing.

Our hearts go out to the Schneider family as they relive the nightmare of losing their husband and father in 2013 because of preventable mistakes, such as the pharmacy’s failure to check records to ensure Judge Schneider was receiving the medication his physician prescribed. Schneider was admitted to Masonic Homes for rehabilitation following a hip infection. His doctor sent orders for an antibiotic administered intravenously for 28 days.

He never received a single dose.

A federal investigation found that some Masonic staff members hid the truth from Joann Schneider and Norton Suburban Hospital, where Judge Schneider died. Last month, Masonic and MedCare Inc. settled out of court for $11 million and $1.9 million, respectively.

We may never know whether low staffing levels at the nursing home contributed directly or indirectly to Schneider’s death. We do know there’s ample research to indicate that more and better trained staff result in better care for residents. 

In court papers, Louisville attorney Chad Gardner, who represented the Schneider family, said “Masonic Homes botched Schneider’s care because of staff cuts designed to improve its bottom line.”

Gardner also said in an interview that “nearly every employee who was deposed said staffing was a problem and had told management so. They begged (Masonic Homes) to add staff.”

For years, the Nursing Home Ombudsman Agency of the Bluegrass and the Kentucky State Long-Term Care Ombudsman have pleaded with Kentucky’s legislators to enact minimum staffing laws.


Which senator or representative will lead the effort to put the well-being of vulnerable, disabled residents ahead of the nursing home industry’s profit margins?

Let legislators know that you support better care for frail, helpless nursing home residents by calling 1-800-372-7181.

It’s high time we do right by Judge Schneider and others who have paid the ultimate price — and many more who will if legislators allow the status quo to continue.



One of the problems I see as a nursing home abuse and neglect lawyer is with assisted living centers who treat the residents as hotel guests and not vulnerable adults who need supervision and assistance at times.  A recent article in InFORum sadly reminded me of that problem.

A state investigator has issued a finding of neglect and maltreatment against Hillcrest Terrace of Chisholm assisted-living facility after one resident allegedly raped another.  The report, concluded July 11 and posted by the Minnesota Department of Health, was forwarded to the Chisholm Police Department, the Chisholm city attorney and the St. Louis County attorney. The matter is being investigated by Chisholm police and she couldn’t comment further.

According to the report, the female resident states she was raped.  The male resident who allegedly raped her “had a history of touching other clients’ private areas to provoke them” along with a history of yelling, destroying property and impaired judgment when upset.

On June 17, the victim told the investigator that the male client struck her on the legs with a statue, pried her legs apart and raped her. She said she reported the incident to the staffer and asked her to call the police, but she was told to call the police herself.

According to the report, Chisholm police arrived about 7 that evening, collected evidence from the apartment and took the female client to the hospital for a sexual assault examination. Police then removed the predator from the facility, the report said. Hillcrest Terrace evicted him but he was allowed to return once to gather his belongings. The victim was kept in the nurses’ office during that time.

The employee on duty admitted that she had not been given vulnerable adult training, but her personnel file indicated that she had completed the training and received retraining two months before the incident. The staffer was placed on 90-day probation and assigned to a different facility where there always would be two staff members working, according to the report.  The investigator faulted the staffer, but also faulted the facility for not supervising the staffer and not providing retraining after the incident.

After taking Micardis for a while, I suddenly started to cough. When I discontinued medication, there was a gradual recovery, i. the irritating cough disappeared. But what am I doing now with my hypertension?