John Ette, a certified nurse assistant is charged with abusing an 88-year-old bed-ridden resident at Adirondack Medical Center’s Mercy Nursing Home. He is accused of hitting, grabbing and punching the visually and dementia-impaired woman last October, leaving her with a broken collarbone and facial bruising.  Officials say John Ette hit and pushed an 88-year-old bedridden woman while working at the Adirondack Medical Center and Mercy Nursing Home in Tupper Lake. The woman had multiple bruises and a fractured clavicle in October 2008.

Shortly after midnight on Oct. 20, 2008, Ette struck the bedridden patient in the face, grabbed her arm and pushed her down into her wheelchair, according to the court complaint filed against him.  The patient suffered a broken collarbone and some facial bruising. Her condition is now stable, and she still lives at the nursing home, said David Doyle, spokesman for the state Office of the Attorney General.

Ette admitted the act to state investigators on Nov. 12, 2008.  Nursing Home staff noticed the woman’s severe injuries the next morning and notified administrators and her family. Ette was fired following an internal investigation last October.  Ette was charged Wednesday by the Attorney General’s Office with second-degree endangering the welfare of a vulnerable elderly person, endangering the welfare of an incompetent or physically disabled person and willful violation of health laws.

"Nursing-home care must be administered with the respect and professionalism that New York’s seniors deserve," Attorney General Andrew Cuomo said in a news release. "It is appalling when our dependent and vulnerable loved ones are victimized by the very people who are entrusted with their care."

AMC goes through an extensive screening and background check process before it makes a hire.

Ette’s estranged wife, Jodi Ette, told the Enterprise John Ette had displayed violent tendencies in the past. She said he had never been violent toward her but had lashed out at inanimate objects.  She said that when the incident happened, it took John Ette several days to divulge the details of the alleged abuse. "He wouldn’t tell me the full story for quite some time," she said.

"We want to reassure families that we are taking the proper steps to protect the safety and well-being of our residents, patients and staff," AMC’s Chief Financial Officer Patrick Facteau said.



 He had worked at Mercy since Feb. 21, 2006.


Extendicare Real Estate Investment Trust ("Extendicare REIT" or the "REIT") (TSX: EXE.UN) reported improved 2009 first quarter results.


– EBITDA of $64.8 million in Q1 2009 increased 18.4%, relative to $46.2 million in Q1 2008.

– EBITDA margins improved to 11.1% in Q1 2009 from 9.7% in Q1 2008 from "cost saving initiatives" and the back-to-basics plan. No details as to what initiatives they mean but it wa sprobably cutting budgets for staff and food!

– Medicare Part A and Managed Care rates grew 8.5% and 13.4%, respectively, from Q1 2008; and 2.1% and 2.6%, respectively, from Q4 2008.

Cash on hand of $120.1 million with no significant debt maturities until 2011 and beyond.

Adjusted funds from continuing operations improved $6.0 million, or 33.0%, to $24.2 million ($0.332 per basic unit) in the 2009 first quarter from $18.2 million ($0.258 per basic unit) in the 2008 first quarter.  Distributions declared in the 2009 first quarter of $15.3 million, or $0.07 per unit per month, represented 63.2% of adjusted funds from continuing operations.


The average daily Medicare Part A rate for our wholly owned U.S. subsidiary, Extendicare Health Services, Inc. (EHSI), grew 8.5% to US$445.71 in the 2009 first quarter from US$410.69 in the 2008 first quarter. The October 1, 2008, market basket inflationary increase accounted for approximately 3.4% of the rate increase, with the remainder primarily related to higher average acuity levels among Medicare patients served. In comparison to the 2008 fourth quarter, our average daily Medicare Part A grew 2.1% due to a continued improvement in the mix of Medicare residents.

Our percentage of Medicare residents in the nine highest Resource Utilization Groupings (RUGs) classifications increased to 41.0% this quarter from 37.2% in the 2008 first quarter, as well as increasing from 38.9% in the 2008 fourth quarter. In addition, we experienced an increase in the percentage of Medicare residents receiving therapy services to 89.4% this quarter from 87.5% in the 2008 first quarter, as well as from the 2008 fourth quarter of 88.0%.

The average revenue rate for Managed Care clients increased 13.4% to US$379.58 this quarter from US$334.86 in the 2008 first quarter, and increased 2.6% from the 2008 fourth quarter. This is an important revenue growth opportunity as it represents the second highest rate component of our quality mix of residents.


While our same-facility average daily census (ADC) remained relatively unchanged from the 2008 fourth quarter level of 14,984, we did see an improvement in our skilled mix of 188, or 5.6%, to 3,544. We experienced a similar trend last year from the 2007 fourth quarter to the 2008 first quarter. Our same-facility ADC from EHSI’s skilled nursing centers declined 217, or 1.4%, to 14,981 in the 2009 first quarter from 15,198 in the 2008 first quarter.



A recent report came out on the hourly wages, injuries suffered, and poverty of CNAs. CNAs are certified nurse assistants.  They are typically unlicensed health care providers with little education and training.  They provide 80-90% percent of the care and treatment given to residents in a nursing home, if not more.  It is rare an actual RN examines or assesses residents. 

This report summarizes conditions for CNA’s.   More than 50% received at least one work-related injury last year, and roughly 16% don’t have health insurance, mostly because of cost. More than 33% of CNA’s are receiving some form of public assistance, such as food stamps or rental subsidies. Their median wage is $10.04 an hour.  They provide 8 out of every 10 hours of resident care.   Forty-two percent of uninsured CNAs cite not participating in their employer-sponsored insurance plan because they could not afford the plan. Years of experience do not translate into higher wages; CNAs with 10 or more years of experience averaged just $2/hr more than aides who started working in the field less than 1 year ago.

The nursing home industry exploits these workers and then they wonder why their turnover rate is so high and retention is so low?  Corporations who own these nursing home chains need to understand that they should train, pay, and provide health care to these front line workers.  Provide incentives to become LPNs and RNs.  Offer better benefits or paid vacation time.

I am a big proponent of using surveillance cameras in nursing homes especially when privacy concerns are protected.  There are numerous benefits to placing cameras in certain areas of the facility.  Medication room, nursing station, and hallways and exits would deter theft, neglect, and elopements.  They would also protect seniors in hospices, nursing homes and other group home settings from abuse, and would comfort guardians of such patients who might live far away.

The San Francisco Chronicle had an article about a proposal to let patients in care facilities or their families or guardians install surveillance devices in the patients’ rooms.  "The capabilities of monitoring from a remote location provide a sense of security to both the facility and the residents," said Cegavske, the bill’s primary sponsor.

Cegavske said she introduced SB290 in large part because of an unexplained hand injury her mother sustained while in a Minnesota nursing home last year. Cegavske’s mother has Alzheimer’s disease and can no longer play the piano as a result of the injury. 

Also backing the bill was Lillian Mandel, who said her mother was abused twice last year in a nursing home. She said one of the incidents involved a diaper shoved in her mother’s mouth.

"I realized I needed some kind of evidence in my mother’s room to protect her and any senior around because this is totally unacceptable," Mandel said, adding that the cases involving those responsible for abusing her mother were eventually resolved.

Changes to the bill made in the Senate specify that the monitoring devices use video without sound.   Why is that necessary?  What if someone is yelling out for help–shouldn’t the camera record that? 

Another change would release the facility from liability arising from any issues involving the monitoring device.


The Middleton Journal had an article about two different employees of a nursing home, acting separately, stole narcotics from residents for years, and altered the residents’ charts to make it look like residents actually received the need pain medication.  How could they not have been caught earlier?  didn’t the residents complain that they were still in pain? 

Deborah Renee Richardson and Denise “Bells” Holtkamp are both accused of stealing Oxycodone from the Lebanon Country Manor nursing facility in Ohio.  Both nurses separately altered patient records so they could steal the addictive painkiller for their own use.

Both women were indicted by a Warren County Grand Jury on two counts of illegal processing of drug documents, a fourth-degree felony; two counts of theft of drugs, a fourth-degree felony; and two counts of aggravated possession of drugs, a fifth-degree felony.


Nevada Appeal had an article about the sale of the building where Evergreen Mountain View Health and Rehabilitation Center operates for $8.2 million from Evergreen’s parent company, Vancouver, Wash.,-based Evergreen Healthcare.  Chicago based Aviv Asset Management bought the building and will keep the same management team.  Evergreen took over management of the 146-bed nursing home in 2002.   It bought the building for $5 million in 2005.  So in less than 4 years, the value of the building itself (not the on going nursing home operation) increased by $3.2 million.  some thing smells fishy about this deal.

Josh Kocheck, asset director for Aviv, said Aviv is a real estate business and will serve only as a landlord.  He said people are concerned when a nursing home gets a new owner, but Aviv has no intentions of running a healthcare company.   Evergreen Healthcare runs other nursing homes. It has 58 nursing homes concentrated in Western states.

Aviv owns about 125 nursing homes across the country, according to the company.

Evergreen Mountain View has had several problems with government agencies since its parent company started managing it.   It was the only nursing home in the state that made the Centers for Medicare and Medicaid Services list of 131 worst nursing homes last year. As a “special focus facility,” the state checked the nursing home twice a year rather than the usual once a year from 2004 to 2008.



On this Memorial Day, I was going to mention and celebrate all the veterans now living in nursing homes.  Here is a link to information about veteran services and nursing home care.  I hope and pray that these brave men and women receive the best care, treatment, and services America offers.  Unfortunately, there are stories every day about how veterans are treated poorly in nursing homes and don’t get the care necessary to live with dignity. 

The Denver Post had an article about the administrator of the State Veterans Nursing Home in Rifle, Colorado,  who was finally fired after an audit discovered he stole resident’s money.  He has been indicted for paying an employee $7,290 in state funds for veteran care to an employee who helped him restore a 1951 Cadillac. 

The indictment alleges that Robert Leslie Shaw asked Rifle nursing home maintenance worker Michael Walker to help him restore the car at Shaw’s residence.  The work on the car began in October 2007, and Walker spent numerous weekdays and weekends working on the car at Shaw’s home.   In addition, Shaw asked Walker to travel out of state to pick up parts for the car, and Shaw paid Walker for the transportation costs and expenses.  Shaw later paid Walker for 3,645 hours of on-call service, even though his job status did not entitle him to on-call pay. Nursing home employees who remain on-call — willing to come in to work in case of emergencies — are compensated $2 per hour for their time.

The Denver grand jury returned the indictment  charging Shaw with two counts of felony theft and one count of first-degree official misconduct, which is a misdemeanor.

I hope this guy rots under the jail.


Lexington Herald-Leader had an article about nursing homes that caused at least 6 deaths due to their ignorance and negligence.  Incredible. State investigators have cited 4 nursing homes for failing to perform lifesaving measures on residents who had requested that they be resuscitated.

The errors alleged by the state provide ammunition for those who are pushing for a new law or regulation that would mean all nursing homes would use a purple wristband to identify residents who had signed a do not resuscitate — or DNR — order.

Kentucky has no uniform regulations regarding how to inform staff members of DNR orders at the bedside at nursing homes or hospitals.   Three different groups of nursing home and hospital officials are meeting in the next several weeks to determine whether Kentucky should join other states that have adopted a color-coded system.

Five of the six facilities sanctioned received Type A citations, the most serious the state can give. In all six cases, the individuals died.

■ Kenton Healthcare in Lexington was cited in September 2007 after the staff allegedly did not initiate lifesaving measures on a resident despite a doctor’s orders that everything possible be done to save the patient.

■ Hillcrest Health Care Center in Owensboro was cited in December 2008 after cardiovascular pulmonary resuscitation was not performed on a resident who wanted to be resuscitated.

■ In April 2007, staff members at Christian Health Center in Bowling Green did not immediately resuscitate a resident, despite a doctor’s orders that lifesaving measures should be used.

Staff members told state investigators that the facility did not have a system that allowed immediate access to the code status of a resident.

■ Woodland Oaks Nursing Home in Ashland is appealing a citation it received in January. Officials there deny failing to perform CPR on a dying patient who had requested lifesaving measures.

■ On the other end of the spectrum, Green Meadows Health Care in Mount Washington received a citation in March 2008 for trying to revive a resident who had signed a DNR order. Green Meadows officials did not return a telephone call seeking comment.

■ In March, Jefferson Manor in Louisville was cited after 95-year-old Eva Karem was resuscitated in February 2008 despite a DNR order. (It received a citation that was not as serious as a Type A.)

The Karem case prompted a series of meetings of lawmakers, nursing home officials and others who are looking at the use of wristbands.

"It is very important to accurately identify patients’ preferences regarding resuscitation, while also protecting their privacy, which is a factor we will be taking into careful consideration when making our decision," she said.

Defendant nursing homes in litigation often attempt to confuse the jury regarding DNR orders.  Nursing homes always claim that a DNR allows them to ignore and neglect residents because "the family signed the order and must have wanted him/her dead".  Ridiculous.


The Lexington Herald-Leader had an article about a Richmond nursing home facing allegations of abuse has been added to a list of nursing facilities requiring federal oversight.   The federal Department of Health and Human Services’ Centers for Medicare and Medicaid Services added Richmond Health and Rehabilitation Center to its "Special Focus Facilities" list in April.

The Richmond Register reports the facility also known as Madison Manor is considered "Class A," meaning it is newly added and pending a standard survey by federal inspectors.  The "Special Focus Facilities" list highlights facilities that either have more problems than most nursing homes, more serious problems than most other homes or a pattern of serious problems over a long period of time, according to the department.

The Kentucky attorney general’s office is investigating allegations of abuse at the facility after the family of the late Armeda Thomas, 84, hid a video camera in her room in September to document employees’ behavior.   That recording led to criminal charges against several former employees of the facility. Former nurse’s aide Jaclyn Dawn VanWinkle pleaded guilty last month to reckless abuse or neglect of an adult and received a probated 12-month jail sentence in exchange for assisting prosecutors with their case. She was seen on the video dancing in front of Thomas in her room.

Amanda Sallee of Richmond was charged with wanton abuse and neglect of an adult for allegedly eating Thomas’ meals instead of offering them to her or offering to help feed her.

Valerie Lamb of Berea was charged with reckless abuse and neglect of an adult for allegedly lifting Thomas by her neck and lifting her legs higher than necessary when performing incontinent changes, her misdemeanor indictment says.


The British newspaper The Mirror had a shocking story about an elderly woman tragically abused and neglected.  She was found bed-bound, underfed, dehydrated and covered in ulcers.  She died after she was so badly neglected in a nursing home that horrific open wounds covered most of her body.

Gwendoline Hoar had painful pressure ulcers on her back, hips and feet.   She was in dreadful pain but managers at the private home refused to give her pain relief until the final two days of her life.  Two docotrs who visited Mrs Hoar and failed to help her have refused to co-operate with the coroner.

Two years after she died – no one has been arrested over her death.  Gwen’s family now want a full inquiry. Son-in-law Gavin Langley said: "What happened was avoidable and dreadful. Someone has to be held to account. It’s horrifying."

Gwen lived at home until the death of second husband Stan in 2004. He had been her teen sweetheart and they wed after first husband Cyril died. Gavin said: "They had 25 blissful, happy years. It was idyllic."

When Gwen developed dementia devoted Stan cared for her at home until his death. She went into one nursing home where she was well looked-after, but her condition got worse and she had to move to River Court. Both homes were paid for from savings.

Within four months of entering River Court she was close to death. After concerns were raised about the home, BUPA sent in skin expert Ann Moore, told the inquest into Mrs Hoar’s death: "I found a frail little lady in her room who appeared quite undernourished.  She was very dehydrated. I could see she hadn’t been turned frequently. In fact she hadn’t been turned at all, according to the documentation."   Ms Moore found more wounds than listed in the notes. Some had dressings but others were open to infection. A specialist mattress to relieve sores had not been fitted properly so was of no benefit.

It was another month – and only after a visit from inspectors – before the local health trust was called in. Two district nurses who examined Gwen were shocked by her condition, which had got even worse. One said there were too many sores to list.   Some were found to be Grade 4 – the most serious – with skin and tissue split down to the bone. But instead of sending her to hospital doctors took the advice of a BUPA nurse that Gwen should be treated in the home.

The inquest heard that when they were urged to provide 24-hour pain relief for Gwen, managers "resisted" installing the equipment until two days before she died. A post-mortem found the sores were so painful they stopped Gwen moving, which led to pneumonia.

Coroner Graham Danbury said the care provided at the home was "seriously disturbing". 

Daniel Blake of Action on Elder Abuse said it was "a disgrace" no one had been held to account.