Nursing homes continue to object and try to prevent residents from getting copies of medicaid and medicare cost reports despite the fact that this are public documents and federal regulations require the disclosure of the documents.  When the nursing home objects, inform the Court about the specific regulation requiring disclosure:

42 U.S.C. §1395i-3(g)(5)(A) which states,

Each State, and the Secretary, shall make available to the public–

(i) information respecting all surveys and certifications made respecting skilled nursing facilities, including statements of deficiencies, within 14 calendar days after such information is made available to those facilities, and approved plans of correction,

(ii) copies of cost reports of such facilities filed under this subchapter or subchapter XIX of this chapter,

(iii) copies of statements of ownership under section 1320a-3 of this title . . .

The DesMoines Register had one of the most disturbing articles I have ever read.  Daniel Larmore is the chairman of the board that oversees Iowa’s nursing home administrators.  That board is charged with licensing and disciplining Iowa’s nursing home administrators — but it has taken no action against an administrator in two years.   He characterized the sexual abuse of a resident in his facility as a "meaningful" relationship that caused no harm to the resident.  How dare he say such an irresponsible thing.  Who the heck does he think he is.

Larmore was the administrator at the Harmony House care center in Waterloo.  State records show that Larmore himself faced allegations from the state inspectors in 2004 — and was never investigated or disciplined by the board.  The incident resulted in a $3,500 fine against the facility, a detailed report of the inspectors’ findings should have been sent to the Iowa Department of Public Health, which would have passed the information on to the board for its review.  It is unclear whether Larmore’s case was ever sent to the board for consideration. But Larmore has also acknowledged to the Register that the board failed to review some cases that were sent to the board for potential disciplinary action.

In June 2004, the Iowa Department of Inspections and Appeals alleged that Larmore failed to properly investigate and respond to complaints that a female nurse aide had repeatedly engaged in sex with a brain-injured, 29-year-old male resident of the home. The aide’s co-workers had witnessed several suspicious encounters between the resident and the aide, and had reported their concerns to supervisors. At one point, the resident’s roommate complained, saying the two seemed to be having sex on the other side of a privacy curtain.

State inspectors accused Larmore of making little effort to investigate the matter when an employee first voiced her suspicions. The state also alleged he failed to separate the resident and the aide once the complaints were made. The aide finally confessed to having sex with the resident.   In a written response to the state’s allegations, Larmore argued that sex between the caregiver and the resident did not cause injury or harm to the resident.  The resident had a brain injury and clearly could not have given consent.

Larmore wrote: "The relationship was initiated by, and was meaningful to, (the resident). … The presented situation was one of mutual interest of a (resident) and a caregiver and, although inappropriate, did not present potential or actual harm to the consumer due to the reciprocal fond relationship."

In Iowa, a professional caregiver who engages in sex with a nursing home resident can be criminally charged with dependent-adult abuse. Larmore acknowledged in his response to the state that after the first concerns were voiced about intimate or inappropriate contact between the resident and the aide, he didn’t talk to other employees or to the victim. In May, before Larmore resigned as Harmony House administrator, he fired nurse aide Tina Turner, 29, for allegedly having sex with a resident of the home and providing the man with marijuana.

Turner denied the allegation. One of her co-workers alleged Turner confessed to disconnecting the man from his ventilator so he could inhale the drug, saying, "I didn’t want to kill him or anything. I just wanted to get the dude high."

So this SOB covers up the sexaul assault of a brain damaged resident and fails to properly investigate of prevent it and he gets rewarded by becoming the chairman of the group that investigates Administrators?  Are you kidding me?

Minnesota’s Star Tribune had a disturbing article about a teenage aide at Glenwood Village Care Center nursing home who physically and emotionally abused two frail residents — getting one to cry by telling her she soon could see her dead husband and threatening to send the other to jail, where she might be raped.

The case represents the fourth time in just over a year that Health Department investigators concluded that aides emotionally and physically abused frail residents of residential facilities. Two of the cases have resulted in criminal charges.  Many of the aides implicated in the other abuse cases also were teenagers.

Another Glenwood Village employee told administrators June 22 that on the previous evening, the aide threatened to hit her, telling her coworker, "I wouldn’t really hit her, but believe me, I want to. I just want to smash her."   A different employee later told investigators that the aide said she had told the resident, "If you hit me, you are going to go to jail, and do you know what happens to people in jail? They get raped."

Later that evening, the aide began lifting another resident’s leg and continued moving it when the woman cried out in pain, telling her, "Cry if you want to cry."

The string of high-profile abuse cases began in Albert Lea on Aug. 29, 2008, when the Health Department found that four aides had abused 15 residents with dementia over five months by poking and groping residents’ genitals, sticking fingers in their mouths and noses and taunting them until they screamed. Two teenagers who worked at the home were charged as adults.   In Montevideo, an aide pleaded guilty this summer to charges that she abused four residents. This month, three aides at a Virginia assisted living facility were found to have pinched and slapped several elderly residents.



The George Washington University School of Public Health did a study about health insurance fraud.  Here are some interesting excerpts from the study:

In 2007, the U.S. spent nearly $2.3 trillion on health care and public and private insurers processed more than 4 billion health insurance claims.  The National Health Care Anti-Fraud Association (NHCAA) has estimated that, conservatively, 3% of all health care spending—or $68 billion—is lost to health care fraud. Other estimates by government and law enforcement agencies place fraud-related losses as high as 10% of annual health care spending; at this rate, the losses in 2007 alone –over $220 billion – would have been enough to cover the uninsured.

Medicare and Medicaid may be susceptible to fraud in part because many investigative reports on victims of consumer swindles suggest that financial fraud is not uniformly distributed across all households; instead, it disproportionately targets the elderly, women, minorities, the less educated, and the poor.  In other words, Medicare and Medicaid fraud may reflect the vulnerable nature of the populations that depend on the program rather than any failing on the part of either program. reported that two Burlington nursing homes were hit with big fines for having an unauthorized employee. Federal prosecutors say the Burlington Health and Rehab Center and the Starr Farm Nursing Home both hired a nurse who had been previously banned from working in facilities that receive federal health care funds, like Medicare. Such bans often result from fraud convictions, though prosecutors did not release specific details about the employee.

To settle the case with the government, Burlington Health and Rehab paid $175,000 in penalties. Starr Farm paid $40,000. 

How could this happen?  Didn’t the nursing homes do the standard background check?  I wish they gave details of why the nurse was banned from working at a nursing home.


UGH!  Another article about a nursing home employee sexually assaulting one of the resdients.  I can’t believe how often this happens.  This story comes from the Salt Lake Tribune.  An employee of Hillside Rehabilitation Center nursing home is accused of sexually abusing an elderly patient with Alzheimer’s Disease.  Clifford Ray Holt was charged with one count of second-degree felony forcible sexual abuse of a 62-year-old resident.   Holt led the woman into a room, told her "this is my place" and started massaging her shoulders once the door to the room was closed. He then grabbed the woman’s breast aggressively enough to cause a bruise.

Court records show Holt pleaded guilty to burglary of a vehicle, a Class a misdemeanor, in March 2006, and was sentenced to serve a year in prison. He also pleaded guilty to burglary of a vehicle in 1997 and 1999. How did a felon get a job at a nursing home?  Why didn’t they do a background check?  Who was supervising this guy?  I hope the nursing home answers these questions.



I am honored to be a speaker at the upcoming nursing home seminar for National Business Institute.  Here is a pamphlet explaining who will be speakers and what topics will be discussed. I personally know most of the speakers and look forward to hearing from them all.

I strongly encourage anyone who litigates or is thinking of litigating nursing home cases to register for the seminar and participate in this discussion. had an article about the investigation and minimla punishment given to Saint Mary’s at Asbury Ridge’s after the discovery that one of the nurse employees had been verbally abusive to several residents for a lengthy period of time.  The incidents occurred over several months in late 2008 and early 2009. The female employee, who was identified in a violation report only as "S.C.," subjected 12 residents to "repeated verbal and emotional abuse."  How could the management of this facility either not know what was going on or fail to stop it in a timely manner?  Though co-workers were aware of the behavior, they did not report it to their supervisor, as required by law.

St. Mary’s is one of Erie County’s largest nursing homes.  It is now operating under a provisional license after a nurse’s aide verbally and emotionally abused a group of residents for months. A provisional license allows a facility to operate but notifies it that the state is keeping a close watch. The facility must pass an inspection to have its regular license restored.  What a ridiculous punishment!  Isn’t the state supposed to be keeping a close watch anyway!?!  No fine, no violations, no limitations. had a story and also ran a story about a nursing home employee who worked for Regents Park Nursing Home charged with sexual assault on a vulnerable elderly resident.  Anthony Njorge was arrested on two counts of sexual battery on an elderly resident who was not only mentally impaired but also physically helpless.  This guy needs to go to jail for a long time.  Nursing homes are places family members trust to keep their loved ones safe and cared for properly.

According to the arrest report, the incident happened around 3:40 a.m. Sunday when another employee told officers she heard noises coming from the victim’s room.  The witness later told police in the report she saw Njorge in the victim’s room cleaning up, then came out of the room with a clear plastic bag he threw into the disposal room.  A witness told Jacksonville police she heard something from one of the rooms, and when she went in she saw nurse Njorge assaulting the resident. The witness told police she reached for her cell phone, but the man tried to stop her. Police are withholding information both because of the nature of the crime and the investigation.


The DesMoines Register had an article about the outrageous delays in disciplinary actions in Iowa.  I am sure it has something to do with all the political campaign contributions given by the nursing home industry to Iowa politicians. The state board that disciplines Iowa’s nursing home administrators hasn’t issued any sanctions in two years and isn’t reviewing the state’s own care facility inspection reports.  The Board is made up of industry lobbyists and insiders, and doesn’t even have the requisite number of citizen representatives.  Of the two most recent citizen representatives, one is a former hospital lobbyist with a poor record of attendance at board meetings, and the other resigned in protest last year after complaining that she had been marginalized by the board.

The chairman is a former nursing home administrator who recently resigned from a Waterloo care facility for "confidential personnel reason". He admits that some cases of abuse and neglect aren’t being reviewed by the board.  The records show that the board doesn’t act even when the state’s own regulators have alleged criminal wrongdoing.

The board is meant to protect the 24,000 residents of Iowa nursing homes. The board licenses and reviews the conduct of facility administrators who are ultimately responsible for meeting the needs of the residents. However, since 2001, the Board of Nursing Home Administrators has disciplined only nine of Iowa’s 750 licensed administrators. In some cases, the discipline had no real effect, because the administrators were already retired from the profession or in prison.

Board records show how lengthy the delays can be:

– In January 2001, nursing home administrator Randy Downey was convicted of assault and jailed for physically attacking his wife in a care facility in front of the residents. Three years passed before the board took action by placing Downey’s license on probation and imposing a $250 fine.

– In July 2003, Kenneth Opp was sentenced to prison for embezzling $400,000 from The Abbey, a Des Moines care facility. It wasn’t until October 2004 that the board revoked his administrator’s license.

– In 1999, Stanley Schryba was accused of sexually harassing a co-worker. In late 2003, the case was disposed of when Schryba agreed to refrain from renewing his license once it had expired. By that time, he had already moved from Iowa and retired.

Other cases that have resulted in no action by the board:

– In 2002, the administrator at Mapleleaf Health Care Center in Mount Pleasant failed to tell the state that a resident had been found dead with his or her head wedged between the mattress and side rail of a bed.

– In 2003, the administrator at Van Buren Good Samaritan Home in Keosauqua allegedly concealed information about a resident who died there after choking on a hot dog while left unattended in the dining room. Inspectors alleged the administrator failed to report the choking episode to the resident’s physician and family, and falsely told the home’s own medical director the resident had suffered a seizure.

– In 2004, the administrator at Davenport’s Meadow Lawn Nursing Home was fired for transferring three residents to other care facilities simply because they "annoyed" her. The owner had allegedly ordered the administrator to apologize to the residents and tried to have them moved back to Meadow Lawn.

– In 2004, the administrator of the Stacyville Community Nursing Home was fired after she allegedly put a friend on the payroll, then routed more than $12,000 from a fund used for nursing services into a bank account she maintained with that friend.

– In 2007, ManorCare nursing home in West Des Moines was fined $12,500, and the federal government temporarily cut off Medicaid and Medicare funding for the home. One of the most serious allegations was tied to "resident dumping" – the practice of forcing out elderly residents once their savings are depleted and Medicaid begins paying for their care. The administrator allegedly told inspectors, "I don’t want to fill up 120 beds with Medicaid long-term-care residents."