Lawyers and Settlements had an article about the lawsuit filed in a case where a surveillance camera captured images of nursing home abuse in what has been deemed the second-worst elder care facility in the nation, according to the US Government Accountability Office (GAO).

Richmond Health and Rehabilitation Complex in Madison, also known as Madison Manor, was also ranked the worst facility in the state of Kentucky.   Madison Manor is owned by Extendicare, a for-profit chain that operates 21 facilities in the state. The Lexington Herald Leader reported Wednesday that three Extendicare facilities are on the GAO national list of worst performers.

Last year a hidden camera at the Richmond facility caught images of abuse inflicted on an 84-year-old resident by nursing aides. The resident, Armeda Thomas, has since died. However, in September of last year, Thomas’ family hid a video camera in her room at Madison Manor in an effort to explain bruising on the resident’s body.

Nursing assistants were seen physically abusing and taunting the Alzheimer’s patient. The nursing assistants were also allegedly shown refusing to feed or bathe the resident.

Thomas died two months later. Her family proceeded to sue the nursing home, and three nurses’ aides were indicted and charged with abuse.  Jaclyn Dawn VanWinkle pleaded guilty earlier this year. Amanda G. Sallee stands trial in March and Valerie Lamb is set to enter a plea early in the new year.



The Madison Record had an article about a recent complaint filed by Steven Steiner against Caseyville Nursing and Rehabilitation Center and Caseyville Property.  Theresa Mary Steiner died after employees at an Illinois nursing home allowed her pressure sores to deteriorate, causing sepsis to flow throughout her blood.

On Dec. 12, 2008, Caseyville Nursing and Rehabilitation Center admitted Theresa Steiner as its patient, according to the complaint. At the time of her admission, Theresa Steiner had three stage II pressure sores on her buttocks and one pressure sore on each of her heels, the suit states.   However, by the time of her discharge on Dec. 19, 2008, Theresa Steiner had three stage IV pressure sores on her buttocks and multiple pressure sores on her heels, the complaint says.

"Steiner sustained personal injuries, including, but not limited to, development and deterioration of her pressure sores on her buttocks and bilateral heels which, in turn, led to Steiner developing sepsis throughout her bloodstream," the suit states. "On December 19, 2008, Theresa Steiner was hospitalized at Memorial Hospital in Belleville, Illinois, where she subsequently died on January 7, 2009, due to sepsis and acute respiratory failure."

Before her death, Theresa Steiner experienced severe pain and suffering, mental anguish, emotional distress and loss of dignity.  Steven Steiner blames the defendants for a number of negligent acts, including their failure to properly screen Theresa Steiner before admitting her, their failure to have an adequate wound care nurse on staff, their failure to develop an appropriate plan to treat Theresa Steiner’s pressure sores, their failure to advise Theresa Steiner’s physician of the deterioration of her pressure sores and their failure to adopt appropriate policies to treat pressure sores.

In the six-count complaint, Steven Steiner is seeking a judgment of more than $300,000, plus attorney’s fees, costs and other relief the court deems just. William P. Gavin of Gavin Law Firm in Belleville will be representing him.


The Herald-News had an article about a recent jury verdict against Rosewood Care Center.  The jury awarded $51,000 and attorney’s fees.    Resident Catherine Taylor died after suffering a huge bedsore that ate through her skin to the bone causing her death.  Taylor, who was 88 when she died in December 2004, was a resident of Rosewood in July and August 2004, On Aug. 19, 2004, Taylor, a former teacher, was taken to Provena Saint Joseph Medical Center and six days later "underwent a procedure to remove bedsores and treat bone infections brought on by her confinement to her bed and her exposure to urine and other bodily fluids during (her) care," according to the complaint against Rosewood.

"She had a hole in her backside the size of my fist," said Scott Pyles, the other attorney representing Taylor’s estate.  And Pyles said the bedsore was the fault of the nursing home staff.

"Rosewood screwed up on 8/18 (2004)," he said. "Everybody who testified in this case has told you about it, and it caused Catherine Taylor’s death."

"We feel vindicated that we proved that they did something wrong," said Frank Cservenyak, one of the attorneys representing Taylor’s daughter, Mary Pat Barney, who was acting as the administrator of her mother’s estate.


 Louisville Courier-Journal had an article about the recent jury verdict against ResCare Inc. A jury in Albuquerque, N.M., returned a damage award of about $54 million against ResCare Inc. over the rape of a disabled male resident in one of the company’s group homes.  After a three-week trial, the jury unanimously found ResCare negligent, Bettinger said. The company was ordered to pay nearly $5 million in actual damages and more than $49 million in punitive damages.

Carl Bettinger, an attorney for the plaintiffs, said the incident occurred a few weeks after ResCare fired nine of the 12 employees of its group home in Roswell, N.M., because they failed or refused drug testing. Bettinger said in an interview that ResCare’s now-defunct New Mexico subsidiary “scrambled” to hire new staff for the home. One of the new hires had been fired from his last job, where he had been found kissing a male resident, Bettinger said. ResCare didn’t call that employer to check on the new worker before hiring him.

The man worked one night at the ResCare facility. That was the night the resident was abused, Bettinger said.  No eyewitnesses came forward.  Physical evidence was lost when the resident was showered the next day.

The award surpasses the $36.6 million profit earned in all of last year by ResCare, one of the nation’s largest providers of residential care to persons with disabilities.


Ventura County Reporter had an article about the recent verdict involving abuse of a resident in a nursing home.  A  jury compensated the family of a 71-year-old stroke victim who filed an elder abuse lawsuit against the Fillmore Convalescent Center.  The trial, which featured a videotape of the woman being abused, lasted 22 days. The jury deliberated for two days before announcing the verdict: $2.75 million in actual damages and $5 million in punitives.  The verdict splits liability among three defendants: the center, 40 percent; owner Eduardo Gonzalez, 40 percent; and Garcia, 20 percent.

Johnson said he offered to settle the case with the center in July for $500,000.   “They never offered me one dime,” he said. “They never offered to go to mediation, nothing. There was a lot of arrogance.”

In 2006, Maria Arellano, 71, was a resident with brusies of unknown origin that family members discovered during a visit. They complained to management but the nursing home refused to  investigate. So the family set up a hidden video camera on a side table in her room.

The camera caught employee Monica Garcia slapping Arellano, pulling her around by the hair, bending her neck, fingers and wrists, and treating her violently in a shower chair.  During the ordeal at the center, the Arellano family met another resident, Daniel Sanchez, 83, who was staying across the hall. His family suspected he, too, was being abused.

“The Sanchez family, they found bruises and hair pulling,” said Johnson, who’s filed a lawsuit on the family’s behalf that is slated for trial in January. “Mr. Daniel Sanchez has since died. They (Arellano and Sanchez) were both stroke victims who were non-verbal.”

About two weeks ago, Fillmore Convalescent received a five-star rating, the highest, from the Nursing Home Compare system, run by the Centers for Medicare and Medicaid Services.

“The five-star rating doesn’t always reflect what’s going on today or what went on yesterday,” Stein said.


Merry Christmas from Poliakoff & Associates.  I hope many of us take the opportunity to visit friends, family, and residents without family and friends in local nursing homes.  Christmas time in nursing homes can be the toughest time of year.  During this holiday season I hope we count our blessings and recognize those of us who may not be as blessed.

Have a safe and healthy Christmas!

Lexington Herald-Leader had an article about Kentucky indicting nursing home employees for neglecting a resident and trying to cover it up.  A nurse and two nursing assistants have been indicted in connection with a case of neglect at Creekwood Place Nursing Home in Logan County.

One of the nursing assistants, Melissa L. Lyon, was trying to transfer a patient into bed on her own, even though the patient’s care plan called for two people to lift the person.   As a result, the patient suffered a fractured leg.   After the incident, Lyon and the other nursing assistant, Destiny W. Duncan, "concealed the true facts of the incident," the news release says.

The nurse, Barbara A. Moore of Beechmont, "did not call a physician or family member or check on the victim, all of which caused the victim prolonged suffering and pain," the release states.  Each of the women was indicted on a single count of knowing abuse or neglect of an adult, a Class C felony. 


The Washington Post had a great article about the Green House Project..  I think Green House is a great improvement in nursing home quality of life for most residents.  The change has been too slow becuase it costs so much on the front end but it is well worth it. 

"The Green House is a philosophy, and you can change your philosophy of operation in any setting," Tierney said. "I think it’s very forward-thinking of the board [of county supervisors] to consider the well being of people who need long-term care services and that they are interested in ways we can better serve people and keep them in community because they are all vital members of the community."



Green House provide living areas for a handful of residents to live, setting their agenda and getting one-on-one attention from staff members.  Conventional senior care is being transformed as a few localities nationwide embrace a new philosophy about long-term care that emphasizes independence and puts control in the hands of the country’s aging population.   Green Houses, so named because they are intended to be places of continued growth and life, are built for seven to 10 people. Residents are the primary decision makers and are not subject to the monotonous schedule often found at nursing homes, according to the Green House Project. The houses have kitchens and family rooms where residents can gather as well as individual bedrooms they can decorate. A medical staff is on hand, with nurses providing medicine and care on an individual basis, not at a centralized nursing station

"We used to think of [long-term care] as institutional nursing homes, and that is no longer the case," said Courtney Tierney, director of the Prince William Area Agency on Aging. "It’s all about consumer choice now and resident-directed care."

Tierney briefed the Prince William Board of County Supervisors last week on the Green House Project and how it can fit into the county. The project, the brain child of New York geriatrician William Thomas, aims to de-institutionalize care for the elderly and place people who need assistance back in the community in a Green House, where personal care and clinical services are provided in a more relaxed and homelike setting.

"Nursing homes were modeled after hospitals, and no one wants to live in a hospital for potentially years; people want to live in a home," said Ruta Kadonoff, Green House Project deputy director. "There is a growing desire to create an environment that allows people to grow and thrive and live no matter what their medical or cognitive needs may be, and that’s where the Green House fits in."

The concept has grown from a single Green House built in Mississippi in 2003 to 73 across the country, Kadonoff said. She said the closest ones nearing the construction phase in the region are in Baltimore and Harrisonburg, Va.

Tierney said one of the reasons for the shift away from traditional care is efficiency. If residents and staff members are happier, the facility will be more efficient with less turnover and medical costs could potentially be lower, she said. People want to age in place, she said, and regulations are mandating that nursing homes become less institutional.

Research shows the cost to operate a Green House is similar to that of a traditional nursing home, Kadonoff said. Medicaid coverage is also the same at both facilities. According to the 2009 MetLife Market Survey, the average cost for a private room in a traditional nursing facility is $219 a day. People might pay a little extra out of pocket, depending on which Green House they choose.

Although the Green House Project is focused on building houses instead of traditional nursing homes, Tierney said the Green House philosophy can be adopted in existing facilities. Prince William County, Manassas and Manassas Park have five nursing homes and 14 assisted-living facilities. Nursing homes, she said, can change their staffing structure to allow for more one-on-one interaction or turn hallways into "neighborhoods" or small communities to make the facility feel more like home.



Jackson Free Press had an interesting and scary article about presidential contender Haley Barbour’s flip flopping on Medicare and history as a lobbyist and Tom Delay’s indictment for illegal campaign donations.   When Haley Barbour was head of the Republican National Committee from 1993 to 1997, he loathed Medicare, and tried to gun it down in the GOP “Contract with America.”  By 2000, Barbour had returned to his lobbyist job at Barbour Griffith & Rogers, and had dramatically flip-flopped on Medicare, then lobbying for more federal tax dollars to be directed into the program. 

The Alliance for Quality Nursing Home Care Inc. was formed in 2000 as a corporate coalition of 14 of the country’s largest for-profit nursing home companies to help ease the way for the corporate consolidation of the nursing-home industry.   The coalition opposed Medicare cuts and government regulation of nursing-home standards and consolidation, and, perhaps most vitally, wanted low caps on the lawsuit damages the companies had to pay for abusing and neglecting nursing-home residents. The coalition paid top dollar to ensure the election of candidates who agreed with its agenda.   It directed impressive campaign donations to mostly Republican candidates around the country who would, in turn, honor the wishes of one of the country’s most tenacious industries.

That resolve is how a check for $100,000 written three years ago this week ended up illegally funding Republican candidates for the Texas statehouse.  That’s also how that canceled check ended as a primary exhibit in the case of State of Texas v. Thomas Dale Delay et al.

Unlike Mississippi, the state of Texas has long taken campaign-finance violations seriously, especially donations coming from outside the state to try to tell Texans what to do, and how to vote.  Violation is a felony, punishable by hefty fines and up to life in prison.

Rep. Tom Delay appears to have put considerable effort into circumventing that law. The former bug exterminator from Sugar Land became majority leader of the U.S. House of Representatives by his complicated web of political friends and family members including his own wife, Christine, and daughter, Danielle Ferro.

Delay has run a creative maze of schemes since the mid-1990s to get Republicans elected to office and “keep Republicans in lockstep,” using “threats and incentives,” as The Wall Street Journal characterized his style in June 2004.  He has been investigated five times and brought before the House Ethics Committee for his strong-arming of fellow members of Congress, trying to use donations to a children’s charity for a donor cruise, rewarding check-writers with face time with GOP stars, and other irregularities.

What prompted a grand jury of his home-state peers to indict him in September and again earlier this month on conspiracy and money laundering charges was his Texans for a Republican Majority Political Action Committee, known as TRMPAC.  Delay used the PAC to collect illegal corporate contributions (a third-degree felony) from January 2001 through the end of 2002 from corporations and then slip the money to 2002 candidates for the Texas statehouse (a first-degree felony). Much of the money was used to fund a last-minute campaign blitz—another violation of Texas law.

In return, the donors had a laundry list of demands—including tort reform and a blind eye to their consolidation plans.  The nursing-home industry, with its heavy reliance on government payouts for profits, is ripe for exploitation. And stories about the internal workings of nursing-homes aren’t exactly sexy enough for front page news.

What we have seen is these corporations evolve to trying to shield themselves from liability or from paying taxes in such a way to finagle the law in ways no one imagined just a few years ago,” said Mississippi Rep. Jamie Franks, a lawyer and Democrat from Mooreville who is leading an effort to more closely monitor Mississippi’s nursing home industry.  “It’s amazing what high-dollar lawyers and high-dollar accountants can do.” He added: “And high-dollar lobbyists. You can throw that in there, too.”

What those high-dollar strategists did in 2000 was form the Alliance for Quality Nursing Home Care Inc., so that the industry giants—for-profit nursing homes that were members of the American Health Care Association—could pool their resources to overcome regulations regarding standard of care and limit lawsuit damages in as many states as possible and, ultimately, on the federal level in order to supersede state law.

The Alliance heavily lobbied the federal government to increase Medicare payments because for-profit nursing homes take more money from Medicare than Medicaid, which tends to sustain their competitors, the non-profit nursing homes. 

In October 2002, the Alliance invested in Delay’s scheme to pack the Texas statehouse (and thus Congress) writing a check for $100,000 to TRMPAC, dated Oct. 18 and signed by Alliance leader Stephen L. Guillard of Harborside Healthcare Corp. in Boston. On Oct. 21, Chris Winkle—then the chief executive of Mariner Health Care in Atlanta—met state Rep. Tom Craddick, R-Midland. They talked about the need to limit liability in lawsuits against nursing homes; then Winkle presented Craddick with the check, which TRMPAC deposited two days later. On Oct. 24, the Alliance contributed another $300,000 to the Texas Association of Business, an employers’ group that is now also under indictment in Texas for allegedly helping collect and launder illegal contributions.

After the 2002 election, in which 21 additional Republicans were elected to the Texas statehouse, Craddick became speaker of the Texas House of Representatives, and the Legislature quickly gave industry its desired “tort reform”—including $250,000 in non-economic damage caps and special provisions to shield nursing homes—that would become the model for industry efforts in other states, such as Mississippi in 2004 (which ended up compromising on $500,000 damage caps).

Ironically, it was one of the alleged conspirators who exposed the scam. The Texas Association of Business, or TAB, could hardly contain its glee over its success, reporting in a newsletter to members that it “blew the doors off the Nov. 5 election, using an unprecedented show of muscle that featured political contributions and a massive voter education drive.” And as the Wall Street Journal reported, its president, Bill Hammond, a former Texas legislator, bragged to the media that the group had used corporate money to finance a $2 million advertising campaign backing Delay’s slate of candidates.

Watchdog groups like Texans for Public Justice in Austin took notice and started following the money, ultimately finding that TRMPAC’s tax return showed that it had raised $1.5 million to help with the state races—and that $600,000 had come from corporate donations. Travis County District Attorney Ronnie Earle started investigating TRMPAC’s activities after Texans for Public Justice filed a complaint based on the revelations on the tax returns.

In September 2004, the indictments began when a Travis County grand jury handed down 32 indictment counts against TRMPAC and TAB and their leaders, as well as against eight companies that had supplied corporate funds, including State Farm Insurance, AT&T, the Union Pacific Railroad and the Alliance for Quality Nursing Home Care. On May 25, 2005, District Judge Joe Hart ruled in a civil case brought by 2002 Democratic candidates against TRMPAC that the use of corporate funds had violated the Texas Election Code.

On Sept. 28, 2005, the grand jury indicted Tom Delay and associates Jim Ellis and John Colyandro for conspiracy in the illegal scheme, and then on Oct. 3, a different grand jury indicted Delay on two new charges of money laundering.

Other friends of TRMPAC and its donors, such as now-Gov. Haley Barbour—who lobbied for the Alliance until he left his hefty stock in Barbour Griffith & Rogers in a reversible blind trust so he could take over the governor’s mansion in Mississippi—are distancing themselves from the beleaguered Alliance, if not from Delay.   It is not in dispute, that Barbour was lobbying in his client’s interest to block Medicare cuts at the same time that his client was presenting a $100,000 check to Craddick. (The $300,000 check from the Alliance to TAB followed a few days later.)

Andrew Wheat, the research director of Texans for Public Justice, balks at the idea that Barbour was not privy to the Alliance’s agenda—especially since his lobbying firm represented three of the corporate TRMPAC donors (the Alliance, Kindred Healthcare and Reliant Energy)—lobbying contracts worth $440,000 to Barbour Griffith & Rogers in 2002 alone. Barbour’s clients gave more money to TRMPAC than any of the other 10 lobbying firms who were represented. He was CEO of Barbour Griffth & Rogers and representing the nursing homes when the Alliance was created in 2000.

The Alliance’s agenda is one that is wreaking havoc in states like Texas, Arkansas and Mississippi, where its members control much of the nursing-home business and are now getting their way, thanks to a nationwide corporate realignment, consumer advocates say. The changes in the historically tightly regulated nursing-home industry are profound.

Franks points to the December 2004 sale of Mariner Health Care for $1.05 billion to National Senior Care, owned by New York real estate investor Harry Grunstein. Harry is Leonard Grunstein’s brother.  Leonard Grunstein is partners with Murray Forman.  Harry sold Mariner’s assets to cover the costs of the acquisition, reducing the worth and assets of Mariner to $12 million and, critics say, operating the nursing homes more like rental units. “It basically became a real-estate transaction rather than a group caring for vulnerable adults,” Franks said. He added that, now, the nursing homes seem to be escaping accountability with these transfers. “There is no background check to find out whether they are financially solvent, or good corporate citizens. They simply transfer the license,” he said.

Because it is the licensee that is regulated, the process of stripping that licensee of its assets is essentially a tricky end run, allowing the real-estate owners, such as Grunstein, to escape liability. This, combined with the increased “tort reform” damage caps sought by the Alliance, insulates the corporate owners from the regulatory safeguards that are meant to protect patients and the elderly.   In turn, those licensees are now defaulting on money owed to vendors in states like Mississippi. And because assets are being ripped away from the nursing homes themselves, they end up with little to be sought in lawsuits brought by the vendors looking to be repaid.

One unpaid Mississippi vendor is the law firm Brunini, Grantham, Grower & Hewes in Jackson, which is suing Mariner for $951,915.17 in legal fees for defending the nursing homes. In the complaint, filed in Hinds County Chancery Court, Brunini describes Mariner’s “leveraged buyout” scheme, which it alleges is “fraudulent.”   Franks points to hearings in Arkansas, called by a Republican and a Democrat, that just concluded that the state has ended up with “no” regulatory power over these companies, due to their maneuvering. “This is not partisan,” Franks said. “It’s a consumer issue. It’s about protecting vulnerable citizens and our tax dollars.”




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The L.A. Times had an article about firms that supply temporary nurses to the nation’s hospitals and nursing homes.  The article reveals that these firms take perilous shortcuts in their screening and supervision, sometimes putting seriously ill patients in the hands of incompetent or impaired caregivers.  Emboldened by an alleged nursing shortage and scant regulation, the firms vie for their share of a free-wheeling, $4-billion industry. Some have become havens for nurses who hopscotch from place to place to avoid the consequences of their misconduct.

An investigation by the nonprofit newsroom ProPublica and the Los Angeles Times found dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls. Some hired nurses sight unseen, without even conducting an interview.  As a result, fill-in nurses with documented histories of poor care have fallen asleep on the job, failed to perform critical tests or stolen drugs intended to ease patients’ pain or anxiety.

Among reporters’ findings, based on disciplinary records, personnel files, court documents and interviews:

* Firms hired nurses who had criminal records or left states where their licenses had been restricted or revoked. At least three firms employed a nurse in California whose license had been suspended in Minnesota for stealing drugs at a string of temp jobs. One used him after he’d been convicted of doing the same thing at a Santa Rosa nursing home.

* Temp agencies shuffled errant nurses from one hospital to another, even as complaints mounted. A Culver City agency continued sending one nurse to hospitals despite more than a dozen warnings that she was ignoring her patients and sleeping on the job. Before she was hired, the nurse had been convicted of 12 crimes, including prostitution, carrying a concealed weapon and possessing cocaine.

* Nurses who got into trouble at one agency had no problem landing a job at another. An Oklahoma nurse cycled through at least four Southern California agencies in a year, accused of pilfering drugs while at each. Before her final stop, she was arrested in her home state for calling in prescriptions while posing as a doctor’s office employee.

Oversight of nurses in general has been weak. A Times/ProPublica investigation in July found years-long delays in disciplining nurses accused of serious misconduct. California’s registered nursing board is among a minority that does not require hospitals, agencies or anyone else to report even serious lapses by nurses, including temps. When staff nurses err, hospitals typically retrain or monitor them afterward. Temp nurses often are just exchanged for replacements, never receiving further guidance.

Many agencies leave it to applicants to reveal previous problems. Using multi-page checklists, they are asked to rate themselves on how well they manage critical care patients, use complex equipment and administer drugs. Some nurses admit lying on applications or withholding information from their employers.

Although the healthcare system as a whole is increasingly regulated, the nurse staffing industry remains a Wild West. No one knows how many agencies exist nationwide; estimates range from 3,000 to 6,000. Dozens of Internet sites tout the easy profits and hawk how-to guides for as low as $69.95.

Last year Los Angeles County health staffers went through the files of 29 agencies seeking to provide nurses to its public hospitals. Most of the firms lacked key documents, including evidence of tuberculosis screenings or proof that nurses had current licenses. One agency had 90 missing or invalid records, another 63. The lapses were "surprising," said Vivian C. Branchick, director of nursing affairs for the county Department of Health Services. "They know — and they’ve known it all along" — what the standard is. All of these firms were allowed to correct their shortcomings and won county business.

In late 2006, the county audited Reliable Health Care Services in Culver City, which had received $8.9 million for temp services during the previous fiscal year. The audit found that Reliable had "forged" results of tuberculosis skin tests, physical exams and CPR training cards, which "jeopardized the safety of county patients." Reliable also made "false and misleading statements," the audit said, citing a general "lack of trustworthiness and integrity."

According to Riverside County Regional Medical Center more than 60% of the 339 temp nurses rejected since 2003 failed to demonstrate basic nursing skills on the job. Arrowhead Regional Medical Center, San Bernardino County’s public hospital, reported that it had rejected 61 temp nurses since 2005 — more than half for performance problems.

In another case, St. Jude Medical Center in Fullerton informed MedStaff Healthcare Solutions in March 2007 that it suspected nurse Donald Paradise of stealing drugs and asked that he never return, a hospital spokesman said. Six months later, Paradise was accused of stealing drugs at a sister hospital, where he also had been sent by MedStaff.

In interviews, several temp nurses who had been in trouble said their employers focused more on keeping slots filled than on who filled them.