The Wall Street journal had an interesting article about Omnicare’s legal troubles.  Mr. Gemunder’s was CEO of Covington, Ky.-based Omnicare, the nation’s largest dispenser of pharmaceuticals to nursing homes serving 1.4 million beds in 47 states.  Obviously, Omnicare gets its profits from Medicare, Medicaid and health insurance.

Mr. Gemunder had been in charge since 1981, but recently retired with a large lump-sum pension payout.  He’s getting a $91 million pension payout, plus severance, vesting of restricted stock  that bring his final payday to at least $130 million. And that’s on top of the $14 million he bagged last year.

And what did the shareholders get for their money? Omnicare shares took a tumble last week after the company reported a shocking drop in the number of prescriptions it fills.

And what did the taxpayers and customers get? Omnicare has litigation costs amid evidence of kickback and billing schemes.  For example, in November 2009, Omnicare announced it would pay $98 million to settle a civil case brought by the Justice Department that it paid kickbacks to nursing homes and took kickbacks from pharmaceutical companies, including Johnson & Johnson. Omnicare also agreed to pay $49.5 million in 2006 to settle Medicare fraud claims. And last month, new details emerged in a continuing kickback lawsuit in Illinois.

 

McKnight’s reported the news that an Illinois judge ordered Illinois-based for-profit nursing home operators to stop using scare tactics on mentally ill residents including issuing misleading “information sheets” to mentally ill residents.  U.S. District Judge William Hart ordered the facilities to stop distributing the sheets immediately. Hart referred to some passages as inaccurate and incendiary, and ordered the operators to cease communication with the mentally ill patients without the consent of the ACLU or other patient representatives.

The American Civil Liberties Union filed the lawsuit against nursing home operators alleging that mentally ill residents were being misled about their options. A recent Illinois Nursing Home Task force recommended that they be allowed to seek community-based support services. “Information sheets” being distributed to the residents were purposefully lacking in details, and implied that those residents would be left homeless and without care if they left the nursing home, the ACLU charged.

 

Aboutlawsuits.com had a good summary of the recent Pennsylvania case that held that nursing homes can be held corporately liable for injuries caused by substandard care.  The Pennsylvania Superior Court overturned a lower court verdict, ruling that Grane Healthcare, which owns Highland Park Care Center, can be held liable for the 2004 death of one of their residents. The case stems from a lawsuit filed by the son of Madeline Scampone, who died from a heart attack after suffering from a urinary tract infection,untreated bedsores, malnutrition, and dehydration while in the nursing home home.

Key to the case was the fact that the nursing home was chronically understaffed, which the panel of judges said expressly showed failing on the part of the management company.   Witnesses testified on Scampone’s behalf that the nursing home was chronically understaffed, and said that the company would temporarily boost staffing levels when an inspection was scheduled and then immediately return to its understaffed state after the inspection was over. They also testified that nursing home staff altered medical records to hide substandard care.

 

The panel unanimously ruled that a nursing home has the same responsibility and liability for its residents as a hospital has for its patients, indicating that the evidence suggested the management company and nursing home staff acted with reckless disregard for residents and made nursing home abuse and neglect more likely.

Corporate negligence as a basis for liability is supported as a cause of action against Grane because it was the entity that managed all aspects of the operation of the nursing facility,” Supreme Court Judge Mary Jane Bowes wrote in the opinion. “Grane had assumed the responsibility of a comprehensive health center, arranging and coordinating the total health care of the nursing facility residents.”

The Superior Court determined that not only could the company be held responsible for compensation, but that a jury could determine it should suffer punitive damages as well. The lower court had ruled that there was insufficient evidence for punitive damages.

The National Quality Forum has studied and evaluated medical errors.  They have created a limited number of "never events" meaning, of course, that they should never happen.   See article here.   Most of these mistakes happen while a patient is being cared for in a nursing home.

Here are some that you often see in nursing home litigation: 
-Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended 
-Patient death or serious disability associated with patient disappearance for more than four hours 
-Patient death or serious disability associated with a medication error 
-Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility 
-Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility 
-Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility
-Patient death associated with a fall while being cared for in a healthcare facility
-Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility 
-Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider 
-Sexual assault on a patient within or on the grounds of a healthcare facility
-Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a healthcare facility

To learn more about this list, and the criteria for including a medical error on this list, visit the Center for Medicaid and Medicare Services website.

 

Entering a nursing home (and losing independence) is the most difficult, but sometimes necessary, decision for many families.  One of the reasons why so many of us are scared about ending up in a nursing home is because of stories like this:

Six Northern California nursing home employees of Valley View Skilled Nursing Facility are under arrest becuase they covered several elderly patients with cream to make them slippery as part of a "prank" against their co-workers.  All of the patients were diagnosed with dementia, and were obviously unable to object.

California Attorney General Jerry Brown called the alleged abuse "despicable behavior."

They face one misdemeanor count each of injury to elder or dependent adult; battery committed on elder or a dependent adult; conspiracy; and battery committed while on hospital property.

Bail has been set for $7,500 each.

 

 Ken Teegardin had a traumatic time finding care for his father in Georgia so he created his own website (http://www.AssistedSeniorLiving.net) with the goal of presenting the widest variety of senior care options (especially nursing homes) with objective information.

He has spent a lot of his personal time compiling a comprehensive list of senior care options so that others will have better support than he did when he had to make the critical decision.  The site is:
– The most comprehensive senior directory on the web. Users can search by care type, location, organization name, review status and more.
– Totally unbiased. The directory is based on government data combined with other independent sources. It is NOT a paid-inclusion corporate site so every senior care organization gets fair exposure.

The site features:
– Location based search – His advanced Geo-location search shows the nearest 50 senior care options to any desired location based on a zip code, city, or street address. Click on the map and get instant driving directions to each option.
– Hot lists – Users can build a custom list of possible services and print that list with full contact information.
– Complete listing information – We provide full contact information, photos, costs, and other details (where available) so users can compare apples to apples.
– Safe usage – There is no data taken about users. The goal of the site is share information, not to gather sales leads.
– Reviews – The site includes both positive and negative reviews.

AssistedSeniorLiving also donates $1 to non-profit senior care organizations for every review created.
 

Lexington Herald-Leader have been writing some great articles on different problems going on in Kentucky’s nursing homes.  This article discusses the failure to protect residents from sexual assaults such as Mae Campbell who was sexually abused twice as a resident of Hazard Nursing Home, according to the sworn testimony of two former nursing home employees.

Campbell, who has Alzheimer’s, was sitting in the hallway of the home last year when, within sight of a nursing supervisor and other staff members, a male resident walked up and ejaculated on her face, according to a former nurse’s aide.  When former Hazard nurse’s aide Debbie Salley was deposed in the wrongful death case, she said that she had quit working at the nursing home in 2009 after witnessing the episode in the hallway. Salley said she thought the nursing home should have better protected Campbell.

Three months later she was sexually abused by another male resident who performed a similar sexual act, according to the deposition of a former nurse.  Sandy Noble, a former nurse who also was deposed in the wrongful death lawsuit, said she found a second male resident with Campbell in a room where he had blocked the door. He was nude from the waist down and Campbell had semen on her. The nurse said a supervisor told her not to tell anyone and that no harm had been done to Campbell.   According to the deposition, the nursing supervisor told Noble "to go on and keep working and … not to be discussing it with anyone," and that "there was no actual harm done to the patient."

Under state law, nursing home officials and staff members are required to report incidents of abuse, neglect and exploitation to the cabinet. Hazard Nursing Home did not. "The facility failed to protect residents from unwanted sexual contact, failed to report the allegations to appropriate state agencies and failed to thoroughly investigate the allegations of sexual abuse," said the state’s citation in the Campbell case.

In May, Campbell’s sons sued the nursing home, saying that neither they nor authorities were contacted about the sexual abuse.  "Someone at the nursing home should have told us what was going on," said John C. Campbell Jr., a son. "If they had, we could have protected Mom. … We could have gotten her out of there."

A Herald-Leader investigation found that since 2007, nine Kentucky nursing homes received Type A citations for cases involving sexual abuse and assault. At least two other cases of sex abuse have been documented that did not receive Type A citations. The abuse was committed by staff members, residents and visitors. In one case, a registered sex offender abused a woman when he visited a nursing home.

There were cases in which, despite warnings to nursing home officials by staff or family members, residents’ sexual abuse of fellow patients went unchecked by nursing home officials.

Pamela Teaster, a University of Kentucky professor who is doing national research on sex abuse in nursing homes, said she suspects that such abuse is under-reported and "woefully" under-prosecuted.   Teaster and her fellow researchers have reported that some nursing home staff confuse assault with consenting activity among residents or assume that there is no harm to residents with cognitive problems.

Other sexual abuse cases cited by the cabinet since 2007 include one in which the facility failed to protect an 89-year-old woman from sexual abuse from a 44-year-old resident and a facility that failed to protect a resident from sexual abuse by a visitor.

In several cases, nursing home officials failed to monitor residents who had aggressive sexual behavior. In one, a male resident targeted nine female patients, in another case, 14 patients.

A male nurses’ aide in a Western Kentucky nursing home sexually abused two female residents. In two cases, nurse’s aides used cell phones to distribute nude or inappropriate photos and recordings of residents.

 

 

 

KCRA reported a lawsuit against El Dorado Care Center in California for the wrongful death of Johnnie Esco.  "Some people called her Sunshine. She’d walk in the room and the room would light up. She was my life," her husband of 61 years said.

Johnnie was 77 years old when she recovered from pneumonia, and went to El Dorado Care Center in Placerville for short term physical therapy to regain her strength, then go home. Two weeks after entering the nursing home, her health had deteriorated. She was rushed back to the hospital, where she died in 2008.

"If she had received proper care, she would still be alive today," Esco said.  He sued El Dorado Care Facility and parent company Horizon West, which owns 27 nursing homes.  "My wife’s death was ruled unwarranted, but the facility was fined $18,000. That is ridiculous," Esco said.  "She basically did not receive care. She was neglected, warehoused," attorney Lesley Clement said.

The suit alleged the nursing home staff failed "to provide basic custodial and nursing care services, a failure to assess and treat her pain and a failure to prevent Mrs. Esco from developing a severe and life-threatening bowel impaction." It also alleged that Horizon West "failed to staff El Dorado Care with sufficient numbers of trained and supervised caregivers."

In taped depositions, employees say they were understaffed.  Research shows Horizon West increased its acuity levels, accepting more of the sickest and most expensive Medicare patients, while at the same time, decreased the nursing staff qualified to care for them.

Esco and Horizon West settled the lawsuit out of court. They won’t say for how much, but KCRA 3 was told the nursing home paid a significant amount of money to Esco.

 

 

NY Times had an article about cuts in home-care services for elderly and disabled because of budget shortfalls despite the fact that programs have been shown to save states money in the long run because they keep people out of nursing homes.

Since the start of the recession, at least 25 states and the District of Columbia have curtailed programs that include meal deliveries, housekeeping aid and assistance for family caregivers, according to the Center on Budget and Policy Priorities, a research organization. That threatens to reverse a long-term trend of enabling people to stay in their homes longer.

States that have made cuts:

Oregon, facing a $577 million deficit, was cutting home aides to more than 4,500 low-income residents.  State legislators say home care is a service the state can no longer afford. Cuts affecting an additional 10,500 people are scheduled for Oct. 1.

¶Florida placed 69,000 people on waiting lists for home or community services last year, and more than 5,700 of them ended up in Medicaid nursing homes.

¶Alabama cut housekeeping services — useful for people who can no longer do some cleaning tasks — for more than 1,000 elderly residents.

¶Arizona sliced independent living supports and respite programs for family caregivers.

¶Kansas, with a $131 million shortfall, will cut independent-living services for 2,800 people with disabilities in the next year.

In Illinois, providers of Meals on Wheels have stopped adding clients because the state was not reimbursing them.

Colorado, Mississippi, Missouri, Nevada, New Jersey, New York and Texas have all made cuts or frozen spending at a time when the elderly population — and the need for services — is growing.

In California, which faces a budget shortfall of $19.1 billion for the 2010-11 fiscal year, Gov. Arnold Schwarzenegger’s office proposed eliminating adult day health care centers that serve 45,000 people and in-home supportive services that help more than 400,000 elderly, disabled or blind residents.

Because Medicaid regulations require states to provide nursing home care to receive federal Medicaid money, legislators often have more leeway to cut from home services. Advocates for the elderly and the disabled worry that these cuts are just the beginning, because state ledgers tend to recover more slowly than the national economy.

 

Chicago Tribune had an article about the transformation of the culture at nursing homes.  The article discusses Bethesda Home and Retirement Center. Traditionally, the world of nursing homes have been run like highly regimented mini-hospitals. Bethesda made a change two years ago taking its first step to join a movement that hopes to transform the nation’s nursing homes.

The "culture change" movement seeks to get these facilities to alter their physical layout and their caregiving practices to create homelike environments where residents are seen not as passive recipients of care but as individuals with control over their lives. Nursing homes that embrace the new philosophy are letting residents decide when to bathe, eat and sleep; allowing them to organize their own activities; and redesigning nursing units into small "households."

Advocates say residents in such homes are happier and healthier; the employees have more job satisfaction; and giving care this way even costs less. The idea is not new. The Pioneer Network, a national umbrella group of nursing home providers and consumer advocates, has been promoting it since it was formed in 1997.

Yet only 25 percent of the nation’s nursing homes say they have "for the most part" embraced culture change, according to a 2007 survey by the Commonwealth Fund, and only 5 percent say they have done so "completely."

Nursing home operators, who are under tremendous pressure to cut costs, are often afraid that culture change would cut into their profits.  However, flexibility is more cost-efficient.

The experience of the Bethesda Home illustrates the challenges. Janet Meyer, the home’s director of nursing, had proposed a single change: letting residents sleep late. But "that’s a bigger deal at a nursing home than you might think," she said.

Mealtime practices had to be changed to accommodate late risers. Housekeeping had to be done more flexibly to avoid waking residents for vacuuming.

Most challenging, the morning medication system had to be changed. Nursing homes traditionally give out medications during a two-hour period. But if residents were allowed to sleep late, Bethesda could no longer give morning medications only between 8 and 10.

So the home made another change: Residents could get their morning medications any time between 6 and noon, by individual request.

Other practices were loosened too. At staff meetings, administrators told employees that they needed to be flexible and perform caregiving tasks like bathing when residents wanted them.

The Health Reform Act passed in March calls for conducting demonstration projects at nursing homes to establish the best ways to effect culture change. So many organizations and government agencies are now working toward culture change that "everything is in place for widespread dissemination," said Bonnie Kantor, executive director of the Pioneer Network.