I have read several articles including The State’s article regarding the arrest of Robert Edward Tidwell and his daughter Roberta Marie Young on charges of abuse and neglect of a vulnerable adult in the death of wife and mother Harriet Ruth Tidwell.  See mug shots from Lexington County.

"Arrest warrants allege that Dec. 1, Harriett Ruth Tidwell was transported by ambulance from her home to Palmetto Health Richland Hospital, where medical personnel determined she weighed about 48 pounds, had numerous bed sores and was so emaciated that her spinal cord and ribs were clearly visible."

She died the next day.  Harriett Tidwell was bed-ridden after her legs were amputated about 14 years ago. She was married to her husband for more than 30 years.  State law charges the Department of Social Services with assuring the safety of vulnerable adults being cared for at home.

Under South Carolina law, a person who knowingly and willfully abuses or neglects a vulnerable adult who later dies as a result of the abuse or neglect is guilty of a felony, which carries a maximum punishment of 30 years in prison.

Hospital personnel reported the abuse of Harriett Tidwell. A hospital social worker told a deputy that Harriett Tidwell had gone several days without eating or drinking. Harriett Tidwell was last seen by her primary care physician on July 13, and a home health care worker last visited Harriett Tidwell on November 9 at her home. Lexington County Sheriff James Metts said a doctor visiting 60-year-old Harriett Tidwell’s home in April reported squalid conditions to social services officials.

Tidwell weighed 48 pounds and had numerous bed sores when she died December 2.  The family says Tidwell’s husband and caretaker was anything but neglectful.

"Somebody failed to do their job, besides the two individuals that we’ve charged," Metts said.  "We are trying to find out what DSS did, if anything," said Metts. "We have already subpoenaed records.""People failed this lady," the sheriff said. "I believe very strongly that if this lady had been given proper care, she would be alive now."

See article at The Sun News

Despite the economic downtown, health care has remained one of the fastest-growing occupational fields in the U.S. According to the Bureau of Labor and Statistics, 10 of the 20 fastest-growing occupations are health care-related. Employment in physicians’ offices, home health care, services for the elderly and disabled and nursing care facilities is expected to grow by 2 million.  While most sectors of the health care field grew in 2010, nursing stayed level, according to most officials.



Kindred Healthcare Inc. has agreed to purchase RehabCare Group Inc. in a $1.3 billion transaction that will create the nation’s largest provider of rehabilitation services. A merger agreement, which has been approved by both companies’ boards of directors, calls for Kindred to pay RehabCare (NYSE: RHB) shareholders $26 per in cash and 0.471 of a share of Kindred common stock for each share of RehabCare stock.  RehabCare, based in St. Louis, offers program-management services at more than 1,250 hospitals and skilled-nursing facilities in 42 states and Puerto Rico. See article from Business First.  Kindred had a very good year.

The deal also includes the assumption of about $400 million in debt. Kindred expects to issue about 12 million shares in connection with the pending transaction.  The combined company will generate more than $6 billion in annual revenue and have operations in 46 states.

Kindred, led by president and CEO Paul Diaz, said it expects the combined company to achieve operating savings of $40 million within two years of completion of the acquisition, with $25 million expected in the first year after closing.

Finkelstein Thompson LLP is investigating potential claims on behalf of shareholders of RehabCare Group, Inc. concerning the sale of the Company to Kindred Healthcare, Inc. for $26.00 per share in cash and 0.471 of a share of Kindred common stock.  The investigation is focused on the potential unfairness of the consideration to RehabCare shareholders, the process by which the Board of Directors considered the transaction, and potential conflicts of interests among RehabCare Board members.

Faruqi & Faruqi, LLP, a leading national securities firm headquartered in New York City, is also investigating the Board of Directors of RehabCare Group, Inc. for potential breaches of fiduciary duties in connection with their conduct related to the sale of the Company to Kindred Healthcare, Inc. for an estimated $900 million. The transaction is subject to approval by shareholders and expected to close on or a bout June 30, 2011.

Whether the RehabCare’s Board of Directors breached their fiduciary duties to RehabCare’s stockholders by failing to conduct an adequate and fair sales process to sell the Company prior to agreeing to this proposed transaction, whether the proposed transaction undervalues RehabCare’s shares and by how much this proposed transaction undervalues the Company to the detriment of RehabCare shareholders are the key focus of this investigation.



The Beaufort Gazette reported the arrest of a CNA at Carolina House, a Hilton Head Island nursing home with three counts of elder abuse after a co-worker saw the employee verbally and physically assault a 93-year-old female patient, giving her a bloody nose, according to a Beaufort County Sheriff’s Office news release and incident report.  The reporting employee recorded the incidents on an audio device she had been carrying with her.

Sonia King is charged with three counts of abuse of a vulnerable adult in connection with an ongoing investigation into possible patient mistreatment by King at Carolina House.  The Sheriff’s Office is continuing to investigate whether King assaulted other patients during her employment.

The other two victims were 70 and 79. Each woman was treated with injuries

Brookdale Senior Living is the Tennessee-based company that operates Carolina House.


The Athens News Courier reported the arrest of Larosalyn “Missy” Etherich Freeman, a Decatur CNA at Athens Convalescent Center, accused of abusing an Athens nursing home resident and harassing and scratching the car of the employee who reported her. Freeman was charged with neglect or abuse of an aged or disable adult, first-degree criminal mischief and three counts of harassment.

Records show Freeman was being held in the Limestone County Jail in lieu of posting a $5,000 bail on the two felony charges — neglect and criminal mischief. Bail on the three misdemeanor harassment charges was $1,500, records show.


The New York Times’ Blog called The New Old Age had an informative discussion on Medicare reimbursement and overpayment.  Facilities operated for profit are far more likely to classify patients as needing the highest levels of care, and therefore to collect the biggest payments from Medicare, than nonprofits, according to a recent report by the inspector general’s office of the Department of Health and Human Services. Tellingly titled “Questionable Billing by Skilled Nursing Facilities,” the government study looked into how often nursing homes seek reimbursement for the costliest levels of care and found a huge increase in just two years.

In Medicare, people receiving benefits in nursing homes after a hospitalization (the only way Part A pays for nursing homes) are slotted into categories called resource utilization groups, or R.U.G.’s. Which group the beneficiaries fall into depends on how much therapy they receive and how many activities of daily living they need help with. The higher the classification, the more Medicare pays.

From 2006 to 2008, the inspector general’s office discovered, the proportion of patients classified in the highest therapy groups jumped to 28 percent from 17 percent, costing an additional $5 billion. And for-profit nursing homes, which constitute more than two-thirds of the nation’s nursing homes, were strikingly more apt to seek the highest reimbursement, the report found. Almost a third of their patients were in the highest R.U.G.’s, compared with 18 percent in nonprofit homes and 13 percent in government facilities. For-profit facilities also kept patients substantially longer, 29 days versus 23 at nonprofit homes.

Moreover, among the for-profits, the large chains were the most likely to charge for patients in the highest care categories and to extend their stays.

“These billing patterns indicate that certain [skilled nursing facilities] may be routinely placing beneficiaries into higher paying R.U.G.’s” — regardless of how much care they need — “or keeping beneficiaries in Part A stays longer than necessary,” the report concluded. Unnecessary treatments and therapies can harm patients, not just the Medicare budget, the report noted.

The inspector general’s office, continuing its review, made several recommendations (stronger monitoring, for instance) that the Centers for Medicare and Medicaid Services have accepted, and the office also referred the 348 worst offenders to Medicare officials for action.

“It’s consistent. The for-profits have the worst staffing ratios and poorer quality based on the number of deficiencies — violations of federal requirements — and the most serious deficiencies,” said Charlene Harrington, professor emeritus of social and behavioral sciences at the University of California, San Francisco, who has led a lot of that research.

In a new study, not yet published, Dr. Harrington also has found that of all forms of ownership, homes owned by the 10 largest chains fared worse than other for-profits. “These facilities are reporting the highest acuity levels” — meaning the most serious conditions for patients — “and the worst staffing,” she told me. “Facilities are supposed to increase their staffs when people are sicker.”


The Sacramento Bee had an article about the video evidence of abuse and neglect at Fair Oaks Residential Elderly Care.  "Granny cams" installed by family members were unplugged or showed poor care.  Sean Suh installed a small camera beside the bed to make sure the staff knew someone was watching.  As Suh was finding a new place for his grandmother, she died from complications caused by the neglect.  Duncan’s autopsy report showed potentially toxic levels of narcotics in her system, at least one of which her doctor had never prescribed, according to the document. The lawsuit charges that she suffered injuries, infection and "lethal doses of drugs," all of which contributed to her death.

"A short video clip captured by Suh’s "Grannycam" that shows a staffer violently shaking Duncan in her wheelchair now plays a key role in the state’s decision to shut down the care home."   The clip was discovered only her death. Following an investigation, the California Department of Social Services ordered the care home’s operators, Myung S. Kim and Jay J. Kim, to cease operations by the end of the business day. The state is moving to permanently revoke the home’s license.

The state’s suspension order accuses the home of violating the personal rights of residents. One of the concerns the state cites stems from the "Grannycam" clip, which shows staff members moving Duncan from the floor to her wheelchair, then dumping the chair backward with Duncan in it and shaking it. Among other allegations: that staff members improperly restrained Duncan and failed to quickly attend to her after she had fallen.

Once, the state alleges, family members arrived to find Duncan, crying and unattended, positioned upside down in her wheelchair. The order also cites instances in which Duncan suffered mysterious bruises and infections that went untreated.

Suh said he chose the Fair Oaks facility after informing administrators that he intended to install a camera. "I wanted to let them know I would be making sure that my grandmother got the utmost care and had the highest quality of life," he said.


The Houston Chronicle reported the $10 million jury verdict against Family Medi Clinic in The Woodlands for an overdose death of Michael Skorpenske who died two days after his only visit to the clinic where he received a prescription for three potent drugs: hydrocodone, xanax and soma.  He had sought help there for chronic pain he suffered from a motorcycle injury and a fall at a petrochemical plant.

The clinic’s director, Dr. Maurice Conte, had prescribed this same drug combo — known as the "holy trinity" — at least 3,800 times between 2006 and 2007 at more than 17 pain area clinics that he then oversaw, records showed.

Jurors were hoping the verdict deters other "pill mills" that have turned Houston into a national hub for prescription drug abuse. 

"Our verdict shows how much our community is against these pill mills and wants things to change," said juror Lauren Simmons, after finding gross negligence led to the overdose death.

Another juror, Tim Bammel, agreed, saying the verdict should discourage others who might be improperly churning out the addictive drugs that killed Skorpenske.

 Skorpenske’s sister, Sandra Smith, referring to more than 1,200 pill deaths recorded in the last two years, says "the jury has given a lot of hope to other families of those who are dying all over the place from this."


Sue Scheible writes about aging for The Patriot Ledger in Quincy, Massachusetts, and on the website "A Good Age".   She wrote a recent article on the misuse of prescription medications at nursing homes.

Have you had an elderly parent in a nursing home and wondered what medications they were being given?  As more aging Americans crowd into nursing homes, a new report from Consumer Reports Health details the misuse of risky drugs to sedate elderly patients. The report is part of an ongoing investigation of drugs prescribed by doctors “off-label.”  The report analyzed the use of atypical antipsychotics, officially approved by the U.S. Food and Drug Administration (FDA) to treat bipolar disorder and schizophrenia, but frequently used “off-label” to control agitation, aggression, hallucinations, and other symptoms in elderly patients with Alzheimer’s disease or other forms of dementia. There are no FDA approved drugs for these uses, but doctors can legally prescribe any drug they deem appropriate.

However the report concludes that these medications pose significant, increased risks especially to older people, including diabetes, sudden cardiac death, movement disorders, pneumonia, stroke, and weight gain. During a three-month period in 2010, 26 percent of nursing home residents received antipsychotics, according to the report.  Consumer ReportsBBD is a public education project to evaluate and rate drugs for more than 35 medical conditions.