MSN had a story about U.S. News & World Report’s issue on the Best Nursing Homes.

3.3 million Americans move into a nursing home each year.  One in seven Americans age 65 and older will spend time in one of the nation’s 16,000 nursing homes this year and for those 85 and older, the chances are more than one in five. Finding one that provides quality care is a challenge. Best Nursing Homes highlights meaningful data, like what proportion of residents have bedsores or are in pain.  Be leery of nursing homes that the government has labeled Special Focus Facilities. In Best Nursing Homes, facilities in this category are flagged with an icon that indicates they’ve been singled out by the state where they operate and by CMS as nursing homes with long histories of subpar or inconsistent health inspections.

The U.S. News rankings are built on data from Nursing Home Compare, a consumer web site run by the federal Centers for Medicare and Medicaid Services. CMS sets and enforces standards for all nursing homes enrolled in Medicare or Medicaid.  The data for Nursing Home Compare come from regular health inspections carried out by state agencies and from the homes themselves. Based onthat information, CMS assigns an overall ratings of one to five stars to all nursing homes other than a few too new for meaningful data to be available. Homes are also given one to five stars in how well they do in the health inspections, in providing enough nurses, and providing a high level of quality of care.

At Nursing Home Compare, you can search for a specific home or for all homes in a particular state or within a certain distance of your city or ZIP code.

Here are more details about the CMS standards that determine a home’s rating:

Health inspections

Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months.  Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents’ rights and quality of life, and proper skin care. A home’s rating is based on the number of deficiencies, their seriousness, and their scope, meaning the relative number of residents who were or could have been affected. Deficiencies are counted that were identified during the three most recent health inspections and in investigations of public complaints in that time frame.

Nurse staffing

Even first-rate nursing care falls short if there isn’t enough of it because of too few nurses who can spend time with residents, so CMS determines average nursing time per patient per day. Homes report the average number of registered nurses, licensed practical nurses, licensed vocational nurses, and certified nurse aides who were on the payroll during the two weeks prior to the most recent health inspection and their number of hours worked. The information is compared with the average number of residents during the same period and crunched to determine the average number of minutes of nursing time residents got per day. To receive five stars in the latest CMS ratings, nurses and aides had to provide slightly more than four hours of care a day to each resident, including 33 minutes from registered nurses. The time provided by each home is shown in the rankings.

Quality measures

CMS requires nursing homes have to submit clinical data for the most recent three quarters detailing the status of each individual Medicare and Medicaid resident in 19 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair.


USA Today reported that more than 560 of the nation’s nursing homes have not improved care for the past three years from a one-star federal government rating — the lowest on a five-star scale — even though most homes improved, according to a USA TODAY analysis of federal data.  See ratings for nursing homes.

The lowest overall rating is awarded to homes "much below average" compared with others in their state, according to CMS.   The star ratings are part of a broader federal effort to increase transparency for consumers of health care.  The federal government contracts with states to inspect nursing homes about once a year. The star ratings combine scores of data points, including information from annual inspections, quality measures and staff time spent with residents.

USA TODAY analyzed the ratings for 15,700 nursing homes for the past three years. Among the findings:

•Some homes are stuck at the bottom: 564 homes — representing 77,315 beds — received one star in each of seven reporting periods analyzed over three years. But 448 homes received the best overall rating — five stars — during each period.

Among the consistently low performers, almost two-thirds were for-profit nursing homes that are owned by chains. That’s a higher share than the 40% of all nursing homes in for-profit chains.

Lower staff turnover can create better care because employees become familiar with the routines and needs of nursing home residents.



The Chicago Tribune reported the suspicious death of a resident after a fatal altercation with another resident at Oak Park Healthcare Center.  The nursing home failed to report the altercation to the health department for further investigation. Anibal Calderon, 80, died of head injuries after an alleged fight that took place.  Calderon’s death was ruled a homicide by the Cook County medical examiner’s office. The Illinois Department of Public Health is now investigating.

Under state law, the nursing home should have reported the incident immediately to the health department as well as to the family of the victim and local police. Federal regulations require that nursing home residents involved in violent incidents be removed from the facility if necessary for their safety and the safety of others.  State officials have no record that Oak Park Healthcare notified the health department, said spokeswoman Melaney Arnold.  The for-profit nursing home has 204 beds and an occupancy rate of about 75 percent, according to the state. 

Nursing homes are also required to make available for public inspection the five most recent years of survey materials that would list possible violations, according to the IDPH website. But the Tribune reporter was escorted out of the Oak Park facility after requesting to look at the documents.


The Grand Rapids Press had a story about the tragic incident involving Matthew Ambrose. On Sept. 12, Matthew Ambrose perched at the edge of his bed at the Grand Rapids Home for Veterans.  Staff knew Ambrose was a high risk for falls because he suffers from Alzheimer’s disease, has a poor sense of balance and could not be left unattended when he was in a position where he could fall.

A privately contracted nurses aide sat the World War II veteran on the side of his bed and left the room to retrieve a lift apparatus to transport him from his bed into a wheelchair. When she returned, Ambrose was on the floor with his neck broken.  "The Ambrose lawsuit claims the contracted nurses aide should have known Ambrose was a risk to leave alone. According to the suit, Ambrose has dementia, Parkinson’s disease and "a history of falling," worsened by prescription medications that make him "even more prone to falling." Ambrose now resides in a Grand Rapids nursing home, where Eskola visits him virtually every day. After his fall, Eskola said, her father had surgery at Metro Health Hospital in which a surgeon inserted a metal screw to stabilize a neck bone broken by the fall."

His daughter, Janice Eskola, believes her father’s fall represents more than one unfortunate incident at the home. It is about putting budget priorities ahead of the welfare of men and women who served their country. "State officials insist budget pressures afford them little choice but to trim expenses because of a $4.2 million cut in state funds to the home and stalled plans to replace 170 union nurses aides with non-union contract workers. "

Gov. Rick Snyder intends to extend privatization in the 2012 budget for the home, at an estimated savings of up to $5.8 million a year. State funds to the home were cut by $4.2 million in anticipation of that move.



WSPA and the Spartanburg Herald had articles on the recent investigation into the serious allegations of sexual assault at Ellen Sager nursing home in Union, S.C.  Ellen Sager has had a history of problems.  The victim’s daughter accuses a nursing home employee of sexually assaulting her mother by exposing himself and making the woman touch his genitals. The 28 year old suspect entered the patient’s room, drew the privacy curtain, and then exposed himself. The woman said the man then had her mother touch his penis while he rocked back and forth.

The woman doesn’t want to be identified for fear of revealing her mother’s identity. An investigation has been launched. The Union County Sheriff’s Office is investigating the matter and has asked the South Carolina Law Enforcement Division to assist with the investigation, Union County Sheriff David Taylor said.  SLED was asked to aid in the investigation to avoid a conflict of interest because the nursing home receives partial funding from Union County, Taylor explained.

Ellen Sagar Nursing Home — part of the Union Hospital District — has more than 100 long-term care beds and offers nursing home care, along with physical, speech and occupational therapy, according to Wallace Thomson Hospital’s website. The hospital and nursing home share the same board of trustees, according to the website.

Sexual exploitation is listed as the offense on the incident report, which contains little information about the alleged crime. Information about the victim, complainant and suspect was redacted from a copy of the report provided to the Herald-Journal.


The Clarion Ledger reported the arrest of a nursing home worker, Lee Ray Martin, who is accused of taking more than $101,000 from 83 residents of Shady Lawn Nursing Home and Vicksburg Convalescent Center.  Martin was arrested on multiple counts of exploiting vulnerable persons.
While working as the business office coordinator for both facilities, Martin allegedly wrote checks from the residents’ trust fund or petty cash account, and then cashed them for her own use.

The Austin Daily Herald reported the tragic and preventable death of Wayne Bye from choking.  The resident who had swallowing problems was left unattended and unsupervised while eating.  Adams Health Care Center is accused of neglect when Bye choked to death in his room on March 18, 2011. According to a Minnesota Department of Health report, Bye was not adequately supervised while eating, and he was found choking in his room with no staff present. Bye went into respiratory arrest, according to the report, and passed away during the incident.

An employee was in the room when Bye started choking. Then, two nurses entered the room and confirmed he had stopped breathing and had no heart rate. A nurse said a couple of bites of fruit were eaten, and Bye’s lips were blue, according to the report. The nurse said no emergency interventions were performed.

Bye’s medical record stated that he was at risk for aspiration pneumonia and had difficulty swallowing. Staff was supposed to make sure Bye swallowed each bite twice, ate slowly and elevated his head 90 degrees while eating and 45 degrees for 30 minutes after eating.

He was to be returned home the day he died.  See article from the Star-Tribune.

Joseph Tartakovsky is a law clerk at the United States Court of Appeals for the 10th Circuit who wrote a great article for the NY Times on Charles Dickens and how novelists are similar to lawyers.

Lawyers appear in 11 of his 15 novels.  At 15, he was hired as an “attorney’s clerk,” serving subpoenas, registering wills, copying transcripts; later he became a court reporter. For three formative years he was surrounded by law students, law clerks, copying clerks, court clerks, magistrates, barristers and solicitors who (reborn in his fiction) uttered cheerful sentiments like “I hate my profession.” His portraits of nearly every London court — Chancery, Divorce, Probate, Admiralty, etc. — are so accurate that one scholar wrote a lively book called “Charles Dickens as a Legal Historian.” At 32 he filed his first suit against a pirate publisher. Dickens told a friend afterward that “it is better to suffer a great wrong than to have recourse to the much greater wrong of the law.”   Dickens himself enrolled as a law student in 1839 and, in 1846, inquired about work as a magistrate. His biographer Claire Tomalin hints that Dickens, like David Copperfield, didn’t pursue a legal education in part because he could not afford the 100 pounds needed. (Incidentally, of his 10 children, only Henry was successful — as a lawyer.)

The article quotes Judge Jed S. Rakoff of the Federal District Court in Manhattan. He tells me lawyers are scorned because “they think there are two sides to most stories, while many people think there is just one side: theirs.”

"Are attorneys just amoral mouthpieces? Samuel Johnson, the great critic who himself once hoped to enter the bar, knew better: “A lawyer has no business with the justice or injustice of the cause” — that is “to be decided by the judge.” The best means we have of discovering truth is to take opposing sides and let them tango. If a lawyer had to believe in the client’s cause, most people would go undefended."

The difference btween Dickens’ social justice in his written works is that lawyers take facts as they exist instead of inventing them. "Dickens, for all his genius and wrath, was himself unable to undertake reforms, or protect clients, or draft fairer rules. He needed lawyers to achieve his vision of a just society. Even the inimitable novelist would agree that the two old trades must go hand in hand, together improving the noble system that, for all its Dickensian farce, makes us civilized."


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