CVN blog had an excellent article written by David Siegel on a recent multimillion dollar verdict involving the neglect of Doris Cote.  National for profit nursing home chain operator Five Star Quality Care Inc. decided to try a case where they recklessly neglected one of their residents.  The jury decided against them with a $16.7 million punitive damages verdict in Arizona state court after the jury compensated the family with a $2.5 million compensatory verdict for allowing an 86-year-old woman to develop an infected bedsore, bringing the total damages awarded to her family to $19.2 million.

Cote’s family filed an action against Five Star in 2012 for wrongful death and elder abuse, claiming that she was overmedicated with narcotics, allowed to fall multiple times, suffered from malnutrition and dehydration, and developed a prssure ulcer which got infected with Methicillin-resistant Staphylococcus aureus, known as MRSA.  The jury agreed that caregivers at The Forum at Desert Harbor recklesly and consciously disregarded policies and procedures required to keep patients from developing bedsores.  The jury also found that the staff intentionally falsified medical records to cover up signs of neglect like severe weight loss.  Cote weighed around 115 lbs. when she entered The Forum and lost nearly nine percent of her body weight due to malnutrition.

Lloyd explained to the jurors that Five Star’s valuation on the New York Stock Exchange is over $200 million and that the company brings in annual revenues of over one billion dollars. He asked the jury to award between $18 and $20 million.

The Consumerist had the below on their website.

Companies have been taking away your right to sue them when they screw up for years, using small, hidden clauses to require mandatory binding arbitration instead. After years of consumer groups voicing their concern over this anti-consumer practice, there’s finally a new bill in congress that proposes to bring back your right to sue.

The Arbitration Fairness Act of 2015, which was introduced by Minnesota Sen. Al Franken and Georgia Rep. Hank Johnson, would eliminate mandatory arbitration clauses in employment, consumer, civil rights and antitrust cases by amending the Fair Arbitration Act to its original intent.

The use of arbitration clauses has skyrocketed by companies since 2011, when the U.S. Supreme Court affirmed that it was perfectly okay for companies to take away a consumer’s right to sue or their ability to join other wronged consumers in a class action case by inserting a paragraph or two of text inside lengthy contracts.

To add insult to injury, most consumers are unaware that they’ve signed away their right to be heard in court. A Consumer Financial Protection Bureau report from March found that 75% of consumers surveyed did not know if they were subject to an arbitration clause in their credit card contract. And among consumers whose contract included an arbitration clause, fewer than 7% recognized that they could not sue their credit card issuer in court.

“There is overwhelming evidence that forced arbitration creates an unaccountable system of winners and losers,” Sen. Johnson said in a statement. “Unlike America’s civil justice system, which has evolved through centuries of jurisprudence and social progress, forced arbitration does not provide important procedural guarantees of fairness and due process that are the hallmarks of courts of law.”

According to a statement from Sen. Franken’s office, the Arbitration Fairness Act would restore the intent of the original Fair Arbitration Act (FAA) passed by Congress in 1925.

When FAA was passed it was intended to target commercial arbitration agreements between two companies of generally comparable bargaining power. Over the years, however, the Supreme Court broadened the reach of the law to include consumer and employment disputes, effectively superseding all other federal laws protecting consumers, workers and small businesses.

Under the newly introduced Arbitration Fairness Act of 2015, agreements to arbitration of employment, consumer, civil rights and antitrust disputes could only be made after the dispute has arisen.

To be clear, the Act doesn’t prohibit companies and consumers from going to arbitration to settle a dispute, it simply mandates that the decision to go into arbitration not be made before the dispute has actually taken place.

The Act seeks to ensure transparency in civil litigation by protecting the integrity of Civil Rights Act, the Equal Pay Act, the Americans with Disabilities Act, and the Age Discrimination in Employment Act and others that are frequently skirted by companies using forced arbitration.

Additionally, the Act would continue to allow pre-dispute mandatory arbitration to continue in business-to-business agreements, and does not apply to collective bargaining agreements.

“The Arbitration Fairness Act, is a commonsense reform to our justice system that will restore Americans’ right to challenge unfair practices by corporations and ensure meaningful legal recourse when everyday Minnesotans and small businesses are wronged,” Franken says in a statement. “It’s clear that we’re at a point where big corporations can write their own rules and insulate themselves from liability for wrongdoing—this can’t continue.”

Consumer groups, many of which have called on regulators to revise forced arbitration rules, applauded the Act’s introduction.

Both the National Consumer Law Center and the National Association of Consumer Advocates say they support the new measure, calling on Congress to follow through restoring consumers’ Constitutional rights.

“We should never have to give up our Constitutional rights just to do the everyday things in our lives,”NACA’s legislative director Ellen Taverna said in a statement. “The Arbitration Fairness Act stands up for consumers, servicemembers, workers and all Americans and restores our right to hold corporations accountable when they break the law.”


The StarTribune reported that a resident of Evergreen Terrace was neglected causing significant injuries.  The resident stumbled and broke a leg while being improperly lifted out of bed, then was left in the dining room for lunch without medical personnel being notified, according to a state investigation. The injury to the resident at Evergreen Terrace is being attributed to an aide who helped the resident by herself and did not heed requirements that two attendants and a mechanical lift be used when moving the resident from bed.  The resident died about two weeks later.

An aide “failed to follow the resident’s care plan,” according to details of the Health Department investigation.  The staff member explained that she “felt rushed” while assisting the resident to the dining room, the report said.  Most likely, the facility was short-staffed placing pressure on staff to attempt to get their custodial responsibilities completed in a short period of time.

Weeping relatives of a mute 64-year-old woman sexually abused by a male aide at a Bronx nursing home labeled the creep as subhuman as he was sentenced last month to six months behind bars.  “He’s an animal. He preyed on my mother, knowing that she couldn’t do anything about it,” the victim’s 37-year-old son said about Nanic Aidasani.  The 42-year-old sicko pounced on the unwitting victim as she lay on her bed at the Marble Hill facility.  A fellow worker had discovered the nursing assistant on top of the woman, who has dementia and can’t speak because of a stroke.

Aidasani, an aide at the 200-bed Manhattanville Health Center, pleaded guilty in February to abusing the woman in 2014.  Aidasani originally faced four years on an attempted rape charge, but took a plea deal for onlysix months behind bars and five years’ probation.  As part of the sentence, Aidasani handed over his nursing license, and was labeled a Level Two sex offender — a distinction that will stay with him forever.


The New York Times had an interesting article on the “cutthroat race for Medicare dollars” and how it affects quality of care. Nursing homes are now marketing to sicker people to get Medicare dollars.  At the same time, hospitals are trying to cut costs by pushing some patients out early — like those who have had hip replacement or heart surgery. Not quite ready to go home, they need continuing care somewhere. And for older adults, Medicare usually pays the bill.  Competition for these patients has become intense because Medicare, the health insurance program for older adults, pays 84 percent more for short-term patients than nursing homes typically get from Medicaid, the health insurance program for the poor, for long-term residents.  Most of the homes are not up to the challenge of providing the intensive medical care that rehabilitation requires. Many are often short on nurses and aides and do not have doctors on staff.

A report released in 2014 by the Department of Health and Human Services’ Office of the Inspector General found that 22 percent of Medicare patients who stayed in a nursing facility for 35 days or less experienced harm as a result of their medical care. An additional 11 percent suffered temporary injury. The report estimated that Medicare spent $2.8 billion on hospital treatment in 2011 because of harm experienced in nursing facilities.

The combination of factors has created a bull market in the once-struggling industry as investors clamor to snatch up homes with the most potential to bring in short-term patients. Sale prices of nursing homes averaged $76,500 per bed last year — the second consecutive year of record-breaking prices, according to Irving Levin Associates, which analyzes the senior housing market.

The shifting landscape, some say, marginalizes poor long-term residents with extensive medical needs. “This focus on Medicare, Medicare, Medicare has pushed out people in the custodial care world,” said Anthony Chicotel, a staff lawyer at California Advocates for Nursing Home Reform, who says he fields calls at least once a week from residents who are being evicted because their Medicare coverage, which lasts 100 days, is expiring and the residents will transition to lower-paying Medicaid. “They’re being pushed out, and they don’t have anywhere to go, really, that can take care of them.”

The profit-driven focus on Medicare patients has intensified as many long-term residents moved to assisted-living facilities, and hospitals have sought to discharge patients earlier. On a typical day in 2000, about 9 percent of residents in an average nursing home were covered by Medicare, according to federal data. By 2014, that had risen to 15 percent.

“I think a lot of the time when it comes to managed care, it’s a race to the bottom,” Anthony Chicotel, a staff lawyer at California Advocates for Nursing Home Reform said.

A new study found one in five nursing home residents with advanced dementia harbor strains of drug-resistant bacteria and more than 10 percent of the drug-resistant bacteria are resistant to four or more antibiotic classes. The research was published online today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.  Drug-resistant Escherichia coli (E. coli) and Proteus mirabilis (P. mirabilis) were the most common bacteria found among the study subjects. Nearly 90 percent of the bacteria found were resistant to three types of antibiotics, most notably ciprofloxacin, gentamicin and extended-spectrum penicillins.

“Nursing home residents with advanced dementia usually have an increased need for healthcare worker assistance, as well as frequent exposure to antibiotics. This combination may be leading to a subset of vulnerable long-term care residents at high risk of both acquiring and spreading these dangerous bugs,” said Erika D’Agata, M.D., an infectious disease physician at Rhode Island Hospital and lead author of the study. “Frequent hospitalization among these residents also provides a constant influx of drug-resistant bacteria into the hospital setting, further fostering the spread throughout the healthcare delivery system.”

Genetically related bacteria were detected in 18 of the 22 nursing homes (82 percent). Possible routes include overlapping hospital stays among residents with advanced dementia from different nursing homes and healthcare professionals cross-covering multiple nursing homes.

“Ongoing efforts to curb the acquisition and spread of this bacteria among nursing homes residents is crucial since this is an issue that goes beyond just one realm of care,” said D’Agata. “Healthcare institutions must work together to help curb the transmission of these emerging, dangerous pathogens.”

The Telegraph reported that Ronnie Rollins, CEO of Macon-based Community Health Services of Georgia, was “speechless and stunned” when CMS demanded he return more than $100 million in improper payments made to his nursing homes.  The company nursing homes had received the “extra” Medicaid funding in question for more than a decade. This past December, a federal ruling declared the funding to be inappropriate.

A Dec. 8 letter and report from the federal Centers for Medicare and Medicaid Services said the “unallowable” payments to more than 30 nursing homes were made in fiscal years 2010 and 2011.  The Centers for Medicare and Medicaid Services report targeted 35 Georgia nursing homes that were owned by local development authorities and were the source of “intergovernmental transfers” to get “upper payment limit dollars”.  But the Centers for Medicare and Medicaid Services report to state officials said “these nursing facilities are actually privately owned” — not owned by a public agency as required.


WDTN reported on the sad state of nursing homes in Ohio.  Nursing homes are supposed to be a place of care, rehabilitation, and cleanliness but many are not living up to that standard.

Bev Laubert is Ohio’s Long Term care ombudsman. She’s an expert on nursing homes. She says these surveys can tell you if nursing homes follow the rules. “These are minimums, so if a nursing home isn’t meeting the minimums it calls into question how high do they go. How high of quality do they provide?” said Long-term Care Ombudsman Bev Laubert. CMS tries to answer that question for families. It even has a rating system in place.  “A one star home is a problem,” said Laubert.

Before you put your loved one in a nursing home, do your homework, visit the facility and ask questions.

“You just intuitively pick up stuff. It tells you, look at the residents. Look at how their hair is combed, look at whether they are shaved. Are they out of their rooms? Simple little things,” said Jones. reported that a certified nurse’s aide named Renee Geloso has been charged with hitting a nursing home resident while another person is accused of trying to cover the incident up.  The state attorney general’s office said that Geloso was working as a certified nurse’s aide at the Valley Health Services in Herkimer when she hit a resident of the nursing home after becoming frustrated with the resident.  Geloso was charged with first-degree endangering the welfare of an incompetent or physically disabled person and willful violation of the Public Health Law.

While investigating, authorities charged a second person. Jordan Gonzales was charged with first-degree falsifying business records and willful violation of the Public Health Law.  Gonzales is accused of making a false statement to protect Geloso and of not quickly reporting the incident as required by law.  illful violation of the Public Health Law carries a maximum punishment of a year in jail or three years of probation. Endangering the welfare of a disabled person and falsifying business records can carry a penalty of up to three years in prison or five years probation.

“Caregivers are entrusted with an important responsibility to keep our loved ones healthy and safe,” Attorney General Eric T. Schneiderman said in a statement. “Those who violate this trust by deliberately harming a nursing home resident must be held accountable.”



The Times Online reported that raising the minimum wage even beyond a proposed $10.10 per hour would help the state’s nursing home workers care not only for themselves and their families, but also older residents, according to a new report from the Keystone Research Center.  The economic think tank in Harrisburg has called for the minimum wage for nursing home workers to be raised to $15 — a number backed by the Service Employees International Union Healthcare Pennsylvania, which represents health care workers.

In “Double Trouble: Taxpayer-Subsidized Low-Wage Jobs in Pennsylvania Nursing Homes,” the KRC says that low wages force many of the state’s nearly 87,000 nursing home workers to rely on public assistance or hold multiple jobs, and also contribute to high turnover at facilities across the state.

About 52 percent of nursing home workers who were surveyed by KRC said they could not support their families on their wages, and 16 percent said they work more than one job.  The nursing home industry received about $5.9 billion in public funding from Medicare and Medicaid in 2013, and 14 percent of nurse aides and 28 percent of dietary workers employed by the facilities said they or their family members receive public assistance, according to the report.

That means taxpayers are “double subsidizing” nursing homes in some cases, the report’s author, KRC Executive Director Stephen Herzenberg, said in a news release.  “If we hope to strengthen the state’s economic recovery, rebuild the middle class and ensure that the commonwealth’s aging population receives the consistent, quality care it deserves, caregivers need to make a living wage of at least $15 per hour,” he said.

The report said nursing home costs would only increase about 4 percent with a $15 minimum wage, and the KRC suggested reigning in CEO salaries to adjust for it.  The report also said that raising the minimum wage would reduce staff turnover and associated costs, while generating 1,500 jobs and more than $30 million in new tax revenue for the state and its municipalities. It would also benefit more than 50,000 workers and put nearly $300 million in their pockets, according to the KRC.