Monthly Archives: September 2015

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The Sacramento Bee reported the tragic death of James Populus, who suffered burns over 90 percent of his body from an arson fire decades earlier.  Populus died in August 2014 after 14 months at the facility, which has become a frequent target of state and federal officials for alleged violations. The neglect at Verdugo Valley led Populus to suffer “severe weight loss, sepsis and pneumonia” and that he died of “multiple system failure due to sepsis,” with infections throughout his body.  Populus was not examined frequently enough by a doctor, despite his fragile health, according to the attorney general.

California’s attorney general has filed criminal charges against the facility and two of its nurses in connection with a resident’s death. Attorney General Kamala Harris announced that Verdugo Valley Skilled Nursing & Wellness Centre faces involuntary manslaughter charges for its “grossly negligent” care of a burn-victim resident.

In pursuing a criminal case against Verdugo Valley, the AG’s office said it also was filing charges of dependent adult abuse against the director of nursing, Alexiuse San Mateo, who “willfully permitted the patient’s death.” Consuelo Policarpio, a supervising nurse, is charged with dependent adult abuse causing great bodily injury.

The action marks another blow for nursing home owner/operator (and multi-millionaire) Shlomo Rechnitz of Los Angeles, whose facilities have faced increasing scrutiny in recent months from state and federal health regulators. Since October, the government has yanked certification from three Rechnitz nursing homes for alleged poor quality care.

In 2011, Harris announced indictments against the same nursing home’s former administrator for felony abuse and neglect after the death of a patient. The patient had committed suicide.

The 138-bed skilled nursing home earned a one-star rating, the federal government’s symbol for achieving the lowest quality of care. So far this year, it has received three state enforcement actions, one of which for failing to have proper maintenance throughout the building.

 

The Daily Beast had an article on a new study that shows how loss of quality sleep may contribute to the cause of Alzheimer’s disease.  According to researchers at the University of California Berkeley, disturbed sleep may contribute to the development of dementia. The study, performed at the university’s Sleep and Neuroimaging Laboratory, relied on the brain scans of people with both diagnoses. Loss of sleep, they determined, caused a buildup of a “garbage” protein in the brain—one that directly impacts cognition.

The biology, in this case, comes down to a “stringy” toxic protein that dangles off another one in the brain. Scientists aren’t exactly sure why it’s there, but they do know that it’s dangerous. Luckily, our bodies are aware of this too, and use an enzyme to metabolize the protein until it evaporates.

When we fall asleep, it goes into “overdrive.” Those who routinely get a good night of sleep easily get rid of the protein. Those who don’t, leave behind a mess the body doesn’t recognize. Sticky in nature, the protein attracts others that were also left behind, forming a dangerous sheet of  “gooey garbagey proteins.”  At first, the “gooey garbage” isn’t an issue.  But over time the buildup—which can be seen in Alzheimer’s patients up to 20 years before a diagnosis—wreaks havoc.

The concept builds on a study from the same center in October of last year, which examined whether obstructive sleep apnea (OSA) had the potential to cause Alzheimer’s. Published in Neuroscience and Behavioral Reviews, the study relied on sleep brain imaging to examine the overlap in the structure of patients’ brains with the two diagnoses. While a direct link could not be proven, the images showed a “cognitive decline” from OSA, and suggested that perhaps “sleep disturbances” alone may be the issue.

 

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When Bernice Robertson’s mother, who cannot speak due to throat cancer, suffered a mysterious broken arm and developed bruises on her body in February, Bernice decided to plant a hidden camera in the 84-year-old woman’s nursing home. When she watched the footage, she was shocked.  The video showed Bernice’s mother, Hope Robertson being assaulted by her caregiver, Ncedisa Mkenkcele. The nurse was caught aggressively and impatiently forcing the frail woman into her bed and even punching her in the face.  After Bernice took the video to police in East London, Ncediswa was arrested and charged with assault.

Bernice told Herald Live:

“There were not enough good reasons as to what happened to her from the staff, other than that she had fallen off the bed or bumped herself. It really has been a traumatic experience for me and my family. I saw my mother being beaten and pushed around.”

 

Public Integrity reported that the Government Accountability Office will conduct a review of the federal government’s nursing home rating system —the subject of a Center for Public Integrity investigation last fall. (The Center’s series was the recipient of The Joseph D. Ryle Award for Excellence in Writing on the Problems of Geriatrics from the National Press Club.)  Investigations by the Center and the New York Times found widespread gaps between staffing levels reported by nursing homes to a widely used federal website and those calculated through an analysis of the homes’ annual financial documents. The gaps occurred across both for-profit and nonprofit nursing homes, with more than 80 percent of nursing homes reporting higher levels of registered nurse care to the Nursing Homes Compare website than were reflected in their reports to Medicare.

The action by the watchdog arm of Congress comes in response to a request from Senators Bob Casey, D-Pennsylvania and Ron Wyden, D-Oregon, and Representative Elijah Cummings, D-Maryland.

 

 

Modern Healthcare had a great article on how CMS is trying to improve the care provided at nursing homes.  The CMS announced that it is combating the cost of nursing home hospitalizations by injecting funds into the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.  According to a 2013 report published by HHS’ Office of Inspector General, $14.3 billion was spent on the hospitalization of nursing home residents in fiscal 2011.

“In 2013, the CMS partnered with seven Enhanced Care and Coordination Providers in 144 nursing facilities across seven states to test a model to improve care for long-term residents. The ECCPs provided training, preventive services and helped improve the assessment and management of medical conditions.”

The new funding, slated to begin in October 2016, will allow the organizations currently participating in the initiative to apply to test whether a new payment model will further reduce avoidable hospitalizations, improve the quality of care and lower combined Medicare and Medicaid spending, the CMS said.

“This initiative has the potential to improve the care for the most frail, most vulnerable Medicare-Medicaid enrollees—long-term residents of nursing facilities,” said Tim Engelhardt, director of the Medicare Medicaid Coordination Office. “By aligning financial incentives, we can improve the quality of on-site care in nursing facilities and the assessment and management of conditions that too often now lead to unnecessary and costly hospitalizations.”

The goal of HealthInsight’s model is to quickly recognize and intervene when a resident’s condition changes, Huber said. The staff deployed to the nursing homes by HealthInsight helped identify eating and weight patterns and heart conditions of residents, and then recommended antibiotics that could be used to treat conditions earlier than before, she said.

While Unroe is excited by the opportunity the CMS initiative has provided with this additional funding, she said to really make a difference, the initiative needs to extend across the country.

 

The BerkshireEagle reported the guilty plea and minor sentence given to Rolline Gadson who admitted to stealing cash, credit cards and jewelry from residents of Ruth’s House, the nursing home where she worked. Gadson was sentenced to only two years of probation and ordered to pay more than $6,000 in restitution to 11 victims.

The 30-year-old Gadson pleaded guilty to one count of larceny from a person over 65, and under terms of the deal 18 other counts were continued without a finding. Authorities say Gadson started stealing cash from residents’ units last October. Some of the items she stole were found at area pawn shops.

The Pop Tort website had the below article on their website.

Vunies High was the sister of heavyweight boxing legend Joe Louis. For 25 years, she was a public school teacher and counselor, but later in life she suffered from Alzheimer’s. She lived at The Heatherwood, a Detroit assisted living facility operated by a large Dallas corporation called Capital Senior Living Properties. This company did not take care of Vunies. On February 18, 2008, Vunies froze to death, having wandered outside “dressed only in pajamas and wearing only one shoe,” with “her face stuck to ice on the ground.”

Unfortunately, as ProPublica noted in its recent examination of health and safety problems at nursing homes,

One regularly cited deficiency involves unsafe wandering, a well-known problem that can result from inadequate supervision. A report this year in the journal Annals of Long Term Care, citing earlier research, said up to 31 percent of nursing home residents with dementia wander at least once. …

And that is far from the only health and safety problem facing residents of these homes.

A search for injuries produced 7,912 results. MRSA, a drug-resistant staph infection, yielded 514 entries. The word ignore is found 275 times, and entrapment, which can happen if a resident gets stuck in bed rails, brought 194 matches.

As ProPublica also noted, “For decades, federal auditors have flagged dangerous and neglectful conditions in U.S. nursing homes and faulted the government’s oversight.” The government has issued several recent reports on this topic, finding that in 2012, for example, “85 percent of nursing facilities reported at least one allegation of abuse or neglect to OIG [i.e. the federal government].” What’s even worse, according to the National Research Council,

[A] vast reservoir of undetected and unreported elder mistreatment in nursing homes may exist. Because nursing home residents as a class are both extremely physically vulnerable and generally unable either to protect themselves or report elder mistreatment they experience, the physical and emotional costs of elder mistreatment in such environments are likely to be very high.

We all should worry. As OIG also notes,

In 2050, the number of Americans aged 65 and older is projected to be 88.5 million, more than double the population of 40.2 million in 2010.  Nursing facilities are likely to experience increases in their resident population; therefore, it is important to ensure that residents are protected from abuse and neglect.

Ha, that’s an understatement.  Nursing home residents are some of the most fragile individuals in our society and depend on these institutions for their literal survival. So the very last thing we should be doing is allowing policies that remove this industry’s financial incentive to maintain safe facilities. Yet that is exactly what’s happening today.

First of all, in the last few years, many nursing homes purchased by investor groups have provided inferior care while shielding themselves from regulators and litigation by creating intricate structures of shell companies and subsidiaries.

But perhaps even worse for residents, today almost all nursing homes force them to sign forced arbitration clauses as a condition for admission, making it almost impossible for anyone later abused and neglected to sue nursing home companies in court. Families cannot “not sign” what a nursing home is forcing them to sign. They have no choice.  This is especially true when families are dealing with emergencies where a family member is being thrown out of hospital after suffering some terrible illness or injury.  If the family is lucky, they’ll quickly find a facility with a decent reputation, not too many state violations, hopefully accepts Medicaid – and they’re fortunate if they find even that.

Here’s why forced arbitration is a problem. Under forced arbitration programs, negligence and abuse cases must be resolved in private, secretive, corporate-designed dispute systems. Anti-patient bias infects this process. Nursing home arbitration companies have a financial incentive to side with repeat players who generate most of the cases they handle. Arbitrators are also not required to have any legal training and they need not follow the law. Court rules of evidence and procedure do not apply. There is limited discovery making it much more difficult for individuals to have access to important documents that may help their claim. Arbitration proceedings are secretive.  As we have noted before, “[C]ourt proceedings are conducted in a public courtroom and leave a detailed public record that can inform industry practice and help develop case law, say experts. Not so with arbitration hearings, which are conducted in private and whose proceedings and materials are often protected by confidentiality rules.”

Decisions are still enforceable with the full weight of the law even though they may be legally incorrect. This is especially disturbing because these decisions are binding. Sometimes, victims must split the sizeable costs of arbitration with the nursing home.

And it’s not just the patient who suffers in this process.  We all suffer.  The lives of countless seniors and many millions of dollars in future health care costs have been saved as a result of lawsuits in court against nursing homes. Here are a few examples, reported in this Center for Justice & Democracy fact sheet:

  • A 78-year-old woman, admitted to a nursing home for short-term hip and wrist rehabilitation, died after suffering severe pressure sores, malnourishment and dehydration.  As part of the settlement, the company changed its patient monitoring and care procedures in each of its 65 nursing homes.
  • A 63-year-old Alzheimer patient was strangled to death by the restraints in her bed rails while sleeping.  As part of the settlement, the nursing home agreed to numerous operational reforms, while the bed rail manufacturer agreed to warn its customers about the dangers of entrapment.
  • A 79-year-old nursing home patient suffering from Alzheimer’s disease drowned in a bathtub after being left unattended.  As a result of this lawsuit, the nursing home installed safety strips in bathtubs and exercised closer supervision of its elderly patients.

And in a 2010 settlement in a case called Lavender v. Skilled Healthcare Group, Skilled Healthcare Group settled with a class of approximately 32,000 current and former residents of Skilled Healthcare LLC health and rehabilitation facilities, including family members of residents, who sued Skilled Healthcare Group for understaffing in their facilities in violation of California state law.  The settlement of $50 million also included injunctive relief valued at approximately $12.8 million, requiring Skilled Healthcare Group to staff their facilities to meet state-mandated minimum requirements.

So why talk about this now?  Because the Center for Medicare and Medicaid Services has just issued a notice of proposed rulemaking regarding long-term care facilities and has asked for public feedback on “whether agreements for binding arbitration should be prohibited.”  Comments are due September 14, 2015.  PLEASE EXPRESS YOUR VIEWS! And sign Public Citizen’s petition here.

Do it for Vunies High, whose family was able to seek justice and accountability on her behalf and sue. Do it for a loved one in your life.  Hey, do it for youself!

Syracuse.com reported the guilty plea of a nurse named Nicolle Wagner-Stinson for covering up sexual abuse and neglect at a nursing home in Herkimer County.  Wagner-Stinson, director of Mohawk Valley Health Care Center nursing home, pled guilty to two counts of tampering with evidence.  Wagner-Stinson admitted to destroying a witness statement which described a sexual assault incident between two nursing home residents and concealing medical records to cover up patient neglect.

Wagner-Stinson also admitted she concealed a patient’s medication administration record from the state Health Department which was evidence of Mohawk’s failure to provide doctor ordered medication to that patient.

“The neglect shown by senior leadership at this facility is shocking,” Schneiderman said in a prepared statement.

 

 

 

CBSNews reported on an interesting study that shows low vitamin D levels are linked to a greater risk of bone fractures in women after menopause — but taking high doses of supplements is not the answer, according to new research. A study published online in JAMA Internal Medicine suggests the common practice of prescribing vitamin D supplements to fill the gap does not have any benefit for older women’s bones or muscle strength.

Vitamin D is the companion to calcium, working to help the body utilize more of the mineral necessary to strengthen bones and help muscles function. The amount of vitamin D is less important than how much is “bio-available,” or readily absorbed. The NIH says there is some risk that too much vitamin D in the bloodstream can cause digestive problems and kidney damage, though complications are rare.

“While high-dose vitamin D did indeed increase calcium absorption, the increase was only 1 percent and [it] did not translate into gains in spine, hip or total body bone mineral density,” study author Dr. Karen Hansen, an associate professor of medicine at the University of Wisconsin School of Medicine and Public Health in Madison, told HealthDay. Her team “did not find any benefit of vitamin D, in either high or low dose, on muscle mass, two tests of muscle fitness or fall.”

Although the high-dose supplement group achieved the goal of raising their vitamin D levels to 30 nanograms per milliliter, they did not show any benefit in bone density testing, muscle strength measures or a sit-and-stand test, which assesses risk for falls.

“I think this is the final, and negative, word on vitamin D supplementation,” Dr. Rita Redberg, a professor of medicine with the University of California, San Francisco’s Philip R. Lee Institute for Health Policy Studies and editor of JAMA Internal Medicine, told HealthDay. “There are a lot of women getting vitamin D blood tests and taking vitamin D supplements of various doses. This study suggests that those practices should stop. In other words, if you are going to start vitamin D to improve bone health, and if you are currently taking it for that reason, you can stop. I know of no other benefits for vitamin D supplementation.”

However, some doctors suggest the case is not yet closed. “A few other studies have shown the opposite, that it does improve muscle strength,” Dr. Houman Danesh, assistant professor of anesthesiology and assistant professor of rehabilitation at the Icahn School of Medicine at Mount Sinai, told CBS News. “Furthermore the type of vitamin D used makes a difference. There is more literature showing the benefits of supplementing with D2 rather than D3. [Vitamin D] supplementation has many other potential benefits such as preventing osteoarthritis, diabetes and Alzheimer’s. These effects are most likely present in individuals who are deficient.” He noted it is important not to take too much, since an excessive level of vitamin D can be toxic.

The U.S. Preventative Services Task Force does not recommend vitamin D supplements to prevent fractures and falls in post-menopausal women until age 65 or older.

 

The Chicago Sun-Times reported identity theft at the hands of a nursing home caregiver.  Shantell Winters has been accused of stealing the identities of several nursing home residents in order to claim refunds from their tax returns, federal authorities said.  The indictment listed 12 counts of wire fraud, three counts of identity fraud, and one count of filing a false claim against the United States, the U.S. Attorney’s office said in a statement.

Between late 2009 or early 2010, until 2012, Winters prepared and electronically filed a dozen individual federal income tax returns made out in other people’s names, the indictment alleges.  The indictment further claims Winters created fraudulent W-2 forms for corporate entities. The tax returns also included false amounts of income, deductions and losses, wages and other information.  Each wire fraud count carries a maximum sentence of 20 years in prison, the statement said.