Ashton Place Health and Rehabilitation Center nursing home has been hit with record fines after inspectors found widespread neglect resulting in actual harm to multiple patients including one who died after transfer to a hospital showed widespread wounds with maggots that apparently had gone untreated.  A male patient who was admitted to the home on July 26 of this year with no visible wounds ended up being transferred to a hospital for ulcers and ultimately died on Oct. 11 where hospital staffers found maggots in wounds that appeared to be untreated.

The 98-page inspection report cites multiple cases of patients suffering actual physical harm due to failure to follow a physician’s orders, failure to administer prescribed drugs and failure to inform physicians’ of their patients deteriorating condition.  According to the report, the home’s medical director stated, “I have support, no direction. I have talked (to them) about the staff they have here. I don’t have much confidence in them.”

The fines totaling $50,000 were imposed on the 211-bed nursing home.  In addition to the fines Tennessee Health Commissioner John Dreyzehner ordered a rare freeze of any new admissions to the facility and appointed a monitor to oversee its operations.

Neglect and poor care was also detailed for other patients, including a female patient suffering from ovarian cancer whose worsening condition was not reported to her doctor. She died on Oct. 24.

 The report was highly critical of managers at the facility and noted that top officials contended they were unaware of the problems reported by direct care staffers.  What is worse?  Knowing of a problem and ignoring it or not even being aware of what is going on at the facility?

See article at Commercial Appeal.

Time reported the story of Catholic nun Sister Irene Morissette, a resident of Chateau Vestavia, an assisted-living facility near Birmingham, Ala.   Sister Irene told a staffer that she was raped in her bed.  What added insult to injury was her inability to sue the facility that failed to keep her safe.

Morissette told police that someone held her 5-ft. 2-in., 140-lb. frame to the bed by her shoulders. She recalled the “terrible experience of being penetrated,” according to a recorded police interview reviewed by TIME. “I was so scared,” she said. “She was afraid to call anyone,” an examiner wrote later, “because she was afraid that the assailant would be the one to come back to her room.”

“Police and medical records paint a disturbing scene. Police investigators found two semen stains in Morissette’s bed and blood on the “inside rear area” of her green-and-pink-flowered pajama bottoms, which had been shoved underneath the mattress. A sexual-assault examiner at a local hospital reported that Morissette had sustained multiple abrasions inside and outside her vaginal canal, wounds that could be consistent with rape. “The genital exam was very painful for the client,” the examiner’s report said.”

“After a criminal investigation by local police failed to produce enough evidence to identify a suspect in the alleged attack, Morissette’s family tried to file a civil suit against Chateau Vestavia, alleging everything from negligence to outrageous conduct. They felt there was plenty of evidence to back up those charges. The semen on the nun’s bedsheets was enough to suggest sexual contact, and Morissette, because of her dementia, could not legally consent to any sexual act. But none of it would see the light of day in a courtroom.”

When Morissette first came to Chateau Vestavia, she had signed the facility’s standard admissions contract. Buried in pages of terms and conditions was what is known as a pre-dispute binding arbitration agreement. By signing it, the elderly nun gave up her Seventh Amendment right to trial by jury and any right to bring a civil suit against Chateau Vestavia or its then parent company, Trinity Lifestyles Management, for any reason and at any time in the future.

More than a million other elderly Americans may have waived away their rights in the same way Morissette did.  More than half the 2.5 million Americans in nursing homes or senior living centers are likely bound by them. Legal advocates who work on behalf of seniors estimate that as many as 90% of large nursing-home chains in the U.S. now include arbitration agreements in their admissions contracts.

With arbitration, there is no courthouse, no judge and no jury. There are no requirements to follow state or federal rules on procedure, and effectively no appeals process. Whatever the arbitrator decides is almost always final.

 In June, the Trump Administration proposed a new rule that would allow nursing homes to require residents to sign arbitration agreements as a condition of admission to a facility: either sign it or find somewhere else to live. With the number of elderly Americans projected to double over the next 30 years, mandatory arbitration clauses in nursing homes will likely affect millions of people. Which means some may find themselves in the same private system of dispute resolution that Morissette and her family fell into.

“This is blatantly a sellout to the big CEOs and the Wall Street guys,” says Kenneth Connor, a self-described conservative and a South Carolina trial attorney.

As for Sister Irene’s case, Reed Bates, one of Chateau Vestavia’s lawyers, argued ridiculous theories to defend the failures of the nursing home.  He argued that Sister Irene was lying and had not bee raped.  Bates then argued that the traumatic vaginal abrasions were caused by Sister Irene’s masturbation.  Bates then offered speculation that the semen stains on the nun’s bedsheets got there while being laundered or handled by staff.  Ridiculous.

The arbitrator sided with the facility claiming Chateau Vestavia was not accountable. Neither the assisted-living facility nor Trinity Lifestyles Management would be required to compensate Sister Irene nor issue an apology.  And with that, the case was closed.

As a final indignity, Morissette’s family was handed a bill for roughly $3,000 to cover the cost of renting the Marriott room where the arbitration had taken place.

Fox 8 reported that police are investigating a suspicious death at Concord Care and Rehabilitation Center in Ohio after a confrontation between two nursing home residents.  Police Detective Joe Rotuno said Richard Cain, 65, was found unresponsive in his room at Concord  around 7 p.m. Thursday.  Rotuno said Cain’s roommate, who is 63 and usually in a wheelchair, told staff Cain was lying on the ground, and he believed he was dead. Staff then found Cain clutching a chunk of his roommate’s hair and called police, according to investigators.

The roommate told officers that the pair had argued over whether to close the room door when Cain began choking the roommate, according to Rotuno. He said the roommate reported he then punched Cain in the stomach, causing him to fall backward and hit his head.

Rotuno said both roommates suffered from mental health and other issues, and that staff reported the roommate had a history of anger issues. He said they had gotten into arguments in recent weeks.  “We’ve heard there’s been a lot of verbal altercations between the two,” Rotuno said. “Our suspect does have a history of being what we would call ‘angry’ at the facility, having issues with other residents, having issues with other staff.”

“If his roommate had to defend himself, I don’t blame him at all. I blame the nursing home and staff for not paying attention,” said Bonnie Cain. “They’ve been in several verbal confrontations weeks prior and nobody’s done anything about it. Why couldn’t you separate them?”

She said she wants justice and more training for nursing home staff.

“Every time I close my eyes I see my dad, and it’s just so heartbreaking,” Cain said. “Why couldn’t something be done? Maybe my daddy would still be with me today.”

 

 

WFAA had a troubling investigative report on the care provided at nursing homes in Texas.  Part One is here.  Part Two investigates the nursing home industry hiring criminals to care for our loved ones.  A six-month WFAA investigation found 200 aides certified to work in North Texas nursing homes have serious or violent criminal histories.

The most troubling part is that current regulations in Texas allow many certified nurse aides (CNAs) with criminal histories to work in nursing homes legally.  The WFAA investigation found CNAs who have been “convicted of crimes that should make them ineligible to work, yet slipped through the regulatory cracks — and continue to remain state certified and employable.”

The WFAA review found CNAs with arrests for crimes that include the following: aggravated assault with a deadly weapon; continuous violence against family; injury to a child; abandoning a child; aggravated robbery; aggravated sexual contact with a child; and burglary.

There are three major oversight flaws, according to the WFAA findings.

Loophole 1: Inadequate initial background checks

The first involves the initial certification.

The state requires DPS to conduct a criminal background check prior to an applicant being certified. That’s different from Texas requirements in other industries, for example, like child daycare in which a national background check using fingerprints is required.

The WFAA review found the DPS checks apparently fail to uncover various state convictions. That’s resulted in nurse aide applicants getting certified, though they should be barred for life.

Loophole 2: No background check on re-certification

A second flaw appears in the re-certification process. The state requires a nurse aide to get re-certified every two years, yet does not require regulators to re-check a CNA’s criminal background.  Instead, any further background checks fall to the nursing homes.

WFAA found individuals who commit crimes that should bar them from work – and have their certification pulled – yet remain certified and employable.

Loophole 3: Deferred adjudication probation

The third and most common loophole WFAA found is buried in the state’s regulations. It says if you commit a serious or violent crime, you are eligible to become a CNA as long as you don’t have a “final conviction.”  WFAA found dozens of nurse aides who pleaded guilty to violent crimes. But since they got probation, the law allows the nursing homes to keep hiring them.

That means a nurse aide can commit a serious or violent crime, gain deferred adjudication, and successfully fulfill the terms of their probation, to avoid a “final conviction.” The individual, though often pleading guilty to a serious or violent crime to gain probation, remains eligible to be a CNA.

This can be very dangerous to any resident but especially those with dementia.  At minimum wage, a nurse aide must clean, bathe and feed as many as 30 residents at a time. That’s compounded by Texas’ lack of minimum staffing level requirements.

They have dementia, Alzheimer’s, symptoms that cause them to have a lack of communication,” said Ernest Tosh, an attorney who handles nursing home abuse cases across the United States.

They can’t express exactly what happened, which is why violent offenders should be screened out from working in these facilities,” Tosh said. “They can physically or sexually assault an individual and there be no repercussions because that individual can’t identify them or communicate what happened.”

I think our state needs to recognize that nursing homes are not as poor as they claim to be,” said J.T. Borah, an attorney who specializes in nursing home abuse and neglect. “If the industry were to finance and staff at the level they were supposed to, they could afford better employees. They could have better applicants.”

 

The Age published an article on recent deaths caused by untreated flu.  The fatal flu outbreak at St John’s Village nursing home caused the death of 10 residents and two others from respiratory illness.  The government investigation blames serious management failures–it took days after infections began in August for management to report the outbreak.  By the time they did, 16 residents and eight staff were already sick.

In response, the St John’s Village nursing home accepted the resignation of its own former acting care services manager and referred him to his professional body for potential sanction.

Politico reported that many insurers in the Affordable Care Act market are on pace to record profits this year for the first time, according to a POLITICO analysis of 31 regional Blue Cross Blue Shield plans, many of which dominate markets in their states.  The POLITICO analysis shows that insurers, on average, spent 78 percent of premium revenues on customers’ medical claims through the first nine months of this year.

“The political narrative is over a market in crisis, and that’s just not how the market actually looks right now,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, a nonpartisan research group. “At this moment, the individual insurance market looks quite stable and most insurers have achieved profitability.”

However, Trump’s reckless decision to cut off subsidy payments that insurers rely on to reduce the costs for low-income customers means plans will take a more than $1 billion financial hit, according to the National Association of Insurance Commissioners.

The Department of Justice announced four San Diego-area nursing homes owned by Los Angeles-based Brius Management Co. have agreed to pay at least $6.9 million to resolve allegations that their employees paid kickbacks for patient referrals and submitted fraudulent bills to government health care programs. The four nursing homes involved in the settlement are: Point Loma Convalescent Hospital, Brighton Place – San Diego, Brighton Place – Spring Valley, and Amaya Springs Health Care Center in Spring Valley.  The settlement resolves an investigation into allegations that their employees paid kickbacks to discharge planners at Scripps Mercy Hospital San Diego to induce patient referrals to the nursing homes in violation of the federal Anti-Kickback Statute.

“Kickbacks for patient referrals are illegal under federal law because of the corrupting influence on our nation’s healthcare system,” said Acting United States Attorney Sandra R. Brown. “This settlement demonstrates our resolve to combat fraud that compromises the care provided to patients served by a government healthcare plan. This case further shows the power of whistleblowers to shine a light on corrupt activities and obtain significant recoveries on behalf of United States taxpayers.”

The investigation examined additional allegations made in a “whistleblower” lawsuit that the nursing homes submitted false claims to Medicare and Medi-Cal for services provided to patients referred from Scripps Mercy Hospital. Bills submitted for patients referred as a result of illegal kickbacks would constitute fraud against the United States and the State of California.

The settlement resolves a lawsuit brought by a former employee of one of the nursing homes under the qui tam – or whistleblower – provisions of the federal and state False Claims Acts, which allow private citizens to file lawsuits on behalf of the United States and California and share in any recovery. The whistleblower, Viki Bell-Manako, will receive 20 percent of each settlement payment. Pursuant to the settlement, United States District Judge John F. Walter today dismissed the lawsuit, United States of America, State of California ex rel. Bell-Manako v. Brius Management Co., et al., CV11-2036-JFW.

Nursing home employees conspired to pay kickbacks allegedly without the knowledge of Brius Management Co. The nursing homes admitted that their employees used corporate credit cards to pay for gift cards, massages, tickets to sporting events, and a cruise on the Inspiration Hornblower that were given to planners at Scripps Mercy Hospital as kickbacks.

“Skilled nursing facilities that pay kickbacks in order to boost profits will be held accountable for their improper conduct,” said Christian J. Schrank, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General. “We will continue to crack down on kickback arrangements, which can corrupt medical decision-making and undermine the public’s trust in the health care system.”

 

 

The Buzz had a peculiar story about Rick Scott’s attempt to hide and cover-up the neglect and abuse in Florida’s nursing homes.  Recently, with no announcement or notice, AHCA wiped its website clean of all nursing home inspections, shielding the industry to the detriment of consumers.

For many years, Florida’s Agency for Health Care Administration’s website included links to inspections of nursing homes, retirement homes and hospitals. They were available with a few keystrokes with very few redactions. The agency then began to heavily redact the reports — eliminating words such as “room” and “CPR” and “bruises” and “pain” — and rendering the inspections difficult to interpret for families trying to gauge whether a facility is suitable for a loved one.  AHCA says the redactions were necessary to protect medical privacy, though patients were identified only by number.

In the past year, the state spent $22,000 for redaction software that automatically blacks out words the agency says must be shielded from the public. Those same words were available on a federal website unredacted. Elder and open-government advocates said the newly censored detail did more to protect the homes than patients.

 

 

 

The Clarion Ledger reported the settlement between the Department of Justice and a Georgia nursing home and its management company for “grossly substandard care”.  Hyperion Foundation, the owner, and AltaCare Corp., the management company, agreed to pay $1.25 million to resolve allegations of Medicare and Medicaid fraud for failing to provide care at Oxford Health and Rehabilitation nursing home.

The poor quality and lack of staff caused serious health issues including pressure ulcers, dehydration, malnutrition, and falls according to the government investigation.  I hope the DOJ continues to investigate the adequacy of the services provided to nursing home residents to increase quality and to rid the industry of the waste, fraud, and abuse that is so common.

 

 

 

CBS12 Investigates uncovered reports of true horror stories happening at nursing homes across the country that should have been reported to law enforcement.  These cases include life threatening falls, starvation, even sexual assaults that were not reported.

 “We found that CMS, the Centers for Medicare and Medicaid Services didn’t have adequate controls in place to detect these potential instances of abuse or neglect,” said Curtis Roy, Assistant Regional Inspector General for Audit Services, OIG.

“CMS acknowledged that that they are not doing the data match to identify cases of neglect,” added Roy. “They also acknowledged that they have not identified any instances of nursing home staff not reporting cases as required.”

The audit found 38 cases that were so bad, by law the nursing homes were required to contact local law enforcement. But, they didn’t do it.

CMS must initiate protocols to adhere to a long-standing federal statute that requires nursing homes to report abuse cases to police and other state agencies immediately or risk fines of up to $300,000.

“They don’t care about those fines,” explained attorney Joe Landy. “It is business as usual. It is cheaper to pay those fines to keep these facilities understaffed with people that are not properly trained while they make record setting profits.  “It exposed what is a long-standing problem in Florida,” said Landy. “It exposed a nursing home that was making a huge amount of money with no accountability whatsoever.”