McKnight’s had an article about the new in-depth analysis published by the Henry J. Kaiser Family Foundation.  According to the data, occupancy rates at nursing homes fell between 2009 and 2016, however, the needs of nursing home residents have grown considerably — placing more demands on unprepared and under-staffed nursing employees.  Average total nursing hours increased to 4.1 per resident day for 2016, up from 3.9 in 2009.

In 2016, nearly half of nursing home residents had a dementia diagnosis, and just under one-third had other psychiatric conditions such as schizophrenia, mood disorders or other diagnoses. In addition, the report found nearly two-thirds of residents received psychoactive medications, including anti-depressants, anti-anxiety drugs, sedatives, hypnotics and antipsychotics.

Over the past 25 years, numerous research studies have documented a significant relationship between higher nurse staffing levels, particularly RN staffing, and the better outcomes of care,” wrote lead researcher and staffing expert Charlene Harrington, RN, Ph.D., FAAN, professor emeritus at the University of California-San Francisco School of Nursing. “Nursing assistants who provide most of the care to these individuals often have limited training in working with this [behavioral health] population. … Regulations could implement ACA requirements to improve the quality of care for residents with cognitive impairments and further restrict the use of psychotropic agents.”

The report is based on the federal Online Survey, Certification, and Reporting system (OSCAR) and Certification and Survey Provider Enhanced Reports (CASPER) system and also examines staffing levels, payment, and compliance.  The most common deficiencies in 2016 were given for failures in infection control, accident environment, food sanitation, quality of care, and pharmacy consultation.

“In 2016, more than one in five facilities received a deficiency for actual harm or jeopardy,” Harrington wrote. “As with other outcomes, there was wide variation across states in these outcomes; however, some states had high rates across all top ten deficiencies.”

Other key findings of the report include:

  • Between 2009 and 2013, the average number of deficiencies per facility declined from 9.33 to 7.28, though there was a slight increase between 2013 and 2016.
  • The proportion of for-profit facilities increased from 67% in 2009 to 69% in 2016.
  • Medicaid is the primary payer source for most certified nursing facility residents, with 62% of residents — about 832,000 people — having Medicaid as their primary payer in 2016. States in the East have higher Medicaid population shares.

The Anderson Independent Mail had an article about Orianna’s bankruptcy due to corporate mismanagement and how that affects pending lawsuits and victims.  Lawsuits incuding thos einvolving wrongful death of residents at Orianna’s nursing homes have been halted since the company’s bankruptcy filing last month in Texas.  Lawyers handling pending suits against Orianna have hired bankruptcy attorneys in Texas as part of an effort to have their clients heard in the company’s bankruptcy proceedings. Victims of abuse and neglect are classified as unsecured creditors, and may not be able to get any compensation for their injuries and wrongful death.

Orianna, which is the Upstate’s top nursing home operator, currently runs 42 nursing homes with more than 4,000 beds in seven states. It has about 5,000 employees.

The company intends to sell its Upstate nursing homes and several other facilities throughout South Carolina and Georgia under terms of a restructuring agreement with its landlord, Omega Healthcare Investors Inc. Plans call for Orianna’s 23 other nursing homes to be transferred to a new operator.

However, the U.S. government has objected to a plan by the bankrupt operator of the Orianna Health Systems nursing home chain to protect companies that would acquire facilities through its restructuring from successor liability. The nursing home operator, 4 West Holding Inc, has facilities in seven states. It is seeking a court order that would allow the transfer of assets free of any liability, which the government said is not allowed by Medicare provider agreements.

Besides seeking to halt all litigation in pending cases as a result of its bankruptcy filing, the company has stopped making payments related to some previously settled suits.

Freelance Contribution by Jessica Walter

 

Medicaid is the poor man’s insurance in the US and if Medicaid cuts will be implemented, seniors are part of vulnerable groups that will be hit the hardest. South Carolina has been identified as the state that will experience tough times. The recent Kaiser Analysis revealed that the state, along with 10 others will be in trouble should a $834 funding be slashed in the next decade. Most of the resources of Medicaid is spent on elderly care and people with disabilities.  At present, seniors 65 years and above comprise 16.7% of the state’s population.

 

Over 50 Million Americans Rely on Medicaid

 

Millions of Americans rely on Medicaid as an accessible form of health insurance. It covers low-income groups as well as vulnerable groups such as handicapped people, the elderly, children and pregnant women. Funded jointly by the federal states and the government, the Federal Medical Assistance Percentage differs from state to state according to factors such as income levels. Its eligibility is determined by using the supplemental security income (SSI) for individuals 65 years and older, or who have a disability or blindness. Nearly 1 in 5 Americans are covered by Medicaid. It covers 2/3 of the nation’s nursing homes. As such, it is the biggest expense to Medicaid.

 

Dental coverage can be included in Medicaid but each state is governed by different rules.  15 states will cover dental insurance when it is an emergency dental service and necessary dental procedures. It is up to the state to determine what is necessary and an emergency.  Dental benefits for SC residents were available on December 1, 2014 to pay for cleaning, fillings and extractions with a $750 per annum cap and $3.4 co-pay. This move benefited seniors with disabilities or who are on low incomes.

 

Impact of Repealing the Affordable Care Act

 

President Trump and Congress are trying to scrap the Affordable Care Act. After the elections, efforts were directed at cutting funding to Medicaid by a fifth. The Trump administration also mandated states to impose work requirements as a condition for eligibility to receive Medicaid assistance. The Center for Medicare & Medicaid Services (CMS) has already approved work requirements in Indiana and Kentucky and 8 states are going to follow. Proponents of the work requirements as conditions for Medicaid assistance say that this move will only target those who are not working, actively seeking work or unable to work because of an illness/disability. With work requirements, access to healthcare by low-income families and disadvantaged groups is reduced.

 

Medicaid cuts to South Carolina will affect its beneficiaries including seniors since it has the fourth highest federal match rate. That means for every $1 the state spends, the federal government gives $2.5. Budget cuts will affect everyone because there is no money to spare. It will limit access to healthcare and reduce further the number of people who can see doctors. The elderly will find it difficult to maintain mental, physical and emotional health. Overall wellbeing will diminish.

Managing the health care systems properly is important to provide access to services for the poor and senior groups. Without Medicaid, there are very little options available for mature adults especially those who need long term care or for those with no families to take care of them. Even towards the end of life, this means that the elderly are denied a dignified life without medical and health care.

Many people suffer in nursing homes either from abuse or neglect. Nationally, more than 1 in 5 Medicare recipients do, according to a 2014 study from the federal Department of Health and Human Services. Almost 60 percent of those abuse or neglect cases could have been prevented. The harm came from “substandard treatment, inadequate resident monitoring, and failure or delay of necessary care,” according to the study.

Under a measure advancing in the Louisiana statehouse, families would be able to install video cameras in loved ones’ nursing home rooms.  Under the legislation, nursing homes would be prohibited from denying entrance or retaliating against residents who opt for monitoring devices.  The cameras would be voluntary. Costs would have to be paid by the nursing home patient or family member. Any roommate would have to agree to the installation.

Rep. Helena Moreno (D-New Orleans) said her proposal would offer peace of mind to family members monitoring a parent or grandparent while also ensuring residents’ safety.  “What’s wrong with just having an extra set of eyes, with having a loved one being able to check up on you?” Moreno said.

Missouri is also considering allowing video cameras in nursing home rooms.  See article here.  Two bills have been introduced in the Missouri House this year allowing cameras in nursing home rooms, which advocates say could help prevent elder abuse. One would give families the ability to install cameras and mandate that nursing homes couldn’t prevent the installation. The other, which has already been handed over to the Senate, would give nursing homes the final say.

AARP, the Missouri Coalition for Quality Care and VOYCE, a St. Louis-based organization that sends volunteers to inspect nursing homes, supported the version giving families more power. That version received a public hearing last week but, so far, isn’t scheduled to be debated on the floor. Less than two months remain in the legislative session.

In-room cameras would go a long way toward giving residents and their family members a greater sense of security and could deter potential abuse or neglect, said Mary Lynn Faunda Donovan, VOYCE’s executive director.

“Surveillance cameras are not a suitable replacement for the personal involvement of the staff and family members,” she said. However, “video can provide compelling evidence” of abuse or neglect.  “A camera in the room could exonerate a staff member from any accusations of wrongdoing,” she said. “It works for both sides.”

As of 2017, five other states had nursing home camera laws, with additional rules for assisted living in two.  Andrew Muhl, advocacy director for AARP Louisiana, called it “a very common-sense approach.”

WFAA reported on the investigation into over-medication at Duncanville Healthcare and Rehabilitation Center.  Parkland Hospital investigators are conducting a review for possible over-drugging of patients in an alleged practice known as taking patients “to China.”  The reviews follow the WFAA series, “Drugged and Dying,” that investigated the unnecessary use of alleged powerful antipsychotic drugs to sedate or control patients.

In an effort to cut costs on staffing, many nursing homes drug the elderly rather than hire needed staff, patient advocates warn. They have dubbed the practice “chemical restraints.”  WFAA found in its “Drugged and Dying” series that about 70 percent of a typical nursing home expense goes to staffing.

Several witnesses have come forward stating that residents at Duncanville Healthcare and Rehabilitation were being sedated unnecessarily and inappropriately.   “They said: ‘Take this lady to China,’” the former employee told WFAA.  “It just can be any medication that will put a person to sleep,” the worker said.  “They took that lady to China, and she went to the hospital,” the worker said. “The lady never did come back from the hospital.”

The former employee claims the patient was given the antipsychotic drugs Risperdal and Seroquel. However, the patient, who had been awake and talkative – after receiving the drugs – was placed in bed and became nonresponsive, and within six hours was picked up in an ambulance – and later died, the worker said.  Advocates say the medications – particularly antipsychotics – may become another form of abuse when inappropriately and unnecessarily given. In fact, antipsychotic drugs may be potentially fatal for elderly patients.

Other patients at the Duncanville facility also may have been unnecessarily medicated, according to several workers.

 

 

 

Kansas is taking over 15 nursing homes with 854 residents across the state because of the owner’s mismanagement and diverting funds away from the facility operations. Now the owners can’t make payroll.  All of the care homes are operated under a variant of the name Care and Rehabilitation Center and are owned by a company called Skyline Health Care. Skyline is based in Wood Ridge, N.J. The company was founded in 2016 and took over a number of nursing homes and assisted living facilities that had been previously operated by Golden Living.

The Kansas Department for Aging and Disability Services is moving to contract with another operator to try to ensure the quality of care doesn’t continue to suffer for residents who live in the facilities.  Mission Health Care, which operates 14 nursing homes in Kansas and four other states, will operate the facilities until a permanent solution is found.

Recently, Nebraska had to take over 21 Skyline-owned facilities when the company informed that state it couldn’t pay its employees.

Advance directives are legally recognized documents that specify care if a person is incapacitated. They can confirm that a patient doesn’t want to be resuscitated or kept on mechanical life support, such as a ventilator or feeding tube, if they have a terminal condition from which they’re not likely to recover.

The National Review had an interesting article discussing an NPR story on “aggressive advance directive” that would force nursing homes to starve dementia patients — even if they are willing and able to eat — when they reach a specified stage of cognitive decline. The directive, finalized by the board for End Of Life Choices New York, aims to provide patients a way to hasten death in late-stage dementia, if they choose.

The document offers two options. One option is a request for “comfort feeding” — providing oral food and water if a patient appears to enjoy or allows it during the final stages of the disease. Another alternative would halt all assisted eating and drinking, even if a patient seems willing to accept it.  The options would be invoked only when a patient is diagnosed with moderate or severe dementia, defined as Stages 6 or 7 of a widely used test known as the Functional Assessment Staging Tool (FAST). At those stages, patients would be unable to feed themselves or make health care decisions.

 

SavaSeniorCare, one of the nation’s largest nursing home providers, has been sued in the United States District for the Northern District of California for multiple wage violations.

SavaSeniorCare owns and operates seven residential care and rehabilitation facilities in locations throughout California and more than 200 facilities throughout the United States. The proposed national class action lawsuit is seeking compensation for unpaid overtime and minimum wages, as well as missed meal and rest periods. The plaintiffs, current and former employees of SavaSeniorCare, have brought this action on behalf of all current and former non-exempt employees nationwide.

According to the complaint, the plaintiffs and other similarly situated employees were denied uninterrupted meal periods and rest breaks, overtime compensation, and other wages in violation of the federal Fair Labor Standards Act (FLSA) and California law. Plaintiffs also allege that SavaSeniorCare deducts 30 minutes of pay for meal breaks that employees do not take. In addition, plaintiffs allege that SavaSeniorCare fails to provide proper, itemized wage statements as required under California labor law.

Attorney Bryan J. McCormack of San Francisco-based employment law firm McCormack & Erlich, and Edward J. Wynne of Wynne Law Firm, are representing the plaintiffs.

According to McCormack, “SavaSeniorCare’s conduct of deducting 30 minutes of pay for meal periods that are not taken and failing to pay its employees overtime compensation for all hours worked over 40 per week is not only unjust, but also illegal under California and federal law.” “What is especially concerning is that the company’s practices have affected its employees nationwide for years. Employers need to be held accountable for failing to pay their employees correctly for all the hours they have worked.”

For more information contact:
SavaLawsuit@mcelawfirm.com

McCormack & Erlich
150 Post Street
Suite 742
San Francisco, CA 94108
Phone: (415) 296-8420

The State reported that a Lexington County jury has found Lexington Medical Center Extended Care guilty of gross negligence in the death of one of its residents.  Jurors compensated the family of Samuel B. Cunningham $450,000, including $200,000 for Cunningham’s pain and suffering, medical and funeral expenses, and $250,000 for the family’s mental shock and suffering, wounded feelings and loss of companionship.

Cunningham was admitted to the facility at 815 Old Cherokee Road in Lexington on April 29, 2013, at age 81. He was suffering from dementia and was legally blind.  The family alleged that Cunningham often was found by his family soaked in urine, unclean and lacking in oral care.  Nursing home records showed Cunningham suffered 26 falls. He was found on the floor 19 times without anyone seeing him fall. On one occasion, he was found on the ground outside the building with multiple ant bites.

“We were heartened by the jury’s verdict and hope that it will provide incentive for the facility to get its act together and start treating its residents with the dignity and care that they deserve.,” Ken Connor, the Cunningham family’s attorney, said in a news release.

The suit alleged improper care; on one occasion, Cunningham fell and required a hip replacement at Lexington Medical Center, which also operates the nursing home.

Cunningham also developed bed sores because of improper care, and was not properly fed. He also developed pneumonia, which was not addressed in a timely fashion by the nursing home.

On July 1, 2015, Cunningham was admitted to Lexington Medical Center suffering from multiple areas of skin breakdown, malnutrition, dehydration and infections, the suit claimed. He was unable to recover from his decline and died two weeks later at Agape Hospice House in Columbia.

The Chicago Tribune reported that a Cook County judge upheld a ruling from last summer, which would award $4.1 million to the family of a deceased 89-year-old woman who suffered a stroke while recuperating from an injury at a Bartlett nursing home.  Cook County Circuit Court Judge Thomas Lyons also ordered Bartlett-based Clare Oaks to pay an additional $1.5 million in attorney fees and awards to the family. Attorneys for the family said the amount is a record total issued under the Illinois Nursing Home Care Act.

In February 2011, Dolores Trendel was transferred to Clare Oaks for physical therapy after fracturing her left hip, according to court records and the family’s attorneys. Trendel’s physicians ordered various medications for Trendel to take, including Coumadin, which thins the blood to prevent clotting and strokes, according to court records.

A jury last summer agreed that the stroke contributed to Trendel’s death. The stroke caused Trendel to lose the ability to walk, talk, and enjoy life in any realistic manner.