Monthly Archives: June 2018

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PennLive is taking a hard look at nursing homes that were formerly operated by Golden Living.  The Texas-based chain-long battered by lawsuits and accusations of poor care (and rightly so!)- sold all 35 of its Pennsylvania homes between 2016 and 2017.

However, there are signs that problems remain in many of those homes.

If you or your loved one has any experience with these facilities – whether good or bad – please take a moment to fill out the form for PennLive on the link above, making sure to include accurate contact information. PennLive states that No information that you provide will be published without your permission.

If you’re unsure whether you or your loved one is in a former Golden Living nursing home, take a quick look at the list on the link above.

If you prefer, you can also reach PennLive reporter Daniel Simmons-Ritchie at simmons-ritchie@pennlive.com or at 717-255-8162.

McKnight’s had an article about FDA concerns over the use of Nuedexta as a chemical restraint.  Nuedexta is the only drug approved to treat uncontrolled laughing and crying due to pseudobulbar affect.  However, some nursing homes are using it for residents without pseudobulbar affect.   It’s a rare condition yet the U.S. government is cautioning private insurers to look for suspicious off-label use there because officials fear the drug is being misused to control behavior.

A CNN investigation published in October found Nuedexta’s maker had been “aggressively targeting frail and elderly nursing home residents for whom the drug may be unnecessary or even unsafe.”   CNN unearthed what seems to be a concentrated effort to keep the increasingly controversial drug in nursing home’s formularies.  The station obtained complaints sent to the Food and Drug Administration from insurers and nursing home physicians who questioned the maker’s marketing and advertising tactics.

In a follow-up article published Monday, the news organization said the Centers for Medicare & Medicaid Services issued a March memo asking Medicare Part D providers to monitor prescriptions for appropriate use.

The CMS memo told plan sponsors that Nuedexta is only approved to treat pseudobulbar affect, and that they are legally required to ensure the drug is only covered for medically-accepted prescriptions. Neudexta’s maker, Avanir Pharmaceuticals, has said that dementia patients may suffer from PBA.  No medical research supports that contention.  Since the drug launched in 2011, CNN reports Avanir has generated millions of dollars in annual sales in nursing homes.

McKnight’s had an interesting article regarding the arrests of operator-owner Joseph Zupnik and Daniel Herman, a top-level manager.  The men ran Focus Ostego, which was operated by CCRN, which was owned almost entirely by Zupnik, according to The Daily Star.  They were arraigned May 31 on three counts of first-degree endangering the welfare of an incompetent or physically disabled person, a felony; two counts of second-degree endangering the welfare of an incompetent or physically disabled person, a class A misdemeanor; and three counts of willful violation of health laws, an unclassified misdemeanor.

In 2014, the Ostego County nursing home had 298 employees. By 2016 — under new, private ownership — that number was down to 225, despite immediate jeopardy findings and plenty of other regulatory and staff warnings about quality of care.  Short-staffing always affects the quality of care.

“Upon taking ownership and control of the home’s operation in October 2014, Zupnik, Herman and CCRN cut staff payroll, cut staffing and cut other necessary services and supplies needed to provide safe and adequate care to more than 200 individual residents who were in the care of Focus through at least November 29, 2016, when Focus was designated as a Special Focus Facility by the Centers for Medicare & Medicaid Services,” read the state’s complaint.

The Attorney General’s office said CCRN disregarded communications from local and federal officials and senior staff “that residents were at risk for harm.”   Those missed opportunities for improvement included:

  • State health inspection surveys and reports that contained immediate jeopardy findings in 2015 and 2016.
  • Warnings from senior managers about the defendants’ 50% cuts in payroll and staffing and required double shifts.
  • Six arrests between May 2015 and August 2016 of Focus staff for crimes at the facility involving healthcare offenses. These included neglect of a 91-year-old fall victim and a 94-year-old woman who developed a pressure sore after 41 hours in a recliner.

Otsego County owned and operated the nursing home in question before selling it to Focus for $18.5 million. Focus has since been resold to Centers Health Care, which renamed it Cooperstown Center for Rehabilitation and Nursing.

McKnight’s had another great article on the ongoing use of anti-psychotics in nursing homes.  Approximately 20% of nursing home residents — more than 250,000 nationwide — are still receiving antipsychotic drugs as part of their long-term care treatment despite the well known dangers of off-label use of these medications.  The Long-Term Care Community Coalition claims only 2% of the population will ever have a diagnosis for a condition which the government uses when it risk-adjusts for potentially appropriate use.

Despite concerted industry and government efforts to phase out the use of certain drugs, nursing homes are still placing residents at risk of known dangerous side effects. The use of antipsychotics has been watched closely since at least 1987, when a sweeping new nursing home reform law prohibited inappropriate drugging and the use of chemical restraints. In 2005, the Food and Drug Administration issued a “Black-Box Warning” on serious risks of atypical antipsychotic drugs for elderly patients with dementia.  Several patient advocacy organizations have continued to criticize their prevalence in long-term care.

“Too many residents and families are not even made aware of the dangerous potential side-effects of these drugs, or the fact that they are not clinically indicated for so-called dementia ‘behaviors,’” said Richard Mollot, executive director of LTCCC. The New York State based coalition of consumer, community, civic and professional organizations says its goals including raising quality and accountability of care.

The analysis, based on first-quarter information for 2018, provides usage rates for “every” U.S. nursing home and provides state breakdowns.

In February, Human Rights Watch issued “‘They Want Docile’: How Nursing Homes in the United States Overmedicate People with Dementia,” a scathing report that estimated 179,000 U.S. nursing home residents are given antipsychotics without an appropriate diagnosis each week.

At the time, providers and a national association representing them said the report ignored the improvements made in nursing homes since the Centers for Medicare & Medicaid Services set a 15% reduction target in 2012.

In March, AHCA announced its latest round of quality initiatives would push providers nationwide to reduce their off-label use of antipsychotics by another 10%.

CMS has also linked financial outcomes to quality improvements and prescription management.

McKnight’s reported that a judge has ordered the appointment of a special prosecutor to investigate an $80,000 wire transfer from a nursing home owner to a former state senator’s construction company — money that allegedly moved just days after the lawmaker introduced an amendment to limit negligence claims in Arkansas.

Sebastian County Prosecutor Dan Shue asked for an outside investigator to avoid any potential conflict of interest. The Times-Record also reported that Shue has asked the local U.S. Attorney to determine whether the wire transfer violated any federal law.

Jake Files (R), the one-time Fort Smith lawmaker at the center of the case, pleaded guilty in January to unrelated charges and is scheduled to be sentenced June 18. He faces counts of wire fraud, bank fraud and money laundering in relation to improper use of state improvement funds intended for a local sports complex.

The Times Record first discovered the 2014 nursing-home related transfer in civil court documents last year.

The money came from David Norsworthy, part owner in a dozen Arkansas nursing homes. It followed on the heels of a constitutional amendment that sought to limit damage lawsuits — like negligence claims commonly pursued against nursing homes — to $500,000.

That amendment failed then, but it found new life in the current session, before Files resigned in January.

Neither Files nor Norsworthy have explained the $80,000 transfer with media or in court.

The Arkansas Times reports the case has become an issue for those who support  limiting lawsuits through Issue 1, a bill that has been publicly backed by nursing homes, doctors and chambers of commerce.

Fox25Boston reported a tragic incident that occurred at a Rhode Island nursing home.  Frank Palin, age 67, was arrested for sexually assaulting a patient with dementia in a nursing home. Palin is charged with a single count of indecent assault and battery on a person over age 65, stemming from an incident through his work with Old Colony Hospice.

According to the police report, on May 19th, Palin showed up to Cornerstone without an appointment, asking and employee to unlock the secured facility where the victim stays.  According to authorities, the woman’s children had installed a video camera inside her room, so they could check in on her, which helped them find out what was happening.

Palin is a contract employee with Old Colony but was working as a nurse practitioner at Cornerstone at Canton, where the victim is a resident of the facility. She reportedly suffers from dementia and lives in the memory care unit at Cornerstone.

Bob Larkin, the president of Senior Living Residences, the management company in charge of operations at Old Colony Hospice and Cornerstone at Canton, issued the following statement on Friday afternoon:

“The alleged violation of a vulnerable elder is appalling beyond words. We support the victim’s family and the police department in seeking criminal prosecution to the fullest extent of the law. Nothing is more important to us than the safety and well being of our residents. The accused nurse practitioner was not an employee of our company; he worked for a third-party local hospice agency that has no contractual or other relationship to our assisted living community. Any questions about the individual’s employment or exact duties should be directed to his employer, Old Colony Hospice in West Bridgewater, 321 Manley St, West Bridgewater, MA,  781-341-4145. Also please call the Canton Police for any information about the ongoing investigation. Please note, HIPAA patient privacy and confidentiality standards preclude me from providing specific information about any resident. “

Western Slope Now had an interesting article on a new treatment at the Palisade Life Center.  The nursing home is taking Alzheimer’s and Dementia treatments line by line and stanza by stanza.  They’re using poetry to exercise the minds and creativity of the patients in their care.  The group meets once a week to create poems, reaching back into their memories and emotions in a way to express themselves and communicate.

“You can really just see it in their eyes when things are clikcing and coming together,” Caleb Ferganchick, the life engagement coordinator at the center, said, “it allows them the space to share their memories in a structure way to engage and structure conversation that they otherwise wouldn’t be able to do themselves.”

“Actually stimulating the brain,” Jennifer Sims, the specialty programs director for Sava Senior Care, the parent company for the facility in Palisade, said, “Our brain is no different than a muscle in that sense that  if we use it, it’s going to slow the progress of the disease.”

The poems have been created into a book for a self-published collection.

“We took all of the poems we created and we created kind of an anthology called “My Father is in the Arbor” Ferganchick, who started the poem program, said. “It’s named after one of the poems in the book that I really liked.”

The book is for sale online at http://www.blurb.com/b/8750722-my-father-is-in-the-arbor

The profits benefit the residents in the Alzheimer’s and Dementia facility at the Palisade Life Center.

Politico had an article about Trump’s continued attempts to sabotage Obamacare.  The Trump administration asked a U.S. District Court in Texas to strike the most popular part of Obamacare.  “Republicans who have tried to repeal Obamacare for nearly a decade believe the Trump administration is reviving a politically risky battle with a court filing that could eliminate one of the most popular parts of the law: protections for people with pre-existing conditions.”  The Trump administration wants a federal court to strike the protections despite their popularity and the needed protection against insurance companies unfair practices.

Few congressional Republicans agree with the Trump administration and none rushed to defend the administration’s move, instead emphasizing their support for preserving pre-existing condition protections.  “I’m not going to have to defend anything I don’t agree with — regardless of who says it,” said Rep. Phil Roe of Tennessee when asked if he would defend the administration’s request on the campaign trail this fall.

Sen. Susan Collins of Maine — one of three GOP senators who blocked the Obamacare repeal effort last year — also pushed back, warning the administration’s new bid “exacerbates our current challenges” and could undermine key patient protections.

In 2017, “I introduced [an amendment that] would guarantee coverage for pre-existing conditions. I think that’s a pretty essential pact with the American people,” said Rep. Tom MacArthur (R-N.J.). “We need to let them go forward and see if it goes anywhere. Right now they’ve simply made an appeal to the court.”

The insurance industry has already blamed the Trump administration of increased premiums because of decisions to undermine the health law, such as cutting off a key subsidy program to help low-income people pay their out-of-pocket health expenses.

“The insurance industry trade group America’s Health Insurance Plans swiftly broke with the Trump administration Friday, warning that eliminating Obamacare’s major protections would be “destabilizing” to the market and drive premiums even higher. AHIP signaled it will file an amicus brief in the case, officially siding with the blue states that have stepped in to defend the law’s constitutionality.”

“Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” the group said in a statement.

Naples News had a great article on a growing and disturbing trend in nursing home ownership–a large corporation made up of a network of related businesses operating nursing homes at a profit for their investors.  This type of ownership structure allows the parent corporation to profit from the lack of funding that causes injuries and avoid accountability.  It is a scam meant to siphon as much of taxpayer resources as legally allowed.  It is morally repugnant.  See the investigative report Naples News did on Consultate Health Care.  At the crux of the story: how Consulate — and most other large nursing home operators — allegedly use a network of related businesses to shift assets and make a profit for their owners and investors.

The article discusses Consulate Health Care which operates as the nation’s sixth-largest nursing home provider. Consulate reported operating revenues of $1.7 billion in 2016, according to the American Health Care Association.  Taxpayer money flows to Consulate nursing homes and profits earned go to the chain’s owner, the Atlanta-based private equity firm Formation Capital.  Related (meaning common ownership and/or common control) real estate, management, rehabilitation and other companies receive payments from Consulate’s nursing homes.

“Everybody knows what’s going on. Everybody knows about this shell game,” said Brian Lee, former head of Florida’s Long-Term Care Ombudsman Program in the Department of Elder Affairs, now heading the nonprofit Families for Better Care.

Despite the big money generated from Medicare and Medicaid programs, Consulate’s nursing homes are intentionally designed to appear cash-strapped. While individual nursing home LLCs are essentially empty shells, they pay rent, management and rehabilitation service fees to Consulate or Formation Capital-affiliated companies.

The convoluted corporate structure is designed to make it difficult for lawyers to recover damages, said Dale Ewart, assistant regional director of the 1199 SEIU health care workers union in Miami.

“It’s also baffling, I think, to disguise the real profitability of the nursing home industry,” he said.

 North Carolina has substantiated claims that a nursing home mistreated a resident after a daughter secretly recorded staff insulting her father.  Knapton said she placed a camera in her father’s room after he told her that staff routinely insulted him. She also suspected she wasn’t being told about all the times her father, who had had a stroke, had fallen out of bed.  The hidden camera Rebecca Knapton placed in her father’s room at Universal Health Care/North Raleigh captured staff belittling him after he had fallen out of bed and was calling for help.

ichard Johnson, 68, is recovering from a stroke, and video from the hidden camera shows that he fell out of his bed early on April 10. It took more than an hour for staff to respond, and they berated him when they did.

“Man, you stink,” one worker told Richard Johnson as he lay on the floor. He told them he fell trying to get to the bathroom.  One worker told the 68-year-old that he shouldn’t complain about lying on the cold floor.

“You were on the bed, you decided to go on the floor, so that’s your fault,” one worker said. “You decided to go on the floor, so don’t complain that it’s cold.”

“How old are you? You’re supposed to be enjoying your retirement. Instead, look what you are doing, pooping on yourself. Shame on you,” a staff member says.

At one point a worker told him that his suffering was his own fault. “You must have done something really, really bad,” she said.

Knapton said her father told her, “they talked down to him, they treat him mean, they call him names, they fuss all the time.”

A state investigation triggered by Knapton’s complaint pointed out problems with the care of other patients.

According to documents Knapton received, surveyors for the state Division of Health Service Regulation interviewed staff and residents and reviewed document at the nursing home from April 10-15.

One patient complained of chest pain for two days, but there was no indication that he received nitroglycerin as the doctor ordered, according to the state report. The man was sent to the hospital on the second day. Hospital records show a nurse saw him at 1:30 p.m. in the emergency room, and that he died about four hours later. However, a nurse’s record at the nursing home had the man leaving for the hospital at 7 p.m.

The N.C. Department of Health and Human Services said that the Centers for Medicare & Medicaid Services will initiate enforcement action and notify the facility.

Steven Bryant recorded a recent visit he made to Universal Healthcare of Lillington to see his 82-year-old mother. Sudie Bryant had complained of the care she had been receiving, he said, so he wanted to document what happened while he was there.  Sudie had been lying in a puddle of urine for so long that it had turned brown.

“Sir, I’ll be honest with you. We’ve been doing our best,” an aide said. “It’s just two [aides] in this hall, and honestly, we’re doing the best we can.”

As one aide leaves to get an administrator, the other explains staff cutbacks are the problem.

“I am glad that you are here to see it because we tell them time and time again that it’s too much, too much,” she said. “They don’t listen to us. We need the families to complain. We need families to see how it really is.”

Choice Health Management Services has 16 facilities in North Carolina, most operated under the Universal Healthcare brand. Medicare has levied fines totaling $567,976 for problems at six of the facilities since 2015.

Universal Healthcare Fuquay-Varina topped the list, with $234,260 in fines, followed by Universal Healthcare Lillington, with fines of $151,483. Universal Healthcare North Raleigh was fined $31,186 two years ago, the smallest fine against any of the six facilities.

The Raleigh facility has a history of repeat federal violations for insufficient staffing and failing to answer patients’ call bells in a timely manner.

The fines assessed against the three Universal Healthcare facilities in the Triangle combined to top the $246,000 in fines Medicare levied against 22 other nursing homes within a 25-mile radius of Raleigh in the past three years.

The incident at Universal Healthcare Lillington, where a man recently recorded a video showing improper care for his mother, involved a patient infested with maggots.

A doctor from an outside clinic found “maggots living in a wound on the resident’s foot” when he removed the patient’s shoes, according to a report. An aide at Universal Healthcare told investigators she discovered the maggots the previous day and went “screaming out of the room” without taking further action.

Universal Healthcare of Fuquay-Varina was fined after a resident at risk for wandering walked out the front door and across the parking lot. Inspectors checked all of the bracelets worn by at-risk patients to alert staff if they were about to wander off and found that none of them worked, according to a report.

“That’s ridiculous,” Powell said when he heard about the issues at Universal Healthcare facilities. “I am at a loss for words. I got to find a place to move my mom.”

See more information at WRAL, The News & Observer, and WFMY.