Bustle published John Oliver’s excellent investigation into how guardianships may exploit the elderly.  John Oliver’s guardianship segment picked apart the disturbing system that so many senior citizens face, demonstrating how it can strip people of their rights and resources.  Guardianship often comes into play when a senior citizen is showing signs of not being able to care for themselves. At that point, anyone can petition a court to appoint a guardian for this senior citizen. The guardian, depending on the court’s findings, may either be a family member or a private guardian. A private guardian is a professional, usually a stranger, who is paid to manage a ward’s personal affairs.

As Oliver explained, the system is unfortunately fraught with problems, guardians have a significant amount of control over the affairs of their wards and, thus, have access to a myriad of very personal entities, like bank accounts and health records. Moreover, being placed in a guardianship often means that senior citizens are stripped of many of their rights. As Judge Steve King of Tarrant County, Texas explained in a clip played on Oliver’s show, “Guardianship is a massive intrusion into a person’s life. … They lose more rights than someone who goes to prison.”

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As the host explained, private guardians can charge their wards for each service they provide and can withdraw that money directly from wards’ accounts. Moreover, charges are often questionable and exorbitant.  Moreover, Oliver noted that only 12 states require professional guardians to have any type of certification, meaning that, in much of the United States, anyone can become a guardian. As the host noted, the lack of guardianship oversight “is worrying in a system that can be easy to fall into and very difficult to get out of.” As Oliver pointed out, it took one elderly couple that he highlighted on his show over two years to be freed from a guardianship — and, by that time, much of their money had been drained from their account.
The late-night host then played a clip of several older celebrity guests, including Cloris Leachman, Rita Moreno, William Shatner, Lily Tomlin, and Fred Willard, who had collectively recorded an infomercial for the show about the guardianship process, as Time reported. In the clip, the guests advocated for senior citizens talking with their families about plans for their care as they age — and for making sure that anyone who is appointed as their guardian is someone they know and trust.
There is also a great documentary that will provide more information to protect you and your loved ones.  See  http://www.cbc.ca/documentarychannel/m/docs/the-guardians

In 2016, the Labor Department sued Bridgeport Health Care Center and Bridgeport Manor and the nursing home’s chief financial officer, Chaim Stern, alleging they funneled $4 million from the facility’s retirement plan to themselves and a religious organization.  The feds alleged Stern diverted at least $4 million in plan assets to Bridgeport Health, himself, and Em Kol Chai, a New York-based Jewish organization that lists Stern as its president and trustee.

Workers accused Stern of failing to pay them on numerous occasions and failing to pay the company that manages their healthcare benefits. The nursing home filed for bankruptcy April 18 leaving many workers high and dry.  The 240-bed facility has a two-star rating on Nursing Home Compare and had been dinged for a high number of days without registered nurse staffing.

A spokesperson for the U.S. Attorney’s Office confirmed to News12 that “federal law enforcement activity” was taking place at the nursing home, but would not say which federal agencies were involved.  A warrant was served and the FBI, Department of Labor staff and others were on the scene raiding the facility’s administrative offices.

Alex Spanko is the Assistant Editor at Aging Media Network and covers the skilled nursing and reverse mortgage industries for Aging Media.  He wrote an interesting article on Georgia’s new law on background checks for Skilled Nursing News.  The new law will subject the owners and management to the same requirements as direct care caregivers and other employees who provide treatment and services to the  residents. But the threshold for who qualifies as an owner remains unclear.

“Employees, owners, and administrators will be required to undergo fingerprint background checks starting October 1, 2019, according to an analysis of the law from the firm of Arnall Golden Gregory, LLP. That check involves a search of the FBI’s registry, and long-term care stakeholders will also be required to submit to a check of Georgia’s sex offender registry — as well as those of states where the applicant or potential owner lived in the previous two years.”

Unfortunately and bizarrely, who the nursing home designates as an owner, however, will be largely up to interpretation.  The law exempts so-called “passive investors” who control the operations but do not admit to directly overseeing the operations at a facility.  For example, an owner is defined as someone with a 10% or greater ownership stake who, among other things, “purports to or exercises authority of a facility,” has an office on site, can directly access the building, or who even agrees to buy a specific facility.

“Most surrounding states use the FBI’s fingerprint-based national background check to screen prospective employees seeking work at long-term care homes,” the government-sponsored group wrote in its report. “This ensures that applicants who are convicted of a crime that makes them ineligible to work in such homes do not move to an adjoining state and obtain employment in a facility.”

But Georgia only used a name-based system that searched for crimes that occurred within the state’s borders, a structure that concerned the members of the council — which include state lawmakers, judges, and the executive counsel to Gov. Nathan Deal.

“In 2017, the council learned that there are approximately 25,000 employees in more than 10 different facility categories that provide care for the elderly and are subject only to the name-based background check,” the members wrote.

 

WSLS ran an article on the epidemic of bullying in today’s nursing homes.  Around the U.S., caregivers say they’ve seen gossip, exclusion and even incidents of physical violence popping up.  Arizona State University professor Robin Bonifas says for some who see their independence and sense of control disappear late in life, bullying gives them a feeling of regaining lost power.  Bonifas, a social work professor at Arizona State University and author of the book “Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic,” said existing studies suggest about 1 in 5 seniors encounters bullying. She sees it as an outgrowth of frustrations characteristic in communal settings, as well a reflection of issues unique to getting older.

Every month, as many as 20 percent of older Americans who live in nursing homes are subjected to seriously bad behavior from one of their fellow residents, such as physical and verbal abuse, privacy invasions or unwanted sexual attention. “The findings suggest that these altercations are widespread and common in everyday nursing home life,” says study co-author Karl Pillemer, Ph.D., professor of gerontology in medicine at Weill Cornell Medical College in a press release.

Nationwide, that translates to hundreds of thousands of people who endure abuse. Many incidents of name-calling, bossy behavior, loud arguments and, at its most extreme, physical violence go unreported.

 

Valley News reported on Vermont’s new law that will change the way officials scrutinize nursing home ownership changes after the state’s oversight came under scrutiny last year when the 67-bed Brookside Health and Rehabilitation Center closed because of unaddressed health and safety violations.  The Brookside incident aside, state officials also have been engaged in a more general discussion of changes in the nursing home industry. Those changes include a trend toward large, out-of-state companies buying nursing homes, then breaking up home operations and real estate into separate corporations.  This is done to avoid accountability for abuse and neglect, and to siphon funds to related entities.  Green Mountain Care Board member Jessica Holmes told the House Health Care Committee earlier this year that such companies are “buying up small mom-and-pop nursing homes, operating them at arm’s length and extracting short-term gains.”

The law created an eight-member group to study the ways to improve the state’s oversight of nursing homes. Nursing Home Oversight Working Group is supposed to “examine the oversight of nursing homes in Vermont, including financial stability and licensing criteria, in order to ensure the provision of high-quality services and a safe and stable environment for nursing home residents.”  The working group will look at a wide variety of issues, including the information currently reported by nursing homes and “what types of additional financial data may be necessary to evaluate nursing homes’ ongoing financial stability.”

Also, as of July 1, oversight of nursing home transfers will switch from the Green Mountain Care Board to the Agency of Human Services.  Officials with both entities support the change, saying the care board is ill-suited to regulate the increasingly complex world of nursing home ownership. Human Services Secretary Al Gobeille is pledging to develop “a very thorough, very credible review process” for when his agency takes over.   “I completely agree with the Green Mountain Care Board’s assessment that this is not the work for them,” Gobeille said.

 

 

The Marietta Daily Journal had an article about the prevention and treatment of scabies in nursing homes.  The article explains that members of the Cobb Elder Abuse Task Force met in May to discuss how and why contagious illnesses like scabies occur at senior homes.

Scabies is caused by microscopic mites that burrow into the skin and lay eggs. It can be spread without precautions in place by prolonged skin-to-skin contact and often manifests as an intensely itchy rash.  According to the Centers for Disease Control and Prevention, nursing homes and extended-care facilities are often the sites of scabies outbreaks because they have a large number of people in close contact.

Scabies should not typically be fatal on its own, however untreated scabies can lead to bacterial infections that can be fatal, especially among the elderly.  Nursing homes can be found negligent in failing to recognize the infestation and by allowing the disease to progress so far that it injures the residents. If properly recognized and diagnosed, it can be treated with a simple prescription lotion or cream, according to the CDC.

MyPalmBeachPost reported that Eva Mae Rhodes died a painful wrongful death at age 98 after caregivers at Lakeside Health Center nursing home left her outside unattended where she blistered and baked in Florida’s sun.  Rhodes was transferred to the hospital with a temperature of 103.2 degrees, suffering from heat stroke, severe dehydration and second-degree burns on her shoulders, arms and mouth. An investigator for the Florida Department of Children and Families concluded inadequate supervision was to blame. After Rhodes died two weeks later, the Palm Beach County Medical Examiner listed her cause of death as “hyperthermia” caused by exposure to the sun and heat.

The family filed a lawsuit to make sure that this doesn’t happen to other vulnerable adults.   “The message I want to send is we will not tolerate the abuse of our elderly,” CandaceMcKinley told reporters. “I’m mortified that nothing more has been done.”

Lakeside Health Center is owned and operated by the national for profit nursing home chain Life Care Centers of America.

 

 

New Jersey legislators are introducing a bill that would require nursing homes to increase staffing of certified nurse aides to a safe level. New Jersey requires nursing homes to provide 4.1 hours of care per resident each day, with additional rules for specialty care units. Assembly bill 382 would set a ratio of one CNA for every 8 residents during the day; 1:10 during the evening; and 1:16 overnight.

The proposal was supported by caregivers, consumer advocates, and experts.  The nursing home industry claims that increasing staffing will hurt their profit margins.

The Assembly Human Services Committee advanced a bill to establish specific staff-to-patient ratios. It would enact regulations supporters say are on par with staffing levels already in place in other states. The bill would not affect requirements for LPNs, RNs or other nursing home employees.

In her testimony, SEIU vice president Milly Silva told committee members their state ranks 44th in the nation for staff-to-patient ratios.

“These statistics are alarming and should serve as a wakeup call,” she said.

WFAA had an article about the continued use of dangerous medications to chemically restrain nursing home residents.  See Part 5 (See Parts 1, 2, 3 and 4 of WFAA’s continuing investigation of nursing home abuse and neglect.)  Despite the FDA’s warning to stop using anti-psychotics for dementia patients, the majority of nursing homes still uses them — more than 25 percent of the residents continue to take them for uses not approved by the FDA.

The story begins in 1993. Risperdal had just gained FDA approval for use in treating schizophrenia and bipolar disorder. But that’s a relatively small market. Dementia patients, however, comprise about half of nursing home residents.

Federal and state attorneys argued that Johnson & Johnson “developed a scheme to turn the drug into a blockbuster,” court documents show. In testimony, the attorneys claimed Johnson & Johnson used Texas as the “model state” to promote the drug “locally and nationally.”

The goal, according to federal and Texas attorneys: Get doctors to prescribe Risperdal over other drugs and for conditions – like dementia – for which it was not FDA-approved. It’s known as “off-label use.”

An off-label use of a drug is not illegal,” said Michael Elliott, a former assistant U.S. attorney who specialized in health care fraud. “What is inappropriate is for a drug company to market that drug for off-label uses.”

Texas court records and exhibits show Johnson & Johnson recruited influential doctors like Steven Shon, then medical director of the now defunct Texas Department of Mental Health & Mental Retardation. Texas Attorney General attorneys alleged Johnson & Johnson “made a series of illegal payments to Dr. Shon that effectively turned him into a salesman for Risperdal,” court documents show.

Dr. Shon testified in the case that the money did not influence him.  Sure….

The company also paid lucrative fees to a major pharmacy provider to promote the drug in nursing homes, court documents show.

Despite the FDA’s warning that using Risperdal to treat elderly dementia patients was dangerous, business plans in federal court filings show Johnson & Johnson created a sales force they called “ElderCare.”

The alleged objective? Target dementia patients, federal court records show.

From the late 1990’s to 2004, sales reps made thousands of calls promoting the drug “as safe and effective” for treating “behavior problems” in elderly dementia patients, court documents show.

As a result, court exhibits show, domestic sales of Risperdal increased from $892 million to $2 billion per year.

According to Johnson & Johnson’s own market research, as much as “75 percent of the prescriptions for Risperdal were for off-label uses.”

The Indy Channel had a sad story about a 102 year old nursing home resident that suffered a wrongful death after Bethel Pointe Healthcare nursing home removed her safety bed rails allowing her to fall out of bed.  Thelma Pauline Rector would have celebrated her 103rd birthday in March if not for the fall that led to her wrongful death nearly three months earlier.

Rector’s family was pleased with Bethel, until her accident this past November revealed her bed rails had been removed. Dowling says no one bothered to call Thelma’s power of attorney to report their removal or explain the decision.

“She actually fell out of bed and hit the floor – face-first – and that’s when we actually realized that they were gone,” Dowling said. “When we went in to talk to the people at the facility – that’s when they actually told us [about a] new law that you have the right to fall which I could hardly believe.”

“It didn’t go over well with me,” Dowling said. “Somebody is in a facility and that’s why you put them (there), to have 24-hour care and you put them there because we were having trouble keeping them from falling at home. You expect that care to be given to them.”