Fox4KC reported the disturbing truth that most states do not require nursing homes to disclose to residents that they are sharing a home with convicted sex offenders and sexual predators. Indeed, there’s no requirement in the laws of most states that patient background checks be completed and shared with staff.

It is a wide-spread problem. In a 3-month investigation, FOX4 investigative producer Lisa McCormick cross-checked the Missouri sex offender registry with the state’s long-term care facilities and found at least 200 registered sex offenders living in the homes.

Elder law experts, consumer advocates, and families of residents argue it’s time that state laws mandate background checks and notice to residents and potential clients that sex offenders are in the population, and how they are being cared for to protect the safety of staff and clients.

FOX4 discovered other states have taken the following action to address concerns regarding sex offenders living in nursing homes:

California: The Department of Corrections or other governmental agency must notify a nursing home if a registered sex offender is released into a facility. Otherwise, registered sex offenders must self-report their status before becoming a resident of a long-term care facility.

Nursing homes must notify all residents and employees that a registered sex offender lives in the facility.

Illinois: Nursing facilities are required to do a criminal background check and mental health evaluation on residents prior to admission.

A forensic psychologist reviews those reports and creates a report that describes patients’ risk level and possible security issues. The nursing home, local police, an ombudsman and the Illinois Department of Public Health receive that report.

Sex offenders are not allowed to have roommates in nursing homes and other long-term care facilities.

Massachusetts: State law prohibits anyone who is a Level 3 sex offender from living in nursing homes. The level is based on a risk assessment. At least one nursing home resident has successfully challenged this law.

Minnesota: State law requires registered offenders to notify nursing homes of their status. The police must also prepare a fact sheet for the home, which includes information about the offender’s criminal history, risk level and profile of potential victims.

All residents in the home must be given a copy of that fact sheet when the offender is admitted.

Ohio: Nursing homes must check the state’s sex offender registry before admitting a new resident. The facilities are also required to notify other residents or their families about how the home will care for the offender.

Oklahoma: In 2008, the state passed a law to create a nursing home just for registered sex offenders. No one, however, bid on that project.

Nursing homes are required to check the sex offender registry before admitting residents. Nursing homes must notify the state health department if an offender moves in the facility. Nursing homes are also required to post notifications that a registered sex offender lives in the facility.

Oregon: Registered sex offenders are required to inform nursing homes of their status before admission.

Virginia: Nursing homes must check to see if potential residents are registered sex offenders. All residents must sign a document stating they know how to check the sex offender registry.

Nursing homes, however, are not required to disclose that a registered sex offender lives in the facility.

News-Press had an article about the lack of enforcement, fines, and penalties for abuse and neglect in Florida’s nursing homes.   Florida’s Agency for Health Care Administration (AHCA) is the department that oversees the state’s 687 nursing homes.  As the state agency responsible for making sure nursing homes are safe, AHCA rarely issues fines even when another state agency reports neglect, abuse, or mistreatment by a home’s staff.

And there is often no evidence AHCA even investigates those deaths, raising questions about whether nursing homes are held accountable when patients die from mistreatment.

“The industry complains about how punitive and horrible the system is and, in reality, almost nothing happens to any of them, no matter how bad the situation,” said Toby Edelman, senior policy attorney with the nonprofit Center for Medicare Advocacy in Connecticut.

As part of its investigation, the Network reviewed 54 patient deaths verified by the Department of Children and Families as resulting from nursing home neglect or mistreatment from 2013 through 2017. The deaths were detailed in reports on 43 cases, one involving multiple deaths. The state-verified findings of abuse and neglect by nursing home staff were sent to AHCA, which has the authority to take action against the homes.

In about three-quarters of the verified cases, or 32 of 43, AHCA took no action — no fine or penalty — against nursing homes after the state determined staff caused or contributed to a patient’s death.

 In nearly two-thirds of the cases, there’s no evidence AHCA investigated the deaths or the nursing home’s role. The agency admits it failed to investigate 10 cases, and in 18 others it’s not clear AHCA investigated because the deaths are not noted in inspection records.

 State reports show the neglect and mistreatment identified in the nursing home patients’ deaths often were not isolated occurrences and AHCA knew it. In at least 25 of the 43 cases, AHCA cited the nursing homes for similar problems.
USA TODAY NETWORK – FLORIDA has reported on how AHCA allows the state’s worst nursing homes to remain open despite repeatedly failing to meet state and federal standards; imposes small fines and rarely uses the sanctions available to penalize poor performers; and allows the state’s largest nursing home chain to thrive despite a history of poor patient care.

The New York Times had a fantastic article about the growing market for assisted living facilities (ALF). Unlike nursing homes, the facilities generally do not provide skilled medical care or therapy, and stays are not paid for by Medicare or Medicaid.  But are they safe for residents with dementia?  The article discusses several examples of neglect and abuse including a woman who was not supervised properly for seven hours, and was eaten by an alligator in South Carolina.

Four in 10 residents in assisted living facilities suffer from dementia. Half are over 85. Nearly a quarter of the nation’s 30,000 assisted living facilities either house only people with dementia or have special areas known as memory care units. These wings have locked doors and other safeguards to prevent residents from leaving. The facilities often train staff members in techniques to manage behavior related to these diseases and provide activities to keep the residents engaged and stimulated.

These units usually are more expensive, with monthly costs averaging $6,472, compared with $4,835 for regular assisted living, according to a survey by the National Investment Center for Seniors Housing & Care, a group that analyzes elder care market trends. Senior housing investors earned nearly 15 percent annual returns over the last five years, higher than for apartment, hotel, office and retail properties, according to the center. Beth Burnham Mace, chief economist at the center, said memory care unit construction was outpacing all other types of senior housing.

However, assisted living facilities were originally designed for people who were largely independent but required some help bathing, eating or other daily tasks. Dementia care is the fastest-growing segment of assisted living. But as these businesses aggressively market themselves to people with Alzheimer’s and other types of dementia, facilities across the country are straining to deliver on their promises of security and attentive care, according to a Kaiser Health News analysis of inspection records in the three most populous states.

In California, 45 percent of assisted living facilities have violated one or more state dementia regulations during the last five years. Three of the 12 most common California citations in 2017 were related to dementia care.

In Florida, one in every 11 assisted living facilities has been cited since 2013 for not meeting state rules designed to prevent residents from wandering away.

And in Texas, nearly a quarter of the facilities that accept residents with Alzheimer’s have violated one or more state rules related to dementia care, such as tailoring a plan for each resident upon admission or ensuring that staff members have completed special training, according to nearly six years of records.

There is a belief in our office that many facilities do not staff to the level” necessary to meet the unanticipated “needs of residents, especially medical needs,” said Fred Steele, Oregon’s long-term-care ombudsman. “Many of these are for-profit entities. They are setting staffing ratios that maybe aren’t being set because of the care needs of the residents but are more about the bottom line of their profits.”

These concerns, though particularly acute for people with dementia, apply to all assisted living residents. They are older and frailer than assisted living residents were a generation ago. Within a year, one in five has a fall, one in eight has an emergency room visit and one in 12 has an overnight hospital stay, according to the Centers for Disease Control and Prevention.

The rules and regulations for assisted living remain looser than for nursing homes. The federal government does not license or oversee assisted living facilities, and states set minimal rules. Residents’ families, their lawyers and advocates say the violent behavior of agitated residents and escapes could be avoided with better training and more staff. Too many facilities are accepting residents they weren’t prepared to adequately care for because they wanted to maximize their income.

Aggressive behavior, a hallmark of dementia, is a major problem in assisted living facilities. One national study, published in 2016, found that at least 8 percent of assisted living residents were physically aggressive or abusive toward residents or staff.

 

 

 

Authorities are investigating credible reports that a nursing home employee sexually abused residents of the nursing home where he worked.  The suspect has a sordid history.  Richard T. Coleman was arrested August 16 by Louisville Metro Police on a warrant from Oldham County charging him with sexual abuse of a co-worker. Coleman was indicted November 10 on four counts of sexual abuse by an Oldham County Grand Jury.

Authorities say the new claims being investigated involve Friendship Manor residents. Other Friendship Manor employees have also reported similar incidents involving them and Coleman. Those are also under investigation.

When arrested, Coleman was working at Forest Springs Health Campus in Eastern Jefferson County.

 

 

Another elderly woman died after suffering from a preventable fall at a nursing home.  Her premature death has been ruled a homicide because she fell during an altercation with another resident, the York County Coroner said. The coroner’s definition of homicide means death at the hands of another person. Law enforcement determines whether such deaths are criminal. The facility failed to properly supervise the residents.

Nancy Young died from a left hip fracture resulting from a fall. She was a resident at the Pleasant Acres Rehabilitation & Nursing Center in Springettsbury Township.  An investigation showed that Young fell sometime after dinner on Dec. 8 during an altercation between another resident and Young. Young fell and broke her hip, resulting in her death a week later, the coroner wrote.

Young had entered another resident’s room, which resulted in a verbal altercation, Gay said. It was not witnessed by anyone else.  Both Young and the other resident have severe dementia. Young walked into the other resident’s room, and the resident screamed and slammed the door shut.  It wasn’t clear if Young fell because the door hit her or because she was startled. The staff heard Young’s call for help and went to her aid, Gay said.

The County of York sold the nursing home to Premier Health Care Management earlier this year for $30.8 million cash.

The Buffalo News had an editorial about the need to prevent the operators of nursing homes that provide low-quality care to buy more facilities.  The state Health Department — which reviews applications to operate nursing homes — has submitted a bill to the state Legislature that would give the department more muscular oversight of long-term care facilities. The Legislature should pass the bill when it convenes in January.  The bill in the Legislature would authorize the Health Department to appoint an independent quality monitor at chronically deficient nursing homes, increase the amount of the maximum fine the state can impose for violations from $10,000 to $20,000, and require more ownership transparency with individuals buying homes listing if their partners are relatives. The bill hasn’t gotten out of committee.

And the state has given licenses to operate at least 10 Buffalo area nursing homes in the last decade to new owners who had been fined for providing poor care to residents at other facilities. More than 1.3 million people are in long-term care across the country, with approximately 7,000 in Erie and Niagara counties.

Bill Ulrich, a health care consultant in Washington State, said national figures indicate the industry is at an all-time low of average occupancy in nursing homes, “hovering right around 80 percent, which is very low.”

Lower demand means some Western New York facilities will eventually close. The best outcome for consumers is for the homes given the lowest ratings by the federal Centers for Medicare and Medicaid Services to be the first to go. But more vigorous oversight by the Health Department would also help.

It would be nice if the federal government’s one-star ratings for the poorest performing nursing homes caused them to clean up their act, but it doesn’t always work that way. The Gottfried-Hannon bill would at least help state health officials to not allow the owners of poorly run facilities to keep popping up in new locations.

The Centers for Medicare & Medicaid Services (CMS), which administers Medicare and partners with state governments to administer Medicaid, recently announced steps to strengthen its oversight of nursing homes in hope of improving quality of care and patient safety.

The steps were announced after the discovery that a number of nursing homes nationally have low unsafe staffing levels, particularly on weekends, and periods where no registered nurses are onsite.  CMS Administrator Seema Verma said the agency discovered “potential risks” of staffing inflation after reviewing new payroll-based staffing data that is self-reported but not audited by the nursing homes.

“We’re deeply concerned about potential inadequacies in staffing, such as low weekend staffing levels, or times when registered nurses are not onsite, and the impact that this can have on patient care,” she said.

CMS said it aims to address the risks by using “frequently updated payroll-based data” to provide state survey agencies with a list of nursing homes that have a significant drop in staffing levels on weekends or that have several days in a quarter when a registered nurse isn’t onsite.

State survey agencies then will be required to conduct surveys on some weekends based on the list, CMS said. If surveyors identify insufficient staffing levels, the facility will be cited and required to implement a plan of correction.

Other initiatives announced by CMS include clarifying how facilities should report hours and deduct time for staff meal breaks, and providing facilities with tools to help ensure that their resident census is accurate.

CMS said the initiatives are part of broader efforts to strengthen safety and health outcomes for nursing home residents. Among them are the “Nursing Home Compare” website, and facility “star ratings” which CMS provides to increase transparency about nursing home quality and to help consumers and their caregivers make informed decisions.

Other CMS initiatives include the “National Partnership to Improve Dementia Care in Nursing Homes,” which strives to reduce the “inappropriate prescribing” of anti-psychotic drugs in nursing homes, and the recently-launched “Civil Money Penalty Reinvestment Program,” which is an initiative to improve residents’ quality of life by providing nursing home staff, management, and others with certain tools, education, and assistance to enhance care.

Popular Science reported on the decline in life expectancy in America.  Because of the for-profit health care market, America spends more on healthcare per citizen than almost any other.  We are not seeing the returns. Life expectancy had been steadily climbing for decades but in the last few years life expectancy has declined.

“A new report from the Centers for Disease Control shows that a small decrease in life expectancy, from 78.7 to 78.6 years, is part of a continuing trend. Even as we make progress treating cancer, heart disease, and stroke—three of the biggest killers—we’re losing ground on other fronts and have been since 2014. That makes this continuous decline unlike anything we’ve seen since World War I and the Spanish influenza, which both happened between 1915 and 1918.”

The CDC highlighted three things that have contributed to American’s shrinking life expectancy in recent years: drug overdoses, chronic liver disease, and suicide. “Increased death rates for unintentional drug overdoses in particular—a subset of unintentional injuries—contributed to the negative change in life expectancy observed in recent years,” the report reads.

But the changes aren’t affecting everyone equally. Take a look at these charts:

life expectancy factors

Geographic location is significant.

life expectancy US 2016

 The Best Seven Years of My Life: The Story of an Unlikely Caregiver is a book about how a husband and son handle taking care of their loved one after a stroke.  Chad’s mom had a stroke seven years before her death in 2017 and had various and serious medical issues during the last years of her life.  Her stroke thrust Chad’s dad into the role of caretaker, a role he never anticipated.  The book is about those 7 years.

Here’s Robert F. Daley’s review of the book:

“George Shannon had his life and marriage on cruise control…until his wife Carol suffered a life changing medical crisis.  Carol’s crisis changed George’s life as well…but not at all in the way he expected.  The Best Seven Years of My Life, written by George and his son Chad Patrick Shannon is a sometimes heartbreaking, often funny, and an always honest look at George and Carol’s lives – both before and after Carol’s crisis.  The book provides an inspirational, in depth view of love and marriage and shows how love and devotion can overcome obstacles and hurdles no matter how difficult they may seem.  George and Chad Patrick pull no punches in describing those seven years, and their narrative draws you in and ultimately leaves you spellbound as you see Carol’s unbelievable inner strength revealed.  Her inner strength both humbles and inspires George to not only be a better husband but also a better man.  The Best Seven Years of My Life is a must read for anyone who wants to be inspired and wants to be amazed at the power of love!  Highly, highly recommended.”