A $53 million senior living complex may be one of the newest developments in the growing Carolina Forest community of Horry County. The woods could soon be the home to something much different: a senior living complex. Horry County’s administration committee is expected to discuss the plans for what would be called The Villas at Carolina Forest. It would have 166 units on about 18 acres of land off Carolina Forest Boulevard next to the Canterbury Apartments.

The project could receive $50 million in bonds from the South Carolina Jobs-Economic Development Authority. This type of borrowing allows a private entity such as a nonprofit to utilize the same tax-exempt financing that a government does. The Villas at Carolina Forest would have assisted living and memory care units. It would also have space for physical rehabilitation, therapeutic services, dining facilities and common areas for social activities.

 

Experts and consumer advocates are concerned that reduced federal oversight and enforcement of regulations of nursing homes will remove incentives for facilities to improve the care patients receive.  Nursing homes nationwide are monitored by the Centers for Medicare and Medicaid Services. Advocates, experts, and concerned legislators worked for years to secure new protections for residents of nursing homes. The year 2016 brought national long-term care regulatory reform.

The new safety rules to improve the quality of care included increased oversight in infection control, added training for staff and protections against abuse, neglect and exploitation. But those regulations, some of which were due to be implemented in November 2017, were halted by the Trump administration.  The nursing home industry provided millions in campaign donations in the 2016 campaign.

In May, 18 Attorney Generals condemned the reduction of oversight and patient protections. The letter, addressed to the U.S. Department of Health and Human Services, cited a 2017 report from the inspector general that found the Center of Medicare and Medicaid Services has “inadequate procedures to identity and report incidents of abuse and neglect.”  Patients need more protection, not less, the letter said.

An estimated 22 percent of Medicare beneficiaries experienced adverse events — including infections, pressure ulcers and medication-induced bleeding — during stays at skilled nursing facilities, a report said.  Nearly 70 percent of these adverse events were preventable or could have been avoided if the facilities had provided better care, according to the letter, and over half of residents harmed needed hospital care.

A combination of low pay, inadequate training, and the difficulty of the job due to short-staffing contributes to poor turnover rates. The federal government did a study back in 2001 that found that, more than likely, it takes more than four hours of direct care per resident per day just to prevent harm.

“There are a lot of nursing homes that are even worse off for staffing in the state,” she said. “If there is not enough staffing, no matter how good they are, they can’t do the job they’re there to do.”

The Buffalo News reported the tragic and preventable death of Frank Williams.  Frank Williams died Dec. 21, 2016, from sepsis from pressure ulcers or bedsores he suffered at Safire Rehabilitation at Northtowns.  Williams didn’t have any skin breakdown or bedsores when he left Kenmore Mercy Hospital and entered the nursing home for rehabilitation after a stroke. Williams’ case illustrates how vulnerable individuals who go to poorly rated and understaffed nursing homes for rehabilitation can quickly succumb to preventable but lethal ailments like bedsores.

Four months later, when he returned to Kenmore Mercy, the retired ironworker had seven bedsores on the lower half of his body. He died 14 days later from sepsis – an extreme response to infection – according to his death certificate. Hospital records cite infections from bedsores as the most likely cause of the sepsis.

After he arrived, hospital records note, Kenmore Mercy staff discovered bedsores on the lower half of his body, including one with “foul smelling drainage” and greenish gray and black spots, along with dead tissue.

According to hospital medical records, there were bedsores on his lower back, right ankle, right and left heels and right big toe. There were two lesser wounds on his right pelvis and scrotum. 

“The sore on his right ankle looked like it was down to the bone,” Mark Williams said.

“They told me this is the worst case of bedsores they have ever seen from that nursing home,” his son, Mark F. Williams Sr., recalled doctors and nurses telling him in the emergency room. “The sores were black. I’d never seen that before. I was shocked. I thought it was the black plague.”

Bedsores, also known as pressure ulcers, occur when a section of the body is pressing against a surface for too long and not repositioned to alleviate the pressure. Several other factors, such as nutrition, the surface on which the body is pressing and moisture also contribute to bedsores, according to experts in the prevention of  these injuries. Yet there is consensus among nursing homes and other health care providers that the vast majority of pressure injuries can be prevented.  In fact, the nationwide average for pressure ulcers is less than 5% in most facilities.

 

Max Brantley wrote a great blog for the Arkansas times about the bribery and corruption of Arkansas’ judicial branch based on the Arkansas Democrat-Gazette’s Debra Hale Shelton reports which further details the Arkansas Supreme Court Justice Rhonda Wood’s connection to the federal bribery case against former Republican Sen. Gilbert Baker.  The U.S. attorney’s office says more information will be revealed at Baker’s trial.

Baker has been indicted for bribing then-Circuit Judge Mike Maggio with campaign contributions from nursing home owner Michael Morton to reduce a $5.2 million jury verdict in a negligence case against one of Morton’s nursing homes. Morton has not been charged yet. Maggio is serving a 10-year prison sentence, but as we indicated earlier, he was moved from federal prison to a private facility closer to Little Rock (in Tennessee) to provide new cooperation with prosecutors. That cooperation immediately preceded Baker’s indictment last week.

The indictment cited Wood’s communication with Baker by text messages the day before Maggio reduced the verdict by $4.2 million. She was, at the time, close to Maggio as colleagues on the bench in Faulkner County. They campaigned together — she for Supreme Court, he for Court of Appeals. She received $48,000 in contributions from Morton arranged by Baker (who also likely was key in a number of other contributions by Morton to judicial candidates in Baker’s home in Faulkner  County.)

Now to the news. Shelton asked Wood about her text messages to Baker. Wood said she no longer has them and can’t remember what they might have said. But she said she had asked the U.S. attorney’s office for them so that she could release them to clear the air.

Wood has stoutly defended her propriety in this matter previously. She has also defended sitting on nursing home cases involving Morton, in part by saying she returned some of Morton’s contributions. Her race ended up being unopposed, however.

Wood was once considered a prime candidate for the federal judgeship from which Leon Holmes has retired. The judgeship remains vacant because of problems that occurred with at least three candidates. Her connection to the Maggio case has long been thought a factor in a nomination of her not going forward. Another Conway candidate for the job, Circuit Judge Troy Braswell, also has apparently fallen by the wayside for unknown reasons. It so happens that he, too, was a recipient of Morton money in his first race for a judgeship, but only a relatively paltry $8,000 of the more than $60,000 he raised. Nor was Wood the only member of the Arkansas Supreme Court to receive Morton money.

Justice Karen Baker got $20,000 of the $27,000 she raised in 2014 from Morton. Justice Jo Hart got $23,000 from Morton to pay off debt from her last race and thanked Morton at her investiture. Justice Courtney Goodson got $91,000 from the nursing home lobby in her first race for Supreme Court. Justice Robin Wynne got $7,700. Justice Shawn Womack made a race for the court after a constitutional amendment prohibited corporate contributions, but as a Republican senator he sponsored legislation backed by the nursing home lobby to cap punitive damages and was a supporter of a tort reform amendment to the state Constitution. Only Chief Justice Dan Kemp, who defeated Goodson in her race to move up on the court, doesn’t make the list of direct nursing home connections

As far as we know, however, Wood is the only one whose text messages to Gilbert Baker might be in the hands of U.S. prosecutors investigating public corruption. It is unclear if the prosecutor possesses only the record of an exchange of texts between Wood and Baker or also the texts themselves (and if there might be messages between Wood and Maggio). Wood said she has cooperated fully with the Justice Department.

I think we can agree none of this presents a good appearance for the Arkansas justice system, particularly the election of judges.

An exclusive 2017 CNN investigation found the federal government has cited more than 1,000 nursing homes for mishandling or failing to prevent alleged cases of rape, sexual assault and sexual abuse at their facilities between 2013 and 2016. Nearly 100 of those facilities had been cited multiple times during the same three years.  That’s likely just the tip of the iceberg. Experts say such abuse is not only under-reported and under-investigated, but often unnoticed or ignored.
According to the National Consumer Voice for Quality Long-Term Care, women and men with dementia are most likely to be victims. They say resident-to-resident sexual aggression is the most common form of abuse in nursing homes, but perpetrators can also be temporary and permanent staff, family, friends, even complete strangers visiting the facility.
“If they have any sign of mental illness, dementia or Alzheimer’s, they could say, ‘I was raped by so and so’ but nobody believes them,” said Pat McGinnis, executive director of California Advocates for Nursing Home Reform, a non-profit advocacy organization dedicated to improving long-term health care.
The 2017 CNN investigation also found most citations dealt with cases of residents abusing other residents. But the analysis also showed accusations made about aides, nurses and other staff members tended to be far more serious, involving allegations of forced intercourse, oral sex and other forms of sexual assault.
Physical signs of abuse include bruising in genital areas, breasts and inner thighs, unexplained vaginal infections or bleeding, pain or irritation in the vaginal or anal areas, and torn, stained or bloodied underwear or linens. Also look for sudden or new difficulty walking or sitting, according to the National Consumer Voice for Quality Long-Term Care.
Not all abuse is visible, but there are other, possibly subtle signs as well. An abused loved one might withdraw from social activities and interactions, or develop sudden fears of the dark, increased nightmares or disturbed sleep. They could react differently to their abuser and show fear or avoidance of that person or a singular place. Panic attacks, extreme agitation and other PTSD symptoms could suddenly appear or grow worse. Some might even attempt suicide.

The Hamilton Spectator, aka the Spec, writer Carmela Fragomeni had a great article (published 1.2.19) about the struggle one woman faces to get her medical care to match her wishes.

At 75, Arleen Reinsborough’s fear of nursing homes has her more determined than ever to seek assisted suicide.  Of course, fear of long-term care doesn’t qualify her for medical assistance in dying. But Reinsborough is confident her unbearable pain will.  Reinsborough has severe osteoarthritis, asthma, psoriasis so bad that her feet bleed whenever she stands up, and a damaged back and neck that linger from two past car accidents.

But it’s her future that makes her despair the most.

It isn’t depression that makes me want to die, it’s the fear of living with inhumane, overcrowded conditions, loneliness and lack of hope,” she says, referring to life in a nursing home.

“I’m trying to do all I can to prevent going to long-term care. I believe in quality of life, not quantity of life.”

The homes she says she can afford “are worse than living on the street or living at all.”

Reinsborough accepts that, as a member of the baby boom generation (born 1945-1965), there will never be enough services because of the size of the aging demographic.  Hamilton has 1,717 people on a wait list for a room in a long-term care (LTC) facility, most of them for the cheapest, basic room which costs about $1,848 a month. A private room is $2,640 a month and semiprivate runs about $2,228.

She has a “small, wonderful” family with two adult children who are “stretched to the limit” trying to help care for her, all while working and caring for their own children — two of whom have medical issues, and another has a learning disability.

“How could I ask more of them?”

 Reinsborough’s decision to apply for assisted dying was difficult. “I have chronic illnesses. The only way that ends is very badly,” she says.

I’m like a prisoner of a war camp I can never escape from, and every day I get a level of pain from four to 10 — every day. “In other words, it’s torture.”

Her husband of 52 years, John, 82, is not keen on her wish for assisted dying, but he respects it; he understands her suffering. “The medical profession doesn’t seem to offer too many solutions,” he says. “Either you sit by and watch your wife suffer, or you watch her pass away.”

Their son and daughter, however, are non-committal, according to John. It is hard for them, because they are younger, to truly know their mother’s pain, he says.  Reinsborough says her children did not want to comment because they wish to remain anonymous. “This is not an easy route to take but I cannot see any other options and there is a time for all of us,” she said.

“We’ve lost our compassion for seniors,” she says. “We’re not cute. Some people say we also smell. Well, so did they when they were babies.”

“There is such a lack of places to die in peace, dignity, and pain-free with gentle care,” she recently wrote the prime minister in a plea to expand assisted dying rules. “All I see ahead of me is poverty, suffering and a lack of caregivers.”

“If assisted suicide is not available to seniors like me, there will be a lot of botched attempts,” which she says will put a strain on hospitals.

 

 

 

Here is a follow-up to the blog dated Jan. 14 where a disabled semi-comatose nursing home resident was raped and had a baby without anyone at the nursing home knowing.  This week, Nathan Sutherland, a licensed practical nurse at Hacienda Skilled Nursing Facility, was arrested in the sexual assault of the incapacitated woman.  Police obtained a DNA sample from Sutherland and confirmed that he was the father of the child.  He was responsible for caring for the victim and had access to her at the time of the incident.

CNN had an incredible article on the ongoing problem of sexual assaults in long term care facilities, and the willingness to cover these crimes up by the industry, the police, and the prosecutors.  It’s these systemic failures that make it especially hard for victims to get justice — and even easier for perpetrators to get away with their heinous crimes.

Throughout the country vulnerable senior citizens are being attacked by the people their families pay to care for them. Seniors that cannot walk or talk, and depend on others for basic needs are being raped and assaulted in nursing homes across the country. CNN researched several cases across the country and in most cases the nursing home was somehow found not to be “at fault” by law, but all failed to take preventive measures to maintain and promote the safety and well-being of the seniors in their care.  Most of the cases examined by CNN involved lone actors. But in some cases, a mob mentality fueled the abuse. And it’s not just women who have been victimized.

For months, a group of male nursing aides at a California facility abused and humiliated five male residents — taking videos and photos to share with other staff members. One victim, a 56-year-old with cerebral palsy, was paraded around naked. Another, an elderly man with paralysis who struggled to speak was pinched on his nipples and penis and forced to eat feces out of his adult diapers. He was terrified his abusers would kill him. While the aides lost their certifications, an investigation by Disability Rights California found that many of them never faced charges.

CNN’s analysis found that the nursing homes themselves are a large part of the problem. The article stated that more than 1000 facilities had been cited for failing to investigate and report allegations of sexual abuse thoroughly to authorities or for not properly screening employees for potentially abusive pasts. In most of the cases reviewed by CNN, the caretakers had multiple allegations and the facilities chose to ignore them or actively covering the crimes up instead of doing a thorough investigation. Even those facilities that actively impede investigations or cover up abuse often get little more than a slap on the wrist. The vast majority of nursing homes with horror stories chronicled in the inspection reports are still in business, accepting new residents today.  The law requires the nursing facilities to pay a fine, and it is very unlikely that they will no longer receive Medicaid and Medicare, so the nursing facilities are not facing any consequences for their negligence.

CNN reviewed several cases throughout the country, but one of the cases that gained a lot of attention is the sentencing of a male nursing assistant, George Kpingbah, in 2015. Kpingbah was accused and convicted of raping 83-year-old Sonja Fischer. During the case it was revealed the Kpingbah had three other allegations made against him and the nursing facility, Walker Methodist Health Center, and instead of terminating Kpingbah, the facility suspended him each time and allowed him to continue working after the suspension. If Kpingbah was not caught in the act, he would have been able to continue assaulting the residents at Walker Methodist Health Center with no interference from the officials of the health center.

It is obvious that seniors are being taken advantage of in several facilities across the country and they have little to no representation. They are more than likely disabled in some form and their accusations are taken lightly. Hopefully with the work of CNN more accusations will be reviewed thoroughly and action will be taken against the nursing facilities and the perpetrators.  Despite the litany of abuses detailed in government reports, there is no comprehensive, national data on how many cases of sexual abuse have been reported in facilities housing the elderly.  More than 16,000 complaints of sexual abuse have been reported since 2000 in long-term care facilities (which include both nursing homes and assisted living facilities),according to federal data housed by the Administration for Community Living. But agency officials warned that this figure doesn’t capture everything — only those cases in which state long-term care ombudsmen (who act as advocates for facility residents) were somehow involved in resolving the complaints.

Legal advocates, government regulators, criminal investigators and medical experts agree that sexual abuse in nursing homes can be extremely challenging to prevent and detect. But they say many facilities should be doing much more to protect vulnerable residents.

  1. “When you have a sexual assault claim, you shouldn’t go to a conclusion she’s a problem patient. You should investigate as a sexual assault until proven otherwise.” — Dave Young, district attorney for Colorado’s 17th Judicial District
  2. “Preserve evidence! Don’t bathe or change clothing, sheets, etc., when an assault is suspected.” — Sherry Culp, Kentucky long-term care ombudsman
  3. “Most abuse is undetected and never reported mainly because observable signs are missed or misinterpreted. A little training could go a long way.” — Tony Chicotel, staff attorney at California Advocates for Nursing Home Reform
  4. “As with nearly every type of abuse and neglect seen in nursing homes, the better staffed the facility the less likely sexual abuse will occur. This is a crime of opportunity, so the more supervision the better.” — Kirsten Fish, elder abuse attorney
  5. “There needs to be a reporting system. …The system doesn’t keep track of cases that haven’t been substantiated, [and] their rules for substantiating a complaint are just astronomical. It’s virtually impossible to substantiate a complaint.” — Lt. Chris Chandler, Waynesville, North Carolina, Police Department

 

Farrah Rubani, the CEO of New York home health aide company, Hopeton Care, has been accused of embezzling $11 million from Medicaid to fund a lavish lifestyle with her NYPD cop husband. Rubani’s husband is 50th Precinct NYPD Officer Richard Tricario. Rubani was arrested on December 18 on a first-degree grand larceny charge in an alleged scam to submit false claims through her Brooklyn-based company Hopeton Care. State investigators allege that Rubani, a native of Pakistan, stole nearly $4 million in that scheme alone.

The New York Attorney General’s office claimed that Rubani and her partners billed New York State Medicaid for home care for children when was none provided, then paid the kids’ parents to stay quiet, the New York Daily News reported.  “Rubani misrepresented to parents… that the Medicaid program permitted Hopeton to pay them directly to care for their children instead of sending a nurse, notwithstanding the fact that these parents were not qualified to provide the nursing services that their children required,’ the AG said in the lawsuit filed in Manhattan Supreme Court.

Prosecutors allege that he spent some of the ill-gotten money on a $250,000 Bentley, a $60,000 Dodge Ram pickup and a $1.8 million Cape Cod vacation home that the couple nicknamed ‘Rich At Heart’.  Tricario wrote nearly $3 million in checks on the couple’s joint bank account between 2016 and 2018.

WalletHub published a list of States with the best elder protection laws.  South Carolina did not do well based on 14 key indicators of elder-abuse protection in 3 overall categories. The data set ranges from “share of elder-abuse, gross-neglect and exploitation complaints” to “financial elder-abuse laws.” In fact, South Carolina was dead last!

Overall Rank
(51=Worse)
State Total Score ‘Prevalence’ Rank ‘Resources’ Rank ‘Protection’ Rank
51 South Carolina 15.49 50 34 22

Vulnerable older Americans are among the easiest targets for this misconduct, especially those who are women, have disabilities and rely on others for care. By one estimate, elder abuse affects as many as 5 million people per year, and more than 95 percent of all cases go unreported.

Unless states take action to prevent further abuse, the problem will grow as America becomes an increasingly aging nation. The U.S. Census Bureau expects the population aged 65 and older to nearly double from 43.1 million in 2012 to 83.7 million in 2050, much to the credit of aging Baby Boomers who began turning 65 in 2011. And by just 2030, 1 in 5 U.S. residents will be retirement age.