Another big win for nursing home residents and transparency. The North Dakota House passed a Senate bill that sets up rules allowing people to place cameras in nursing home rooms.  Nursing home patients, or people acting on their behalf, may soon be allowed to look in on loved ones.  This will make it easier to detect waste, fraud, and abuse.  Backers of the bill say this will help families monitor their loved one’s care from afar.

“My mom lived in a long-term care facility for 10 years. I saw a couple advantages to this. Since the rest of my family lives out in California, it would’ve been easy for them to monitor my mother,” said Rep. Dick Anderson, R-Willow City.

The Senate must approve the bill one more time before it can go to the governor’s desk.

The family of Barbara Jones-Davis is suing Wesley Enhanced Living assisted living facility because the facility’s negligence resulted in their loved one’s death. The resident, who was visually impaired and suffered from dementia, was allowed and able to leave the facility unsupervised and was killed after falling from the second floor onto a sidewalk.

The incident happened July 2018 when Jones-Davis opened an unguarded and unlocked door on the side of the facility and wandered outside alone. The door Jones-Davis used to exit allegedly had an alarm, but surveillance video shows no one from the facility responded to the alarm for 25 minutes  She was outside for 23 minutes until she walked to the edge of the property and fell almost two stories onto the sidewalk. An employee allegedly later closed the door without inspecting the property for any residents who may have left.

Jones-Davis was found alive by a passerby and was taken to the hospital where she later died.  The facility allegedly learned of the incident about an hour later when a nurse was notified.

“Wesley Enhanced Living at Stapeley and its security contractor, U.S. Security Associates, were both negligent and grossly negligent for failing to put the appropriate systems, processes, and precautions in place to prevent such an event from happening, especially where similar instances involving unsupervised residents who wandered from the facility had occurred previous to this tragedy,” alleges the suit.

Officials with the Pennsylvania Department of Health and Human Services say there have been three recent incidents where residents have left the facility unsupervised, according to the lawsuit.

Dr. Hooshang D. Poor has admitted to Medicare fraud and is facing an indefinite suspension of his medical license faces allegations of sexual assault.  Dr. Poor is facing civil action stemming from an alleged Sept. 16, 2016, assault on a licensed practical nurse who claims Poor groped her from behind while they were working together at the Kindred Nursing and Rehabilitation Tower Hill Nursing Home.

Poor has had other legal troubles in his decades-long medical career.  Last month, Poor agreed to pay $680,000 to resolve allegations of Medicare and Medicaid fraud.

“As a result of Poor’s assault on her, the (nurse) has been seriously and permanently injured, and continues to suffer at present from psychological disease, which impairs and affects all aspects of her life,” the suit states.

The nurse has incurred past expenses for medical treatment and will likely incur more expenses in the future, the suit claims. It also states she has lost income.

Following the assault, the nurse had to avoid coming into contact with Poor when they both still worked at Kindred and since then she has had to avoid him at other nursing homes where she has been employed, which “has caused her to suffer continual emotional upset and interfered with her employment opportunities and schedule,” according to the lawsuit.

The suit states that the nurse promptly reported the assault to the nursing home’s human resources office. It’s unclear if the assault was reported to police.

The Massachusetts Board of Registration in Medicine indefinitely suspended Poor’s medical license on Dec. 20, 2018, after finding that he negligently treated two patients and kept inadequate medical records for four patients.

Connecticut’s Human Services Committee passed a bill that would increase the required amount of time that CNA’s spend with nursing home residents each day.

Rep. Michelle Cook said, We recognize that the Certified Nursing Assistants really do the ‘grunt work’ in a nursing home and this is what that’s about. This is about raising the hours of which a Certified Nursing Assistant should be caring for each and every individual patient in a nursing home.

But that requires more CNA’s and, because the majority of nursing home patients are on Medicaid, it will require the state to kick in more money. So the underlying issue is how much more is the state willing to pay for Medicaid funding if it increases staffing and therefore improves the quality of the care and the safety of the residents..

 

SavaSeniorCare LLC, the owner and operator of Cheyenne Healthcare Center recently week settled a 2018 lawsuit against the national for-profit chain for neglect and negligent services provided to a resident that led to his significant injuries.  Daryl Farrington filed the lawsuit in February 2018, claiming he suffered multiple injuries during a three-month stretch in 2015 due to an inadequate level of care and planning by the staff. Cheyenne Healthcare Center is run by SavaSeniorCare LLC, which operates about 200 facilities across 20 states and is one of the largest assisted-living providers in the country.

According to the lawsuit, Farrington suffered multiple falls that resulted from a lack of trained staff, and the facility not developing a comprehensive care plan that met his medical and physical needs. The lawsuit also claimed the facility failed multiple times to notify Farrington’s family of his falls that resulted in injuries and other medical issues that developed during his stay.  The facility was not properly staffed according to many witnesses.

The staff at Cheyenne Healthcare Center even had Farrington allegedly mark his own psychiatric medication consent forms with an “X,” despite him not being competent to make those decisions.  SavaSeniorCare’s defense was to blame the resident.

The Mountaineer reported on the horrific saga involving SavaSeniorCare in North Carolina.  In August 2017, Luis Gomez, a former certified nursing assistant at the Brian Center — now known as Haywood Nursing and Rehabilitation — was found guilty of several felonies, including forcible rape, by a Haywood County jury. The charges related to two victims, both of whom filed a separate civil suit in Haywood County Superior Court before filing in federal court last month.  The nursing home was owned and operated by SavaSeniorCare–a national billion dollar for-profit chain.  The Sava chain is managed by SavaSeniorCare Administrative Services LLC and SavaSeniorCare Consulting LLC.

According to the suits, which uses the term “Sava Senior Care — ALL” to refer to the defendants (including the parent company), the staff at the Brian Center was aware of the dangerous conditions its residents were subject to.  Gomez began working at the Brian Center in July 2015, and the suits allege that abuses were reported to management prior to Gomez being reported to law enforcement or even fired from the facility.  Perhaps most shocking is that the suit alleges that the defendants worked to cover up Gomez’ horrid deeds by silencing his victims. They further allege that had The Brian Center given the initial complaint adequate attention that he would have not been able to assault more helpless women.

“At the relevant times, on information and belief, Sava Senior Care — ALL were fully aware that the failure to provide sufficient numbers of competent nursing personnel to meet the basic needs of residents jeopardized the health and safety of such residents and would, in all reasonable likelihood, cause serious injury to residents, including [the plaintiff],” it continues.

The suits allege that the knowledge of sub-standard conditions was known by all even the management company, related entities, and the parent company but they only cared about profits and the bottom line.

“Sava Senior Care — ALL, on information and belief, entered into a continuing course of negligent conduct by creating, implementing, and enforcing dangerous operational budgets at the Haywood Sava Senior Care-Brian Center Facility that deprived residents, including [the plaintiff] of adequate staffing necessary to meet custodial needs,” the suit continues. “This course of conduct deprived residents, including [the plaintiff], of supplies and personnel necessary to meet her needs. Further, this course of conduct failed to ensure that qualified employees worked at the facility. This course of conduct allowed a sexual predator to be employed by and to work at the Haywood Sava Senior Care-Brian Center Facility and to cause severe harm to multiple residents, including [the plaintiff].”

“Upon information and belief, Sava Senior Care — ALL conducted a purported investigation of the complaint of Jane Doe; discounted and minimized the reports and complaints of Jane Doe; gathered and manipulated information to criticize and disparage Jane Doe; and promptly arranged to have Jane Doe involuntarily committed to another facility for psychiatric evaluation,” one suit reads. “On information and belief, the commitment of Jane Doe by Sava Senior Care — ALL rendered her unavailable for interview and evaluation at the facility by the appropriate authorities, including representatives from the Complaint Intake and Health Care Personnel Investigations Section of the North Carolina Department of Health and Human Services.”

Evergreen Health and Rehabilitation Center and its parent company Pinnacle Services Inc. have finally accepted responsibility and settled for $300,000 with the family of Edna Marie Bunting who died two months after being admitted to the nursing home. Bunting developed painful and disgusting pressure injuries when she was not turned and re-positioned enough to offload the pressure to her skin.  Proper offloading prevents the vast majority of pressure injuries.

In a lawsuit filed in January 2018, attorney Jeffrey J. Downey wrote that Evergreen staff “recklessly disregarded” Bunting’s safety by knowingly under-staffing the facility based on the foreseeable needs of the residents.

The state Department of Health in 2016 cited the facility for several violations including failing to prevent and properly treat bed sores.

Downey said last week that nursing home patients are at greater risk under the Trump administration because the U.S. Department of Health and Human Services has underfunded state health departments, including Virginia’s, and decreased enforcement.

In addition to reducing fines, Downey said the Department of Justice has reduced prosecutions of nursing homes for Medicare fraud.

“The combined effect of those two regulatory changes has basically given nursing homes, in a lot of ways, a green light to go back to their practices of understaffing for profit,” he said.

Attorney Robert J. Zelnick, who represented Evergreen, didn’t return a call last week.

The Washington Post had an interesting article on the unintended consequences of Trump’s decisions on nursing home residents.

In December 2017, Trump proudly “deregulated” the nursing home industry.  However, certain regulations were essential to protect vulnerable and disabled nursing home residents, and to prevent waste, fraud, and crime in Medicare payments.

Nursing homes regulations were always poorly enforced and few administrations made them a priority. President Obama attempted to craft policies to put pressure on poorly managed facilities. In 2014, he issued policy guidelines that urged regulators to issue daily fines against nursing homes for infractions until those violations were remedied. By 2016, that approach applied to two-thirds of cases. He also issued a rule that would have barred facilities from requiring that disputes with residents be settled in private arbitrations that limit the companies’  exposure.

Trump rolled back these policies. The number of per-day fines plummeted. The ban on mandatory arbitration was blocked. Trump delayed the enforcement of new health and safety requirements by 18 months, much to the delight of the nursing home industry. Less accountability for nursing homes that treat their residents poorly. 

“They were fighting it, and they got a lot of what they wanted,” said Toby Edelman, a senior policy attorney and expert on nursing home regulation at the nonprofit Center for Medicare Advocacy.

 The Kaiser Family Foundation published an analysis that found that under the Trump administration, the average fine levied against nursing homes that have endangered or injured residents dropped from a high of $41,260 in 2016 to $28,405 in the first quarter of 2018.   This is important because elder care is a multibillion-dollar field, and nursing homes have revenue in the millions of dollars. Small, one-off fines barely register in this context.

CMS’s record looks even uglier when it comes to how it’s regulating the worst of the worst in the industry — nursing homes known as “special focus facilities.” These are the nursing homes cited for a pattern of serious infractions: residents falling; medication not getting to patients; staff slapping residents for not cooperating with treatment; bed sores neglected for so long that they become gaping, bloody wounds.

Edelman has been closely tracking these nursing homes, especially those that the federal government classified as having “not improved” since they were first listed as special focus facilities. She has found that the Trump administration has largely pulled back its enforcement of them.

The Gainesville Sun had the below editorial:

Right now, a nursing home patient in Florida is hungry, another soaks in soiled clothes, or still another has fallen out of bed. Others wait too long for their medications, and many face tragic life and death consequences, all due to understaffing in the state’s nursing facilities.

When it comes to providing proper care in nursing homes, every minute counts. Yet, state Rep. Rick Roth, R-Palm Beach Gardens, has introduced a bill (HB897) that would further worsen conditions for our seniors and their caregivers.

This dangerous legislation is strongly opposed by nursing home workers and other true senior citizen advocates such as AARP and LeadingAge Florida, while unsurprisingly supported by profit-minded lobbyists who want to deregulate the industry.

The bill claims to increase the amount of required “direct care hours” a nursing home resident must receive from an average of 3.6 to 3.9 hours per day, but it creates gaping loopholes likely to result in dangerous reductions in time and care. HB 897 will be a Trojan Horse boosting facility profits, that will hurt, not help nursing home patients and workers.

Under current law, Certified Nursing Assistants (CNA) handle the vast majority of essential daily living needs — including eating, dressing and hygiene – for nursing home residents. But Roth’s proposal removes the CNA requirement and would allow untrained non-certified employees to conduct these critically important tasks.

The bill also could permit facilities to categorize services performed by therapists, counselors and others as part of minimum time requirements in place of indispensable CNA care. Our seniors can’t afford these cuts, and nor can caregivers in a long-term care (LTC) system that already has great problems and inequalities.

Florida nursing homes make up a $20 billion private, for-profit industry, funded with hundreds of millions of public tax dollars. For 20 years, the state legislature has weakened regulations and/or sided with nursing home operators who make large political donations. These companies don’t need more help to rack up huge profits at the expense of patients and caregivers.

My fellow members of 1199SEIU and other dedicated healthcare workers carry out extremely important and challenging jobs: caring for fragile patients often with serious medical issues. Families depend on us to deliver care and compassion to their loved ones in their most delicate years of life.

We’re committed to provide the very best to our patients, yet most workers are paid low wages with minimal benefits. The average CNA wage in Florida is $11 per hour; meaning some CNAs can’t afford their own health coverage. So many of my co-workers face this same sad irony while we deliver care to others. We struggle to support our families week-to-week, and if we get sick, it’s a real crisis.

When it comes to serving seniors, LTC workers consider ourselves the true “guardians of quality.” We strongly urge Rep. Roth to reconsider and/or repair his current bill. He should partner with workers, families and other genuine stakeholders to make our nursing home system safe, fair and better for seniors and caregivers alike.

DUKINS DELINOIS, WEST PALM BEACH

Editor’s note: Delinois is a nursing home worker in West Palm Beach, and a member of 1199SEIU Florida, the union representing more than 25,000 healthcare workers throughout the state.

 

McKnight’s had another great article on medical marijuana; this time, in Virginia.  As a bill that expands access to medical cannabis becomes law, associations representing assisted living operators in Virginia are looking for guidance on whether it applies to assisted living residents and their caregivers, as the Virginia chapter of the National Organization for the Reform of Marijuana Laws maintains.  The legislation was passed unanimously in both the state House of Delegates and the state Senate.

SB 1719 allows for “registered agents” to pick up or receive delivery of medical cannabis — specifically, cannabidiol (CBD) oil and THC-A oil — for people who physically are unable to do so for themselves. The bill language does not reference assisted living, but Virginia NORML said the bill applies to assisted living communities and hospices as well as home healthcare providers.

Virginia Assisted Living Association Executive Director Judy M. Hackler told McKnight’s Senior Living that the organization has contacted state regulators to see how the bill, if signed, will be implemented in long-term care settings.  “We have been telling our providers that we know that it’s coming, that all the laws are changing for all the states,” she said. “And so we’re asking them all to be proactive in developing company policies as far as what they want to have allowed and, of course, full disclosure to residents and staff. You’ve got to think about who is going to be administering it for the residents and whether there are going to be any side effects to the employees. …There need to be some safety measures in place.”

The Virginia Health Care Association / Virginia Center for Assisted Living also is taking a closer look at the legislation to see how assisted living communities could be affected, said Amy Hewett, CAE, the group’s vice president of strategy and communications.

“We have plans to meet with representatives of the Virginia Board of Pharmacy to learn more,” she said. Agents must register with the pharmacy board.

LeadingAge Virginia President and CEO Melissa Andrews said the bill is “a step toward our mission of ensuring positive aging for every Virginian.”

The organization, she added, “supports legislation that enables older adults to have access to all necessary prescribed medication, regardless of their physical ability or location. We are pleased that our legislature is taking this positive step and are confident that regulations will be promulgated to ensure the health, welfare and safety of residents within these communities.”