I thought I had seen it all.  I have been a nursing home abuse and neglect lawyer for over 20 years and this latest story surprised even me.

Apparently, three caregivers at a facility owned and operated by the Affinity Living Group have been charged with creating a makeshift fight club at Danby House in North Carolina. Their “fighters” were victims of dementia under their care at Danby House, a facility in Winston-Salem, police say.  The Winston-Salem Police Department received a tip in June about elder abuse at the assisted living and memory-care facility, according to Fox 8.

Marilyn Latish McKey, Tonacia Yvonne Tyson, and Taneshia Deshawn Jordan were arrested and charged with assault on an individual with a disability in early October, according to authorities. McKey, Tyson and Deshawn filmed two residents in Danby House’s “special care unit” for dementia patients and encouraged them to fight.

Resident 8 and Resident 9, as the women are referred to in the documents, fought in Resident 8′s room as the trio of health-care workers encouraged them and and recorded the assault.  The three caregivers can be heard in the video saying, “Stop screaming, [expletive].” Someone also prompts one of the residents to “punch her in the face.” Another is concerned that the phone is actually recording the video, so that it could be sent to her later.  Video shows the patients falling onto a bed in Resident 8′s room as Resident 9 continued her assault, according to court documents reviewed by Journal. The anguished pleas for help were ignored.

Staff members took video of the fight, which led to “one resident being strangled with her face turning red,” and shared it on social media.  The employees let the fight happen because one of the residents “always caused problems.”

They were only charged with Class A misdemeanors, which only come with a maximum penalty of 150 days of incarceration and a discretionary fine. Their next court date is Nov. 14.  Incredible.

Affinity Living Group is the fourth-largest provider of Alzheimer’s care and memory care in the country, according to its website.

McKey faces an additional charge after shoving one of the residents during a separate incident when staff took video while McKey pushed the woman “into a room, turned off the light and yelled to the resident to go to sleep, and then closed the door leaving the resident in the dark room,” according to the report.

A nursing home resident at Oxford Rehabilitation and Health Care Center allegedly beat his roommate to death with a walker Oct. 5. The tragic incident is getting a lot of attention but attorneys who specialize in nursing home abuse and neglect are not shocked because we know these types of assault happen often especially when short-staffing prevents sufficient supervision and monitoring of easily agitated residents.

When police arrived to find Jose Veguilla swinging a bloody walker at staff, Veguilla responded to an officer’s request to drop the walker. Veguilla has dementia and was speaking incoherently. He had not been given his medication that day.

Police then found the victim, Robert Boucher, unresponsive in his room. He had a large cut on his forehead, among other defense wounds. Boucher had been living at the Oxford Manor nursing facility since April after having a leg amputated. He was engaged to be married. He was pronounced dead soon after.

A judge ordered Veguilla to undergo a competency evaluation after he pleaded not guilty to murder on Oct. 7.  The suspect suffered a traumatic brain injury during a fall at his home last year. A court psychologist questioned Veguilla’s competency at his hearing.

Veguilla’s son Henry said his father had not been taking his medicine and that he felt it was the facility’s duty to ensure the health and safety of all their patients.

“How does an 83-year-old man have the time to do what he is being accused of doing and no one stepping in to intervene?” his son said.

Athena Health Care Systems operates the nursing home. Oxford Manor receives a much lower than average rating on Medicare.gov and was the subject of a settlement by the Mass. Attorney General earlier this year. They failed to protect patients in the past and now that same state-licensed nursing home is part of an ongoing investigation after an elderly patient is accused of murdering his roommate.

According to state and federal reports obtained by 5 Investigates, the nursing home has a history of problems related to the abuse and care of patients, including patient-on-patient assaults.

The state found the facility failed to protect residents from alleged abuse, including abuse of patients by a resident who was a potential sex offender. In another case, Oxford Rehab waited six months to contact police about an allegation of patient-on-patient sexual assault.

The nursing home even hired back a certified nursing assistant who was previously suspended for verbally and mentally abusing a patient.

As a nursing home abuse and neglect attorney in Spartanburg, S.C., we often attempt to get the real story of what is going on at a nurisng home from talking to former employees.  Current employees are too scared to lose their job to tell the truth.  Former employees have no reason to lie or cover-up the abuse and neglect they witnesses.

Recently a certified nurse aide named Miaya Ramirez at University Heights Rehab & Care in Aurora, Colorado shared her credible concerns. Ramirez worked for University Heights Rehab & Care for several months.

Patients being neglected, not getting showers, not getting fed properly, being left in their room, unsanitary conditions, being left in soiled briefs,” Ramirez explained to Denver7.

The week after she started working, Ramirez says the Director of Nursing asked her to lie on a state report about being understaffed.

We had holes in the staffing book and the DON (Director of Nursing) asked me to fill in people’s names in the staffing book and I told her I didn’t feel comfortable doing that,” she said.

She says the doctor of one patient even called police about the neglect.

“When the doctor pulled the bandages off she couldn’t believe what she saw; she said the wounds were worse,” Ramirez said. “She asked if the dressings were being changed when they were supposed to, if the resident was getting up out of bed when she was supposed to and I told her ‘no,’” Ramirez said.

Ultimately, Ramirez was fired for putting a clean bandage on that patient. She shared recordings of her termination. University Heights said she was operating out of the scope of care.

“What they told me was I should have left the dirty bandage on her backside,” Ramirez said.

Complaints investigated by the Colorado Department of Public Health document multiple instances of alleged neglect and abuse.

In April, there were several complaints of patients being left in their beds overnight or all day not being checked on. One family complained they found their loved one in a soiled bed and briefs and in the same position they left her in the evening before.

In March, a resident said his dressings were not being changed for a pressure ulcer.

Then, there are multiple instances of residents falling out of lifts. Last year, a 61-year-old resident fell out of a lift and had a brain bleed so bad it “contributed to a decline in his ability to eat, drink and breath,” according to one report.

Another resident broke her leg trying to be transferred improperly.

Ramirez says under staffing and lack of training is the problem.

“They will lie and cover up,” Ramirez said. “When I came back from the doctor’s office, the DON was re-doing paperwork to make it look like they were taking care of that resident.”

One of the worse situations we investigate as a nursing home abuse and neglect lawyer in South Carolina is physical abuse by caregivers and resident to resident altercations. Violence and mistreatment between nursing home residents is a common occurrence, according to experts.

In a 2014 study of nursing homes, Cornell University researchers Karl Pillemer and Mark Lachs determined that resident-to-resident elder mistreatment affected nearly 20 percent of residents over a four-week period. Researchers concluded that people who typically engage in resident-on-resident abuse are cognitively disabled to some degree but physically capable of moving around.

Specific types of mistreatment included verbal incidents, such as cursing, screaming or yelling at another person (16 percent); physical incidents, such as hitting, kicking or biting (5.7 percent); and sexual incidents, such as exposing oneself, touching other residents or attempting to gain sexual favors (1.3 percent).

Their underlying dementia or mood disorder often can manifest itself as verbally or physically aggressive behavior, the study found.

In 2015, nursing and residential care facilities were also among the industries with the highest prevalence of nonfatal occupational violence, with a rate of 6.8 per 100 full time workers, according to the U.S. Bureau of Labor Statistics.

One study revealed that nursing assistants at facilities with special units for Alzheimer patients had a significantly high risk for assault injuries and human bites. Thirty-five percent of nursing assistants reported physical injuries caused by aggression from residents, and 12 percent reported experiencing a human bite within the previous 12 months while working.

A black housekeeper is suing the assisted living facility in Rutherfordton, North Carolina, where she was reportedly given a birthday cake with “a noosed up black hangman”.  The facility argues it was just a stick figure.

“While it is unknown whether (these) claims will survive testing at a later stage of this litigation, the allegations in her complaint, when viewed cumulatively and taken in the light most favorable to (her)… are sufficiently plausible,” a magistrate judge in the Western District of North Carolina said recommending the suit continue. A federal judge accepted his recommendations and rejected the senior care facility’s motion to dismiss.

Tonya R. Chapman penned her complaint late last year, saying she was a jack of all trades at Oakland Living Center where she worked as a housekeeper, personal care aid and cook for more than 10 years.

But as “the lone black employee,” she said Oakland and the family who runs it harassed her to the point of quitting.

“I deserve to be treated better,” Chapman wrote.

Chapman alleges in the complaint that she was subject to various instances of harassment during the course of her employment, including hearing one defendant reportedly say they needed a new beach house “because of all the blacks at Myrtle Beach.”

She said later in the suit that she was forced to turn sideways like a prisoner when taking her photo ID while another defendant joked she would be given a “slave number” on her badge.

The young son of one defendant also reportedly taunted Chapman with a chant — “N-word, N-word, get to work N-word” — and told her that his father had called her a “lazy black N-word” because she didn’t come to work, Chapman said.

“I asked him to please stop but he continued the ugly language,” she wrote in the complaint. “He then kicked me and hit me on the bottom. I just ignored him until he got bored and walked out of the kitchen for a minute.”

Chapman also said she was given a birthday cake in 2014 that depicted a black person in a noose.


Nursing home mogul Philip Esformes wept and pleaded for mercy before being sentenced to 20 years in prison for what the U.S. Justice Department called the largest single health care bribery and kickback scheme in American history. Esformes, who once controlled a network of more than two dozen health care facilities that stretched from Chicago to Miami, garnered $1.3 billion Medicaid revenues by bribing medical professionals who referred patients to his Florida facilities then paid off government regulators as vulnerable residents were injured by their peers, prosecutors said.

He housed elderly patients alongside younger adults who suffered from mental illness and drug addiction — sometimes with fatal results. In Esformes’ Oceanside Extended Care Center in Miami Beach, “an elderly patient was attacked and beaten to death by a younger mental health patient who never should have been at (a nursing facility) in the first place,” prosecutors wrote in a pre-sentencing memo.

In arguing for a 30-year sentence, prosecutors said his years long bribes-for-patients schemes involved the corruption of medical professionals and government regulators, and entailed grievous injuries to a massive number of elderly patients. Many of his younger, drug-addicted patients spent the daylight hours wandering the streets of Miami while he collected government payments for services that were never delivered, prosecutors said.

“Phillip Esformes used deceptive and calculated means to orchestrate a fraud of the magnitude that we have not seen before,” Medina said. “People who needed to get better, who wanted to get better, they had no shot.”

“His fraud involved thousands of patients, 16 nursing homes, the systematic payment of bribes, a complex web of bank accounts, and brazen obstruction of justice to try to prevent it all from coming to light,” prosecutor Elizabeth Young wrote in a sentencing memo filed with the court this week.

Prosecutors said Esformes should be forced to pay $207 million in restitution to Medicaid and Medicare; attorneys for Esformes sharply questioned that amount in court Thursday.
In one of Esformes’ crimes, prosecutors said, he used some $300,000 in stolen Medicare and Medicaid proceeds to bribe the head men’s basketball coach at the University of Pennsylvania to admit Esformes’ son to the school.

The dozens of nursing facilities Esformes ran with his father and business partner Morris Esformes for decades earned millions of Medicaid and Medicare dollars annually despite repeated federal law enforcement probes and Chicago Tribune investigations alleging substandard care and incidents when disabled patients were assaulted by fellow residents.

Absolutely disgusting!  Every time I see a news article about another resident being abused and harassed, I want to scream.  As a nursing home abuse and neglect attorney, we see this type of behavior often especially in short-staffed facilities where frustration and burn-out run rampant.

Video evidence shows that the staff at the Grace Care Northpointe Center nursing home physically abused a 93 year old resident.  The video is hard to watch and listen to because the resident was clearly roughed up by a certified nursing assistant where she’s been staying for about a year.

“She just snatched her around and continued to hit her over and over again while my mom just screamed for help,” Teno said.

Teno said after her mother complained of being hurt by some staff members, she decided to set up a hidden camera. Beyond what Teno said was verbal abuse, she also says there was physical abuse.

“It hurt me to see my mom being treated like that. And she could not defend herself,” daughter Mary Teno said.





Ryan Sheridan owned the Horn Nursing Home building and sought to turn the facility into a for-profit drug treatment center.  He was one of six people who pleaded guilty to a $48 million Medicaid fraud scheme.  Sheridan was the owner of Braking Point Recovery Center.  Prosecutors said Braking Point between January 2015 and October 2017 falsely billed Medicaid nearly 135,000 times. They say those claims included inflated costs for services, billing for patients who hadn’t been medically diagnosed and case management services for patients working out at Sheridan’s gym.

Authorities want Sheridan to forfeit $3 million, as well as properties he owns in several Ohio counties and replica movie vehicles.

After purchasing the former Horn facility, Sheridan unsuccessfully sought a tax-abatement incentive to develop the detox center.

Sheridan eventually defaulted on his mortgage payments to Huntington Bank, leading to a court-ordered auction.

There was a great article on Health Affairs website discussing the failures of nursing home oversight by CMS and their attempts to improve.

“More than 30 years after Congress passed the Nursing Home Reform Act, we are still failing to protect nursing home residents. Recent cases of abuse and neglect, repeated failures of governmental oversight, and stories of owners’ mendacity and greed are not only wake-up calls but sobering reminders of how far we have to go.”

The government has focused attention on nursing home care, releasing blueprints to put “patients over paperwork.” CMS also issued a proposed rule in July taking aim at a range of regulatory provisions it characterized as “unnecessary, obsolete, or excessively burdensome.” Advocacy groups expressed skepticism about CMS’s claims that these changes would “produce significant savings without jeopardizing patient care in any way” and that the “reduction in red tape [will] free up facility resources to focus on patient care.”

Nursing home providers are entrenched in a blind faith in deregulation (if only we reduced regulatory burden, providers could focus resources on resident care). CMS reflects the administration’s broader push toward deregulation and have exacerbated tensions between providers and advocates.

“Most visible among these changes are the repeal of the Obama administration’s arbitration ban, guidance that lessened financial penalties for past non-compliance, and a proposal to relax the frequency of surveys for better-performing facilities.”

“A key aim of nursing home oversight over the past decade has been to ensure greater transparency in nursing homes’ ownership and financing. Nursing homes have been mostly for profit for decades. In the early 2000s, increased private equity investment and ownership complexity spurred a renewed focus on this topic, culminating with provisions to bolster disclosure of ownership and financial relationships being included in the Affordable Care Act. Still, in the wake of scandals such as Skyline Healthcare, where a single owner acquired almost 100 facilities over a relatively short time period across multiple states before running them into the ground financially and putting vulnerable residents at risk in the process, it is clear that substantial gaps still exist.”

CMS should make more complete ownership data widely available, not only to researchers but to state licensure agencies that evaluate applications from potential operators. In addition, CMS should add the ability to examine care across all facilities of specific owners to the Nursing Home Compare website, allowing consumers and others to see quickly if an owner is generally involved in the provision of higher- or lower-quality nursing home care.

Beyond ownership, improving the ability to understand where nursing homes spend their resources and gaining a more accurate sense of their financial well-being are important elements of transparency. Progress has been made in simplifying nursing home cost reporting, yet, according to the Government Accounting Office, there are still substantial questions about the accuracy and completeness of these data. CMS should take further steps to ensure the veracity of these data and develop summary measures for inclusion in public use files or even on the Nursing Home Compare site to convey an accurate picture of facilities’ financial status and spending priorities.


Blue Ridge in Georgetown nursing home and rehabilitation center was named to a list maintained by the federal government of poorly performing facilities.  Blue Ridge in Georgetown was already fined nearly $44,000 for health violations in 2018. The facility received 33 health citations during its last inspection in October 2018.

Blue Ridge joined four other nursing homes in the Palmetto State as candidates for a federal oversight program. Commander Nursing Center in Florence has been officially flagged for the government to focus on since July.  Blue Ridge of Sumter was added to the list of candidates for the SFF program in June. Magnolia Manor in Columbia and The Retreat at Brightwater in Myrtle Beach were added in July.

The Centers for Medicare and Medicaid Services, the federal office in charge of administering the programs, keeps a list of nursing homes that consistently don’t meet standards and agreed to publicly release a monthly update to that list in June.

The most severe offenders are then designated as Special Focus Facilities. This designation increases the frequency that a nursing home must be inspected and sets guidelines for where and how quickly a facility must improve. Around 400 facilities are designated as SFF candidates at one time.

Facilities that do not graduate from the SFF program within 18 months risk losing their ability to participate in the Medicare and Medicaid programs.