Monthly Archives: December 2019

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The news of people abusing nursing home residents are especially tough around the Holidays when I’m trying to get into the festive mood.  Recently, I read about a young woman named Berianne Smith who was arrested over the weekend, with police saying she attacked a patient, twisting the woman’s breasts and nipples.  Smith is a certified nurse aide at Allied Services Meade Street Skilled Nursing.

Smith was charged abuse of care of a dependent person, simple assault and harassment, after city police responded to reports of the assault. A co-worker, Lawrence VanBuren-Morgan, told police he heard the female patient “screaming at the top of her lungs as if she was being attacked or in a fight.”  VanBuren-Morgan said he hurried to her room, where he said he saw Smith “grabbing and twisting at (the victim’s) breast.” VanBuren-Morgan said he heard the patient yelling that Smith was twisting her nipples.

A short time later, VanBuren-Morgan said he saw Smith return to the room, and he once again heard the patient screaming. He returned again to find the woman’s nose was bleeding, claiming Smith had hit her.

The alleged victim was taken to the hospital, where she was treated for multiple bruises and swelling.


I have to be honest. I had never heard of “elder support ratio” until reading an article on The Post Star.  I normally just call it short-staffing. Low staffing also results in higher fatigue and burnout, physically and mentally, and lowers the quality of care and the safety and well-being of the residents.

The elder support ratio — which compares the number of 18-to-64-year-olds who can provide services to those 64 and older — had changed drastically in the last century. In 1900 it was 13.6 to 1, but by 1960 the number of eligible providers had been cut in half. In 2014 the ratio was 4.3 to 1, and by 2030 it is projected to be 2.8 to 1.

This shortage is only going to get more severe as more members of the baby boomer generation — those born between 1946 and 1964 — continue to retire. While 35.1 million Americans turned 65 and became eligible for Medicare in 2000, it is projected 69.7 million Americans will reach that in 2030.

The article emphasizes that “nursing homes are in a race against time to find staff as the “elder support ratio” is getting increasingly lopsided. These facilities are facing understaffing as more and more members of the baby boomer generation are reaching retirement age.”

Many areas of the country claim there is a worker shortage.  But the truth is that if they paid the caregivers a reasonable living wage plenty of people would apply because the work is very satisfying when the employees are treated well.

Some people claim that health care is a “niche” profession and that elder care is even more niche. It requires a lot of work for low wages, not just anyone can do it. But for those with a passion for it, it can be a rewarding career.

The reckless abandonment of an out-of-state ownership group left Arkansas nursing homes in chaos attempting to find new places for residents before supplies ran out.  Georgia-based Marsh Pointe Management took over the facilities a couple of months ago but now refuse to continue operating the facilities.  Such sudden closures are unusual. Officials from the Marsh Pointe company told administrators at the Horseshoe Bend home that they would no longer pay for supplies, including food.

Records show that in early November, the state’s Office of Long Term Care, which oversees nursing homes, denied an application filed by Christopher Brogdon of Atlanta for Marsh Pointe to run the homes.  Brogdon, who is licensed to operate homes in Hazen and Lonoke, is under federal court order to repay more than $80 million to investors, whom a federal watchdog accused him of swindling in nursing home deals.

After reviewing federal Centers for Medicare and Medicaid Services ratings for homes that Brogdon controls in Arkansas and other states, Arkansas officials determined that he “had not demonstrated that his facilities were in substantial compliance with state and federal laws,” a Department of Human Services spokeswoman said Friday.

“Suddenly the management was running up and down the hall telling us, you’ve got to be out of here by Friday. … [The operators are] not going to pay one more penny,” resident Arthur Pigg said. “Not food, not nothing.”

However, Pigg did not blame the nursing home’s caregivers, adding that they had done a good job with the tools they’d been given.

From almost the first day I’ve been here, they’ve had owners and operators who never supported them properly, who put continuous barriers in the way of their doing their work for us,” he said.

The U.S. Securities and Exchange Commission sued Brogdon for securities fraud in November 2015. One month later, a federal judge ordered him to repay investors in 19 bond and private financing offerings.

The SEC complaint accused him of using the money he raised for personal gain and to prop up business interests that were outside the scope of the borrowing. It said Brogdon misled investors in nursing homes and other long-term care facilities as far back as 2000.

The court deemed Brogdon unfit to run publicly traded companies and barred him from management or director roles at firms that report to the Securities and Exchange Commission.

Human Services Department spokeswoman Amy Webb at the time called the finding “concerning” and said officials were unaware of the case when Brogdon received his licenses.



Karen Paredes-Luquin is a nursing assistant at Auburn Oaks Care Center nursing home facing multiple charges of felony fraud involving elders she cared for, according to the Placer County Sheriff’s Office.  Paredes-Luquin was caught on surveillance video Nov. 22 using stolen credit cards belonging to two residents.

Authorities received reports of the fraud from the nursing home and found video at the locations the credit cards were used. One of the videos shows Paredes-Luquin wearing nursing scrubs and a surgical mask while making the purchases, which made the cashier serving her suspicious, according to officials. The cashier followed Paredes-Luquin and wrote down her vehicle information. The cashier was able to provide that information to investigators, who then used it to identify Paredes-Luquin.

Detectives arrested Paredes-Luquin when she arrived at work and charged her with multiple counts of felony fraud. She has since posted $100,000 bail and was released from custody.


The skilled nursing industry lost 1,300 jobs in October and 1,700 jobs in November after the new Patient Driven Payment Model was started on October 1, 2019.  Despite the overall healthcare sector seeing significant growth according to the latest employment figures released by the Bureau of Labor Statistics, somehow nursing homes cut staffing.

The lack of hiring at nursing homes is being impacted by the new Patient Driven Payment Model. There have been numerous reports of full-time therapist ranks being thinned out, for example.  However, long-term care operators are currently complaining about workforce shortage.  Last week, industry lobbyist LeadingAge formally announced an initiative that aims to increase the number of foreign-born aging service workers to help ease caregiver shortages.


When managers and owners of Symphony Residences nursing home discovered employees had stolen more than $700,000 from a 98-year-old resident who has Alzheimer’s disease, they didn’t fire them or go to authorities — they sought to cover it up, according to a lawsuit.  The Cook County public guardian’s office filed a 335-page complaint seeking monetary damages for four entities that own Symphony Residences, several managers and the five employees accused of stealing Grace Watanabe’s life savings.  The lawsuit alleges Cruz and other nursing home executives discovered the theft and failed to report it to law enforcement.

Bank regulators noticed irregularities and brought the case to the attention of authorities.

The lawsuit accuses nursing home executives of locking Watanabe in an office to keep county social workers from moving her to another nursing home. Word of the standoff got back to authorities who dispatched Dawn Lawkowski-Keller, an attorney who works in the financial recovery unit. After a shouting match, Lawkowski-Keller boiled it down for Symphony Executive Director Erika Cruz: “You have 5 minutes or we’re calling the cops.”  Cruz finally freed Watanabe.

An investigation later concluded that five nursing home employees used Watanabe as their personal piggy bank — draining her life savings through a series of ATM withdrawals, forged checks and other payments.  Two of the five employees accused in the civil suit of stealing from Watanabe have been charged criminally with financial exploitation of an elderly person.

A separate civil suit filed seeking information from Symphony is stalled while company executives appeal a September court order compelling them to testify. They are being fined $400 for every day they defy the order and remain silent.

Watanabe was born in Santa Cruz, California, in 1921 and was held in the Poston internment camp from 1942 to 1946. After her release, she earned a bachelor’s degree in English from the University of Illinois at Chicago.


Physician coverage in nursing homes has been cited as a key area of potential improvement for the industry — both for resident outcomes and financial health. Doctors who specialize in nursing home residents tend to be few and far between in many markets, despite the fact that timely interventions from physicians and other advanced practitioners generally lead to better outcomes and fewer penalties under various value-based models.

A new law in New York will require nursing home operators to provide information about their relationship to physicians including  privileges to residents as a prerequisite for admission. Signed into law by Gov. Andrew Cuomo last month, the update to the state’s public health law means that skilled nursing facilities can’t accept residents until they receive a description of the policy regarding granting physician privileges. The issue is a matter of informed patient choice.

Potential nursing home residents have a right to know which physicians will be available to provide care prior to signing a residency agreement,” Sanders said.  “Many individuals enter nursing homes having pre-existing relationships with doctors in their community,” Sanders said. “Whether or not those physicians already have or have the opportunity to be granted privileges may play an important role in choosing a nursing facility.”

As the Patient-Driven Payment Model (PDPM) was rolled out this year, SNF-specific physician groups marketed their services as a way to increase nursing homes’ ability to serve higher-acuity residents and handle the documentation necessary to receiving proper Medicare reimbursement under the new system.



WPDE reported that construction for the $55 million Florence VA nursing home started in July and is progressing well.  It’s being built on 33 acres off of National Cemetery Road just down the road from the Florence National Cemetery and the Florence County Veterans Affairs Office. Officials said the Florence facility will cost about $55 million. The nursing home will include 104 bedrooms, a dining area, and a recreational facility.

The S.C. Department of Mental Health operates all VA nursing homes in the state. The VA center will create 100 new permanent jobs and generate nearly $20 million in revenue for the Florence economy during the construction phase of the project, according to Florence County Senator Hugh Leatherman (R).

Many people in the community said they’re excited that veterans will have a resting place and the new jobs created at the nursing home.


Substance abuse among health care professionals (especially nurses in skilled care facilities) has increased significantly over the last decade.  The opioid crisis has dramatically affected nurses and other caregivers. Recently another registered nurse was arrested for stealing pain mediacation and watering down morphine intended for a patient, according to court documents.  Joshua D. Williams worked at Greenbrier Regional Medical Center. He was charged with tampering with a consumer product.

The indictment says Williams was working as a supervisory registered nurse at Greenbrier Regional in August 2018 when he tampered with a bottle of liquid morphine sulfate prescribed to a patient. The indictment says he removed a quantity of the drug and replaced it with a saline solution, diluting its concentration to about 14% of what it was labeled.

Court documents don’t say why Williams allegedly diluted the morphine, but according to media reports and prosecutors in other cases, medical staff oftentimes steal the opiate for personal use.

“The morphine discrepancy … was detected during a routine audit,” R. Bruce McCorkle, Greenbrier Regional’s administrator said in a statement, indicating staff reported the situation to “the appropriate state and federal authorities.”

The department said he is authorized to work in several other states, including Maryland, West Virginia and North Carolina.


On October 26, 2016, CMS published the final revised federal nursing home regulations for nursing homes participating in Medicaid or Medicare programs (Requirements of Participation).  These requirements have been implemented in three phases: Phase 1 went into effect on November 28, 2016;  Phase 2 on November 28, 2017; and Phase 3 was implemented on November 28, 2019.

The Phase 3 regulations include:

§483.12 Freedom from abuse, neglect, and exploitation
(b)(4) Coordination with QAPI Plan

§483.21 Comprehensive person-centered care planning
(b)(3)(iii) Trauma-informed care

§483.25 Quality of care
(m) Trauma-informed care

§483.40 Behavioral health services
(a)(1) As related to residents with a history of trauma and/or post-traumatic stress disorder

§483.70 Administration
( d)(3) Governing body responsibility of QAPI program

§483.75 Quality Assurance And Performance Improvement
Entire section except for the following provisions implemented in Phases 1 and 2:
(a)(2) Initial QAPI Plan must be provided to State Agency Surveyor at annual survey.
(g)(1) QAA committee — All requirements of this section with the exception of subparagraph (iv), the addition of the IPCO
(h) Disclosure of information
(i) Sanctions

§483.80 Infection Control
(b) Infection preventionist (IP)
(c) IP participation on QAA committee

§483.85 Compliance and ethics program
Entire section

§483.90 Physical environment
(f)(1) Call system from each resident’s bedside

§483.95 Training requirements
Entire section except for the following provisions implemented in Phase 1:
(c) Abuse, neglect, and exploitation training
(g)(1) Regarding in-service training, (g)(2) dementia management & abuse prevention training, (g)(4) care of the cognitively impaired
(h) Training of feeding assistants

However, according to a memo issued by CMS, the Interpretive Guidelines for the regulations will not be released until the second quarter of 2020. CMS notes that until the guidance is released, “our ability to survey for compliance with these requirements will be limited.”  At the same time, the agency emphasizes that facilities are still required to comply with these regulations even without guidance.