The Gowanda Rehabilitation & Nursing Center was fined $10,000 after mishandling the sexual assault of a patient. According to investigators, numerous deficiencies were discovered related to the prevention and investigation of the incident.

According to a report compiled by the New York State Department of Health, a male resident was found with his pants down, on top of a female resident in the early hours of May 29, 2019.  The female resident could be heard saying, “no, no” before staffers intervened. The female resident suffers from “severe cognitive impairment.” The male resident who carried out the sexual assault is said to suffer from, “moderate cognitive impairment” and who, according to the report, “knew what he was doing but not with who. He was confused.”

In the subsequent hours, state investigators say the facility did not take proper steps to preserve or document potential evidence. The staffers denied at first that a sexual assault actually occurred. An examination several hours later at a nearby Emergency Room revealed physical evidence proving an assault had occurred.

 

Manor Pines Convalescent Center nursing home must pay $356,700 to the family of a 92-year-old man who fell and injured his head but was not taken to the hospital, an arbitration panel has ordered.  Calvin Gorsuch had Alzheimer’s disease and a history of falls and had been admitted for rehabilitation. After he was transferred into the skilled care nursing section of the facility, he fell and hit his head. This was Gorsuch’s fifth fall at the facility.

Workers performed an X-ray and deemed him clear to return to his room, rather than sending him to the hospital for treatment. Gorsuch developed a hematoma on his brain and died eight days later.

Gorsuch, a World War II veteran, was married for 65 years and is survived by his wife and two children.

An arbitration panel found Manor Pines Convalescent Center negligent and in violation of residents’ rights. On Nov. 21, the panel awarded the family $6,700 for funeral costs and $350,000 for pain and suffering. Because Gorsuch had fallen before, Manor Pines also should have provided more supervision.

U.S. Representatives Linda T. Sánchez (D-CA) and Jan Schakowsky (D-IL) today introduced the Fairness in Nursing Home Arbitration Act to protect the legal rights of elderly Americans. This legislation would prohibit long-term care facilities from requiring or soliciting residents to enter into pre-dispute, mandatory, binding arbitration agreements.

 Rep. Linda Sánchez – “This legislation is about putting patients and families first. The decision to transfer a parent or loved one to a long-term care facility is heart-wrenching. I still remember the day we moved my late father into a nursing home. My family and I were focused on the quality of care and range of services the facility would provide him. We were not focused on the language in the agreement that would limit his rights should something go wrong. Under this bill, families will no longer have to worry about losing their right to a day in court. I urge my colleagues to join me in protecting one of our most vulnerable groups in society, the elderly.”

Rep. Jan Schakowsky – “Every day, families bring their loved ones to nursing homes all around the country, certain that they will receive the high-quality care and comfort they need. Unfortunately, many of them unknowingly sign away their right to seek justice and are forced into an often unfair arbitration process should a nursing home resident be harmed. Whether it’s willful neglect or a simple accident, residents and their families should have the right to seek justice in front of a judge and jury, and not be locked into a conference room for forced arbitration.”

This legislation is endorsed by:

  • AARP
  • California Advocates for Nursing Home Reform
  • Caring Across Generations
  • Center for Medicare Advocacy
  • Justice in Aging
  • Long Term Care Community Coalition (LTCCC)
  • National Academy of Elder Law Attorneys
  • National Association of Local Long Term Care Ombudsman (NALLTCO)
  • National Association of Social Workers (NASW)
  • National Association of State Long-Term Care Ombudsman Programs (NASOP)
  • National Consumer Voice for Quality Long-Term Care
  • Public Citizen
  • Service Employees International Union (SEIU)

 Rep. Sánchez first introduced the Fairness in Nursing Home Arbitration Act in the 110th Congress after hearing numerous testimony during her time as Chairwoman of the House Judiciary Committee’s Subcommittee on Commercial and Administrative Law.

AARP Senior Vice President of Government Affairs Bill Sweeney – “When individuals and their families make the difficult decision to enter a nursing home, often in emergency situations, they should not be forced to sign away their legal rights through mandatory arbitration agreements. AARP supports the Fairness in Nursing Home Arbitration Act because it would prohibit these fundamentally unfair contract provisions. In the heartbreaking cases where loved ones in nursing homes are abused or injured, they should not lose access to the judicial system. We thank Representatives Sánchez and Schakowsky for their important work on this issue.”

American Association for Justice CEO Linda Lipsen – “Forced arbitration strips our nation’s most vulnerable citizens of their legal rights when a nursing home corporation’s negligence causes the injury or death of a patient. We applaud Rep. Sánchez for introducing the Fairness in Nursing Home Arbitration Act and ask Congress to act quickly to restore long-term care patients with their constitutional right to be heard by a judge and jury.”

Long Term Care Community Coalition Executive Director Richard J. Mollot – “LTCCC believes pre-dispute arbitration agreements are inherently unfair to residents and families. When a resident enters a facility, they are not likely to be in a position to truly consider what future problems may occur. Most people are overwhelmed by the situation and trust that the nursing home is providing them with paperwork to sign that is both necessary and in the resident’s best interest. Nobody knowingly enters a nursing home expecting that they will be abused or neglected.”

Public Citizen Counsel for Civil Justice and Consumer Rights Remington Gregg – “We thank Rep. Sánchez for being a champion for seniors. If seniors are injured, abused, or otherwise harmed, they and their families should have peace of mind that they will be able to hold corporate wrongdoers accountable in court and receive the justice they deserve.”

Center for Medicare Advocacy Policy Attorney Dara Valanejad – “Too often, nursing home residents and families enter into pre-dispute arbitration agreements in the midst of physical and emotional crises. The Fairness in Nursing Home Arbitration Act of 2019 will ensure that long-term care residents and those in community-based settings are not forced, coerced, or “requested” to waive their right to court proceedings before a dispute even arises. Our nation’s most vulnerable individuals deserve to be protected from these pre-dispute arbitration agreements.”

National Consumer Voice for Quality Long-Term Care Director of Advocacy & Outreach Robyn Grant – “The National Consumer Voice for Quality Long-Term Care thanks Congresswomen Sánchez and Schakowsky for their leadership in protecting nursing home residents and individuals receiving Medicaid-funded home and community -based services from forced pre-dispute arbitration agreements. Such agreements are fundamentally unfair to consumers of long-term services and supports in any setting. They pressure people to decide how to settle a dispute – which could involve gross negligence, abuse, or even death – before a dispute arises and without any information about the dispute. Once signed, the individual loses forever their constitutional right to pursue action in a court of law. These agreements take advantage of consumers at their most vulnerable and stack the deck against them by frequently allow the long-term care provider to select the arbitrator, the rules for the arbitration process, and where the arbitration will be held. But pre-dispute arbitration agreements harm more than the individual who is seeking justice and accountability. Because the agreements usually are confidential, the public, including those looking for a nursing home, will never know the nursing home’s full track record – no matter how bad – because it is hidden. We applaud both Congresswomen for their commitment to ending this shameful practice and upholding the rights of vulnerable individuals in need of care.”

 

The Trump administration recently announced getting rid of safety regulations placed on nursing homes.  The administration states that the proposed changes would save nursing homes some $600 million a year, though as NPR noted, the proposed regulation reduction wouldn’t require that any savings be spent on improving patient care or increasing staffing.

One particular proposal, which experts and consumer advocates are concerned about is changing the rules for prescribing danagerous and deadly antipsychotic medications to patients at nursing homesConcerns stem with warnings about antipsychotic drugs – used as a chemical restraint and often off-label – can often raise the risk of death in older individuals, particularly from ones already suffering from dementia, according to the NPR report.

CMS has spent years attempting to get nursing home facilities to reduce the use of antipsychotic drugs.  Under current regulations, nursing home facilities cannot prescribe patients antipsychotic drugs for longer than two weeks without having a doctor reevaluate a patient. Under the new proposed regulations, nursing homes could go as long as one to two months without having a doctor evaluate a patient, according to the NPR report.  There is no medical or nursing rationale for this change.

Richard Mollot, Executive Director of the Long Term Care Community Coalition told NPR that his organization opposes the rule change, and cited a doctor who explained why he likewise opposed the regulation adjustment.

“What he said was that no other insurance company would ever accept that a doctor didn’t have to see a patient before continuing a prescription for medicine,” Mollot said. “But CMS is saying now that that’s okay for nursing homes in this very vulnerable population, and people die from this. They’re affected so catastrophically.”

 

 

 

A recent report published in the Journal of the American Medical Association that looked at the past six decades of mortality data noted a decline in overall life expectancy in the United States for three consecutive years. The JAMA report looked at life expectancy and mortality across the country from 1959 through 2017. Final life expectancy numbers for 2018 will be released soon by the U.S. Centers for Disease Control and Prevention. The general trend: Life expectancy improved a great deal for several decades, particularly in the 1970s, then slowed down, leveled off and finally reversed course after 2014, decreasing three years in a row.

Despite spending more on health care than any other country, the United States has seen increasing mortality and falling life expectancy for people age 25 to 64, who should be in the prime of their lives.  Death rates from suicide, drug overdoses, liver disease and dozens of other causes have been rising over the past decade for young and middle-aged adults. By age group, the highest relative jump in death rates from 2010 to 2017 — 29 percent — has been among people age 25 to 34. The all-cause death rate — meaning deaths per 100,000 people — rose 6 percent from 2010 to 2017 among working-age people in the United States.

In contrast, other wealthy nations have generally experienced continued progress in extending longevity. About a third of the estimated 33,000 “excess deaths” that the study says occurred since 2010 were in just four states: Ohio, Pennsylvania, Kentucky and Indiana. The state with the biggest percentage rise in death rates among working-age people in this decade — 23.3 percent — is New Hampshire, the first primary state.  All five of these states are part of the opioid crisis.

The risk of death from drug overdoses increased 486 percent for midlife women between 1999 and 2017; the risk increased 351 percent for men in that same period. Women also experienced a bigger relative increase in risk of suicide and alcohol-related liver disease.
Obesity is a significant part of the story. The average woman in the United States today weighs as much as the average man half a century ago, and men now weigh about 30 pounds more. Most people in the United States are overweight — an estimated 71.6 percent of the population age 20 and older, according to the CDC. That figure includes the 39.8 percent who are obese, defined as having a body mass index of 30 or higher in adults (18.5 to 25 is the normal range). Obesity is also rising in children; nearly 19 percent of the population age 2 to 19 is obese.

The National Association of Health Care Assistants has come forward to support a bill that would require minimum staffing requirements for nursing homes. The organization disclosed its support of the bill named the Quality Care for Nursing Home Residents Act.

The bill requires facilities to disclose their nurse staffing levels, and implement administrative staffing requirements and whistleblower and resident protections. Facilities could be subject to up to $10,000 in fines per day for noncompliance under the proposal.

No longer shall we accept being understaffed as a standard practice, all while claiming quality care is being provided. The needs of the residents are not being met and one reason is because sufficient staffing is not a requirement,” Dane Henning, NAHCA’s director of public policy, said in a statement. “We are in the business of taking care of humans with humans; how can this not be the most important aspect, the paramount characteristic in providing quality care,” he added.

“There are many aspects to recruiting and retaining staff, in which NAHCA have become experts; however, there really is no incentive for providers to do so. Unlike those that oppose, NAHCA supports this staffing bill, with or without funding. This is necessary in providing quality care and is a given in this line of work. This bill does not arrive a second too soon,” Henning added.

As a nursing home abuse and neglect lawyer, we see first hand how short-staffing affects the resident’s quality of care. I hope that the bill can get passed and signed into law.

There was a time when the “company town” was common–workers were required to rent their houses and buy their goods from their employers.  The Non-Profit Quarterly had an interesting article about the re-emergence of “company towns” as a way to help staff nursing homes.  Nursing homes and assisted living facilities are always hindered by high turnover and vacancy rates because of the low pay, burn-out, and difficult work of caring for vulnerable adults make these jobs less attractive.  The staffing problem is compounded by the lack of affordable housing.  There might be a solution.

Bill Bogdanovich runs Broad Reach Healthcare, a health system that includes both a skilled nursing facility and assisted living. Bogdanovich has invested in a new strategy: buying residential housing and renting it at below-market rates to his certified nursing assistants and other frontline workers.

Bogdanovich is offering below-market rents to attract employees to work in the wealthy community of Chatham, where housing is out-of-reach for his low-wage staff. One of the major barriers has been housing: unable to afford local housing, workers had to drive long distances to work, increasing their costs and reducing their own quality of life. In other words, unlike the company town of old, here housing is an employee benefit, not a profit center.

About a dozen of the certified nursing assistants and housekeepers employed by Broad Reach now live in housing units purchased by Bogdanovich. The units include a six-bedroom shared home in Brewster, as well as two apartment buildings in the Chatham area. More units will become available for Broad Reach employees as existing tenants move out.

Broad Reach has reduced its vacancy rate to eight percent, while the average vacancy rate at Cape Cod nursing homes is nearly 20 percent.

“Having this housing available nearby makes working here that much more doable for many of our people,” Bogdanovich told Boston Globe reporter Robert Weisman.

The Broad Reach solution may not be scalable, but for an independent senior care company, it’s working. By keeping rents low—he’s not looking to profit, just to pay off his mortgages—Bogdanovich has been able to offer his staff a life-changing opportunity: cheaper housing, lower commuting costs, and more time to enjoy Cape Cod, instead of sitting in their cars trying to get to and from work.

Healthcare IT News reported that Virtual Care Provider Inc., which provides hosting and IT services to post-acute care facilities nationwide, was hit by the Ryuk variant, locking access to patient data at 110 nursing homes.  VCPI estimates that  20% of its servers were affected by the attack. The company’s clients are primarily senior living and long-term care facilities, including 110 nursing home organizations with some 80,000 computers across 45 states. The hack against Virtual Care Provider Inc. (VCPI) means some locations cannot access patient records, use the internet, pay employees or order medications.

A ransomware attack carried out by Russian hackers has potentially put the safety of nursing home patients at risk, after Milwaukee-based cloud hosting firm Virtual Care Provider Inc. was hit with Ryuk encryption, preventing access to electronic health record and medication administration data. The Russian hackers, who demanded $14 million in bitcoin for a decryption key that VCPI cannot afford, apparently spread by the ransomware via the TrickBot virus, according to company officials, who said they are “feverishly working” to restore access to critical data.

I wonder if Trump and the Republicans will blame Ukraine?

New legislation seeks to protect individuals in nursing homes by implementing better staffing protocols — including increased clinical hours and training — among other safety measures for residents. The Quality Care for Nursing Home Residents Act has the support of at least 27 representatives and two senators. Nursing homes have a resident population of 1.5 million Americans every year — including older Americans, people with disabilities, patients with physical and mental health concerns.

The bill calls for more sufficient staffing levels, increased nurse training, and stronger protection for nursing home residents’ legal rights.

More specifically, the bill calls for:
  • Increased baseline staffing levels under Medicare and Medicaid;
  • Heightened training and supervision obligations for nursing staff;
  • Safeguards for whistleblowers for both personnel and residents;
  • Bans coercive arbitration arrangements between nursing homes and residents;
  • Implements a regulated protocol for collecting consent, both written and informed, from residents treated with psychotropic drugs

Staffing has come under scrutiny from lawmakers and the Centers for Medicare & Medicaid Services, with CMS recently amending the five-star rating system. The issue has also been in the press for years including a July 2018 New York Times piece revealing that nursing homes had been significantly over-reporting their nurse and caretaker staffing levels for years; CMS eventually re-calibrated and 1,400 buildings had the lowest one-star rating for staffing.

Under the proposal, nursing homes would have to meet the following standards for staffing, or face a freeze on payments and fines of $10,000 per day — as well as potentially having the government temporarily take over the property or terminate its ability to participate in Medicare and Medicaid.

Source: Rep. Jan Schakowsky

 

Falls-related injuries are a major point of concern for nursing home residents. McKnight’s reported on a new study showing the benefits of hip protectors for fall prevention.  Nursing home residents who use a hip protector are three times less likely to suffer fall-related hip fractures than those don’t use them, a new study found.

Patients who fell while not wearing the devices had rates of hip, pelvic and other fractures of 0.92, 0.21 and 0.71 per 100 falls, respectively. The rates of hip, pelvic and other fractures for residents who were wearing the devices during a fall were 0.33, 0.28, and 0.71 per 100 falls, respectively — a three-fold difference.

Experts, investigators, and consumer advocates agree that the findings show clear benefits of using hip protectors “can be achieved in practice” and may have significant impacts on real-world decision making for providers.

“It is one thing to show effectiveness in a clinical trial, where a team of investigators work to maximize adherence,” the authors wrote. “Our study moves beyond the artificiality of the clinical trial environment, to examine the real-life value of hip protectors in reducing hip fractures in LTC homes from a region of (British Columbia) that had attained 60% adherence with hip protectors.”

Researchers used data from residents in 14 long-term care homes who experienced at least one recorded fall during a 12-month period.

The findings were published in the November issue of the Journal of Post-Acute and Long-Term Care Medicine.