A recent lawsuit alleges a Harlem nursing home allowed an elderly woman’s body to decompose for five days after her death. The lawsuit was filed by the daughter of the woman and alleges that staff at the Harlem Center for Nursing and Rehabilitation refused to call the morgue after the woman died and left her body in a storage closet.

The lawsuit alleges a supervisor claimed “it was not their job to contact the morgue. It was too much paperwork and too many questions to answer.” The lawsuit filed in Manhattan Federal Court seeks only $175,000 for emotional distress and other claims.

People are separated from their families, friends and jobs, lives disrupted to maintain social distancing and follow stay-at-home orders.  Residents of nursing homes are isolated, prohibited from seeing loved ones and neglected by short-staffing and ill-prepared facilities. Because of the coronavirus, the lives of the normally active and engaged residents have drastically changed. Visitors are now restricted, group activities are on hold and dining together has been replaced by take-out meals or meals served in their rooms.

“Our residents have been through a lot,” said Tara Ober, vice president of communications and resident life at the Brethren Village. “Many were born in the Depression, have fought in wars, lived through presidential assassinations, and emotionally, they are very tough. It’s unfortunate that they are also among the most physically vulnerable to this virus.”  “There is a heavy emotional toll,” Ober said. “It’s not only the families who have lost loved ones, but our team members have grown very close to our residents, and it’s a loss for them, too.”

In Philadelphia, where most of the state’s cases have been reported, nursing homes have already pivoted from trying to keep the coronavirus out to working like crazy to keep it from spreading, The Philadelphia Inquirer is reporting.
As an advocate, the main concern we are hearing from residents is what appears to be a lack of communication. Residents see staff members in gloves and masks. They see wings of their nursing homes being quarantined off. But they don’t necessarily know what’s going on – or they feel like they’re being kept in the dark about the spread of the virus. The association asks nursing homes to stay in touch with the loved ones of their residents, and if there is a positive case, keep them informed of how they are handling it.  Everyone knows how short-staffed nursing homes are and now with the staff sick or not showing up, staffing becomes even a bigger issue with the expectation that residents will suffer from preventable conditions like bed sores and falls.

The Chicago Tribune reported the settlement between Maxwell Manor nursing home and whistle-blowers. Maxwell agreed to pay more than $1.6 million to settle a portion of a whistle-blower lawsuit involving allegations of extreme patient abuse and Medicaid fraud. The lawsuit remained under seal until Monday, when the settlement was announced. Under terms of the agreement, the federal government would receive $1 million and the state would get $610,000, according to the U.S. attorney’s office.

In settling the federal suit, nobody admitted wrongdoing or accepted responsibility.  Two employees provided evidence that the owners and managers of the nursing home permitted routine sexual assaults, theft and improper medical care that, in some cases, resulted in death, and billed the federal and state government for care that was never administered. Apparently no one is going to jail for this fraud and abuse.

“It was an atrocious case,” said Robin Potter, an attorney for the whistle-blowers, Joyce Toomey, a former facilities program coordinator, and Larry Austin, a former psychiatric rehabilitation services coordinator. “No one exaggerated the conditions.”

The case began in February 2000 when Toomey and Austin filed a whistle-blower lawsuit against owners and operators of the home, which the former workers deemed “a house of filth, terror and death.”  Why did it take 20 years to resolve?

The facility was operated in a physically hazardous manner. According to the suit, chronic conditions included “bulging ceilings, crumbling walls, rodent and insect infestations, pervasive mildew and hazardous fire alarm and electrical systems.”

Managers of the nursing home engaged in a pattern of fraud that included falsifying patient charts to make it appear they were being treated and medicated, as well as failing to report patient accidents, abuse and assaults. In one case, a woman fell into a coma for days before medical personnel were called. She died within days.

“This was not your typical bedsore case,” said Colleen McLaughlin, another of Toomey’s attorneys. “This was much more. This was a hellhole.”


The Blade reported Shawna Isner was sentenced to two years of community control.  Not sure what that is but it seems like a good deal based on what she did to Evelyn Welty.  Isner pleaded guilty to patient abuse, a fourth-degree felony. Ms. Welty was severely injured while under the direct care of Isner at the nursing home. Ms. Welty was described as “spunky” and someone whose life was cut short by an unintentional act.

Isner was working as a state-tested nursing assistant on Aug. 7, 2017, when she was carelessly moving Ms. Welty from her bed without a second person. Ms. Welty was dropped during the incident and later died from her injuries. The Lucas County Coroner’s Office determined Ms. Welty’s death was from complications of blunt head and neck trauma, and it was ruled accidental.

“Every single life has value, and when that life is wrongfully taken, there must be punishment and that punishment must fit the crime,” Judge English said, prior to handing down the community control sentence. Isner must spend six months on electronic monitoring and perform 100 hours of community service. She will also have to pay restitution in the amount of $10,300 to Ms. Welty’s family.

Judge English said it is any child or grandchild’s worst nightmare to leave a loved one in the care of staff and then have that trust betrayed.

“This case is a true tragedy. There was a violation of rules and laws as it relates to the movement of a victim and that is she was required to have two individuals assist her,” Judge English said.




Erica Johnson is an award-winning investigative journalist for CBC. She recently wrote an article on a complaint filed against top-level staff at Athabasca Extendicare nursing home which accuses administrators of under-staffing the facility and locking up diapers to limit their use while incontinent residents sat in urine-soaked pads, suffering from severe bladder and yeast infections, painful skin rashes and open wounds from pressure injuries.

The allegation is just one of many in a complaint filed in December 2018 with the College and Association of Registered Nurses of Alberta (CARNA), claiming that senior staff at Athabasca Extendicare did not deliver proper care and hygiene to 50 residents and that the home was constantly understaffed.

All five people involved in the complaints to CARNA also describe under-staffing at Extendicare Athabasca. A former HCA writes that many shifts were short by one or two staffers and that overtime was “very seldom approved.” That meant “basic care would get overlooked, call bells couldn’t be answered in a timely manner and baths were skipped.”

In a separate dispute, Extendicare Athabasca was recently found to have violated both a collective agreement and the province’s Nursing Homes Act for not having a registered nurse on duty at all times. The company was ordered in December to pay $5,000 to the United Nurses of Alberta to account for lost union dues.

“It’s just despicable,” said Don Bryan, whose mother Sheila endured neglect while a resident before she died at age 83. “You don’t treat elderly people that way,” he said. “That’s just so wrong.”

Bryan, along with a resident, two former health-care aides and a nurse who resigned filed three complaints with CARNA, in December 2018.

Their complaints — obtained by Go Public — take issue with the inner workings of the for-profit nursing home, which former staff say came at the expense of quality care.

The longest, most disturbing complaint was filed by a nurse who worked at Athabasca Extendicare from April 2016 to March 2018 and then quit, Natalie Shipanoff.  She states the home rationed diapers — limiting most residents to three during the day and one at night.  In support of Shipanoff’s complaint, a former HCA writes that the facility ran out of incontinent products “multiple times” and that a diaper change “didn’t happen until the pad was 80% or more wet or soiled with feces.”

“Pads were a constant source of contention,” Shipanoff wrote, saying the director of care often wanted to know why so many were being used.

The director of care told staff, in a September 2017 email seen by Go Public, she was changing the access code to the room storing incontinent pads.

“The new code is not to be shared with HCA’s [health-care aides],” the director of care wrote, because “product removal was being abused.”

From then on, HCAs would have to track down a nurse — who may not be available for hours, wrote Shipanoff — to unlock the stash of diapers.

“What is the HCA supposed to do when the resident is full of feces and they do not have a clean pad to put the resident in?” wrote Shipanoff.

Statistics from the Canadian Institute for Health Information indicate that from 2017 to 2018 the home had a reported urinary tract infection rate of 7.5 per cent, much higher than the national average of 4.3 per cent.

Shipanoff also alleges HCAs were told to only use one diaper wipe when changing a resident, to save money, and that many suffered from painful health problems she attributed to poor hygiene.

She says staff were shown how to fold a 8×10-inch wipe to get 16 different surfaces to clean a resident and describes “fungal infections (yeast infections) of the skin, especially in the groins and perineum that were being left untreated for long periods.”

She describes “red, raw and sore” skin, chronic and “foul-smelling” rash and “open areas near anus from intense scratching.”

In part, she blames the home’s practice of not washing residents with soap and water during a diaper change.

“Can you imagine being incontinent of stool, with an indwelling catheter, and never being washed with soap?” she asks in her complaint. “It’s disgusting.”





The Citizen’s Voice reported the assault suffered by Ruth Ann Albrecht at Allied Services Meade Street Skilled Nursing facility.  Berlanne Smith was charged criminally in December with the assault and harassment of Ruth Ann. Ruth Ann had to file a claim to request compensation for the alleged abuse and neglect. The lawsuit blames a co-worker who witnessed the abuse and their employer, Allied Services Personal Care, Inc.  Smith assaulted Albrecht while she was in the shower, the complaint alleges.

The defendant, Berlanne Smith, while working in the aforesaid facility, engaged in the most depraved conduct that a human being can perpetuate,” the Complaint states. “That is, she took advantage of one of the most vulnerable members of society’s population: a weak, frail, demented, elderly woman.”

According to the police account of the assault, certified nursing aide Lawrence VanBuren-Morgan reported hearing a female resident “screaming at the top of her lungs” and found Smith “grabbing and twisting” at Albrecht’s breast.

Smith left the room, but a short time later VanBuren-Morgan saw her return and close the door, police said. When Albrecht began screaming again, VanBuren-Morgan found her with a bloody nose, saying Smith had hit her in the face, according to police.

The civil complaint targets VanBuren-Morgan as well as Smith, alleging he “did not properly intervene” nor timely report the assault.


The Iowa Dispatch reported the disturbing “care” provided to residents at Rowley Memorial Masonic Home. The nursing home cut staffing to compensate for financial losses and landed on the federal watch list after inspectors cited the facility for contributing to a resident death, hiring an unlicensed caregiver, failing to protect residents from sexual abuse and allowing a kitchen worker to supervise its dementia ward.

The home is now on the Centers for Medicare and Medicaid Services’ Special Focus Facilities list. The national list was created to identify those homes that have an established pattern of numerous, serious violations related to resident care. The home is still allowed to operate on a conditional license from the state.

The home is owned by the Herman L. Rowley Memorial Trust and is part of the Rowley Masonic Community complex, which includes assisted living units and independent living apartments. The facility is run by Health Dimensions Group, a Minnesota company that manages nursing homes in Iowa, Colorado, Wisconsin, Illinois and other states.

In May 2019, the home was cited for failing to have on hand any portable liquid oxygen tanks for the residents who had been prescribed continuous oxygen. Inspectors determined the facility’s oxygen-tank supplier had stopped making deliveries of oxygen due to non-payment of past-due bills.

The inspectors then discovered there were 31 vendors – including suppliers of medical equipment – that were owed almost $600,000 by the Rowley Memorial Masonic Home. Seven vendors that provided essential resident-care services told inspectors they would no longer do business with the home. In addition to that, the facility was $600,000 behind on its mortgage, inspectors said.

At the time, the facility was also cited for a 16% medication-error rate. One resident had to be taken by ambulance to a hospital after being found unresponsive in bed after a staff-induced drug overdose.

Inspectors also cited the home for failing to have a functional call-light system that would allow residents to summon the staff for assistance. Residents reported soiling themselves as they waited 40 minutes for someone to come to their aid. An audit of the call-light system revealed 472 instances, over a seven-week period, in which residents waited 15 minutes or more for a response.

In the wake of that inspection, federal officials fined the home more than $106,000.

Two months later, in July 2019, inspectors returned to the home and cited it for failing to protect a male resident of the home’s dementia unit from sexual abuse at the hands of another male resident. In one instance, a worker saw the alleged perpetrator pin the victim against the wall and put his hand in the other man’s pants. The facility was also cited for medication errors, insufficient staff, and inadequate training for the staff. Residents were waiting up to 62 minutes for a response to their call lights, inspectors alleged.

In October 2019, inspectors returned to the home and issued a 111-page report detailing 21 additional violations, including failure to complete background checks on workers; failure to report physical altercations among the residents; medication errors; improper use of psychotropic drugs; and employing as a nurse aide an individual who had failed the skills test three times and wasn’t state certified as required by law.

The home was also cited for having insufficient bedside medical equipment for a tracheostomy patient who was found in bed, not breathing, three days after admission. With no equipment readily available to suction the resident’s airway, a nurse aide tried to breathe air into the man’s lungs using only her mouth on the surgical hole in his neck. The man was rushed to a nearby hospital where he died two hours later.

The home’s nurse manager and director of operations each told inspectors the man should never have been admitted to the home given the level of skilled care he required.

On at least nine occasions in the month leading up to the October inspection, the only person working a shift in the home’s dementia unit was a kitchen worker who told inspectors he had been “sitting shifts” in the nursing department for about two months, although he had no medical certification of any kind. He told inspectors that while he couldn’t legally provide resident care, he supervised the unit and could shut off residents’ call lights and inform them someone else would eventually come to assist them.

Other workers told inspectors the facility was often short-staffed and residents were falling and being injured as a result. They acknowledged their practice was to answer call lights by shutting them off with a promise to return later and provide whatever assistance the residents needed.

Even with state inspectors on site, there were times when the dementia unit was either entirely unstaffed or had only one nurse aide present. An inspector observed one resident near a doorway repeatedly yelling, “Help me,” with no workers responding.

Additional state inspections were conducted at the home in November, December and January, but the Iowa Department of Inspections and Appeals has yet to publish the findings from those inspections on its web site.

In November, the agency suspended all Medicaid and Medicare payments for new admissions to the home. About damn time!

An 89-year-old woman was found dead outside of Union Printers Home nursing home after she froze to death on a bench outside according to The El Paso County Coroner’s Office.

Margarita Sam’s family hired McDivitt Law Firm to look into her death.

“Oftentimes, these are absolutely avoidable. The injuries are avoidable, these deaths are avoidable,” Attorney David McDivitt said. “Were there protocols that weren’t followed? Were there procedures that were violated?” he said.

McDivitt said Sam’s family still can’t believe their loved one froze to death at a nursing home.

“People go into facilities like this so that they could have that support and that care provided to them, and to find out that they are allowed to freeze to death outside is alarming,” McDivitt said.

A lawsuit hasn’t been filed in the case.

The family wants to get answers, closure and be sure there is accountability. Most of all, they want justice.

Genesis HealthCare, a large publicly traded firm that owns and operates nursing homes, agreed to pay Vermont $740,143 to resolve allegations of neglect resulting in three serious injuries and a death. The agreement settles claims relating to the state’s vulnerable adult statutes and the False Claims Act. The settlement stems from preventable incidents at three facilities in 2018 and 2019.

The three facilities — St. Johnsbury Health & Rehab, Berlin Health & Rehab Center and Burlington Health & Rehab Center —have a history of problems. The St. Johnsbury and Berlin homes both have one out of five stars, based on metrics that include three years’ worth of health inspections, staffing levels and clinical outcomes for residents. The Burlington facility has two stars. The statewide average for nursing homes is 3.2 stars, while Genesis-owned homes average 2.6. Genesis is a Pennsylvania-based corporation that owned or managed 425 facilities in 29 states as of December 2018, according to its reports filed with the Securities and Exchange Commission.

In addition to paying damages and penalties, Genesis said it would create a position for a patient care coordinator, who would be in charge of training staff at the three facilities and report progress to the state. The company also agreed to hire an independent monitor to perform an annual review of the three facilities. However, Genesis denied the clear violations of standards but agreed to the settlement “to avoid the delay, expense, inconvenience and uncertainty of litigation,” according to settlement documents.   In 2017, Genesis agreed to pay $53.7 million to the U.S. Department of Justice to settle claims of false billing practices. Over the past three years, the company has also paid $131,687 in regulatory fines for deficiencies at its nine Vermont facilities. The company reported $4.98 billion in revenue in 2018.

Staffing problems factored into multiple incidents the state flagged as part of the Genesis settlement. In two instances, short-term staffers at the Burlington and St. Johnsbury facilities gave residents who were on specialized diets the wrong food, and the residents choked. The St. Johnsbury resident required hospitalization; the Burlington resident later died.

The state also cited an incident at the Berlin Health & Rehab Center in which staffers identified two ulcers on a resident’s leg but failed to perform required wound assessments. The resident required hospitalization to treat the ulcers.

In an April incident, the Burlington Health & Rehab Center improperly discharged a resident with lower-body paralysis after failing for months to treat his emotional issues and alcohol addiction. A staffer dropped the resident off at a nearby hotel, booked a one-night stay for him and left, despite knowing that he could not get into bed, use the toilet or access food, drink or medications without help. The facility did not notify his family or the Visiting Nurse Association about the discharge until the next day.

After the man spent a single night in the hotel, staff asked police to check on his welfare. He wound up at a hospital, where staff noted he was covered in feces, had a burst catheter bag, and was suffering from fever and an acute kidney infection.

The settlement noted that the facility billed Medicaid for the man’s care the day after he was dropped off.