THI OF SOUTH CAROLINA AT CHARLESTON, LLC is a nursing home in North Charleston owned and operated by Fundamental Long Term Care Holdings LLC which is now known as Hunt Valley Holdings.  The facility is known as Riverside Health and Rehab.  The facility is awful as most of the facilities in that infamous national for-profit chain tend to be because of the policy to under-staff to increase profits.

Riverside is again facing a wrongful death lawsuit because a resident was neglected and died after the facility failed to take care of her.  An expert affidavit states that based on the medical records of the woman who died, it was documented the woman was at high risk for falls, but the facility’s employees failed to “properly implement fall prevention measures” to keep her safe.

The lawsuit was filed last month and claims a woman was admitted to Riverside Health and Rehab in September 2015.  About a year later, employees at the facility allegedly found her on the floor of her room with a laceration above her right eyebrow.  A couple days later, the resident got a fever and was taken to the hospital and diagnosed with dehydration and severe malnutrition.

A couple days after that, the lawsuit says that woman died as a consequence of the traumatic fall.

Public records from the state’s Department of Health and Environmental Control show this facility has a long history of complaints.

In the last five years, people have filed at least 43 complaints against Riverside. That’s more complaints than any other nursing home in Charleston County.

Roughly 36% of skilled nursing facilities saw a drop in their overall star ratings after planned fixes to the Centers for Medicare & Medicaid Services’ (CMS) Nursing Home Compare system took effect last month. About 16% of providers gained at least one star under the ratings overhaul.  Approximately 47% of skilled nursing facilities had no change in their overall rating, but slightly more lost one or more stars on the quality measure, Martin told SNN.

Roughly 48% of providers lost one or more stars in the quality domain, and that’s largely driving the decrease in overall stars.  A building’s five-star score consists of three separate metrics, each of which CMS also ranks from one to five: survey, quality, and staffing.

Staffing had taken center stage in CMS’s ratings overhaul, particularly after a New York Times investigation last summer revealed that operators may have been less than accurate in reporting nurse coverage information. Federal officials responded by slapping 1,400 facilities with one-star ratings on staffing.

Both the staffing measure and the survey measure are important, with survey having the most weight. Still, practically speaking, providers receive one standard survey a year. And improving staffing will require extra funds coming in from somewhere, as well as the effort of finding competent employees in a major workforce crunch.  Improving a SNF’s quality metrics, however, can begin much more quickly.

SNFs can also take steps to improve how they keep track of patients when they are discharged. Readmission penalties are assessed 30 days after hospital discharge, and so SNFs could be on the hook for any complications that arise after a patient leaves their care.

 

The embattled administrator of Veterans Victory House nursing home resigned.  Sandra Ferguson stepped down and has been replaced with Greg McNeil.  The infractions and fines against Veterans Victory House are in a report by the Centers for Medicare and Medicaid Services.

According to the document, the Veterans Victory House was not in compliance with the Medicare and Medicaid guidelines.  According to regulations, conditions at the nursing home were likely to cause serious injury, harm, impairment or death to a resident or patient.

The report also says Veterans Victory House will not be paid any Medicare or Medicaid claims for newly admitted residents. The federal government is giving the facility until Jun. 14 to comply with the guidelines or face the total loss of Medicare and Medicaid funding.
Veterans Victory House filed 29 reports of adverse incidents at the facility in February alone, according to new data from the Department of Health and Environmental Control.  (Nursing homes are required to file a report when there is a serious injury at the facility although often times many do not get reported).  DHEC sometimes even requires two reports to be submitted for every incident–a 24-hour report and a 5-day report.

The reports for Veterans Victory House list several cases that fall under the category “neglect or exploitation, suspected or confirmed abuse.”

Reports filed by Veterans Victory House staff in February also include two instances with a category that uses terms like “severe burns,” “lacerations,” or “severe injuries that could include medical equipment malfunction or misuse.”

Cohousing is a community where people own their individual homes plus a share of common areas such as outdoor space and a clubhouse with kitchen, living and dining rooms. They typically prepare and share meals several times a week and become more than just neighbors.

They are usually structured as a condominium with a homeowners association, but are self-managed. Owners (called members) collectively make decisions, usually by consensus. Committees oversee the financial, administrative, maintenance and other work normally handled by a management company, although they may hire outsiders for some jobs. Each member is expected, and in some cases required, to pitch in, whether it’s cooking, cleaning or fixing the Wi-Fi.

Senior cohousing is a newer type designed for people who want to avoid the isolation that can happen when families move away and friends die. “There is a natural loss of community as you age. There is no way to replace it with jobs or schools,” said Christian Zimmerman, whose company developed Phoenix Commons, where he also lives.

JoAnna Allen called it “a great antidote to the loneliness that hits a lot of people.” She was familiar with cohousing, but her husband, Ken, was less gung ho. He came around “once he realized he could still have his privacy and independence,” she said.

There are 168 established cohousing communities in the United States including 14 that are senior-focused, said Karin Hoskin, executive director of the Cohousing Association of the U.S.  None have been established in South Carolina yet.

Some of the senior communities have minimum age requirements; others don’t but end up with mostly seniors because they lack the space and amenities most families want. In California, senior housing developments generally can exclude residents younger than 55 if they have at least 35 units and meet other requirements.

When members get sick, other members usually will help with meals or trips to the doctor, but “this is independent living. There is nobody there to take care of you if you really need greater levels of care. We are very clear about that,” said Katie McCamant, owner of CoHousing Solutions, a development and consulting firm.

Owners can sell cohousing units to whomever they want as long as they don’t violate antidiscrimination laws. Buyers must meet age requirements in senior communities that have them.

Cohousing is “a peculiar market,” said Bob Miller, a member of Wolf Creek Lodge. Buyers “are not buying real estate. They are buying into a very special community. It’s not going to work for everybody.”

Prices at his 30-unit community range from $300,000 to $500,000. “For Grass Valley that’s not cheap,” he said. “It’s significant to buy in,” but ongoing expenses are “very economical.” Association fees run about $360 per month.

There’s no solid research on cohousing resale values, but in 2010, Davis appraiser Lee Bartholomew did a limited study looking at new and resale prices at five all-age cohousing communities in Northern California. Initially, they sold for more per square foot than standard condos, but they also have green-building features that add to construction costs and appeal to cohousing buyers. From 2008 through 2010, they appreciated faster than standard condos, he said.

A Centers for Medicare & Medicaid Services (CMS) official in a letter to the journal Health Affairs suggested that the public would benefit from more information about resident safety at nursing homes — including the explicit identification of bad actors.  Writing in response to a November study about the correlation between Nursing Home Compare star ratings and safety, CMS chief medical officer Kate Goodrich laid out a case for strengthening existing data sources for consumers

“While we view patient safety and quality improvement as a continuum, we agree that specifically ‘calling out’ facility performance on patient safety can resonate with and be beneficial to consumers,” Goodrich wrote. “In fact, CMS highlights performance on safety measures as a discrete domain in programs for other types of facilities, including those for hospitals and dialysis facilities.”

“We do believe that NHC contains additional measures that either directly capture harm or are highly correlated with harm that were not evaluated by the authors  — such as the measure for inappropriate use of antipsychotics, which is strongly linked to falls and other adverse events,” she wrote. “Nonetheless, we agree that NHC captures only a subset of harm, and a broader set of harm measures may be beneficial.”

Carolyn Rosenblatt who is an RN, Elder Law Attorney, and author related to healthy aging and protecting our elders at AgingParents.com and AgingInvestor.com wrote the below article for Forbes.

Any family member who has had a loved one go to a rehab facility (aka nursing home) after being in the hospital may have encountered this problem. Anyone with an aging parent who has to stay in one of these facilities for more than a few days is sure to have seen it. Understaffing is the problem. There are not enough aides and of even greater concern, not enough Registered Nurses. Of course this endangers residents who have inadequate supervision.  

The New York Times recently reported on this and the piece was commented upon by a trusted resource advocating for elders, The Long Term Care Community Coalition (LTCC). The article and commentary by LTCC emphasized that many facilities do not comply with the legal requirement that an RN must be on duty eight hours a day seven days a week. Why aren’t there enough staff and what can families do about it?

As for aides, I can personally testify from experience that it is a very tough job, very physically demanding and that the salaries are low compared with other, probably easier jobs. I found it rewarding to work with mainly older people in these homes but not everyone gets satisfaction from doing this kind of work. The turnover rate of aides is generally very high. RNs can often find better paying jobs elsewhere. These facilities then use “licensed practical nurses” or “licensed vocational nurses” (LPNs/LVNs) who are significantly less educated than RNs. Less skill can mean limited ability to correctly diagnose problems and communicate effectively with physicians, other nurses, families and providers. While many LPNs/ LVNs are very good at their jobs, they cannot legally substitute for an RN, whose training is more rigorous and extensive. Adding to the problem is the fact that our aging population is growing, the need for long term care such as is provided in these homes is also growing and the number of available, quality aides is not keeping up with demand.

We can’t always predict when a family member will need to go to such a facility. For example, after a stroke or heart attack, an elder may be briefly hospitalized to address the immediate problem, the next step is to send the elder to a place for longer term rehab services, such as physical, speech and occupational therapy. Medicare will not pay for any patient to remain in an acute care hospital for long when rehabilitation is the next step. If your loved one needs any of these therapies, expect that he or she will be discharged from the hospital, sometimes on short notice, and you will be asked to pick a nursing home for the needed rehab services. Typically a discharge planner, who is a nurse or social worker will simply hand you a list of nearby rehab homes and tell you to let them know which one you want, assuming you have some to choose from.

How do you know which ones are good and which ones are not? Some people use Medicare’s Nursing Home Compare, which rates homes on a 5 star basis–5 being the top and going down from there. My suggestion is that you should never rely totally on Nursing Home Compare. The information they give Medicare is self-reported and is based on comparisons with other nursing homes. If they’re all understaffed the site may be giving you an inaccurate picture of how good that home is. Here are some tips for choosing a nursing home for a loved one. It will take work but without that, your loved one can be put into a dangerous situation.

  1. If you have a list of homes, go visit a few before you send your mom or dad there, particularly if you can do so on the weekend. Staffing on weekends is notoriously low. You’ll get the picture if you see no aides around.
  2. Use this site to learn the staffing requirements for nursing homes in your elder’s area  www.nursinghome411.org.  You want to find a place that follows legal requirements.
  3. Check out a website devoted to consumer’s interests in long term care https://www.caregiver.org/national-consumer-voice-quality-long-term-care-formerly-nccnhr-0. You will find there an overview of each state’s nursing home system and licensing agencies, and a consumer’s guide to choosing a nursing home.
  4. Finally, in my book The Family Guide to Aging Parents, I discuss the issues of nursing homes in greater depth including Medicare/Medicaid citations against homes and what that means, fall prevention, skin care, contracts and how to be an advocate for your loved one in a nursing home.

There are hidden dangers in these homes and every family should be aware of them. If we want to ensure our aging parents’ safety, being aware, visiting or calling often and watching over what happens there can help our vulnerable elders as much as possible. Personal contact from family can make all the difference.

 

The Anderson Independent Mail reported on the sad state of care at South Carolina’s Veteran Homes. The article discusses the issues at Veterans’ Victory House,  a nursing home in Walterboro whose sign says it is the “home of the greatest generations.”   It is operated by HMR Veterans Services, Inc. HMR receives nearly $36.5 million annually from the state to operate Victory House and the Richard M. Campbell Veterans Nursing Home in Anderson County, two veterans’ nursing homes that belong to the South Carolina Department of Mental Health. The company also manages seven other homes for veterans in Texas, Alabama and Maryland.

There have been some troubling incidents at the company’s facilities.  In May, a judge approved a $425,000 settlement involving the choking related death of an Air Force veteran at the Anderson home. According to a lawsuit, a latex glove was found lodged in his airway on Christmas Eve 2015. He died five days later.

According to another pending suit, a combat veteran of the Korean War died of injuries suffered when his roommate beat him with a shoe at an HMR-managed veterans’ home in Alabama. The veteran, William Bankston, lived at the Floyd E. “Tut” Fann State Veterans Home in Huntsville almost two years before he was attacked.  Court records show that in the past four years, settlements totaling $900,000 have been reached in three other cases involving the deaths of residents at Victory House.  The largest lawsuit settlement, $525,000, came in August 2014. It involved allegations that William P. Chrisanthis fell 18 times at Victory House between Nov. 18, 2008, and July 4, 2010, when he suffered a fractured left hip. He died two weeks later.

The veterans’ nursing home HMR manages in Maryland was fined $360,875 on Dec. 2, 2016. Federal records show the fine was imposed after a resident choked to death on a peanut butter sandwich. The facility also was faulted for its care of another resident’s bed sores and for allowing dehydration to contribute to a third resident’s loss of 16 pounds in 11 days.

 The frequency of liability claims for abuse and neglect against nursing homes and the costs associated with those claims are rising nationally. According to a biased report last year commissioned by the industry lobbyist American Health Care Association, the frequency of nursing home claims increased 54 percent from 2007 to 2017. The annual costs to providers from those claims nearly doubled during the same period, going from $1,170 per occupied nursing home bed in 2007 to $2,300 in 2017.
Staffing levels at Victory House and Campbell show that the amount of time licensed nurses at both homes spend with the residents each day is below state and national averages.

Listed as one of America’s poorest nursing facilities, Wentworth Rehab in Chicago has a reputation for miserably insufficient maintenance and patient care, as reported in the Chicago Tribune. It’s known for events like the death of Letasha Mims, whose family finds Wentworth to blame for her passing after she became desperately ill during her time there.

Even more recently, a 79 year old man was allowed to smoke while using an oxygen machine at Wentworth, which eventually caused a fire that killed him and caused massive damage in the nursing home. It was reported that the man had a history of destructive behavior and should have been more carefully surveyed for such danger, and also that the staff had acted in a dangerously negligent manner, with one nurse looking on carelessly as the man was burning to death and another nurse attempted to save him.

To those familiar, these kinds of events would not be surprising. None of this even mentions the seeming inescapability of insects and rodents in Wentworth Rehab. Inspectors have reported unidentifiable food being served to patients. Residents can be seen plainly in areas of the nursing home with unimaginably poor personal hygiene. When asked about any of this, Wentworth’s parent company, Alden Management Services, will either deny its facility’s negligence or decline to comment altogether.

There are plenty of bad nursing homes in the United States, many on the same lists as Wentworth. There are even plenty of other bad nursing homes in Chicago, where it’s not hard to imagine a need for affordable or accessible nursing homes. But with its history of lying, neglecting, and ignoring, Wentworth Rehab stands out as a hallmark of bad behavior in nursing homes and a way of looking at any facility’s character.

LoHud.com had an article about the ten questions to ask before admitting a loved one to a nursing home.

What follows are questions to get answered before picking a nursing home.

1. How long has the nursing director worked there? High staff turnover can be a sign of problems while staff retention and longevity is a good sign.

2. How many registered nurses work there, and what is the ratio of licensed nurses to certified nursing assistants? Studies show strong positive relationships between registered nurse staffing levels and quality in nursing homes.

3. Is the staff friendly? Get a sense of how long they’ve worked there and if they like it by talking to them.

4. How good is the food? Visit on a Saturday or Sunday around lunch or dinnertime to see if you would eat what is served and maybe have a meal yourself.

6. Do you see good activities listed on the home’s calendar and are they really going on? Determine how staff works to engage residents.

7. How do residents look? If residents don’t appear clean, comfortable and neat, this could be a red flag.

8. What do state inspectors say? Ask to see the most recent inspection report and research other reports on your state regulatory agency’s website; in New York, it’s the New York Department of Health.

 9. What do federal regulators say about the home? Go to the Medicare.gov Nursing Home Compare website to review the nursing home’s star rating and other information.

10. Is the home a member of a reputable trade association in your state such as Greater New York Health Care Facilities Association? Membership requires meeting certain standards, and members are kept up-to-date on best practices and regulations.

For more, go to Medicare.gov.

Sources: USA TODAY Network, AARP, Medicare.gov, National Institute on Aging, New York Department of Health, Aging Life Care Association, Agency for Health Care Administration

Lauren Weiler for CheatSheets wrote about the dark secrets nursing homes do not want the public to know.

1. Some contracts don’t allow you to sue if something goes wrong:

Knapp & Roberts notes you should review all of the print in your paperwork, and keep a watchful eye out for anything noting “binding arbitration agreements.” Essentially, this agreement means you must settle your differences outside of court, removing your right to sue. If anything serious happens, you certainly don’t want to be bound by this clause.

2. Residents don’t always have as much freedom as they want:

One study found out of 65 nursing home residents interviewed, about half felt depressed due to a lack of independence and freedom, as well as loneliness. The interviewees also seemed to prefer homes that had programs designed to reduce their sense of isolation from others.

3. Residents don’t always get enough to eat:

 A 2015 overview from Nursing Older People found nursing home residents are among those who have higher rates of “anorexia of aging,” and over 50% of residents studied also complained of constipation. Your home of choice should have a plan in place to combat these issues.4. Some of the ‘nurses’ aren’t nurses at all:

Every nursing home has some number of permanent nurses — but not everyone working is a staff member you’ll see again. Bottom Line Inc. explains “agency nurses” are often employed when a home is low on permanent staff. These temporary nurses work for staffing agencies and rarely form bonds with residents because of their position. For your comfort, it’s wise to choose a home with a staff that’s at least 80% permanent nurses.

5. Residents often have to leave the doctors they’re used to behind:

Knapp & Roberts explains most nursing homes have assigned physicians, which makes it difficult for residents to keep the doctors they’re used to seeing. If you’re really attached to your current doctor, it’s best to ask a potential home about their rules regarding this. You should also ask the home how often the physicians see their residents and what the health care plans may look like before committing.

6. Low staffing levels are a huge issue:

Up to 95% of American nursing homes may be understaffed.

Some homes have a difficult time finding enough staff, but other homes purposely understaff to cut costs. Having a bad patient to staff ratio is stressful for the staff and bad for your care. It may also leave you vulnerable to neglect and abuse. Be sure to ask what the patient to staff ratio is in your chosen home so you can ensure you’re getting the care you’re promised.  There should be at least 4.1 hours per person per day of direct nursing care.

7. Nursing homes may send a bill to relatives for the resident’s care:

According to Mass Mutual, the average amount paid for assisted living in 2017 was $3,750 per month. While you may have multiple ways of taking care of these costs, you should ensure none of the expenses accidentally get sent out to relatives. This happened in 2012 to a man who was forced to pay nearly $100,000 of his mother’s care without realizing it. Know what your state laws are regarding billing, and as always, have both you and your family members read the fine print.

8. The staff isn’t always clean:

Nursing home staff are careful with washing their hands, right? While this may seem like an obvious practice of personal hygiene and to prevent the spread of infections and communicable diseases, not all staff members participate. The New York Times reports many nursing homes are being cited for “hand hygiene” deficiencies.  Unsurprisingly, the nursing homes that were understaffed found the most hand-washing issues. Finding a well-staffed home may be key to your overall health.

9. Nursing assistants don’t need as much training as you think:

They may seem official, but many nursing assistants have no formal training at all to take care of you. NursingAssistantGuides.com explains some clinics will hire untrained workers and train them to be nursing assistants at the facility. Even for those who have a degree as a CNA, that can be acquired online with no hands-on experience. And many CNAs start at nursing homes and then move on to jobs with better pay, making the turnover rate incredibly high.  CNAs are not licensed health care providers.

10. Neglect is a common issue in the homes:

Next Avenue explains out of all the cases of nursing home abuse, neglect is the most common. While there are times when neglect is intentional, it isn’t always this malicious. Inadequate staffing and high turnover rates can also lead to this issue.  When choosing a nursing home, take a look at the other residents. Do they seem clean and well taken care of? The living quarters should also be clean and safe, with little wear and tear.

11. Some nursing homes may tell you to get extra aid outside of their care:

Staff in your chosen home are required to provide you with the care you need. If you’re ever told you need an outside aid to assist you for additional costs, Knapp & Roberts says to take note. This is negligence on the part of the nursing home.

12. The physical therapy units aren’t always up to snuff:

While you may be more concerned with what the rooms and eating areas look like, don’t forget to tour the physical therapy unit. Bottom Line Inc. explains if you require rehab of any kind, this is particularly important. Take a look at the machinery and ask if physical therapists are on the staff itself or just doing contractual work. If your nursing home is staffed with physical therapists, it’s likely to give you better service.

13. The ‘activities schedule’ might be a total bust:

U.S. News & World Report reminds us many nursing homes are still lacking in the activities department. While birthday parties and Bingo are commonplace, you’ll need more than that when choosing a place for your future. And the best homes will ask each resident about their interests to try and accommodate as many people as possible. Certain homes offer gardening clubs, cooking classes, and art therapy, so make sure you ask what’s available.

14. Most residents will have a lack of privacy:

While many folks in nursing homes like having company, there’s also another issue you may not have thought of: a lack of privacy. Bottom Line Inc. explains most homes offer a wide range of shared rooms, with private rooms costing serious cash. Not all shared rooms are bad, however. You’ll just want to make sure what’s dividing your bed from someone else’s is sturdier than a thin curtain.

15. More serious forms of abuse take place, too:

The National Council on Aging report about one out of every 10 Americans over 60 experience abuse — and it can even occur in nursing homes, Spangenberg Shibley & Liber LLP says. Neglect aside, the publication notes sexual assault and abuse has also been cited in certain homes. And many other instances of abuse go unreported. Do your research to see if any abuse allegations have been filed against your home of choice.