McKnight’s had an article on lawmakers attempts at figuring out the role of private equity firms in nursing home and long-term care, and how and why their involvement affects the quality of care provided.  Hint:  It is short-staffing to increase profits.

Letters asking for information were sent to Carlyle Group, Formation Capital, Fillmore Capital Partners and Warburg Pincus.  The letters questioned the firms’ impact on the “declining quality of care in nursing homes”  and their management of the facilities.  The legislators cited significant and credible research that “has shown that for-profit chain-affiliated companies often provide a lower quality of care and experience more serious health and safety deficiencies that non-profit facilities.”

“We have concerns about the rapid spread and effect of private equity investment in many sectors of the economy, especially industries that affect vulnerable populations and rely primarily on taxpayer-funded programs such as Medicare and Medicaid, like the nursing home industry,” the lawmakers wrote.

“We are particularly concerned about your firm’s investment in large for-profit nursing home chains, which research has shown often provide worse care than not-for-profit facilities,” they added.

Richard Mollot, executive director of the Long-Term Care Community Coalition, criticized real estate investment trusts’ role in the nursing home industry during a federal hearing last week.

The investment by (REITs) and other entities that have nothing to do with healthcare into the nursing home world has essentially savaged the industry and I think care across the country. We’re seeing that more and more with entities buy up nursing homes, they have no experience in the business, they sell out the underlying property,” Mollot added.

We’re seeing it over and over again that monies are being siphoned away from nursing homes and from care. They’re just being devalued and then sometimes even closing.”

Forbes had a great article written by Mayra Rodriguez Valladares about The Carlyle Group’s private equity investments in nursing homes and long-term care. It appears they stole all the money and let the operating entities go bankrupt. Last year, the Washington Post and Esquire journalists exposed the suffering of nursing home patients at The Carlyle Group-owned ManorCare. While the Carlyle Group owned the ManorCare until it went bankrupt, 25,000 elderly nursing home residents were exposed to significant health risks. There were 2,000 health-code violations, a rise of 26% from 2013 to 2017, at the 230 residences of the ManorCare chain. According to Kaiser Family Foundation data, not-for-profit as well as for profit nursing homes receive significant Medicare and Medicaid funds. Private equity firms are manipulating the tax system to enrich themselves as the expense of vulnerable residents.

As a taxpayer like Ms. Valladares, I care where our taxpayer money goes and am also grateful that Senators and Representatives are asking important questions and sponsoring ‘Stop Wall Street Looting Act’ to “ close the legal, tax, and regulatory loopholes that have long allowed private equity firms to capture rewards of their investments while passing the risk on to target companies, investors, workers, and consumers.”

The Carlyle Group was asked to provide information including a list of all its investments in nursing home and any other long-term care facilities for the past twenty years; what services the nursing home and long-term care facilities offer; what its ownership stake in these facilities is; the total revenue each facility makes; and what percent of the revenue is from Medicare as well as from Medicaid. Answers to these questions can help taxpayers hold The Carlyle Group and other private equity firms accountable.

“Numerous research pieces and articles, especially those by Professor Charlene Harrington, show significant deterioration in the care of patients at nursing homes when private equity firms take over because they cut staffing, training, and supplies. According to the Journal of Health Care Finance a significant problem is that “Private equity nursing homes have lower RN [registered nurse] staffing intensity and lower RN skill mix compared to the control group.”

The Carlyle Group like most large for profit chains have a complex ownership and operation structure of private equity investments. This means that the private equity firm and the nursing home are often immunized from legal judgments, and nursing home residents and their families are left without justice.

“Another good question posed by the legislators is whether any of The Carlyle Group’s nursing homes or long-term care facilities benefit from Section 232 Department of Housing and Urban Development mortgage insurance on loans that cover residential care facilities. These loans help finance nursing homes, assisted living facilities, and board and care facilities. This mortgage insurance protects lenders against losses when borrowers defaulting on their mortgage loans. It is important to see whether the Carlyle Group is loading facilities up with debt, as many private equity companies do. Will taxpayers be left holding the bag if nursing homes default on their debt?”

 

Nursing homes can be dangerous places. In the past 20 years of reviewing and investigating nursing home abuse and neglect cases, I have heard and seen some unbelievable acts of greed, cruelty, and exploitation but this latest story is one of the sickest.  A teenager named Josh Howarth has been arrested for attempting to rape an elderly woman in a ‘sickening attack’ as she lay in her nursing home bed.

Howarth, 18, broke through a ground floor window to try to attack his vulnerable victim – in her 80s – in the early hours of August 4. He was disturbed by a member of staff at New Thursby Nursing Home at around 5am and fled the scene.  He was found after a manhunt and arrested on suspicion of attempted rape.  Unfortunately, his victim never saw Howarth brought to justice as she died on October 24.

Detective Inspector Jamie Lillystone of Lancashire Police said: ‘This was a sickening attack on a vulnerable elderly lady at a place where she should have felt safe. ‘Howarth went to great lengths to break into her bedroom and had intentions of carrying out the most despicable crime. ‘The only consolation is that he was disturbed by a member of staff, but nonetheless this was an extremely traumatic experience. ‘Haworth’s actions were predatory and dangerous. He will now spend a significant amount of time behind bars.’

 

 

 

U.S. News & World Report recently issued their annual rankings of nursing homes.  The methodology is unclear and the ranking are not that helpful.

There are about 1.4 to 1.5 million people living in nursing homes and typically need assistance with one or more activities of daily living (ADL) such as:

— Eating or preparing meals.

— Bathing and dressing.

— Going to the toilet.

— Managing medications.

— Moving around in the residence or getting to other locations.

As we age, these activities tend to become more challenging. Many of these problems occur simultaneously. Some people need more help than others. Assistance feeding and bathing or medical care might be top priority for some, while others may have issues with mobility function or being able to transfer from sitting to standing on their own. All of these needs could mean that an individual will need the type of care that a nursing home can provide.

However, despite the fact that nursing homes, also called skilled nursing facilities, care for a lot of older adults, it’s a common misconception that nursing homes are only for the elderly. Skilled nursing facilities actually look after a wide range of people, and some are well younger than 65. True, older adults do make up a large proportion of the people who reside in nursing homes.

The Centers for Medicare & Medicaid Services report that in 2014, the most recent year for which data are available:

— 7.8% of nursing home residents were 95 years of age or older.

— 33.8% were 85 to 94 years old.

— 26.4% were 75 to 84 years old.

— 16.5% were 65 to 74 years old.

This means 15.5% of the nursing home population is under age 65. Those younger residents (and some of the older residents too) may not be planning to stay there for the duration of their lives, but rather need rehabilitative care after a surgical procedure or injury. Some younger people with certain disabilities that require constant care, such as severe developmental disabilities, may also live in a skilled nursing facility.

Across the board, women make up about two-thirds of the nursing home population (65.6%) and the CMS reports that nearly four of five nursing home residents (77.9%) are non-Hispanic whites. The racial/ethnic mix depends on the community. More urban areas have a more racial and ethnic mix. You didn’t use to see a lot of Latino or Asian residents in nursing homes.

Residents in nursing homes typically have at least one chronic condition for which they need some ongoing medical care, and some have experienced falls or other injuries that have necessitated more intensive care. However, CMS reports that just 5.3% of nursing home residents in 2014 had recently experienced an “injurious” fall. Another 11% had fallen recently but weren’t injured.

While some people may assume that nursing home residents all have cognitive difficulties such as Alzheimer’s disease or other forms of dementia, that’s not the case. Nearly 20% of residents have no impairment to their activities of daily living and “more than one-third (38.7%) had no more than mild cognitive impairment; further 11.1% had no ADL (activity of daily living) impairment and little or no cognitive impairment,” the CMS reports. Those with significant cognitive impairment, meaning they had difficulty with five or more activities of daily living, represented just shy of 15% of the nursing home population.

Genworth Financial, a financial advisory firm, reports in its 2018 Cost of Care survey, the most recent data available, that the median monthly cost of skilled nursing in a private room at a nursing home will set you back $8,365 per month, adding up to more than $100,000 per year.

For example, Genworth reports that Alaska, Connecticut and Hawaii have the highest daily costs for private nursing homes at $907, $452 and $449 per day, respectively. At the other end of the spectrum, Oklahoma, Louisiana and Missouri are the least expensive areas, with per day costs of $174, $182 and $182, respectively.

 

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.

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.