There was a great article on Health Affairs website discussing the failures of nursing home oversight by CMS and their attempts to improve.

“More than 30 years after Congress passed the Nursing Home Reform Act, we are still failing to protect nursing home residents. Recent cases of abuse and neglect, repeated failures of governmental oversight, and stories of owners’ mendacity and greed are not only wake-up calls but sobering reminders of how far we have to go.”

The government has focused attention on nursing home care, releasing blueprints to put “patients over paperwork.” CMS also issued a proposed rule in July taking aim at a range of regulatory provisions it characterized as “unnecessary, obsolete, or excessively burdensome.” Advocacy groups expressed skepticism about CMS’s claims that these changes would “produce significant savings without jeopardizing patient care in any way” and that the “reduction in red tape [will] free up facility resources to focus on patient care.”

Nursing home providers are entrenched in a blind faith in deregulation (if only we reduced regulatory burden, providers could focus resources on resident care). CMS reflects the administration’s broader push toward deregulation and have exacerbated tensions between providers and advocates.

“Most visible among these changes are the repeal of the Obama administration’s arbitration ban, guidance that lessened financial penalties for past non-compliance, and a proposal to relax the frequency of surveys for better-performing facilities.”

“A key aim of nursing home oversight over the past decade has been to ensure greater transparency in nursing homes’ ownership and financing. Nursing homes have been mostly for profit for decades. In the early 2000s, increased private equity investment and ownership complexity spurred a renewed focus on this topic, culminating with provisions to bolster disclosure of ownership and financial relationships being included in the Affordable Care Act. Still, in the wake of scandals such as Skyline Healthcare, where a single owner acquired almost 100 facilities over a relatively short time period across multiple states before running them into the ground financially and putting vulnerable residents at risk in the process, it is clear that substantial gaps still exist.”

CMS should make more complete ownership data widely available, not only to researchers but to state licensure agencies that evaluate applications from potential operators. In addition, CMS should add the ability to examine care across all facilities of specific owners to the Nursing Home Compare website, allowing consumers and others to see quickly if an owner is generally involved in the provision of higher- or lower-quality nursing home care.

Beyond ownership, improving the ability to understand where nursing homes spend their resources and gaining a more accurate sense of their financial well-being are important elements of transparency. Progress has been made in simplifying nursing home cost reporting, yet, according to the Government Accounting Office, there are still substantial questions about the accuracy and completeness of these data. CMS should take further steps to ensure the veracity of these data and develop summary measures for inclusion in public use files or even on the Nursing Home Compare site to convey an accurate picture of facilities’ financial status and spending priorities.

 

Cedar Haven Acquisition, LLC, the company that owns Cedar Haven nursing home filed for bankruptcy in a Delaware court last month to avoid accountability.  Cedar Haven Acquisition, LLC, filed for chapter 11 bankruptcy, meaning they will be able to reorganize the business and keep it open as part of the bankruptcy proceedings without paying judgments or compensating victims of neglect and abuse.

Cedar Haven Acquisition is a subsidiary of Stone Barn Holdings, LLC. According to the filing, Cedar Haven owes money to at least 200 creditors. Cedar Haven owes over $7 million to the top 20 creditors alone, according to the filing.

Where did all the money go?

LeadingAge reported that the GAO was asked to review federal oversight of elder abuse reporting, investigation, and law enforcement notification in both nursing homes and assisted living facilities. Both types of facilities often fail to report neglect and abuse.

The report highlighted specific federal requirements for reporting, investigating, and notifying law enforcement of elder abuse for nursing homes and state survey agencies.  For assisted living facilities, the report noted that there are no similar federal requirements as those are regulated by the states.  The Centers for Medicare and Medicaid Services (CMS), however, requires state Medicaid agencies to develop policies to ensure reporting and investigations of elder abuse in assisted living facilities.

In commenting on the report, the Department of Health and Human Services (HHS) reiterated its commitment to resident safety and acknowledged the distinct, and not directly comparable, oversight frameworks for nursing home and assisted living facilities.  This is a must read for all nursing home abuse and neglect attorneys.

 

 

The Skilled Nursing News reported that the Securities and Exchange Commission (SEC) filed a lawsuit against Zvi Feiner; a businessman at the center of a record-setting nursing home loan default, accusing the man and his company of defrauding investors and misappropriating funds.  The SEC alleged that Feiner, a nursing home owner, raised money from various investors with promises of substantial returns on specific skilled nursing and assisted living facilities — but instead used the cash for personal reasons and to support other faltering properties in his portfolio. The government accused Feiner of using his position as a well-known leader in Chicago’s Orthodox Jewish community to help generate interest in his companies.

The suit also named Feiner’s business associate Erez Baver and multiple companies that Feiner controlled, including FNR Healthcare, LLC.

“From at least 2014 to 2017, Defendants Feiner and Baver operated a fraudulent scheme involving the misappropriation of proceeds raised through the offer and sale of membership interests in limited liability companies (LLCs) that would purchase, own, and sell nursing homes and assisted living facilities,” the SEC wrote in its suit.

In all, Feiner raised $10 million from 62 investors to support the various ownership companies, according to the SEC document.

Baver and Feiner have already reached a deal to settle the case, Bloomberg Law reported, with Baver set to pay $2.25 million and Feiner still negotiating a final amount with the SEC. Under the settlement, the pair will not formally admit any wrongdoing, according to Bloomberg Law.

The lawsuit marks yet another milestone in the long-unwinding case of Feiner and his associates. Back in June, the New York Times reported that Rosewood Care Centers, an Illinois chain owned by a Feiner-led group of investors, defaulted on a $146 million loan backed by the Department of Housing and Urban Development — a record for HUD’s Section 232 program, which provides insurance for loans associated with senior housing and care properties.

A judge in August approved a nearly $1 million penalty against Feiner to settle allegations that he failed to file appropriate paperwork for the Rosewood Care Centers loans; Feiner also faces up to $20 million in unpaid vendor bills and dozens of personal injury lawsuits, according to a Times report on the penalty.

As a nursing home abuse and neglect attorney, I often hear complaints and problems from family members about the neglect suffered by their loved one.  One of the key reasons many do not file grievances; complain to regulatory agencies; or file a lawsuit; is because of fear of retaliation and not being able to see their loved one.  Well, that is exactly what appears to be happening to T.J. Sarrington.

Sarrington was banned from seeing her elderly mother at a nursing home out of retaliation for reporting abuse. In 2018, Sarrington filed a complaint with the Oklahoma State Department of Health, alleging neglect and abuse at Meadowlake Estates nursing home in Oklahoma City.  When the findings of the report were published and substantiated her claims, she called the administrator to get answers. That’s when he told her not to come to the property, or she would be arrested. That day, Sarrington said she was escorted off the property by Oklahoma City police for trespassing. In the months since she was first removed, Sarrington said she missed what may be her mother’s last birthday and last mother’s day.

Among 25 violations, the OSDH found the nursing home committed violations against Sarrington’s mother and two other residents, and failed to “honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights.”
 “I begged him to please let me see my mom. I begged. I swallowed every inch of pride that I had, and I begged,” Sarrington said. “He told me if I showed up, I would be arrested for trespassing.”  Her mother thought her daughter was dead after going weeks without seeing her.

After seeking legal advice from advocates for nursing home reform, Sarrington said she returned to the home over the weekend, armed with a 2013 law saying, “every resident shall have the right to… meetings of family… or any other person or persons of the resident’s choice…”

 The operator in charge of the home again called 911 telling dispatch, “I have a trespasser that’s been advised that she is not allows on our property.”
Sarrington said the responding officer called a supervisor after she said she had a right to see her mother. The supervisor agreed and the officer walked her back to see her mother for the first time in four months.

I read a well-written article on The Journal about allegations of abuse and injuries of unknown origin.  As a nursing home abuse and nelgect lawyer, we hear these type of allegations all the time, and often see photos of disconcerting bruises, skin tears, and other injuries that the nursing home refuses to explain to the resident’s loved ones.

The article deals with incidents of sexual assault, unexplained injuries and poor hygiene standards in nursing homes in Ireland.  Documents show that since January of this year specific concerns were raised about staffing issues, nutrition, residents sustaining injuries and fire and safety issues.

In one piece of correspondence sent to the health watchdog Hiqa, it is alleged that a person received an anonymous letter stating that a resident “suffered physical and sexual assault by another resident”.  Hiqa is responsible for the monitoring, inspection and registration of designated centres for older people, such as nursing homes, in Ireland.

In that same entry, it is claimed that staff were “instructed not to record the incident”.

hiqa1Source: Hiqa

Another piece of information from a concerned person claims that a resident “was naked from the waist down” and “standing at the head of the bed” in their relative’s room.

This person also claimed “another resident previously entered relative’s room and urinated all around it”.

A recurring theme within the documents is residents experiencing bruising.

In one instance, a concerned person (CP) claimed that a resident “suffered a number of assaults by another resident who has challenging behaviour”.

In another instance in the documents, it is claimed that a resident had “significant bruising on a number of occasions”.

“Medical attention was not received by resident until 3 days after a fall,” it was alleged.

One concerned person claimed a resident “suffered unexplained bruising on the face”.

hiqa2Source: Hiqa

Another piece of information outlined that a relative visited a centre to find a resident “sitting in their bedroom very upset and crying”.

“Resident has Dementia but could not communicate what was wrong. Relative lifted the resident’s clothing to find bruising on their arm,” it was claimed.

hiqa3Source: Hiqa

In another instance, it is alleged that a resident “banged their head” and that the family were not informed.

“When another relative visited they noticed the bruising and also that the resident was in soiled, wet clothing in the activity room,” it was claimed.

It continued: “The following day when relative visited again they noticed blood on the bandages used to cover [redacted] ulcer and discovered that the blood was not from ulcer but from a fresh cut.

When relative touched resident’s arm to try hold her whilst investigating the fresh cut they were in pain. Resident transferred to [redacted] hospital and tests confirmed they had two fractured bones in their arm and a lot of bruising under their arms.

The concerned person alleged that “staff cannot give an explanation as to how these injuries occurred”.

Other common issues raised within the documents include hygiene issues, concerns over building standards and staffing worries.

One document alleges that “residents are left in soiled incontinence wear for long periods of time”.

Another piece of information claims that a person found their relative “cold, hungry, soiled and upset” when they visited.

In another complaint, concerns were raised over a resident “not being encouraged to eat or drink”.

In relation to staffing, Hiqa received numerous pieces of unsolicited information.

One person raised concerns regarding staffing levels, “especially at night time”. They claimed that staff are “constantly rushed off their feet”.

The person said they had “witnessed call bells ring constantly without being answered”. They claimed this was because they were “attending to residents who need constant monitoring”.

Another complaint alleged that there is a “lack of supervision” in the day room in the nursing home in question.

One person complained that “there was a lack of appropriate care to meet the needs of the resident”.

The document outlined that the concerned person brought the resident home and discovered they had been “given medication that was prescribed for another resident”.

 

 

McKnight’s had an article about the issues and problems at California Villa in Van Nuys, CA, an assisted living facility.  Staff members were unable to identify a veteran in their care when a case manager from the Department of Veterans Affairs visited, resulting in the case manager reporting that she had visited with the resident — four days after he had died, according to the U.S. Office of Special Council.

The incident is part of a larger issue with the care of veterans in assisted living, according to the office. The alleged incidents are examples of how VA  “compromised patient care” because they “failed to take action on repeated allegations of patient care deficiencies and employee misconduct” at assisted living facilities where veterans live. The VA investigation concluded that because veterans, not the VA, pay assisted living facilities, VA officials did not oversee those facilities as “vigorously” as they did other programs funded directly by the VA.

California Villa was approved to care for veterans by the VA Greater Los Angeles Healthcare System, according to the OSC. When a case manager visited in October 2017 looking to meet with a specific veteran, however, staff members referred her to the wrong resident, a VA investigation found. The resident she had come to see actually had died four days before her visit.

The VA investigation also “confirmed longstanding and well-known” issues at the home, including a general state of disrepair and a disorganized medication room, the OSC said. Between 2015 and 2018, several veteran residents experienced “serious” medication errors, according to investigators.

For instance, staff members did not provide physician-prescribed antibiotics to a 100-year-old veteran with sepsis, the report said. In another case, staff members allegedly did not update records related to physician-canceled prescriptions, resulting in a veteran receiving double doses of medication on two occasions. And in a third case, staff members allegedly did not provide medication to a resident who did not leave his room.

“I am shocked that such lax oversight of facilities providing critical care for vulnerable veterans ever occurred, and I commend these whistleblowers for coming forward to shine a light on this serious issue,” he wrote.

The VA has agreed to begin monitoring more closely the assisted living communities caring for veterans. Also, the VA agreed to make the community care program coordinator a full-time position, and the person in the role now will visit all VA-approved assisted living facilities every month, according to the OSC. All facilities also will be independently reviewed, too, the office said.

Low wages, high staff turnover and short-staffing have combined to create a “resident care crisis in Rhode Island nursing homes,” according to a report released by the District 1199 SEIU New England union.  A coalition of groups called for legislative action to remedy the situation during a press conference at Bannister Center.  The coalition is calling on the General Assembly to establish a minimum staffing standard of “4.1 hours of care per resident per day.” It also seeks an increase of the starting wage for a CNA to “at least $15 per hour” and “and a focus on training and workforce development moving forward as immediate first steps towards resolving Rhode Island’s resident care crisis.”

“Rhode Island nursing homes are understaffed and Rhode Island caregivers are underpaid,” certified nursing assistant Shirley Lomba said. “When our residents have more time with their caregivers, they have better outcomes. The lack of staffing standards forces us to rush through the very basics of care and doesn’t give us any time to answer questions or even just chat with our residents; basic things that are necessary to maintain quality of life.”

The eight-page “Raise the Bar on Resident Care” report states that CNAs in Rhode Island earn $14.42 an hour, compared to $15.54 in Massachusetts and $16.18 in Connecticut.  In comparison, the majority of CNAs in South Carolina get a little above minimum wage and rarely exceeds $12.00.

“I know that the people who provide residential care are engaged in holy work,” said Rabbi Jeff Goldwasser, of Temple Sinai in Cranston. “They are the ones who pay attention to the needs of our elders, who care for some of the most vulnerable in our communities…

“It is our obligation as a society to make sure that these workers are treated according to the dignity of their profession. Nursing home residents deserve consistent staffing to assure that they are cared for, appreciated, known and valued. Nursing home workers deserve to work in an environment where they can see that the residents they care for are treated with dignity and love.”

Nursing home lawyers who specialize in neglect and abuse cases like our firm know that abuse and neglect often occur when caregivers are depressed, tired, and suffering from burn-out.  Nursing homes report higher levels of burnout and job dissatisfaction than any other US healthcare setting. Burnout victims are five times more likely to finish a shift without completing necessary care according to University of Pennsylvania School of Nursing researchers who revealed results of a study involving 540 nursing homes in four large states.

Thirty percent of the nearly 700 direct-care registered nurses involved exhibited high levels of burnout, while 31% said they were dissatisfied with their job. Nearly three in four (72%) reported missing one or more necessary care tasks on their last shift due to lack of time or resources. RNs who were dissatisfied are 2.6 times more likely to leave necessary care undone, said researchers from Penn’s Center for Health Outcomes and Policy Research.

In addition, 33% of respondents with burnout and 25% with job dissatisfaction said they were “unable to administer medications on time, a key aspect of medication safety.”

Improved work environments with sufficient staff hold promise for improving care and nurse retention,” wrote study author, who were led by Brown University postdoctoral fellow Elizabeth White, Ph.D., APRN.

Recommended steps include: 1) creating a culture that emphasizes root-cause analysis of systemic problems rather than punishing nurses for individual mistakes, 2) Involving RNs in quality improvement committees, 3) having administrators consult with direct care staff on solutions to organizational problems, and 4) having formal processes for responding to employee concerns.

They also recommended offering career ladders, preceptor programs for new hires, leadership training and continuing education.

 

There are no cameras at the assisted living home, so it’s also unknown how and why Rhymes ended up face down in a dark, empty room.

The nurse told the same story to Mesa police investigators, who also doubt Broadway Mesa Village and its parent company Pegasus Senior Living’s version of events. One detective documented repeated discrepancies and reported Stein’s “possible fabrication and misrepresentation of facts.”

Throughout the 911 call, the dispatcher struggled to get clear answers from Broadway Mesa Village staff about Rhymes’ condition, whether she was breathing, and if any staff members were performing CPR. No one did perform CPR, records show.

When firefighters arrived, Rhymes was found still face down in the prone position.

“The staff was in disarray and bewilderment,” according to an official statement by a Mesa Fire Department captain.

Hopefully, a nursing home lawyer who knows what they are doing will get involved and find out the truth.