Senior Living: Issues and Challenges

The topic covers recent developments in senior living, focusing on the mixed experiences in assisted living, memory care, and nursing homes. According to the J.D. Power 2024 U.S. Senior Living Satisfaction Study, satisfaction in assisted living and memory care communities has significantly improved post-pandemic, attributing the rise to better care quality and investments. However, independent living communities saw a slight decline in satisfaction. Contrasting these positive trends, the topic also highlights severe issues within certain nursing homes, such as the lawsuit against a major Maryland nursing home chain for alleged inhumane treatment and illegal evictions of elderly residents. The content provides a balanced view of the improvements and ongoing challenges in the senior living sector.

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How to 'Have the Conversation' With An Older Parent

Next to talking to your child about sex, probably the next most dreaded conversation is telling an aging parent you think they should move into a nursing home.

No one wants to do it because, not only is it unpleasant but it confronts a reality that most of us would rather avoid.

"The first time talking about this is going to be really, really hard because it's a painful subject to think about," said Gayle Doll, assistant professor in Kansas State University's College of Human Ecology and director of the Center on Aging. "However, it is also one of the most important conversations you can have."

Research at nursing homes

Doll is an expert on aging, having studied the subject through repeated visits to nursing homes where she talks with residents. She says in many cases, “the conversation” between parent and child isn't nearly as bad as it seems.

Doll found that many residents voluntarily chose to move into a retirement community that included a nursing home to protect their children from having to make the difficult and painful decision about caring for their parent.

"However, only a small percent of older adults are this forward-thinking, leaving many other families, especially now with an aging baby boomer population, to be involved in this important decision process," Doll said.

Don't put it off

Despite the fear and pain, Doll says the conversation should not be avoided. Otherwise, it sets up worse circumstances in the future.

"The most critical thing is to start this discussion before a crisis occurs," Doll said. "At the time of a crisis you're going to be looking at nursing homes and trying to make a decision. Without ample time, that decision may not be based on which home is the best, but rather which one has an opening. That's a factor nobody wants to have dictate a decision."

If you feel it's time for the conversation, here's what Doll suggests:

  • Be honest and direct, beginning with the first conversation. "It won't be something easy to talk about, so that's why it's important to be direct," Doll said. "Say something like, 'I know we don't want to talk about this and I can't stand thinking about a time when our life can't be like it is now, but I want to make sure that when things change we do this the best way we can. The sooner we talk about this the easier it will be in the future and the more we'll get what we want from the situation when the time comes.'"
  • Do not make unrealistic promises and promises that cannot be kept. "So often kids will say, 'I won't ever put you in a nursing home,'" Doll said. "Other times it may be the parent who will say something like, 'Kill me when the time comes' or 'Never put me in a nursing home.' Those are all such horrible things to say and may not be realistic."
  • Make it an annual talk about the same time each year. "A lot can happen in a year, and it's common for people to change their mind a million times about something," Doll said. "By reassessing previous decisions on a frequent basis, you and your loved one can have the latest decision about what you want and don't want because those circumstances will have changed."
  • Start discussing nursing home and end-of-life wishes earlier in life rather than later. Although these topics are affiliated more with older age, an unforeseen injury or crisis could happen, requiring an immediate decision, Doll said. Discussing these topics earlier in life will also help with addressing other difficult and complex issues in life.
  • Do not assume that parents may have a stigma about discussing these topics. "In talking to groups of older adults I've found that they are much more comfortable talking about this subject than we may think," Doll said. "They read the obituaries and they have had friends who have died. The door is open to talk about it; they're just waiting for you to start the conversation."

Next to talking to your child about sex, probably the next most dreaded conversation is telling an aging parent you think they should move into a nursing h...

Marginal Nursing Home Options for Poor

Nursing homes in the poorest ZIP codes in the country are twice as likely to close as the richest ones, giving residents -- particularly minorities -- fewer choices for long term care.

Overall, the United States lost five percent, or 96,902, of its total nursing home beds between 1999 and 2008, as patients with means sought assisted living or other forms of home and community-based care instead.

Nursing homes were also 1.38 times more likely to close in the most predominantly black ZIP codes than in ZIP codes with the lowest representation of blacks, and 1.37 times as likely to close in the most predominantly Hispanic ZIP codes than in the least Hispanic areas.

The research is reported in the journal Archives of Internal Medicine.

Long-term issue

“This is an issue that is not going to go away, precisely because of the aging of the population and the increasing bifurcation of society into rich and poor,” says Vince Mor, professor of community health at Brown University.

Researchers, led by Zhanlian Feng, assistant professor of community health, say in the future people in poor urban neighborhoods will have to travel significantly farther to a nursing home. In ZIP codes where at least one nursing home closed during the decade, the shortest distance to another home increased to 3.81 miles from 2.73 miles.

“The further the patient is from their neighborhood, the more difficult it is for their family members and their neighbors to come visit them,” Mor says.

Vulnerability

In the study period, most nursing homes, whether freestanding or on hospital campuses, in rich neighborhoods and poor ones, have become more economically vulnerable. Homes that depend on Medicare and Medicaid for most or all of their revenue -- for instance those serving poor patients -- have suffered the most pressure.

When money becomes tight, especially at a somewhat inefficiently run home, quality of care declines, sometimes to the point where officials must consider shutting it down.

“This leads to a moral dilemma,” Mor says. “If the local nursing home is closed because their quality is so poor, that’s good, but the cost of that closure is disproportionately borne by a community. How much do you invest in a failing facility and how do you make that investment without rewarding a bad actor who runs a lousy place?”

Alternatives

If finding new money for nursing homes is not the entire answer for preserving access for the poor to long-term care, another option is to shift more money toward alternatives like assisted living, home-based care and community-based care, Mor says.

The new health care law and a system of waivers within Medicaid encourage states to do just that, but they are not targeted specifically to helping the urban poor or minorities, and they are optional programs. By contrast, reimbursements for nursing home care are legally required.

“Given the current budget environment, it is really uncertain how sustainable these alternatives will be,” says Feng. “Nursing homes are generally perceived as a last resort,” he says, but for millions of Americans desirable options in that undesired choice continue to decline.

The study was funded in part by the National Institute on Aging.

Marginal Nursing Home Options for Poor Study of ZIP codes shows vulnerability of facilities ...

Maryland Settles Suit Over Nursing Home Payments

Maryland has begun paying restitution to nursing homes and their residents in satisfaction of a lawsuit alleging that the state wrongly determined that certain patients could foot their own bills.

The lawsuit, filed in August 2005, alleged that the state's Department of Health and Mental Hygiene erroneously concluded that nursing home residents could afford co-payments for their care. That determination failed to take into account the debt that patients accrued while waiting to be approved for Medicaid coverage, according to the suit. Federal and state law requires states to consider patients' debt when calculating their income.

The payments, which will total $16 million, make the settlement the second largest in Maryland history among those where the state is the defendant, according to the plaintiffs' attorneys. Maryland will provide $8 million of the settlement funds, with the federal government paying the other half. The lawyers originally contended that the state owed $64 million for incorrect calculations made since 2002.

A similar suit filed against Washington, D.C. was also settled, with the city agreeing to to abide by the law in the future. The plaintiffs in that suit were not awarded damages.

Settlement could serve as model for other states

This is a great day for Maryland and Washington, DC citizens who need nursing home care but can't afford to pay for it, as well as the nursing homes who have provided that care for years without payment, Cy Smith, an attorney for the plaintiffs, said in a statement. We have succeeded in bringing Maryland and the District into compliance with federal law for the benefit of their neediest citizens, both now and for the future.

Smith told The Baltimore Sun that his firm is starting to send checks to nursing homes now. He said the suit wipes out a lot of debt for the class.

Ron Landsman, co-counsel on the case, said that the settlement ends three decades in which Maryland shirked its obligations under the Medicaid statute.

The state similarly expressed satisfaction with the outcome.

We think that things are pretty well resolved, John Folkemer, Maryland's deputy secretary for health-care financing, told The Washington Post. When someone is in a nursing home not only do you have to recognize what their obligations are, you have to recognize some of the debts they owe.

The class includes 12,000 nursing home residents and over 300 nursing facilities.

The settlement could serve as precedent for other states that fail to take patients' old debt into account when determining their Medicaid eligibility.

Consumers can obtain information at the official settlement website

.

Maryland Settles Suit Over Nursing Home Payments...

Twenty-Two Arrested in Hidden Camera Nursing Home Probe


What goes on in nursing homes when no one is looking? New York Attorney General Andrew Cuomo says he knows, and sometimes it's not pretty.

Cuomo has arrested 22 current and former health care workers at two New York nursing homes after footage from hidden surveillance cameras revealed alleged neglect and other conduct that endangered dependent residents.

The first case involves the arrest of 14 individuals regarding incidents at Northwoods Rehabilitation and Extended Care Facility in Troy, N.Y. The second case involves the arrest of eight people regarding incidents at the Williamsville Suburban Nursing Home in Amherst, N.Y.

"With the consent of family members, we put hidden cameras in nursing homes across the state, watching over the vulnerable who often cannot advocate for themselves," Cuomo said. "My office is strongly committed to using all the tools at our disposal to make sure people are getting the medical treatment and the care they deserve."

The arrests are part of a string of cases where Cuomo's office has used hidden cameras to obtain evidence to prosecute health care workers for mistreating patients. To date, 30 nursing home employees have been convicted based on surveillance recordings. In addition, the corporate owner of one nursing home has been convicted and another has settled a civil suit brought by the Medicaid Fraud Control Unit (MFCU) as a result of a hidden camera investigation.

Northwoods

The investigation along with surveillance video taken at Northwoods Rehabilitation and Extended Care Facility in Troy over a six-week period revealed that staff routinely failed to turn and position an immobile resident, often leaving the resident in the same position for an entire shift.

Nursing staff failed to administer medications, as well as treat the resident's bedsores. The footage also revealed that the aides charged today failed to check the resident for incontinence or change undergarments for long periods of time.

In addition, the resident's medical records show that the defendants falsified medical records to conceal their neglect. A physician's assistant also created a phony record of an annual medical exam that never happened.

Six Licensed Practical Nurses and seven Certified Nurse Aides were charged with multiple counts of Falsifying Business Records in the First Degree (class E felony) and Willful Violation of the Public Health Law (unclassified misdemeanor) in complaints filed in Schaghticoke Town Court.

In addition, the LPNs were charged with multiple counts of Endangering the Welfare of a Physically Disabled Person, a class A misdemeanor. The physician's assistant was charged with one count each of the above charges. A class E felony carries a maximum penalty of four years in prison and the misdemeanors carry a maximum penalty of one year in jail.

Williamsville

The investigation along with surveillance video taken at Williamsville Suburban Nursing Home in Amherst over a seven-week period revealed that staff routinely failed to properly transfer the resident in and out of bed, putting the resident at risk of injury. Staff was required to use a mechanical lift with the assistance of two caregivers.

Video footage also revealed that one aide failed to provide range of motion therapy and two nurses failed to administer insulin, provide skin and wound treatment, and failed to check the resident's vital signs. In addition, the resident's medical records show that employees falsified records to conceal the resident's neglect and endangerment.

Two Licensed Practical Nurses and one Certified Nurse Aide were charged with Falsifying Business Records in the First Degree, a class E felony, in complaints filed in Amherst Town Court. The charge carries a maximum penalty of four years in prison.

Five other Certified Nurse Aides were charged with Endangering the Welfare of an Incompetent or Physically Disabled Person, a class A misdemeanor, with a maximum penalty of one year in jail.

The Certified Nurse Aide who falsified the resident's medical record failed to perform range of motion exercises on the resident's extremities, which were required to prevent muscle contracture.



Twenty-Two Arrested in Hidden Camera Nursing Home Probe...

New York Nursing Home Aide Convicted of Rape


A former aide at a New York nursing home has been found guilty of raping and sexually assaulting a 90-year-old resident of the nursing home. A jury convicted William Morrison, 46, of Utica, of three felonies after a five-day trial conducted before Judge Michael L. Dwyer in Oneida County Court. Morrison was found guilty of Rape in the First Degree, a class B felony, Sexual Abuse in the First Degree, a class D felony, and Endangering the Welfare of a Vulnerable Elderly Person, a class E felony.

Morrison had been employed by Rome Memorial Hospital, in Rome, New York, for several months before he transferred to hospital's affiliated 80-bed nursing home. The crime was committed approximately two weeks after that transfer.

When Morrison began to work at the nursing home, the home sought to perform a criminal background check, but that process had not been completed before Morrison raped the elderly resident, prosecutors said. Such a background check would have revealed that Morrison had previously been convicted of one felony drug offense in 1992 and several misdemeanors in the 1990s. His last conviction was for a misdemeanor drug offense in 1999.

"This horrific crime illustrates how important it is for nursing homes to secure criminal history checks before allowing individuals to care for their residents," said New York Attorney General Andrew Cuomo. "Had the nursing home known of Morrison's criminal history, it is possible that this nightmarish crime might have been avoided. We are continuing to examine whether my office should take any action against the home."



New York Nursing Home Aide Convicted of Rape...

"Grandparents Scam" Exposed


A special report by the syndicated TV news program "Inside Edition" finds con artists are scamming seniors out of hundreds and even thousands of dollars by posing as their grandchildren.

Holly Haase, a Multnomah County, Oregon Sheriff's Deputy, explains how the scam artist works, once the con artist has an elderly victim on the phone. "By calling and saying, 'Hello Grandma, this is your favorite grandson,' they give him the information that he needs."

Con: Hi, Grandpa.
Victim: Hi.
Con: Do you know who this is?
Victim: Randy?
Con: Yeah.

"Even in this line of work, for over ten years, you don't think that somebody is capable of doing this to your grandma," Haase says.

Orville and Dorothy Shanafelt, of Portland, Oregon, were both nearing 90 when they fell victim to a phone scam. The con, posing as their grandson, called them, claiming he'd been in a car accident and needed money wired to him immediately.

The Shanafelt's wired $550 to the con artist, explaining they thought he was in trouble. They say they didn't call to verify the story with other family members because the con artist specifically told them he didn't want other relatives to know what had happened.

"It sure sounded like him on the phone ... I would have sworn on a stack of Bibles it was him," Orville Shanafelt says.

Stephen Lee Brown, the con artist arrested in the Shanafelt fraud case, victimized dozens of seniors and found his victims by scanning the phone book for old-fashioned sounding names.

"The victims [names] were Delores, Dorothy, Ruth, Alberta," Deputy Haase tells Inside Edition.

One of Brown's victims, an 86-year-old grandmother, even had to use a walker in order to get to her bank and withdraw money for him.

What was most shocking, the Shanafelt's say, was where the calls originated. Brown had made all of his calls while serving time at a Portland County Jail, where all inmate phone calls are recorded. He is now serving a 17-year sentence for elder fraud.

However, Inside Edition discovered the positive outcome in Brown's case is an exception when it comes to catching these con artists.

The con man who convinced Edward and Irene Kellerman of Fairlawn, Ohio, that he was their beloved grandson Brian is still on the run. They wired him $3,000.

"It was the perfect set up and these people knew exactly what they were doing," says Edward Kellerman.

The detective on the Kellerman case, Dave Zampelli, was able to track the con to Canada where he retrieved the wire transfer records and a fake id with Brian Kellerman's name on it.

"They're very organized. They know what they're doing. They're cons. They're smooth talkers and daily they 're persuading victims to wire them money," Zampelli said.

The Kellermans, who like many of the other victims are retired and live on social security and small dividends, say they were hurt financially and emotionally by this scam.

"You feel stupid that you were taken by a scam, that is foremost. Secondly, you are embarrassed," Mrs. Kellerman said.

The con man who convinced Edward and Irene Kellerman of Fairlawn, Ohio, that he was their beloved grandson Brian is still on the run. They wired him $3,000...

Nursing Home Operators Indicted on Fraud Charges


A Massachusetts grand jury has indicted three people on charges of massive fraud in the operation of five nursing homes in the state.

Brothers Joel K. Logan, of Norwell, and Todd Logan of Braintree, Massachusetts are charged with patient neglect, Medicaid Fraud, theft of nursing home patients' personal funds, conspiracy to steal those funds, and with embezzlement of employee wage deductions intended for funding 401(k) retirement contributions, and life and disability insurance premiums.

Their nephew, Gregory J. Logan, of Kingston, Massachusetts, who served as the administrator for one of the nursing homes, has also been charged with conspiracy and with embezzlement of residents' funds.

The indictments follow a three-year investigation conducted by the state's Medicaid Fraud Control Unit and the Fair Labor and Business Practices Division, both part of the Massachusetts Attorney General's Business and Labor Protection Bureau, along with assistance from the U.S. Department of Labor's Employee Benefits Security Administration.

A Norfolk County Grand Jury returned a total of 26 indictments against Joel, Todd, and Gregory Logan, and the former nursing home facilities. The facilities involved include: Elihu White Nursing & Rehabilitation Center, formerly of Braintree, Pond Meadow Healthcare Facility, Inc., formerly of Weymouth, Atrium Nursing and Rehabilitation Center, formerly of Middleborough, Logan Nursing & Rehabilitation Center, formerly of Braintree, and Crestview Healthcare Facility, Inc., formerly of Quincy.

The charges stem from allegations that, during January 2001 through June 2003, the Logans, and their corporations, diverted funds received under the state's Medicaid program for their own personal use while failing to provide basic goods and services which, as Medicaid providers, they were required to provide to the facilities' residents.

State officials said the investigation determined that the facilities frequently experienced shortages of food, medicine, linens, and personal hygiene items, interruption of pest control services, and accumulation of medical waste, due to nonpayment of vendors, while at the same time the defendants used the nursing home facilities' assets to fund various personal expenditures, including horse racing activities and luxury boat payments.

The Medicaid Fraud Unit's investigation additionally determined that on multiple occasions during May 10, 2002 through January 10, 2003, Joel, Todd and Gregory Logan removed a total of $82,000 from the Patients Needs Accounts ("PNA") for three of the homes, Pond Meadow, Elihu White, and Logan Nursing & Rehabilitation, for purposes unrelated to the residents' own use. PNA accounts are statutorily regulated accounts held in trust for the sole personal use and benefit of nursing home residents.

Massachusetts Medicaid regulations specify that a nursing home facility may not use PNA funds for any purposes other than the personal use of the nursing home residents, under any circumstances.

The indictments also allege that during July 2002, and during November 2002 through June 2003, Joel and Todd Logan failed to remit approximately $55,000 in deductions withheld from employee wages for the purpose of funding the employer-sponsored 401(k) Plan, a type of investment plan where eligible employees may establish individual retirement accounts.

In total, approximately 25 plan participants were affected, excluding approximately 20 Logan family members and corporate insiders. Additionally, during August 30, 2002 through June 6, 2003, the indictments charge that Joel and Todd Logan failed to remit $22,583.64 in employee wage withholding intended to fund short-term disability policies through Colonial Life Insurance, and individual life insurance policies with Boston Mutual.

Four of the nursing homes were forced into receivership during June 2003, and the fifth nursing home, Crestview, went into receivership a year later, during July 2004, based on allegations of financial mismanagement. Each of the nursing homes was either sold-off to other nursing home operators or were closed by the court-appointed receiver.

The indictments come on the heels of $560,000 in judgments obtained by the Attorney General's Office in June against four of the nursing home owners for contempt penalties, receivership costs, and attorneys' fees incurred in investigating and prosecuting a contempt case.

Nursing Home Operators Indicted on Fraud Charges...

California Fines Nursing Home Chain $1 Million


California's second-largest nursing home chain has agreed to pay $1 million and improve the quality of care at its 30 facilities in the state, California Attorney General Bill Lockyer announced.

The settlement will result in a permanent injunction that resolves a civil lawsuit filed by the Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse in Los Angeles County Superior Court.

"Despite dozens of warnings and fines, Pleasant Care was simply unable to provide an appropriate level of care for its residents. This injunction will make sure that Pleasant Care complies with existing law and also provides the best level of care possible," Lockyer said.

Lockyer's lawsuit stems from numerous allegations of elder abuse and criminally negligent care, including more than 160 citations that the California Department of Health Services (DHS) has issued against Pleasant Care facilities across the state over the last five years for regulatory violations.

The injunction was issued by Superior Court Judge Laura Matz.

Under the terms of the injunction, all 30 of Pleasant Care's skilled nursing facilities in California must comply with numerous conditions that will immediately and dramatically improve the quality of care provided to residents occupying the company's more than 4,300 skilled nursing facility beds, including:

• Mandatory Staff Training - staff must undergo training on proper patient care in such areas as wound treatment, accurate record keeping, and the prevention of malnutrition and dehydration;

• Abuse and Neglect Investigations - each facility is required to implement policies to ensure prompt reporting and investigation of any alleged act of abuse or neglect towards a resident, and staff persons reasonably suspected of committing abuse must be placed on administrative leave during the course of the investigation;

• Compliance Officer - Pleasant Care must hire a Compliance Officer who will be responsible for ensuring that each facility complies with the law, properly responds to state and federal investigations, and delivers proper levels of care to residents;

• Independent Monitor - Pleasant Care will pay for an Independent Monitor, selected in consultation with the Attorney General, who has broad authority to order statewide quality of care improvements, and will annually report its findings to the AG over the next five years;

• Nurse to Patient Ratio - Pleasant Care must maintain nurse staffing ratio of 3.2 hours per patient, per day, subjected to outside audits to ensure compliance, and ordered to pay stipulated fines for any failure to maintain the required nurse-to-patient ratio; and,

• Whistleblower Protections - Pleasant Care must establish and maintain a whistleblower program that allows employees, residents and other individuals to anonymously report suspected violations and mistreatment of residents. A log detailing all complaints made and investigation outcomes also must be maintained and made available to the Independent Monitor and the AG.

In addition, Pleasant Care is required to pay $1 million in civil penalties and $350,000 to reimburse the state for investigative costs. Failure to fully comply with any provision of the injunction also could result in civil penalties of up to $6,000 per violation, other sanctions deemed appropriate by the court, and exclusion from receiving funding from both the Medi-Cal and Medicare healthcare programs.

Pleasant Care currently operates 30 skilled nursing facilities in 14 different California counties, including: Alameda, Butte, Kern, Los Angeles, Marin, Mendocino, Riverside, San Diego, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Sonoma and Sutter.

Over the last five years, DHS has issued more than 160 citations and fines against numerous Pleasant Care facilities for violations of patient care regulations, with several citations involving violations which presented an imminent danger that death or serious harm would result.

In 2004 alone, for example, eight different Pleasant Care nursing homes in California were found to have delivered "substandard" care to residents in annual surveys conducted by DHS.

Other specific instances of deficient service and care also formed the basis for the AG's lawsuit.

In 2003, a resident at the company's Ukiah facility suffered a seizure and a blocked airway, but the nurse was unable to effectively aid the resident due to the fact that the facility's suction machines had not been kept in working order. The resident died from acute cardiopulmonary arrest stemming from his inability to breathe.

In 2004, a resident at Pleasant Care's Novato facility suffered from a pressure sore that was allowed to worsen so severely that the resident ultimately died. The coroner who examined the female resident later told DHS that his examination showed that she had been subjected to "abominable wound care management."

According to data maintained by the Office of Statewide Health Planning and Developement, Pleasant Care has also consistently failed to staff its chain of nursing homes at the rate of 3.2 nursing hours per patient, per day as required by California law. The failure to adequately staff its facilities with qualified nurses resulted in increased profits for the corporation at the expense of its residents' health and safety.

In a related case, Pleasant Care of Northern California (PCNC), a wholly-owned subsidiary of Pleasant Care Corporation, is scheduled to appear in Napa County Superior Court tomorrow for the purpose of entering pleas in a criminal case filed by the Attorney General.

The case alleges that PCNC delivered criminally negligent care to patients at its now closed Napa facility, and charges the facility with five misdemeanor counts of elder abuse and one count of willfully violating California's nursing home patient care regulations.

California Fines Nursing Home Chain $1 Million...

Hidden Cameras Reveal Neglect at NY Nursing Homes


Nineteen employees at two New York State nursing homes where hidden cameras revealed distressing evidence of patient neglect have been arrested, New York Attorney General Eliot Spitzer announced.

In addition to the prosecution of these individuals on criminal charges, the Attorney Generals office has filed a civil lawsuit against the corporations that control one of the nursing homes. The investigation against the other continues.

In a related action, the Attorney General released a comprehensive report that will help consumers better assess the relationship between patient care and staffing levels at nursing homes in communities across the state.

"The residents of our states nursing homes are among our most vulnerable citizens," Spitzer said. "My office is committed to doing all it can to protect these individuals, who are sometimes without friends and family to protect their interests. With these cases we are trying to send a message that law enforcement is watching to ensure that appropriate standards of care are met."

The first case involves the Jennifer Matthew Nursing Home in Rochester. Critical evidence in this case was developed through the use of secretly-recorded videotapes of a bedridden patient, referred to in the court filings as "Patient A."

Patient As family permitted the Attorney Generals Medicaid Fraud Control Unit to install a hidden camera to monitor interaction with nursing home staff.

The complaint describes what the camera recorded -- clear evidence that Jennifer Matthews staff had neglected Patient A. The complaint also describes how Patient A and other residents were not turned and repositioned to avoid the risk of pressure sores and were often left for hours to lie in their own urine and feces, and that medications and treatment were not provided as prescribed.

The court papers also describe how a minimal level of attention from management would have detected these problems.

The facility was sufficiently small that walking into every patient room in the home would have taken a few minutes, and a supervisor would readily be able to determine that residents were not receiving appropriate attention.

Instead, the court filing describes how the staff would move call bells away from patients and stop doing their rounds so that they could socialize, watch movies, sleep, or even leave the building.

Staff members are also accused of falsely claiming in required paperwork that proper care had been provided to the patients.

To date, eight former licensed or certified Jennifer Matthew professionals have pleaded guilty in connection with the neglect and record falsification. An additional former employee was arrested on December 6, 2005, and five more were arrested on criminal complaints yesterday.

Among those charged civilly was the primary owner and operator of the facility, Anthony Salerno, and a consulting company he owns known as Healthcare Associates (HCA).

The second matter involves the Northwoods Nursing Home in Cortland. As with the Rochester nursing home, the family of a resident consented to the installation of a hidden video camera.

According to criminal complaints filed in the cases, the secret camera revealed that licensed professionals at Northwoods repeatedly failed to provide care or treatment to that resident, and then falsified his care records to report that proper care had been administered.

Five employees have been charged with Falsifying Business Records in the First Degree, a class "E" felony, and misdemeanor neglect and endangerment in the Northwoods matter.

These and other patient neglect cases were the catalyst for a report prepared by the Attorney Generals office that details staffing levels at nursing homes throughout the state.

In releasing the data, the Attorney General cautioned that consumers should use staffing levels as just one of many indicators in choosing a home.

The report urges consumers to visit homes, actively monitor the level of care being delivered to their loved ones, talk to others with family members or friends in the home, and consult with knowledgeable professionals.

Hidden Cameras Reveal Neglect at NY Nursing Homes...

Nursing Home 101: Being an Effective Advocate


Many adult "kids" with parents needing residential care think that, once they find a facility that doesn't make them reach for the silver bullet, the job's done. Think again.

Getting into a quality substitute for home is just the beginning. Once Mom or Dad checks in, you'll assume a new role: elder advocate. Many older people aren't terribly assertive about getting their due, whether it's dietary changes, extra therapy or a seat on that field trip bus. And when it's a matter of both health and happiness, someone needs to be pushing for the full package.

Of course, residential facilities are often understaffed and residents can be needy. As a consumer, you've got federal (and sometimes state) law on your side to insist that Mom or Dad get the quality of care they deserve. The Code of Federal Regulations (CFR) and your state law contain many protections.

Here are a few eye-openers from the Code of Federal Regulations:

Care Plan Each nursing home resident is entitled to a personalized "care plan," based on their needs. Such a plan must offer services that allow a person to maintain her highest practicable physical, mental and psychosocial wellbeing. This means that, for example, if Dad wants to sleep until 10:00 am instead of rising at the official 6:00 am call, he is allowed to do so. On a practical note, some families hire a part-time aide or appear themselves to ensure that a request is honored.

Visiting Hours "Family members can only visit during visiting hours." Not so! 42 CFR 483.10(j) allows immediate family the right to visit at any time. And it may be to your advantage to visit during off-hours, to see what things are like when visitors aren't expected.

Who Decides "The care-taking staff determines the level of care Mom or Dad will receive." Not so! In reality, the mandatory care plan drives the level of care and type of services a resident should get. Federal law requires that a facility do a full assessment of a resident's condition within 14 days of admission, and at least every 12 months after that. A care plan should include measurable objectives and timetables.

Making Progress You may hear that if Mom or Dad isn't making progress, the home need not offer therapy. Assuming that the resident needs "skilled nursing services" or "skilled rehabilitation services," a facility is charged with trying to maintain his condition. Any facility needs to make sure that a person's ability to carry out activities of daily living doesn't deteriorate. The only exception: if the person's clinical condition makes deterioration unavoidable.

Feeding Tubes They can be used only if absolutely necessary, not if a resident eats slowly or needs extra help cutting or eating food. The facility must provide whatever help a resident needs to eat normally.

Wandering Relatives In the bad old days, staff sometimes tied residents into chairs or administered calming drugs to prevent wandering, especially among Alzheimer's patients. Now, nursing homes cannot use convenience or discipline as an excuse for restraining residents. The only legitimate purpose for restraint is to treat a person's medical symptoms.

One Doctor Fits All "Mom must use the physician assigned to the facility." Not so! In reality, the "free choice" legal requirements include the right to choose one's own personal attending physician.

Financial Matters

Guarantor "You must sign admission forms as a guarantor or responsible party." Not so! There is no such requirement. 42 CFR 483.12(d) prohibits a facility from forcing a third party to be a guarantor for the tab. You are only obliged to apply Mom or Dad's funds to the bill, not your own.

Custodial Care "Since your relative needs custodial care only, Medicare won't reimburse the home." Not so! In reality, Medicare can pay for up to 100 days, provided a resident either is a) hospitalized for at least 3 nights, or b) needs skilled nursing or skilled rehabilitation. (As of this year, days 21-100 have a daily co-payment of $114.) Even if the facility nixes the need for skilled nursing care, a resident can appeal.

Non-Medicare Beds "Once Dad is no longer eligible for Medicare reimbursement, we can transfer him to a non-Medicare-certified bed." No! A "Medicare certified" bed can be used for patients paying privately or through Medicaid, and a resident asked to move against his will can refuse.

Fixed Fees "Extra charges are set by the facility, and are not negotiable. You have to pay extra for services like bath soap, denture cleaner or hospital gowns." Wrong! A facility's admission agreement should include covered and exempt or "private pay" charges, which are laid out in federal law. See 42 CFR 483.10 ("Resident rights") for details.

Bed Holds Say your parent/relative leaves the nursing home for a hospital stay and the facility claims that his "bed hold" has expired when you try to have him readmitted. Although Medicaid and Medicare won't pay for "bed holds" in many states, private payment is allowed. And even if a "bed hold" expires, a facility must readmit a resident eligible for Medicaid reimbursement from the hospital if that facility has an available bed.

These are just a few of the misconceptions about nursing home and assisted living facility obligations.

Savvy consumers are aware that about 80% of nursing home residents enter from a hospital and hospitals are legally required to provide a discharge plan to any patient needing or requesting one. Your physician can also request one. Often, a well-thought-out discharge plan will set the stage for more focused, organized nursing home care.

More Info

For more information, see:

www.medicare.gov/NHCompare, which compares nursing homes within a given geographical area;

• AARP's checklist on what to look for in a nursing home, available at www.aarp.org/bulletin/longterm.

• The Legal Information Institute at Cornell University Law School, an excellent resource for federal and local law. See www.law.cornell.edu.

---

The author is an attorney in Fairfax County, Virginia

Nursing Home 101: Being an Effective Advocate...

Chicago Nursing Home, Doctor Charged with Abuse


A Cook County, Illinois, Grand Jury has returned indictments against a nursing home doctor and the Cook County nursing home facility where he worked on charges related to the death of a patient in their care.

Attorney General Lisa Madigan said the indictments charge Forest Park, L.L.C., and Care Centers, Inc., doing business as The Pavillion of Forest Park nursing home, and Jason Garti, M.D., former medical director and wound care doctor at Pavillion, with multiple charges of Gross Neglect of a Long Term Care Facility Resident.

Forest Park, L.L.C., and Care Centers, Inc., were indicted as the licensee and owner of Pavillion, respectively.

The charges are the result of an investigation by the Illinois State Police Medicaid Fraud Control Unit. The investigation began after emergency room personnel at Loyola Medical Center contacted the Department of Public Health.

According to the indictments, on September 11, 2002, a resident at Pavillion was transported by ambulance to the emergency room at Loyola Hospital, where it was discovered the patient had a large area of decubitus ulcers commonly known as bedsores.

The indictments charge Garti with two counts of Gross Neglect of a Long Term Care Facility Resident, a Class 4 felony, punishable by one to three years in the Illinois Department of Corrections (IDOC).

The two entities, Forest Park L.L.C., and Care Centers, Inc., were each charged with multiple counts of Gross Neglect of a Long Term Care Facility Resident. If convicted, the charges may result in the closure of the nursing home.

Chicago Nursing Home, Doctor Charged with Abuse...

Indiana Nursing Home Fined After Resident Burns to Death


Shortly after a resident at an Indiana nursing home caught fire, state inspectors descended on the facility and cited it for multiple violations of state code. State officials say the Regency Place nursing home of Dyer, Indiana, faces a fine in connection with the alleged violations.

Rodney Kenney, 72, died at a Chicago hospital where he was treated for burns. Inspectors say the Alzheimers patient was severely burned May 26 when his clothing caught fire as he sat in a wheel chair. Authorities say they found a cigarette lighter near Kenney, but that he was not a smoker. In fact, state law prohibits smoking in nursing homes and patients are not allowed to possess smoking materials.

In their report, inspectors concluded that the staff at Regency Place failed to properly supervise Kenney. In addition, they said they found numerous other problems:

• A nursing home staff member designated as a medication aide mixed up two residents medications one day, leaving one woman sick and dizzy for two days;
• Regency Place didnt adequately screen two new employees;
• the nursing home wasnt adequately staffed.

In fact, the report said that when inspectors arrived the morning of May 28, they were told there was no one in charge. Inspectors also said residents asking for help from staff members were ignored.

A state health department spokeswoman said Regency Place faces possible denial of Medicare and Medicaid payment for new admissions after Aug. 19, along with a fine.

A spokesman for the nursing home said the company has filed a plan of correction with the state is confident we will resolve these matters to the states satisfaction in the near future.



Indiana Nursing Home Fined After Resident Burns to Death...

Oklahoma Nursing Home Shocks Inspectors


Oklahoma Health Department inspectors say they found a shocking situation when they arrived at the Nobel Residential Care Home, along with more cockroaches than they could count. As a result, the residents of the nursing home were ordered evacuated to cleaner quarters.

Department officials say an on-site monitoring visit determined that an emergency existed requiring immediate action to protect the health, safety and welfare of the residents of the home based on widespread infestation of rodents and insects.

Inspectors say they found rodent droppings, urine-soaked kitchen plates and insects crawling all over residents' clothing and bedding.

Noble Residential Care Home housed 34 residents. A separate, unlicensed building housed eight additional residents. An interagency relocation team from the OSDH, Department of Human Services, and the Department of Mental Health and Substance Abuse Services coordinated the relocation of the residents, working with the residents, their families and guardians to find new homes and make the transition as smooth as possible.

James Joslin, assistant chief of Long Term Care Services at the OSDH, reported all residents were out of the building within 24 hours.

"It is a credit to the assisting agencies as well as the receiving facilities that we were able to get these people moved so quickly. We regret the sudden disruption to the residents' lives but the living conditions in this facility fell well below the standards we expect of a licensed residential care home," Joslin stated.

The facility has ten days to request a hearing on the decision to relocate the residents.

"We take our responsibility to protect the residents of these facilities very seriously and we will continue our inspections to ensure the residents are receiving quality care and the operators are meeting state regulations. The residents continue to be our primary concern," said State Health Commissioner Dr. Michael Crutcher.

The action included notice to the facility of the Department's plans to file a petition to not renew the facility's license.



Oklahoma Nursing Home Shocks Inspectors...

Study: Nursing Home Residents Dying Of Hunger, Thirst


Residents of America's nursing homes die every day, but health officials are wondering how many of those deaths could be prevented with improvements in simple, basic care. Some suggest many deaths occur because caregivers don't have the time or experience to properly look after residents.

According to an investigation by the Detroit News, many of the deaths occur because residents either don't eat enough food or drink enough liquids.

Nationwide, malnutrition and dehydration killed at least 13,890 nursing home residents between 1999 and 2002, the most recent year for which numbers are available, federal health records show. Those conditions contributed to the deaths of about 68,000 others.

While some of those deaths probably would not have been prevented even with the best of care, analysis of medical records and government inspection reports suggest many could have been, and it's leading to calls for Congressional action. Sen. Ron Wyden, D-OR, a long-term care advocate who sits on the Senate committee on aging, says there's no reason any nursing home resident should die because of diet.

"America is at ground zero in its fight against [nursing home] malnutrition," he said. "Today, we begin an effort that can improve the health and lives of hundreds of thousands of older Americans."

Wyden said it was "morally repugnant" that nursing home residents are malnourished, particularly in a country with abundant wealth and resources.

Nursing home Industry executives maintain that malnutrition and dehydration - and the deaths they cause - are almost always natural progressions of the chronic diseases that put patients in nursing homes in the first place.

"This is an active stage of dying and not necessarily something people should be alarmed with," said Reginald Carter, president and chief executive of the Health Care Association of Michigan, which represents more than 400 long-term care facilities.

But a study by the Commonwealth Fund suggests there's more to it than that. The study says at least a third of the 1.6 million nursing home residents in the United States may suffer from malnutrition or dehydration, conditions that can aggravate or cause more severe medical problems and hasten death. That suggests a more systemic problem. More importantly, the study says the problem can be corrected.

"Much of this problem could be alleviated by increasing the number of overall staff and trained professional nurses at nursing homes so they can make sure residents are getting enough to eat and drink," said Sarah Greene Burger, executive director of the National Citizens' Coalition for Nursing Home Reform and lead author of the study.

Chronic conditions such as depression and cognitive impairment, and the side effects of treatments for these conditions, are also a major factor. Residents suffering from depression, for example, are more likely to experience weight loss, the study says. Another obstacle to good nutrition is that nursing home residents commonly have a limited choice in what they eat, with their cultural and ethnic food preferences frequently ignored. Poor dental health also contributes to inadequate nutritional intake.

"Malnutrition, dehydration, and weight loss in nursing homes constitute one of the largest silent epidemics in this country," said Karen Davis, president of The Commonwealth Fund. "As this report suggests, we can address this problem by promoting changes in public policy, seeking creative solutions from providers and professionals, undertaking further research on key issues, and enforcing existing standards."



Study: Nursing Home Residents Dying Of Hunger, Thirst...

Nursing Home Cost Hits $70,000 Per Year

Inflation may be under control, but nursing home costs continue to skyrocket. A major insurance company says the average daily cost of a private room in a nursing home in the United States is $70,080 per year, or $192 per day.

The highest rates were reported in the state of Alaska where the cost is $204,765 per year or $561 per day on average. The lowest rates were found in Shreveport, Louisiana at $36,135 per year or $99 per day.

The average length of stay in a nursing home for current residents is 2.4 years, which makes the average cost of a nursing home stay approximately $168,192. The data is contained in the 2004 MetLife Market Survey of Nursing Home and Home Care Costs.

The study also found that the cost of a home health care aide averaged $18 per hour nationally. Home health care is most expensive in Hartford, Connecticut at $28 per hour and least expensive in Shreveport, Louisiana and Jackson, Mississippi where rates are $13 per hour on average.

According to the 2003 MetLife Market Survey of Nursing Home and Home Care Costs the average daily rate for a private room in a nursing home was $181 per day or $66,065 annually. The hourly rate in 2003 for a home health aide was $18.

"The cost of long-term care continues to rise," said Sandra Timmermann, Ed.D., director of the MetLife Mature Market Institute. "Whether one chooses care at home or care in a nursing home, the costs can be exorbitant. As people prepare for their retirement and assess their asset and income requirements, it is also essential that they plan for the possibility that they will need assistance with day-to-day living. Unanticipated long-term care costs can derail an individual's financial plan; long-term care insurance may be a solution," said Timmermann.

People are living longer, but long life may not be accompanied by good health. In 1940, a 65-year-old woman could expect to live an additional 14.7 years; by 2000 a 65-year-old woman could expect to live another 19.5 years, and by 2040 women are expected to live an additional 22 years.

Chances increase that as people age they will develop a chronic condition or physical or cognitive disability for which they will require assistance. For example, almost 38% of people aged 65 and over are diagnosed with a severe disability, and 47% of those aged 85 and older have Alzheimer's Disease or another form of dementia.

Approximately 1.6 million people reside in 18,000 nursing homes in the United States with just under 10% of the residents people aged less than 65 years old and 46.5% aged 85 years and over, according to the National Center for Health Statistics. Most residents (72%) are women and three-quarters require assistance with three or more activities of daily living.

More than 1.3 million patients received home health care services from 7,200 agencies in 2000, with more than half receiving help with at least one activity of daily living. Seven in ten patients were ages 65 and older, and 65% were women, according to the National Center for Health Statistics.



Nursing Home Cost Hits $70,000 Per Year...

Ensign Group Nursing Homes on Watch List


The 2004 Nursing Home Watch List, published this month by Consumer Reports, names seven California nursing homes currently operated by the Ensign Group, whose records "raise questions about the quality of care delivered to residents." The Ensign Group is California's fifth-largest and fastest-growing nursing home chain.

The list, published annually by the independent non-profit organization, uses state records and public complaints to compile a list of homes in states across the U.S. at which consumers should be particularly vigilant.

To compile the Consumer Reports list, researchers looked at five criteria: high-severity deficiencies; substandard quality of care deficiencies; high numbers of repeat deficiencies; high numbers of total deficiencies; and citations for failing to provide access to the survey results.

In a report on the Ensign Group released in August, California-based Nursing Home Watch also exposed resident care problems at several of the company's facilities. The report, "Condition Critical: How Care for Seniors Suffers in California's Ensign Group Nursing Homes," outlined alarming patient care concerns including gangrenous bed sores, repeated falls, unexpected weight loss, medication errors and other problems that threaten seniors at these nursing homes.

Facilities currently operated by Ensign named in Consumer Reports' 2004 Nursing Home Watch List include:

California

  • Arroyo Vista Nursing Center*, San Diego
  • Brookside Healthcare Center, Redlands
  • Cloverdale Healthcare Center, Cloverdale
  • Park View Gardens at Montgomery, Santa Rosa
  • Sonoma Healthcare Center, Sonoma
  • Victoria Care Center, Ventura
  • Vista Knoll Specialized Care, Vista
Texas
  • Northern Oaks Living & Rehab, Abilene, TX
Arizona
  • Sabino Canyon Nursing & Rehab, Tucson, AZ

Hospitals rely on skilled nursing facilities to provide rehabilitation for patients, and regularly refer patients to nursing homes. For information on local hospitals that refer patients to Ensign homes on this watch list, see www.EnsignWatch.com.

Consumer Reports' Nursing Home Watch List can be found on their Web site: www.consumerreports.org.

Nursing Home Watch is a coalition of senior advocates, nursing home staff, nursing home residents and family members, the Service Employees International Union and community supporters who have united to improve the safety and quality of care in California's nursing homes.



Ensign Group Nursing Homes on Watch List...

Nursing Home Chain Settles Arkansas Charges


A Tennessee company that operates a chain of nursing homes has reached a settlement with Arkansas Attorney General Mike Beebe. Advocat, Inc., operating in Arkansas as Diversicare Management Services, will resolve a series of lawsuits and investigations concerning allegations of mistreatment and neglect at 13 Advocat-operated nursing homes in Arkansas.

Under the terms of the settlement, Advocat will spend $600,000 to install sprinkler systems in Arkansas nursing homes. In addition, Advocat will pay $400,000 into the Arkansas Medicaid Program Trust Fund over the next two years. The settlement also includes $300,000 that Advocat is spending on improving staff training and patient care in its Arkansas facilities.

Beebe filed lawsuits earlier this year alleging mistreatment and neglect of patients at Advocat nursing homes in Conway, Hot Springs (2 facilities), Malvern, Sheridan and Eureka Springs. Additional investigations were also conducted regarding practices at nursing homes in Camden, Newport, Pocahontas, Des Arc, Mena, Walnut Ridge and Ash Flat.

The resulting allegations included failure to provide necessary care, rehabilitation, treatment, supervision and medical services. The state also alleged that nursing-home staff members failed to carry out prescribed treatment plans and failed to report health problems or to report them in a timely fashion. No individual staff members were named in the lawsuits.

"These lawsuits were not meant to financially damage Advocat; they were meant to improve the nursing-home care they provide to Arkansas residents," Beebe said. "The last thing we need is fewer nursing homes operating in our state. What we do need is to ensure quality care from the centers we already have."

In addition to allegations of mistreatment and neglect, the state lawsuits also alleged that some facilities submitted fraudulent billings to the Arkansas Medicaid Program for care that was either inadequate or never provided. Advocat does not admit or acknowledge any violations in their Arkansas nursing-home facilities.



Nursing Home Chain Settles Arkansas Charges...

Low Staffing, High Turnover Blamed for Poor Nursing Home Care


A recent survey finds that more than one-third of California's freestanding nursing homes do not meet the state's minimum nurse staffing standards (3.2 hours or more per resident. The finding is one of several in a "snapshot" report prepared by the California HealthCare Foundation (CHCF).

The low staffing levels contributed to more than two-thirds of the staff in California's nursing homes leaving their jobs in 2002. Low staffing and high turnover rates were important contributing factors to poor quality care and a 38 percent increase in complaints between 2000 and 2002.

The CHCF report found that the most common clinical measures of poor quality -- weight loss, time spent in bed, and use of physical restraints -- continued to be serious problems in 2002.

"Low staffing led to 78 percent of nursing homes not complying with federal care and safety regulations during mandatory inspections," said the report's author, Charlene Harrington, Ph.D., School of Nursing, University of California, San Francisco. "An additional 11 percent of the nursing facilities were cited for very serious quality of care problems."

State monitoring by the Department of Health Services resulted in 43 percent of nursing homes receiving deficiencies (warnings for minor problems) and 26 percent receiving citations, which include fines and are indications of more serious violations.

Other findings in the report include:

• The number of facilities with inadequate staffing (according to state requirements) decreased from 46 to 37 percent between 2001 and 2002;
• 93 percent of nursing homes did not meet staffing ratio guidelines of 4.1 hours per resident, per day, recommended in a report to the Centers for Medicare and Medicaid Services; Annual nursing staff turnover rates ranged from 5 to 304 percent. The majority are nursing assistants who earn an average of $10.35 per hour;
• In 2002, 10 percent of nursing home residents experienced substantial weight loss; 9 percent were in bed all or most of the time, and 17 percent were placed in physical restraints;
• Nearly half of the state's nursing homes reported either no profit or a net loss in 2002, and 160 were in bankruptcy between 1999 and 2002;
•Among freestanding nursing homes that receive Medi-Cal reimbursement, the proportion of those that broke even or lost money grew by an average of 26 percent.

Non-profit nursing homes, representing just 18 percent of the state's total, faired better than for-profit facilities, which had:

• An average of 3.3 nursing hours per resident per day compared with 4.1 for nonprofits;
• Staff turnover rates of 70 percent, compared to 49 percent for nonprofits;
• 37 percent more violations than nonprofits.

The report found that in spite of an aging population (the number of residents aged 85 and over is expected to double by 2030) there is ample capacity in the state's 1,400 nursing homes. Occupancy has declined from 85.9 percent in 1991 to 80.9 percent in 2001.

"Nursing homes must do a better job of caring for the 110,000 Californians currently in their facilities, not to mention preparing for a rising tide of elderly citizens who deserve more," said Mark Smith, M.D., CHCF president and CEO.

"Nursing homes face difficult challenges -- low-paid staff, high turnover rates, low margins, and declining reimbursement from government agencies-but seniors deserve quality care and their families must have confidence that loved ones are in a safe environment."

Detailed information on every nursing home in the state-including quality ratings, staffing levels, and results of complaint and inspection visits-can be found at www.calnhs.org. The data is current as of May 2004.

Low Staffing, High Turnover Blamed for Poor Nursing Home Care...

Pennsylvania Nursing Home Owner Sentenced to Prison


A Pennsylvania nursing home owner has been sentenced to four to twelve years in prison for stealing millions of dollars from New York taxpayers by fraudulently billing for services never provided to New York State Medicaid patients residing at his facility and for improperly obtaining payments from New York for services Pennsylvania was already reimbursing.

David Arnold, of Athens, Pennsylvania, and his corporation, Heritage Nursing Home, Inc., were convicted after a two-week bench trial this past January of one count of Grand Larceny in the First Degree and three counts of Grand Larceny in the Second Degree.

Appearing before Acting Albany County Court Judge Stephen Sirkin, Arnold was sentenced to 4 to 12 years in prison on the charge of Grand Larceny in the First Degree and concurrent terms of three to nine years on each count of Grand Larceny in the Second Degree. He was also ordered to make $1 million in restitution to the Medicaid program.

Heritage Nursing Home, Inc., was sentenced to an unconditional discharge and fined $10,000.

We have a special responsibility to protect our more defenseless citizens from the greed of unscrupulous nursing home owners who callously fail to deliver needed health services, said New York Attorney General Eliot Spitzer. The sentence imposed today sends a clear message: nursing home owners who abandon and neglect their patients for personal gain will go to jail.

An overwhelming majority of the Heritage residents are New York patients. The evidence at trial established that, from 1991 through 2000, Arnold and Heritage Nursing Home failed to deliver needed services to hundreds of New York Medicaid recipients who resided in the home. These services included basic dental treatment and occupational and speech therapies for which Arnold and the Home billed the New York State Medicaid program millions of dollars.

Evidence introduced at trial established that patients were jeopardized by Arnolds conduct. The evidence showed that:

  • hundreds of patients never saw a dentist during their time at Heritage, even though New York paid Heritage to deliver routine dental care to patients.
  • patients with swallowing problems were fed with a turkey-baster-like syringe because it was quicker than feeding them with a spoon.
  • numerous patients with swallowing problems that went untreated developed serious conditions, including aspiration pneumonia, which may have been preventable had Heritage delivered the speech therapy that New York paid the Home to deliver.
  • other patients developed contractures, a stiffening of joints and muscles that is properly addressed with occupational therapy. These contractures became so severe that residents lost the ability to feed and dress themselves because they could not move their hands.
  • between 1991 and 1997, no speech or occupational therapists were on staff at Heritage or on contract. Between 1991 and 2000, there was no dentist providing any routine examinations or care at the Home.

The case is part of the Attorney Generals statewide Nursing Home Initiative, which continues to examine the responsibility of nursing home owners and executives for conditions leading to poor patient care and abuse. The Initiative includes the investigation of out-of-state nursing homes that provide care to New York residents.

Pennsylvania Nursing Home Owner Sentenced to Prison...

California Steps Up Nursing Home Oversight


California Attorney General Bill Lockyer announced Operation Guardians conducted 150 surprise inspections of California skilled nursing homes from April 2001 to March 2003, sparking corrections of dangerous conditions and improving the quality of care and living conditions for the facilities' residents.

"Operation Guardians is helping ensure that the 250,000 elderly and dependent adults who reside in the state's 1,400 skilled nursing homes are receiving the care they deserve," Lockyer said. "This program is succeeding in preventing loss, injury and death by identifying health and fire hazards, theft of patients' trust account funds and failures to provide adequate medical services to these vulnerable citizens before they can escalate into life-threatening problems."

Established in April 2000 by Lockyer as a pre-emptive, pro-active program, Operation Guardians uses multi-agency teams to conduct unannounced inspections of facilities and identify problems that threaten the dignity, safety, welfare and quality-of-life of the residents. Operation Guardians operates and inspected facilities in 16 counties: Alameda, Contra Costa, Fresno, Humboldt, Los Angeles, Monterey, Napa, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, Santa Barbara, Santa Clara, Sonoma and Ventura. Additional inspections were conducted at the request of three counties: Marin, San Mateo and Yolo.

"Elder abuse and neglect are very serious problems in California's nursing homes," said Patricia McGinness, executive director of the California Advocates for Nursing Home Reform, California's largest nursing home watchdog group. "Attorney General Lockyer's Operation Guardians program provides the scrutiny needed to protect the residents of the state's nursing homes."

"When we entrust the care of a loved one to a nursing home, we expect them to receive the best possible care in a clean, safe and caring environment," said Tom Porter, state director of AARP, the nation's largest elder advocacy organization. "Operation Guardians creates a strong incentive for nursing homes to maintain the quality of their staff and facilities and ensure patients receive the best care possible."

Lockyer said most of the nursing homes inspected during the past two years quickly responded by making improvements in the facilities and the medical and health care provided. The most prevalent problems identified were failure to meet the state's minimum staffing requirements of 3.2 nursing care hours per day, ensure that nurse assistants possess valid certification, document tuberculosis tests of employees and prevent and document the loss of residents' property.

The inspections showed performance levels ranged from near compliance with federal and state standards of care to situations which required referrals to law enforcement, regulatory or licensing agencies. The inspections resulted in two felony convictions. In one, a licensed vocational nurse was convicted of stealing narcotic pain medication intended for residents in an Oxnard facility. In another, an administrator-in-training at a Napa facility was sentenced to three years in state prison for stealing $49,000 from facility residents and their families, and using threats and intimidation to discourage them from reporting the theft.

"Although the goal of Operation Guardians is to prevent injury by identifying even the smallest of problems that, if left unchecked, could grow into dangerous situations for residents," Lockyer said, "we also are there to root out criminal activities that then can be prosecuted."

Of the 38 facilities statewide that underwent follow-up inspections, more than half either had corrected or were in the process of correcting the problems identified. All of the 328 fire safety-related violations discovered were corrected or in the process of being corrected. Three physicians were referred to the California Medical Board for investigation; two were sanctioned and one is still under investigation. At least 34 facilities have received Department of Health Services-issued deficiencies substantiating Operation Guardians' findings, and in several cases in which the loss or theft of residents' property was identified, the residents have received compensation.

Deficiencies discovered during the Operation Guardians inspections were divided into five general categories:

1. Environmental Non-Compliance, ranging from foul odors emanating from urine and fecal matter, to loose handrails and improperly stored food items.
2. Resident Care Non-Compliance, ranging from failure to adequately document patient care, implement medical staff orders, safely store controlled substances and medical instruments, to over-medicating patients and failing to report alleged abuse to appropriate authorities.
3. Administrative Non-Compliance, which includes failure to maintain proper personnel files of medical staff, protect patients' personal items or document required tuberculosis (TB) tests.
4. Fire Safety Violations, which include inoperable fire extinguishers or fire alarms, obstructed fire exits, exposed wires and unsafe chemical storage.
5. Staffing Level Non-Compliance. Of the 116 facilities in which staffing levels could be inspected, 79, or 68%, failed to meet state laws requiring a minimum of 3.2 hours of nursing care per resident per day. Nursing care does not include services provided by housekeeping, maintenance, kitchen, clerical or non-clerical staff.

Headed by the Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA), Operation Guardians includes local elder abuse ombudsmen, fire departments, prosecutors, police and the University of Southern California School of Medicine. The inspections complement regular inspections conducted no less than every 15 months by the Department of Health Services, which is responsible for licensing and regulating the state's skilled nursing facilities.

The program illustrates the Attorney General's commitment to combating elder abuse, both through prevention efforts and aggressive prosecution. Since Lockyer began his first term as Attorney General in 1999, the Attorney General's BMFEA has increased criminal prosecutions of elder abuse in the state's skilled nursing homes by 749 percent, and convictions by 574 percent.



California Steps Up Nursing Home Oversight...

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Nursing Homes: The Eden Alternative

Bill Thomas, M.D., is co-founder of the Eden Alternative, a replacement for the institutional nursing home. Thomas discussed the concept in an interview with the PBS televison special, And Thou Shalt Honor.

Dr. Bill Thomas: American society views its elders as left-over products, I'm sorry to say. Our elders primarily are seen as a burden in our society and not as a gift. And the work of caring for our elders is seen as a drag on our economy and not as a gift to us as a people. As a geriatrician it's very clear to me that once an older person moves past the jolly period of barefoot water skiing and telling fun stories to the grandkids, and needs some real care and maybe is struggling with some real disability, they are regarded as a burden in our society.

It's a great loss to all of us when we adopt the idea that elders are only worth what they can do and not what they can be.

What is the state of nursing home care in our country today?

I'll put the American nursing home on the critical list. It's not going to make it. In fact my work, my whole passion and my whole work is pulling the plug on the American nursing home. It's really an institution, not just from the 20th century but really from the 19th century. It's a relic. It's a left-over vestige of a factory, assembly-line approach to care that is just not going to meet the needs of elders in the 21st century. And in fact, I'll do everything that I can to see that, as we move forward, nursing homes cease to exist.

Why do you think nursing homes have to be unplugged?

In America there are almost 300 million horror stories that people can tell about nursing homes. Everyone's got a story to tell. And the reason there are all these stories to be told is because the nursing home is a relic. The nursing home is supposedly a place for care, but it really becomes a factory of service, where people are provided with services and the art, the gentle art of caring is set aside. And that's a real tragedy for millions of American families.

When you're looking at the American elderly population, the population that needs care, what percentage of those are now in nursing homes? And how should that change?

Right now in America there are about 1.7 million people living in a nursing home. And any adult American who reaches the age of 65 has a 50% chance of spending time, significant time, in a nursing home. That's a vast proportion of our society. Let me give you an example. The only other segment of our society that is more likely to be institutionalized are convicted criminals. We have about 2 million people living in prisons. So here we have a society that uses an institutional pattern for convicted and violent felons and our frail mothers and fathers. And that, that is, that is a losing proposition in the 21st century.

What has to be done? What does our society have to do to change that paradigm?

The first thing we've got to do is to get away from the idea that there is a long-term care industry. Just the words "long-term care industry" make me want to throw up. Long-term caring for our elders is not an industry. And making it an industry perverts the real value in this. So, first thing we got to do is move decisively away from care as a big business, as a business opportunity.

And I think we can do that by moving away from the idea that care for frail elders has to be localized in buildings we call nursing homes. I think what we're going to see going forward is care for elders being diffused through the community in different places, in different communities, in different ways.

Will the boomers change it?

Let me say this, the baby boomer generation is coming. And the irresistible force of the baby boomers is about to collide with the unmovable object of the nursing home. And there's going to be explosive change that comes from this collision. The boomers will not leave one stone upon another. They will completely wipe out the nursing home we remember from the 20th century.

What will be in its place? Well, best way I think of understanding this is, when the baby boomers were kids there were three flavors of ice cream, and that was it. And when they got done with ice cream, there's a thousand flavors of ice cream. Well, right now there's just a few flavors of long-term care for the elderly. When they get done, there will be a thousand flavors. And that's the way it should be.

How long is it going to take for this kind of thing to happen?

Well, you know what, a nice way of thinking about what's going to happen to long-term care ... look at child birth. Look at what the boomers did to child birth. When they came along, cigar-chomping obstetricians used to strap women down with leather restraints and pull the baby out. When the boomers got done with 'em, 15 years, 20 years, family birthing centers, jacuzzis, lactation consultants ... Poof! The whole thing was different. So I actually foresee a revolution that's going to be ramping up in the next 2, 3 years and then over the next 10 to 15 years will radically change the approach to elder care in America.

You say that you have co-founded this Eden Alternative thing. What is the Eden Alternative? Why do we even need to know about it?

Well, in the early 1990's I took a job, I'm a physician, I took a job working at a nursing home, and I took that job because I thought that it would be a break from my real work as a ER doctor. And I fell in love with the work. And I fell in love with the people. And I came to detest the environment in which that care was being provided.

The nursing home takes good, good, loving, caring people and plugs them into an institutional factory-like arrangement. And it's no good. So what I want is an alternative to the nursing home, an alternative to the institution. And the best alternative I can think of is a garden. I believe that every elder should have a chance to live in a garden. I believe that, when we make a place that's worthy of our elders, we make a place that enriches all of our lives, caregiver, family member and elder alike. So the answer the Eden Alternative provides is a reinterpretation of the environment elders live in, from an institution to a garden. That's why we call it the Eden Alternative.

What are the other components, what are the other criteria of the Eden Alternative?

Number one, the organization begins to treat the staff they way they want the staff to treat the elders. Very important. Long-term care has a bad history of treating its staff one way, not so nice, and expecting the staff to treat the elders a different way.

Number two, the organization brings decision making back to the elders and to the people around the elders, so that they have a voice in their, in their daily routine and their life. Crucial, crucial to re-injecting meaning into peoples' lives.

Third, they've taken real steps to make the place where people live rich in plants and animals and children. I want the people to be confused when they walk through the door. What kind of place is this? I mean, there's kids running around and playing and there's dogs and there's cats and there's birds, and there's gardens and plants and ... I want them to be confused. This can't be a nursing home. Right. It's an alternative to the nursing home.

And finally, there has to be a commitment to ongoing growth. We believe in the Eden Alternative that even the frailest, most demented, most feeble elder can grow. And that the young person who maybe has a difficult home life or is living on the edge of poverty, they can grow. That the organization commits itself to human growth. And those words, human growth, nursing home, they've never gone together before and with Eden Alternative they can.

We need to change the way we think about and care for our elders, because by not honoring our elders we damage ourselves. We damage the very fabric of our communities and our society and our families. We do damage to people of all ages when we fail to honor and care for the frailest and chronic, most chronically ill among us. It's a bad habit which leads to bad things in other parts of our society.

We need to be concrete about it. If we want to improve life for everybody in our society, one of the very best places to begin is changing how we think about, care for and honor our elders. That thread, if you trace it all the way back, is woven through the whole context of our, our social life, our families, our churches, our communities. If we can master the art of caring for our elders, we can make a better society for everybody to live in.

Nursing Homes: The Eden Alternative...