Overuse of Psychiatric Drugs in Nursing Homes Widespread

March 4, 2015

4083394575_687d6ae782_o.jpgOur nursing home negligence lawyers often write on the overuse of dangerous medications in nursing homes - a practice known as chemical restraint - on this blog. It is an extremely important, insidious issue that has been hidden by nursing homes for far too long. Recently, federal investigators urged Medicare to take immediate action to stop chemical restraint after investigations found widespread drug abuse.

The findings of this federal investigation are scheduled for release on Monday, March 9, 2015, so check back for more details at that time. Throughout his tenure, President Obama has been working with nursing homes to curtail the use of dangerous drugs; specifically, the use of antipsychotic drugs, which have Black Box Warnings against use in elderly patients with dementia.

Antipsychotic drugs include: Risperdal, Haldol, Zyprexa, Abilify, Seroquel, Geodon and clozapine. These drugs are intended only for patients with psychotic conditions, such as schizophrenia or severe bipolar disorder. Many of these drugs, Risperdal particularly, are used inappropriately in the general population as well as in nursing homes. More information on Risperdal injury lawsuits can be found here.

According to federal investigators, the Department of Health and Human Services (which oversees Medicare and Medicaid) has done little to reduce antipsychotic drugs use in the elderly. Doctors sometimes prescribe these drugs to elderly patients with combative symptoms of dementia, such as hitting or yelling. This is not only extremely dangerous, but it is abusive and negligent as well.

Understaffing Leads to Inappropriate Drug Use


Chemical restraints are common practice in nursing homes that have an inadequate number of employees. Because the staff is overworked, they are unable to care for each resident properly, particularly those who need more individual care and attention. In order to subdue, restrain, or make it easier to care for these residents, they are dosed with antipsychotic drugs.

Dementia is a complex and not-well-understood disease that causes severe changes in personality and mood, frequently resulting in agitation, violence or agitation. Understaffed nursing homes often turn to chemical restraints to suppress these symptoms of dementia, despite repeated warnings from the FDA.

According to these warnings, antipsychotic drug use in dementia patients is associated with increased risk of death and, if the patient survives, a severely decreased quality of life. The drugs can also increase the risk of serious falls, fractures, hospitalizations and other severe complications.

Chicago Psychiatrist Given $600,000 to Prescribe Antipsychotic


In February 2014 a psychiatrist in Chicago pled guilty to taking illegal kickbacks to prescribe clozapine (brand name Clozaril or FazaClo). Dr. Michael J. Reinstein received more than $600,000 to give this drug to thousands of elderly and mentally ill patients at 30 nursing homes. As a result of the lawsuit against him, Reinstein will pay $3.79 million to federal and state governments.

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Oklahoma Nursing Home to Pay $1 Million for Abuse

March 2, 2015

4131045141_0a1fdcc8da_o.jpgA jury in Oklahoma City recently ordered Quail Creek Nursing and Rehabilitation to pay $1.2 million to the family of an abused resident. The abuse was caught on tape after the family suspected theft was occurring and planted a hidden camera. Nursing home abuse lawyers at Pintas & Mullins discuss this case and the legality of hidden cameras in nursing homes.

The resident at the center of this case, Eryetha Mayberry, was 96 years old when she died in July 2012. We reported on this case in March 2013, nearly one year after her death. The lawsuit was brought by Mayberry's daughters, who planted the hidden camera in her room in attempt to catch the people stealing her belongings.

The camera footage actually caught something much more disturbing: their mother, who suffered from dementia, was systemically abuse at Quail Creek Nursing Home by its staff. Two employees in particular - Caroline Kaseke and Lucy Waithira Gakunga, who have since been fired - repeatedly shoved Mayberry into her bed, pressed on her chest to prevent her from breathing, slapped her, and stuffed latex gloves into her mouth. Gakunga and Kaseke are now facing criminal charges.

The jury in this case found Quail Creek guilty of negligence and abuse, and the federal judge announced the $1.2 million verdict on mid-February of this year. Oklahoma routinely ranks among the worst in the country for nursing home quality. Inadequate staffing is an overwhelming problem in the state, which contributes to abuse and neglect of all forms.

Hidden Cameras in Nursing Homes


The camera installed in Mayberry's room was motion-activated and resembled an alarm clock. Due in no small part to Mayberry's case, Oklahoma recently became the third state to explicitly allow residents of nursing homes to have surveillance cameras in their rooms. The other two states that allow cameras are New Mexico and Texas.

Some government agencies also use hidden cameras to document abuse and neglect in nursing homes. The New York state attorney has relied on hidden cameras for years to investigate and prove patient abuse. In June 2014 the Ohio attorney general announced that his office, with families' permission, was placing cameras in nursing home resident's rooms in numerous facilities. This resulted in at least one Ohio nursing home shutting down permanently.

A simple Google search will pull up similar acts of nursing home abuse caught on tape in various states. Hidden cameras are usually planted by concerned families at the end of their rope, frustrated by the lack of action by state health departments or lack of communication from the nursing home staff.

Of course, there are various legal and ethical questions that come up when planting a hidden camera in a resident's bedroom. These questions are most pronounced if the resident suffers severe dementia or other cognitive issues that make it difficult or impossible to obtain their consent, or if they have roommates that are not told. Most state laws hold that roommates have the right to refuse to be monitored and some have specific rules governing these types of cameras. In Maryland, for example, cameras must be in a fixed position directed only at the intended resident.

Continue reading "Oklahoma Nursing Home to Pay $1 Million for Abuse" »

New Guidelines Cause Nursing Home Quality Score Drop

February 20, 2015

last-station-nursing-home-4.jpegIn our latest nursing home post we detailed the new guidelines for Medicare's Nursing Home Compare website and how it could impact the quality scores of more than 15,000 American nursing homes. It was just confirmed that about a third of these nursing homes are getting lower scores because of the strengthened guidelines. Nursing home negligence lawyers at Pintas & Mullins explain these new quality scores.

Nursing Home Compare is a widely-used website run by the government, which scores nursing homes based on a five-star system. This site is used by millions of Americans in deciding which facility is best suited for their loved one. Unfortunately, the site has also come under intense criticism for its ratings system and its many flaws.

In response to criticism, Medicare has taken quite a few steps forward in revising the rating system. One of the most meaningful improvements was the inclusion of anti-psychotic drug use in nursing homes. Anti-psychotics, like Seroquel or Zyprexa, are frequently used in nursing homes - illegally - to subdue unruly or difficult residents. This is extraordinarily dangerous, as the FDA has repeatedly warned that anti-psychotic drugs can cause premature death in elderly people with dementia.

In addition to this new drug data, Medicare will also use more complex metrics to make sure the staffing levels are correct. Most of the information on Nursing Home Compare is self-submitted by nursing homes, including staff levels and quality measure.

Obviously, there is much concern regarding the validity of this self-reported data. There is really nothing stopping nursing homes from over-reporting how well they staff their facilities and generally overstating how well the facilities are run. The only data that is actually submitted by Medicare itself is information on the government inspections.

As stated, the new Nursing Home Compare rating system uses more refined metrics to confirm staffing levels. After these new metrics were put in place, more than 60% of nursing homes on the site got lower quality of care scores. Nearly 30% dropped one star overall, and about 3% of nursing homes dropped two stars.

This is the first time the five-star system has at all changed since 2008. Only about 340 nursing homes (out of 15,000) saw their overall ratings improve in response to the new metrics.

It is important to highlight that thousands of nursing homes hot the lowest possible score possible on anti-psychotic drug use. Alarmingly, 20% of the 15,000 nursing homes received just one star in the anti-psychotic drug use category for giving these medications to residents who do not have psychiatric conditions.

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Government Agrees to Tougher Nursing Home Evaluations

February 18, 2015

n-a-3280.jpgOur nursing home negligence lawyers recently reported on the broken system the government created to rate and compare nursing homes. After massive outcry from the public and industry insiders, the federal government is now taking immediate action to strengthen the Nursing Home Compare website so many families rely on to find quality nursing homes.

Nursing Home Compare, located here, is the Medicare website that ranks, grades, and compares almost every nursing home in the country. One of the largest problems with this website is that much of the information on the nursing homes are self-reported by the facilities. More often than not, the self-reported quality measures were much, much higher than the quality of care residents actually received.

Chemical Restraints Taken into Consideration


This meant that many negligent and poorly-run nursing homes were rated highly on Nursing Home Compare when, in reality, they were understaffed and residents were routinely mistreated. Understaffed nursing homes often use drugs to control or subdue residents - a practice known as chemical restraints - which is a major focus of the government's new overhaul.

Specifically, the government is making it harder for nursing homes to get high-quality rankings by increasing the scrutiny on antipsychotic drug use. Antipsychotics are medications like Seroquel, Zyprexa, Abilify and Risperdal that should never be given to elderly people with dementia, as it increases their risk of death. These drugs should ONLY be given to patients with severe mental conditions, such as schizophrenia, psychotic depression and bipolar disorder.

The grades on Nursing Home Compare are in the form of five-star ratings. The system was created in 2008 as a critical tool to help concerned, confused families determine the best nursing home to place their loved ones. The site profiles more than 15,000 nursing homes, comparing them based on: quality measures, staffing levels, and government inspections.

Both staffing levels and quality measures are determined, as mentioned, by self-reported data. This is problematic for obvious reasons; nursing homes should not be held to the honor code when they are responsible for the health and safety of our country's most vulnerable citizens.

The "quality measures" section involves many factors, such as how many residents develop bed sores or are injured in falls. In the new government guidelines, this group will now also measure how many residents receive antipsychotic drugs. This information will still be reported to Medicaid by the nursing homes themselves. There are also new guidelines establishing verification of self-reported staffing levels.

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Nursing Home Residents Exposed to Hepatitis C File Lawsuit

January 22, 2015

christian-nursing-home-1.jpgMinot, North Dakota recently suffered the third-largest hepatitis C outbreak in American history, and most of the victims were residents of the ManorCare nursing home. Of the 51 hepatitis C cases linked to the outbreak in Minot, 47 were current or former nursing home residents. Now, the residents are seeking class-action status to move forward with their lawsuit against the nursing home.

Our team of nursing home negligence lawyers is currently investigating cases of serious viral infections contracted at nursing homes.

Hepatitis C is a serious viral infection that attacks the liver, causing extensive damage. It is passed through physical contact with contaminated blood, commonly via needles, so healthcare workers and patients are at a high risk of exposure. People born between 1945 and 1965 have the highest incidence of hepatitis C infection.

Particularly among the elderly, hepatitis C infection (HCV) can cause significant complications, including:

• Cirrhosis, or scarring of the liver
• Liver cancer
• Liver failure
• Death

Although there are some antiviral medications to treat HCV, they have serious side effects and require substantially patient commitment. Some side effects can include serious depression, flu-like symptoms, and loss of healthy blood cells.

In Minot, nursing home residents infected with HCV are in desperate need to medical services and relief. They are hoping that being granted class-action status will help them quickly and effectively receive the help they need.

North Dakota health investigators do not currently know where exactly the outbreak started - though they believe it may be connected to those who received podiatry, phlebotomy, and toenail care services at the ManorCare nursing home. ManorCare and its agent Trinity Hospital deny any role in the outbreak. Trinity provides many health services to ManorCare residents.

According to the North Dakota Department of Health, the unsanitary practices at ManorCare in Minot contributed to the HCV outbreak. As stated, it is believed that poor foot, nail, and blood care have been linked to the transmission. The nursing home residents involved in the lawsuit are claiming that ManorCare failed to properly care for its residents and did not comply with state and federal nursing home regulations related to health and safety.

Infections in Nursing Homes


Infections are a major cause of death and disability in nursing homes because they are so common, and the setting encourages the spread of infections: residents are clustered in close quarters, activities often take place in groups, some residents are unable to follow basic hygiene, and caregivers may be inadequately trained or overworked.

The most common infections in nursing homes are respiratory, skin, soft tissue, urinary, and gastrointestinal. Among these include pneumonia, urinary tract infections, diabetic foot ulcers, bacteriuria, and diarrhea. Scabies, c. diff, e.coli, and salmonella are also common in nursing homes. Unfortunately, according to several studies, infection rates are on the rise in American nursing homes.

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Malnutrition and Dehydration in Nursing Homes - What You Should Know

January 5, 2015

306242870_e31f39c3e4_b.jpgHunger and thirst in nursing homes is a widespread problem, causing already-ill residents to suffer from malnutrition, dehydration, and severe weight loss. Too often a sign of neglect or staff incompetence, malnutrition on nursing homes threatens the health and safety of our loved ones. Nursing home negligence lawyers at Pintas & Mullins take a closer look at this issue, and what families should look out for.

Among the ailments nursing home residents suffer, oral health is not often at the top of the check-up list. It is, however, an important indicator of a person's health and wellness, and may be the reason for general malnutrition. Some elderly Americans have not seen a dentist in years, even decades, rendering them largely unable to chew their food.

Many more elderly people have problems eating than one would imagine - it's not something they want to bring up or complain about. The cost of a dentist visit alone may be preventing seniors from getting the help they need. One study found the percentage of elderly citizens with difficulty eating is as high as 40%, while other experts suspect the percentage is much higher.

Meat, for example, can be extremely hard to chew for those with poor oral health, threatening protein and iron intake. Some nursing homes puree all food for residents, however, this method diminishes the fiber levels.

Identify the Cause for Better Health


Eating and drinking can also be made difficult or impossible as a side effect from various drugs. There are many reasons why eating and drinking is difficult for a nursing home resident, but pinpointing the cause of these problems is the first and most important step in fixing them.

If the problem is not immediately obvious, either a dental examination or direct observation of the specific hurdles to performing oral care and eating or drinking can help illuminate the issue. Some residents can only chew on one side of their mouths because of pain on the other side, which can be a sign of decay or oral cancer.

Problems are often amplified by lack of or inadequate health insurance. Medicare and Medicaid do not fully cover routine geriatric dental care, such as cleanings, fillings and dentures, preventing many elderly people from getting them. This also leads to misunderstandings or misconceptions about oral care, such as how to properly care for dentures and thick handled toothbrush designs.

Even basic self-care is difficult for many nursing home residents who are rendered immobile or incapacitated. Many seniors do not have the grip strength to open the toothpaste bottle or hold their toothbrush, much less brush thoroughly and floss regularly.

The bottom line is, oral care is part of everyone's basic health. It should be addressed alongside all other issues in residents' care plan at their nursing home. Getting basic care to patients residing in understaffed nursing homes can be difficult, however, and delivering specialized care is even harder.

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Nursing Homes Sued for Overmedicating, Defrauding Medicaid

December 8, 2014

5257948497_f5428013aa_b.jpgThe New Mexico attorney general recently filed a lawsuit against one of the country's largest nursing home chains, Preferred Care Partners Management Group, for defrauding Medicaid and causing the neglect and mistreatment of residents. Nursing home negligence lawyers at Pintas & Mullins detail this lawsuit and the horrific consequences of inadequate care.

The lawsuit specifically names 11 nursing homes, although it could have larger implications in other states if it is successful. Preferred Care Partners is based in Texas, with nursing homes in about 10 other states including Iowa and Florida. According to the suit, the chain purposefully understaffed its nursing homes in the pursuit of higher profits, at the expense of the physical and emotional well-being of its residents.

In a related story, NPR recently reported on one of the most pronounced and dangerous problems in American nursing homes: overmedicating residents. These two stories are closely related and impact one another because staff that work at chronically understaffed nursing homes often turn to pharmaceuticals to "restrain," or "subdue" the residents they do not have time to care for.

An estimated 300,000 nursing home residents are currently on antipsychotic drugs to suppress aggression or anxiety. Antipsychotic drugs, like Seroquel or Risperdel, all come with a black box warning (the FDA's most strict warning) to alert patients of the increased risk of death. The FDA also specifically states that most antipsychotic drugs should not be prescribed to elderly patients with dementia.

In fact, in 2013 the agency released a public health advisory, warning that certain antipsychotic drugs were associated with increased mortality among these patients. Several clinical studies, along with the tragic premature death of countless people, prompted the FDA to make this public announcement. The drugs are proven to cause significantly higher death rates, along with infections and heart failures in this demographic.

How, you may ask, are hundreds of thousands of elderly dementia patients still receiving antipsychotics? The crux of this issue can be explained through the lawsuit in New Mexico and its implications. Preferred Care Partners is accused of profiting from falsely billing Medicaid while understaffing its facilities and giving residents substandard care.

Improperly staffed nursing homes are unable to deliver suitable care to its residents, which results in overmedicating residents, leaving residents in soiled clothes and beds, ignoring restroom requests, and higher rates of serious falls. Other allegations against Preferred include neglecting to bathe residents, failing to assist them with meals, and residents suffering from dehydration and malnutrition.

The New Mexico attorney general is claiming that Preferred billed Medicare and Medicaid for services that were not provided, or were fundamentally worthless. Federal law also prohibits the use of antipsychotics in residents who do not have a psychological disorder, such as schizophrenia or bipolar disorder.

More often than anyone would like to believe, understaffed nursing homes give residents these drugs to control them in a practice called "chemical restraint." Powerful, dangerous drugs are given to residents with dementia who express severe anxiety, unruliness, agitation, and other difficult-to-control behaviors. Understaffed facilities simply do not have the time to care for these residents, so they subdue them with drugs.

The vast majority of dementia patients experience behavioral and psychological symptoms at some point. That is simply the nature of the disease, and it is often why residents are placed in nursing homes to begin with: so they can be in a safe environment with medical professionals. In order to give someone an antipsychotic drug, there needs to be a medical need and when the drugs are prescribed needlessly, the effects are obvious.

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Country's Worst Nursing Homes Receive Federal Insurance

November 17, 2014

last-station-nursing-home-4.jpegThe Center for Public Integrity recently revealed that hundreds of the country's lowest-rated nursing homes are receiving federally-backed, guaranteed mortgages. This assistance is worth billions of dollars, so why is it being given to facilities that harm residents and do not meet federal safety standards? Nursing home lawyers at Pintas & Mullins offer an investigation into this issue.

The Department of Housing and Urban Development (HUD) insures mortgage loans through a little-known program with little to no oversight. Throughout the country, nursing homes (and particularly for-profit chains) routinely receive HUD-guaranteed loans, regardless of the quality of care they provide.

Another federal agency, the Department of Health and Human Services (HHS) rates the country's nursing homes based on annual health inspections, staffing levels, and resident care. Take, for example, the Alden Alma Nelson Manor nursing home in Rockford, Illinois, which consistently earns the lowest possible quality rating from HHS, and has earned these abysmal ratings for the better part of a decade. Alden Alma recently paid hundreds of thousands of dollars in fines for the deaths of three residents and incidents of abuse and sexual assault. Despite this, Cambridge Realty Capital approved a $12 million mortgage for the facility, and the HUD insured the loan.

Another Illinois facility that received an HUD loan, the Crossroads Care Center in Woodstock, has a federal one-star rating. It was also fined about $360,000 for the deaths of six residents, including allegations that a nurse purposefully overmedicated and killed residents. That nurse, Marty Himebaugh, was found guilty of felony criminal neglect.

Again, despite this, in 2013 Crossroads Care received $4.4 million in a HUD-backed loan, it's second since 2001. Similarly, the Alden Wentworth Rehabilitation nursing home on Chicago's South Side received a $10.6 million HUD loan, even after a beloved resident fell four stories at the home, prompting a senate hearing. Two years before the loan, another resident died after wrongfully receiving narcotics for three weeks.

Stories like this abound throughout Illinois and the rest of the country. HUD officials claim that they are not made aware of safety and health issues, yet how this can be true is disconcerting. Why is there no system by which HUD employees must check a facility's quality of care before financing it? Why is there no emphasis put on regulatory enforcement, or communication between agencies - particularly when it comes to our nation's most vulnerable citizens?

The Center for Public Integrity states that this type of situation is not uncommon: since 2001, hundreds of the worst-ranked nursing homes in the country have received HUD-guaranteed loans, worth about $2.5 billion. In fact, the number of one-star nursing homes receiving HUD insurance rose every year between 2009 and 2012.

An esteemed nursing professor at University of California at San Francisco said that this HUD pattern points to serious issues about the communication - or lack thereof - between government agencies, an outrageous lack of oversight, and the improper use of public funding. There hasn't been any public scrutiny over the HUD's practices, which makes a bad problem even worse.

How, When, and Why This is Allowed


As mentioned, these loans are made possible by a little-known federal program: the National Housing Act of 1959, which was enacted by Congress to make it easier for nursing homes to secure loans on reasonable terms. It was created in effort to provide a reliable stream of income to nursing homes, which previously had trouble finding loans.

This may seem like a good thing, but the program means that if nursing homes default on the loans, the public pays (about $187 million in defaults have been incurred since 1959). These mortgages have been granted to over 7,000 nursing homes; currently, about 13% of all nursing homes have HUD-guaranteed loans.

About 240 nursing homes with a one-star rating have HUD loans, with Ohio having the most of any other state (30). In Illinois, 20 one-star nursing homes have HUD loans, and California ranked third among states. For-profit nursing homes make up the large majority of one-star loan recipients, with corporations owning two-thirds (despite representing only about half of all nursing homes nationwide). Experts believe that the HUD should restrict its guaranteed loans to only non-profit nursing homes, which generally run higher quality and safer facilities. This makes sense. The government should not be financing large, for-profit, multi-billion dollar corporations.

Part of the reason these facilities are able to get away with the death and demise of residents while still securing financial backing is because the owners spend hundreds of thousands in donations to political candidates.

Continue reading "Country's Worst Nursing Homes Receive Federal Insurance" »

Investigation Finds Nursing Home Care Lower Than Families Believe

November 12, 2014

last-station-nursing-home-7.jpgIn every nursing home throughout the country, staffing levels directly affects the quality of care residents receive. Far too many nursing homes are understaffed, under-funded, and not giving residents the comprehensive care they need. Nursing home abuse lawyers at Pintas & Mullins highlight a recent investigation by the Center of Public Integrity, which found that families may be overestimating the amount of care their loved one is receiving.

The Center for Public Integrity is a nonprofit, nonpartisan organization that recently compiled years of data from Medicare databases on nursing home staffing levels. The Center analyzed data from more than 10,000 nursing homes throughout the country and found that a staggering 80% of facilities report higher levels of registered nursing care to consumer websites than in actual reports to Medicare.

Notably, eight out of then ten states with the largest differences in reporting are in the south; and Arkansas and Louisiana's self-reported staffing levels were more than twice the actual numbers reported to Medicare.

The self-reporting system referred to in this report is the Nursing Home Compare website, which is extraordinarily popular and used by millions of families to find the "best" nursing home for their loved one. We have written about this website and its deficiencies in the past; the posts can be found here.

Experts believe - and are proven correct - that the staffing levels on this website are artificially inflated and, in many cases, extremely overestimated. Families who are looking to place loved ones in nursing homes have few resources at their disposal for finding the best facility. Making matters worse, most are given only a few days to find a facility after their loved ones are discharged from hospital or rehabilitation centers.

As a result, families rely on websites like Nursing Home Compare, and genuinely believe that their loved one is in a well-staffed, high-quality nursing home when that is quite far from the reality. It is only after an avoidable injury or extreme deterioration in health that the truth becomes known, and quite often, that comes too late.

Further complicating the issue, some data indicates that at least 700 nursing homes in the U.S. (and 250 in Illinois alone) have staffing levels that are actually lower than what is required by state law. Only 33 states and Washington D.C. directly mandate staffing requirements.

Real Patients, Real Harm


Too many Americans read stories like this and think it's a problem that does not, or will not apply to them. As the baby boomers grow older, however, more and more Americans will need to be placed in nursing homes in the coming decades, and it is often their families who will have to make the decision.

In its report, the Center for Public Integrity detailed the story of a resident admitted to nursing homes in Little Rock, Arkansas, and her family's experiences. Edna Irving was placed in Chenal Heights Health and Rehabilitation Center when she was 80-years-old. Her daughters believed the facility provided quality care based on the upper-class neighborhood it was in and high ratings on the Nursing Home Compare website.

Just one week after being admitted, however, Edna was hospitalized for a bowel obstruction. After being admitted back into Chenal Heights, her daughter went to check on her and found her lying in her own feces. A month later, Edna fell from her wheelchair, suffering a large laceration to her forehead. One week after this Edna developed a urinary tract infection because of inadequate catheter care.

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Falls a Serious Threat as Population Ages

November 3, 2014

The nursing home negligence attorneys at Pintas & Mullins law firm have decades of experience working with residents who suffer from serious or repeated falls in nursing homes. As the baby boomers age - about 10,000 Americans turn 65 every day - more and more people are entering nursing homes. A large percentage of these residents will fall during their time in these facilities, suffering serious and sometimes fatal injuries.

14658335956_58f10a9b9d_b.jpg The New York Times recently published a series of two articles exclusively on this topic. The first, published on November 2, 2014, begins by profiling a retirement in San Francisco that had strict requirements for residents during meal times to help reduce falls. The residents were required to park their walkers once they reached their table to eat, and remain seated while staff brought them their meal - no additional trips to the buffet were warranted and they could not pick out their own meals.

This was a requirement until a resident sued the retirement community, claiming it took away her freedom to move as she pleased. Now, residents at The Sequoias are allowed to talk their walkers to and from the buffet, but not during peak hours.

Similar battles are being waged in nursing homes and assisted living centers throughout the country, where more and more residents are being admitted with serious disabilities and fall risks. Recently, there has been much attention on how to prevent falls among residents, as more often than not, falls result in disability, decreased quality of life, functional decline, and feelings of helplessness.

Some facilities hire interior designers and architects to mediate the environmental hazards in nursing homes. Some of their recommendations involve floor lighting in bedrooms and energy-absorbing flooring in bathrooms to make falls less severe if they do occur. In research, the National Institute on Aging and the Patient-Centered Outcomes Research Institute recently began a $30 million dollar study on elder fall prevention.

Life-Changing Consequences


In 2012 alone, more than 24,000 Americans aged 65 and older died after a fall, and millions more were treated in the ER for injuries from falls. Unfortunately, many aging residents do not acknowledge their risk of falling or the necessity of taking precautions to prevent it from happening. My 95-year-old grandfather lives alone and does his own laundry, in the basement, down stairs with no railing. "I can do my own laundry," he insists whenever my family inquires.

This is a familiar story for so many families whose loved one refuses to recognize their own vulnerability. Stairs and getting in and out of bed can be particularly hazardous. Nursing homes should regularly inspect rooms to measure bed height, toilet height, grab bars, furniture that could fall if grabbed for support, and other safety measures.

Any failure to take precautions to prevent falls in a nursing home could be considered negligence if those failures lead to a serious injury. Everyone who enters a nursing home is required to be evaluated for fall risk and other conditions so the nursing home can create a unique, comprehensive care plan for each resident. These care plans then need to be routinely updated to account for new, worsened, or improved health conditions.

If a fall does occur, it must be reported to the staff, who then must report it to their higher-ups. This is the only way staff can know the true extent of someone's fall risk and help protect them. When nursing homes are extremely understaffed, which is common among for-profit nursing home chains, residents can lie alone on the floor for hours, even days at time, with a serious injury.

Continue reading "Falls a Serious Threat as Population Ages" »

Nursing Home Reforms Desperately Needed

October 17, 2014

Thumbnail image for christian-nursing-home-1.jpgCorporate America pushes for big business with a heavy emphasis on high profits, and it is affecting nearly every aspect of our economy, from grocery stores to gyms. What many people do not know is that big business now owns most of the country's nursing homes, running the facilities like any other for-profit, investor-owned corporation. Nursing home attorneys at Pintas & Mullins detail these for-profit companies and how they have impacted the care residents receive.

Nursing home chains are expanding throughout the country, operating facilities across multiple states and reaping in profits. As this trend proliferates, these chains are also facing massive liability for their poor standards of care. Nursing home abuse and neglect lawsuits are filed on behalf of residents after they are seriously injured, or in many cases, killed by inadequate care.

Because corporate owners purposefully skimp on resources to boost profits, residents receive less time with nurses, who are so overworked and understaffed that they are physically unable to adequately care for each patient. This leads to wrong medications, frequent falls, dehydration or malnutrition, bedsores, or even elopement, when residents leave the facility without supervision.

Lawsuits Reveal Reality


Some of the most recent lawsuits receiving national media attention include a case in Maine where a resident was discovered to have maggot infestations in his chest wound. Another, in Syracuse, New York, involved a claim of sexual molestation. One nursing home chain in particular, Extendicare, is facing a $40 million settlement for illegal billing practices and substandard care.

Chains keep profits high and costs low largely by reducing staffing, primarily registered nurses, who can be costly to retain. Staff wages are also cut, putting immense stress on those working and causing resentment, fatigue, and stress.

One study found that the four largest for-profit chains, which were purchased by private equity firms between 2003-2008, were cited for more deficiencies after they were purchased. Nursing homes are inspected at least once per year by state officials. Deficiencies include poor sanitary conditions, resident mistreatment, infections, failure to prevent bedsores, severe resident weight loss, and other indicators that residents are facing harm.

This was one of the first studies to definitively link private equity acquisition to a decrease in resident care. The authors of this study point to the need for an increase in oversight and greater accountability, along with funding incentives and support for better staffing levels.

If you live anywhere in Illinois, you have seen the recent attacks on governor candidate Bruce Rauner for the role his own private equity firm, GTCR, played in an exorbitantly negligent nursing home chain. The chain, Trans Health Management and Trans Healthcare, is facing billions in liability after several resident deaths and consequent lawsuits.

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Illinois Ranks Last in Nursing Home Safety

October 7, 2014

elderly-woman-her-view.jpgA recent nursing home report card gave Illinois an "F" grade, putting our state at the bottom of national rankings for nursing home care. The report card is issued once per year by Families for Better Care, a nursing home resident advocacy group. The elder neglect lawyers at Pintas & Mullins take a closer look at this nursing home report card and why Illinois is ranked so poorly.

Families for Better Care scores each state based on eight factors, including:

1. The average amount of time professional nurses or assistants spend per resident per day
2. The percentage of nursing homes with above average professional nursing staff
3. The percentage of nursing homes with above average health inspections
4. The percentage of nursing homes with deficiencies and severe deficiencies

Severe deficiencies are defined as a violation that places residents in immediate jeopardy, or actual reports of resident abuse, neglect, injury or death. In total, 11 states received a failing grade, including many of our surrounding states, such as Missouri, Michigan, Iowa, and Indiana.

The most obvious difference between the best states for nursing homes and the worst is the amount of time staff spends with residents every day. Unfortunately, Illinois is among the most inadequate places for hiring and retaining enough staff to properly care for residents.

On the brighter side, there are quite a few nursing homes in Central Illinois that consistently do a great job caring for residents and keeping staff and safety levels up. In the state overall, one in four nursing homes cited a severe deficiency within the past year.

Government Takes Action


The conditions in American nursing homes are a serious issue needing immediate attention, and although individual legislators are largely failing to act, federal agencies are attempting to take the reins. The agency that oversees nursing homes, the Centers for Medicare and Medicaid Services (CMS), recently issued a press release on a quality improvement initiative.

The press release details two initiatives aimed at improving the quality of nursing home care. The first is the expansion and strengthening of the Five Star Quality Rating System for nursing homes, which we recently wrote about here. This rating system is widely used and trusted by families who need to place a loved one in a nursing home but are unsure where to start looking. The system, however, is immensely flawed, which is why CMS is taking measures to improve it.

The second initiative CMS will establish new conditions for the home health agency, which deliver care to patients living at home. Starting in 2015, CMS will make changes to the Five Star system by conducting random inspections in a sample of nursing homes, verify staffing reporting with payroll information, increase the number and type of quality measures used to rate facilities, and improve the methods they use to score nursing homes.

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Rauner Avoids Responsibility in Nursing Home Tragedies

September 25, 2014

Thumbnail image for 4084144518_8db40df1cb_o.jpgTrans Healthcare and Trans Health Management, nursing home companies that controls a chain of nursing homes throughout the country seems to be continuously fighting off lawsuits, bad press, and claims of fraud. Bruce Rauner, the candidate for Illinois Governor, is snared in these issues, as his former company is accused of scheming to avoid liability for resident deaths. Nursing home negligence lawyers at Pintas & Mullins unpack this story to separate fact from hearsay.

As a federal trial begins in Florida, Rauner is making the media rounds in Chicago to promote himself as the Republican candidate for Illinois governor. When asked questions about Trans Healthcare, Rauner purposefully sweeps the issue under the rug, underplaying his role in the company and declining to respond further.

The scandal is quite complex, which makes it easier for Rauner to avoid the issue while campaigning. It also helps that the federal trial are in Florida bankruptcy court, involving shell companies, private equity firms, and nearly a decade of legal twists and turns. In other words, it isn't exactly the simplified, sensationalist media bait so loved by political candidates.

Elder Neglect, Deaths, and Exploitation


The saga begins, for our purposes, in 2003, at a Trans Healthcare-run nursing home in Florida. A resident there, 76-yaer-old Juanita Jackson, died five weeks after she was discharged from the nursing home due to injuries incurred during her stay. Her family claims the nursing home was negligent in its care for Jackson, leading to severe and numerous bedsores, falls causing head injuries, and malnutrition. A jury agreed with her family, deciding that Trans Healthcare should pay $110 million for her wrongful death.

Trans Healthcare and Trans Health Management were ordered to pay $55 million each, which the Jackson family has yet to see. Sadly, they are not alone: five other families with claims of wrongful deaths against the nursing home companies are stalled as well.

The bankruptcy court trial centers on claims that Bruce Rauner's private equity firm, GTCR, created a shell company to avoid paying over $1 billion for these wrongful death claims. In 2006, Trans Healthcare transferred its assets to a separate holding company (the shell company), while legal liability was transferred to an entirely different firm, which we will call Firm B.

In a heartbreaking testimony, which was videotaped and played for the court on Monday, an elderly graphic artist with absolutely no nursing home experience recounts how he, inexplicably, came to own Firm B. The man, Barry Saacks, testified that he had no idea that he was the lone shareholder of Firm B, and that he did not remember ever signing papers to buy Trans Healthcare.

It is fairly obvious that Saacks was used as a pawn, and his age brings suspect that it may have been a case of elder exploitation and financial abuse. In his testimony tapes, Saacks appears consistently confused by lawyers' questions and disoriented about the company that he supposedly owned. In many interviews, he is in a hospital gown and sits in a wheelchair. He says he's never heard of Trans Healthcare, only that he created logos and designs for an investor who was a partner with GTCR and Trans Healthcare.

Other lawyers state that Saacks was given cash to sign closing documents that made him the sole shareholder of Trans Healthcare. He is now himself living in a nursing home, and is listed as a plaintiff alongside the families with pending wrongful death suits. They are asking the federal judge to unravel the transfers and transactions and rule that the companies engaged in fraud.

Bruce Rauner ran GTCR for over twenty years and left only recently to pursue his campaign for Illinois governor, though he insists that he had little to no involvement in the actions of Trans Healthcare and its nursing homes. GTCR launched the Trans Healthcare nursing home chain in 1998, and Rauner was a member of its board. GTCR asks the judge to dismiss the claims.

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End-of-Life Care Needs National Overhaul

September 19, 2014

Most families with loved ones in nursing homes know that our current healthcare system is inadequate for people nearing the end of life. Our nursing homes are understaffed and underfunded, we continue to pour money into treating illnesses instead of patients, and the population as a whole are living longer and longer. Elder law attorneys at Pintas & Mullins offer a glimpse into this complex problem, and what prompted a national committee to call for a large-scale overhaul. 9735923071_7906977312_b.jpg

In the mid-1800s, life expectancy ranged around 45 years; today, the life expectancy is around 80 years. The factors driving this are multi-faceted and not exclusive only to rich or developed nations - every nation's citizens are enjoying longer lifespans. Although there are obvious, unprecedented benefits to this, there is also considerable worry regarding our nation's healthcare.

The Institute of Medicine recently appointed 21 nonpartisan officials to a committee to discuss, research, and attempt to fix how we handle end-of-life care in the United States. The committee released a report on Wednesday, including recommendations to change current Medicare and Medicaid policies. The simple truth is that, if nothing is done, our healthcare costs will balloon out of control, leaving no resources leftover for other social issues.

Many changes will take congressional action to accomplish, such as providing better long-term coverage for elderly Medicaid patients. Other ideas would take a science and research overhaul, to emphasize living healthily into old age instead of just tacking on a few more years in the nursing home. In other words, instead of treating ailments after they happen, we must focus on prevention.

Many elderly people, particularly those in nursing homes, live out their last years in progressive disability and illness. If elderly patients received the care they personally desired, would they not be happier and, in turn, healthier? Instead of trying to treat elderly patients retroactively, officials are trying to urge Medicare and other insurers to have conversations with patients on advance care planning, well before that time comes.

Major Restructuring

The panel was made up of experts from all fields, including lawyers, doctors and nurses, insurers, aging experts, and even religious leaders. In their report, titled "Dying in America," they ask for a major restructuring of our health care delivery programs, along with elimination of the current incentive programs that encourage expensive tests and treatments with no real value.

Our current insurance system reimburses doctors for performing procedures or implanting medical devices, regardless of whether it is the right or wanted choice for that patient. This type of fee-for-service medicine is the center from which the change must come. Panel members were adamant on this point - saying that if the current law does now allow this to change, then the law itself must change.

Instead of extensive, complex surgeries, elderly patients far and wide prefer low-tech services focused on home-based care and pain management. In this vein, medical groups need to greatly increase training for palliative care and establish guidelines for patients who wish to avoid extensive procedures but still wish to be treated compassionately. Not only would this make heath care more satisfying for those patients, but it would lower the overall burden on the system in terms of dollars.

Ezekiel Emanuel recently wrote an article in The Atlantic stating, very bluntly, that he hopes to die at age 75. He discusses the type and amount of health care he would consent to after 75, and he is adamant that stretching out old age is not the life he wants. He cites statistics from various studies showing, among other things, that half of American women aged 80 and older had a functional limitation.

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Proposed Law to Allow Cameras in Nursing Home Resident Rooms

September 9, 2014

14655032011_2f87222b1e_c.jpgThe Illinois Attorney General's Office recently proposed a new law that would allow camera and audio recordings in the private rooms of nursing home residents. The resident would need to consent to the cameras and they or their family would cover all costs. Nursing home negligence lawyers at Pintas & Mullins applaud this effort by the attorney general, and hope this new piece of legislation is passed.

This law is in response to the thousands of complaints from nursing home residents and their families who are concerned about resident health and safety. Current Illinois law does not allow recording devices to be used in resident rooms, however many elder care advocates argue that cameras can be exceedingly helpful in deterring or preventing abuse and neglect in nursing homes.

In cases where abuse or neglect is confirmed, the recordings could be used in court to hold abusers responsible. This would be particularly useful in situations where injured residents suffer from dementia or other health problems that render them unable to adequately convey what happened to them. The proposal will allow recordings to be used in court, including harsh penalties for anyone caught tampering with the devices.

The main issue causing hesitation among nursing home advocates relates to privacy and whether or not the cameras will breach privacy rights. This needs to be addressed in the legislation, which is now being drafted. Since the cameras will only be installed with the explicit consent of the resident, it seems logical that privacy issues will be few and far between.

State-Wide Outrage Over Nursing Home Safety


Nearly 20,000 complaints against nursing homes are filed every year with the Illinois Department of Public Health (and they can now be filed online - more information here). Complaints ranges from minor, such as inadequate meal planning, to devastating, like the series of assaults, rapes, and abuse in nursing homes.

In 2009, the Illinois Senate held a hearing in which the outrage over the safety and conditions at nursing homes was finally expressed. In response to the uproar, one of Governor Quinn's top advisors outlined steps the state would take to end the cycle of abuse and neglect. Among those steps included efforts to end placing mentally ill adults into nursing homes, many of whom have felony records of victimizing their elderly cohabitants.

Illinois state senators called for a full-scale overhaul of how nursing homes are inspected and monitored, including developing a better screening system for helping mentally ill adults coming from jails, shelters, and psychiatric wards. For families concerned with security and safety of their loved ones, cameras could be an invaluable source of comfort.

More than 100,000 Illinois residents live in nursing homes - a number that is expected to increase steadily as the baby boomers age. Unfortunately, the nursing homes not only in Illinois but throughout the country are not meeting basic standards of health and safety. A recent federal report stated that one in four nursing homes are so substandard that they pose a threat to resident's wellbeing.

"Grannycam" Laws


Five states have similar laws allowing cameras in nursing homes: Maryland, New Mexico, Oklahoma, Texas, and Washington, with additional efforts in Michigan. The legislation in Maryland was the first of its kind to pass, and was driven by the testimony of a state Delegate whose mother was abused in a nursing home. Susan Hecht's mother, who suffers from dementia, repeatedly told loved ones that she was afraid to be in the facility and that she was not receiving good care. Her cognitive problems rendered her unable to remember the names or specific identity of her abusers.

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