Trauma Treatment for the Elderly

May 12, 2015

A recent study found that elderly patients admitted to hospital trauma units are increasingly likely to be discharged to nursing homes instead of inpatient rehab facilities or home. Our team of nursing home negligence lawyers examines how this is negatively impacting the health and safety of our elderly loved ones.

elderly-hospital-patient-543797-m.jpgThe study, published in The Journal of Trauma and Acute Care Surgery, used data from 2003 to 2009. Researchers found that elderly trauma patients were about 34% more likely to be sent to a nursing home and 36% less likely to be sent to an impatient rehab facility (IRF) compared to other trauma patients.

To compare, stroke trauma patients were 78% more likely to be discharged to an IRF. Both stroke and elderly trauma patients are equally dependent on post-discharge rehabilitation. Being discharged to nursing homes is associated with higher risk of death for patients of any age.

The elderly are the fastest-growing trauma population, likely due to the rapid rise in Americans aged 65 and older. Researchers in this study note that hospitals should be investing their time and money to figure out how to ensure the best possible outcomes for elderly trauma patients. This can include investing in post-acute care discharge planning, according to the lead author of the study, Dr. Patricia Ayoung-Chee.

Dr. Chee mentioned that this type of discharge planning may have to be individualized to each patient. Currently, hospitals and trauma centers base much of their discharge decisions off reimbursement and insurance factors. Although this may be best financially, it is not often what is best for the patient.

Medicare requires that at least 60% of all patients admitted to IRFs have at least one of 13 pre-determined conditions for that IRF to be eligible for reimbursement. Among the 13 conditions include stroke and hip fracture.

Elderly patients have more far-reaching needs than just those 13 conditions listed on that Medicare list. An elderly person who suffers a fall needs to be treated so future falls are prevented, and the patient can return to their original functional status and independence. If an elderly patient is simply admitted to a nursing home, their condition will likely worsen irreparably. We have seen too many cases of elderly patients admitted to nursing homes "just temporarily" while recovering, only to spend their remaining days in a poorly-run facility.

IRFs vs. Nursing Homes


Numerous studies have found that IRFs provide better care to patients than nursing homes; IRF patients live longer, have fewer ER visits, fewer rehospitalizations, and spend more days at home. One study focused on hip fracture patients, finding that instead of receiving therapy then returning home, nursing home patients were more likely to remain in the nursing home a full year after their hip fracture.

The differences between nursing homes and IRF centers are systemic. IRF centers often have support groups and mentor programs that match patients who have faced the same health conditions. For example, a former stroke patient could mentor a current stroke patient currently in an IRF, to serve as a role model for following complex medical regimens and improve quality of life. Mentors share information, help relieve anxiety and isolation, and encourage participation and healing.

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A Better Option for Long-Term Care

grandmas-birthday-433128-m.jpgOur team of nursing home negligence attorneys receives similar complaints by families with elderly loved ones, concerned over the true quality of care they are receiving. Families rarely see actual instances of abuse or neglect, rather noticing their loved one's physical, mental and emotional health steadily decline.

Residents who are neglected or abused in nursing homes often become malnourished, reclusive, overmedicated - more simply, not themselves. Nursing homes have been operated the same way for decades, to meet government regulations and qualify for Medicare and Medicaid reimbursements.

Increasingly, nursing home chains are being bought out by large corporations so that now more than one-third of all American nursing homes are run by large, for-profit companies.

The nursing home industry is in desperate need of reform. There are a few pioneers looking toward the future, however. Our population is rapidly aging - by 2050, about one-third of American citizens will be 65 years or older and about 4% will be 85 or older.

Big, for-profit nursing home chains offer long-term care at relatively inexpensive rates. They are able to lower rates by implementing various cost-saving features, such as industrial cafeteria, shared bedrooms, and overworking staff.

The Green House Project and Large-Scale Change


Among those with an optimistic plan for future care for the elderly and disabled include the Green House Project, which we wrote extensively about here and here. The hard truth is that nursing homes hinder resident freedom and happiness; studies show that depression among residents is significant. Perhaps it is the approach altogether that is wrong: tightly controlled lonely institution devoid of personal or loving atmosphere. Profits and economic efficiency are of the utmost importance, rather than the residents or staff quality.

Concepts like the Green House Project aim to remedy this inherent problem. In 2000, Dr. Bill Thomas decided to build a nursing home from scratch that was affordable, could accept Medicare and Medicaid patients, and, most importantly, appeared more like a home than an institution. The first was built in Tupelo, Mississippi.

Each Green House has 10-12 private bedrooms with attached bathrooms (which helps control infection), surrounding communal living and kitchen areas. There are certified nurse assistants and the primary caregivers, which take care of food preparation, housekeeping, and activities for residents, among other duties. The team also works closely with other Green House staff, so they may manage their own schedules and decision-making processes.

In the 15 years since the first Green House opened (there are now nearly 175 in 27 states), several studies have shown exceptional results. These studies show that Green House staff is happier with their jobs and more likely to stay in their positions, residents enjoy a higher quality of life, and families are happier with the settings than traditional nursing homes.

The Green House Project places emphasis on radical culture change within long-term care facilities. Residents get a say in the menu plans, for example, and the care is centered on each unique person's needs. The staff feel empowered because they can organize their own schedules and are coached in their positions, instead of ordered to meet certain goals by executives.

Perhaps the best part is that Green Houses are affordable - more than half of residents are on Medicaid. Residents are not only happier, but healthier as well. One study found the rate of hospitalization per year was about seven percentage points lower for Green House patients compared to those in a traditional nursing home. Employees like their jobs, are not rushed through their duties, and thus are far less likely to abuse or neglect residents.

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Extendicare Pays $38 Million for Poor Care

April 21, 2015

wheelchair-945156-m.jpg One of the country's largest nursing home chains was recently hit with a $38 million negligence and fraud settlement. This type of healthcare fraud is common in poorly-operated nursing homes throughout the country. Any evidence or suspicion of fraud is a red flag of systemic negligence in a nursing home.

Extendicare was charged with billing Medicare and Medicaid for unnecessary and inappropriate services, such as physical therapy, in 33 nursing homes. Extendicare owns and operates 150 nursing homes in 11 states. This is the largest settlement in the Justice Department's history involving nursing home fraud.

Prosecutors for the federal government said that Extendicare failed to hire enough nurses to properly care for residents in its facilities. Understaffing of this nature is rampant in nursing home owned by large chains and can lead to severe problems, such as more frequent falls and bedsore development

They went on to say that the care provided at these 33 facilities was so poor that many residents became dehydrated, malnourished, and suffered infections. This led to unnecessary hospitalizations, head injuries, and a considerable decrease in quality of life.

Whistleblowers Reporting Fraud, Saving Lives


The claims against Extendicare's nursing homes were first filed by a whistleblower in Ohio who accused the company of poor care. Another whistleblower in Pennsylvania also accused the company of inflating their Medicare reimbursements, providing unnecessary care to residents to increase how much they could bill the government. More information on the Pennsylvania whistleblower can be found here.

Medicare reimburses healthcare centers based on the amount of rehabilitation services a resident needs. Nursing homes, particularly for-profit chains, often exaggerate how much rehab a resident needs to milk money from Medicare and Medicaid. The nursing home chain Ensign, for example, recently agreed to a $48 million settlement for similar fraud charges.

The Obama Administration has made nursing home investigation and prosecution a top priority in the justice system. Overall, investigators go after nursing homes that defraud Medicare and Medicaid, and then pursue problems with resident care such as understaffing and overmedication. Poor care and government fraud go hand in hand: if a nursing home is unethical enough to subject residents to unnecessary treatments, it is surely taking other measures to cut costs at the expense of resident safety.

Thus, prosecuting nursing homes for health care fraud not only protects taxpayer funds, but protects the health and safety of residents as well. This was demonstrated in Extendicare's suit by internal emails shown in court. One Extendicare executive expressed concern that a resident with a seizure condition was physically unable to participate in physical therapy. He described this as a "missed opportunity ... a financial loss of 2300 bucks."

The settlement included terms requiring Extendicare to enter a five-year integrity agreement. This will have an independent monitor assess Extendicare facility's staffing levels among other quality measure to make sure it is making improvements. Fortunately, this agreement applies to all 150 Extendicare nursing homes in the U.S.

The rise in for-profit nursing home chains is pervasive - over 70% of nursing homes are now for-profit - at the cost of elderly, sick and vulnerable residents. These chains operate to please investors, not residents, and skimp on the most critical aspects of care like trained nurses and medical supplies.

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Ernie Banks Story Shows Lessons in Elder Financial Abuse

March 11, 2015

ernie-banks-mr-cub-wrigley-field-chicago-il-april-2012.jpgErnest "Ernie" Banks was a professional baseball player who spent his entire career with the Chicago Cubs, earning him the title "Mr. Cubs." He was a national legend but particularly beloved in Chicago, where we consider him one of the greatest players of all time. Ernie Banks died in late January 2015, enacting in a bitter dispute over his will between his family and his live-in caregiver.

Nursing home abuse lawyers at Pintas & Mullins want to highlight this story not to exploit Banks' story or his family, but to illuminate an important issue in elderly care that often goes overlooked. Financial abuse among the elderly is incredibly common, particularly in nursing homes, where residents often suffer from cognitive disabilities that make them seem like vulnerable targets.

Three months before his death, Banks signed a new will that awarded all his assets to his live-in caregiver and agent, Regina Rice, which his family knew nothing about. He also signed a power of attorney and health care directive that gave Rice full and immediate control over his finances and healthcare.

Banks' family - including his wife and two sons - only found out about the documents after his death. Rice, who cared for Banks for over a decade, claims that Banks was a trusted confidant and wanted her to have everything. Eight days after Banks was buried, however, Rice enjoyed a day at the spa, sipping Moet champagne and uploading a video of the pampering on her Facebook page.

Jerry and Joey Banks, Ernie's twin sons, both live in Los Angeles, and told the Chicago Sun-Times that it was difficult to get ahold of their father toward the end of his life. His phone number would change constantly and Rice would deflect questions about his wellbeing. Both brothers and Ernie's estranged wife believe Rice took advantage of him in his declining health, coercing him to sign a new will.

The Banks family plans to vigorously fight and contest this new will in court. The court has ordered Rice to provide more detailed documentation about Banks' assets, and she will not be able to sell any of Banks' assets without court approval while the case is ongoing.

Financial Abuse in Nursing Homes


Elderly people who do not have the capacity or desire to manage their own finances often entrust caregivers with their property and accounts. This is not uncommon or illegal, but it does leave room for manipulation. Entrusted parties are typically given power of attorney, health care directives and other documentation that gives them control of the person's funds.

If these powers are taken advantage of or signed over without consent, the elderly person can be stripped of not only their financial assets but their final wishes as well. Too often, this occurs in nursing homes by staff or attendants. It is critical that families with a loved one in a nursing home keep a close, watchful eye on the resident's finances, accounts, and property.

Some of the most common forms of financial abuse in nursing homes include: cashing a patient's checks, using a resident's credit or debit card, forging a resident's signature, and, of course, deceiving a resident into signing documents.

Signs of financial abuse can include: sudden changes in a financial account or will, unexplained or frequent withdrawals from accounts, extra names on bank documents, signing of contracts without the family's knowledge, and forged signatures.

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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.

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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.

Continue reading "Malnutrition and Dehydration in Nursing Homes - What You Should Know" »

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.

Continue reading "Investigation Finds Nursing Home Care Lower Than Families Believe " »

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.

Continue reading "Nursing Home Reforms Desperately Needed" »