January 23, 2015

Innovatively Treating Residents with Alcohol and Drug Addictions

by Levin & Perconti

Baby boomers have comprised a unique generation in our nation’s history and in American life. They were the first wave of births after the end of the Second World War, and witnessed the transformative decade of the 1960s, disco and rollerblades of the 1970s, the rise of Wall Street and pop music in the 1980s, Y2K, the Chicago White Sox’ first world championship in over a century, and so much more. Within that transformative time, as many know from either experience or the history books, there were periods of increased drug use. Such drug use unfortunately stuck with certain adults who, as we surge through the mid-2010s, are now becoming the elderly population. Thus a notable number of elderly people, some of whom reside in nursing homes and long-term care facilities, still deal with drug addictions, as well as alcoholism.

We have also previously covered the plight of nursing home staffers’ misuse of drugs and medications to sedate patients even when such usage was completely unnecessary and simply the easy way out for staffers to control patients whether or not they were prone to violent or disruptive outbursts. The terrible consequence of such chemical restraint and abuse can be an addiction to that medication. And, as with so many others, life events or other issues can trigger abuse and addiction even later in life. As a local news affiliate has reported, according to a journal study on the issue of baby boomers and drug usage, Americans age 50 and up that face drug or alcohol abuse issues could be as high as 5.7 million by the end of this decade, which will be double the number from 2006.

Continue reading "Innovatively Treating Residents with Alcohol and Drug Addictions" »

January 21, 2015

WV Supreme Court Justice in Possible Conflict Related to Nursing Home Case

by Levin & Perconti

Judges in our court system are stewards of a long tradition of the search for truth and justice, and have been tasked with the important priorities of ensuring that all parties that go before them follow the rules, receive access to due process, and otherwise have a fair and impartial opportunity to prove or defend their respective case. So when there is a conflict of interest, or at least a perceived conflict of interest or the appearance of impropriety involving a judge, it is the common and necessary practice for that judge to recuse him or herself from the case and allow an objective judge to oversee it. Such is now the issue that a judge in West Virginia finds herself dealing with in a nursing home case that has already ended.

HCR ManorCare, a nursing home company, previously faced accusations in West Virginia state court that one of its nursing homes was grossly negligent in its care of a patient, and that the patient died as a result, having experienced pressure ulcers and frequently falls during their stay at the facility. A jury verdict in this elder abuse wrongful death case awarded $91 million to the family of the deceased patient. And then subsequent to that, the company settled a separate case for an undisclosed and confidential amount. The nursing home company had appealed to the Supreme Court claiming that state law caps medical malpractice awards (we had previously covered this issue going to the Supreme Court in West Virginia).

Continue reading "WV Supreme Court Justice in Possible Conflict Related to Nursing Home Case" »

January 19, 2015

The Push to Reduce the Use of Unnecessary Antipsychotic Medications

by Levin & Perconti

Historically, nursing homes and long-term care facilities have had issues when it comes to the unnecessary or improper medication of their elderly residents and patients. Antipsychotic medications have often been used to sedate those with Alzheimer’s, dementia and mental and emotional problems, and justified as the only way to truly keep them in control. Staffers see these medications as the easy way out rather than to find other ways to help the patients remain calm. Excessive antipsychotic drugs can actually lead to infections or cardiovascular damage. There is also the issue of perpetually increasing the usage of these medications, as staffers use some drugs to sedate patients, and then others to wake them up and help them be more alert. This creates a dangerous and possibly deadly cycle of constant medication that can cause permanent damage and can even be lethal. Furthermore, as with the use of medications and drugs, there is also the risk of the patient becoming addicted.

This has caused increased inquiry from the government. For example, pharmaceutical company Johnson & Johnson settled for over $2 billion with the government over civil and criminal charges that its subsidiary encouraged nursing homes to buy and use its antipsychotic medication product for dementia patients when it was only approved for use of those with the psychosis called schizophrenia.

Continue reading "The Push to Reduce the Use of Unnecessary Antipsychotic Medications" »

January 16, 2015

Connecticut Private Nursing Home Cannot Claim Sovereign Immunity

by Levin & Perconti

Just about a few months ago, we touched on a unique case in the Connecticut court system that made its way on up to the state Supreme Court. The case had to do with whether or not a private nursing home facility that served patients under the state’s care as well as prison parolees could qualify for protection under a legal doctrine called sovereign immunity. Sovereign immunity is a centuries-old legal doctrine that essentially protects the state from lawsuits of any type unless the government makes its eligible to be sued by individuals or any specific state under the Constitution or under the law.

Such immunity also may protect federal government officials from lawsuits in certain circumstances. One of the most common laws that grant standing to sue the federal government is the Federal Tort Claims Act. Sovereign immunity also exists on the state level, as states cannot be sued by individuals unless in situations where the states consents to such lawsuits. In Connecticut, for example, residents can sue for a violation of state constitutional rights, as well as for certain torts and injuries under various statutes.

Continue reading "Connecticut Private Nursing Home Cannot Claim Sovereign Immunity" »

January 14, 2015

Elder Care Business - Privatizing Nursing Home Care

by Levin & Perconti

The nursing home business has been a profitable one for many. As baby boomers enter their later years and require care, the customer base is undoubtedly growing. Add in the numerous insurance policies that cover nursing home and long-term care facility stays, including government programs like Medicare and Medicaid, and the sources of revenue for nursing homes are tremendous. Add to this the untenable yet unfortunately realistic incentive to cut overhead and staff levels in order to save even more money and generate greater profit margins.

Such lower staff levels reduce the time and attention paid toward patients who need constant care, and can result in injuries, untreated illnesses, and eventually death. In spite of allegations of abuse, neglect, or fraud in accepting federal dollars for fake services or overstated services, all of which can result in criminal and/or civil charges costing millions in fines and penalties, the business of nursing homes is a profitable one, and many companies are looking to get into this business.

There has been a trend of nursing home ownership becoming bigger and bigger. There are no longer smaller outfits or so-called “mom and pop” single homes. Rather, larger holding companies and management companies have acquired chains of nursing homes to run en masse for greater and greater profit. This has also been a similar trend for once-publicly-run nursing homes, which states are selling off to go under completely private management. Regarding acquisitions from the state, the government is generally motivated to sell because they consistently operate at substantial losses, and the deficits become too much.

The state may have no choice but to sell off to private interests with the cash to make the deal worth it for all involved. Such has been the trend in the state of New York, for example, where private interests can operate the facilities for profit, while the facilities stay open rather than face closure because the state can no longer effectively run it. Private owners work to cut costs, and may not owe the types of benefits and pensions that the state must use

Recent Example

In Orleans County, New York, for example, the government agreed to sell the Villages of Orleans Health and Rehabilitation Center to the management company Comprehensive Healthcare Management Services, for $7.8 million. As reported, this particular company, based out of Long Island, New York, owns a home in the Pittsburgh, Pennsylvania area and has targeted the takeover of other facilities around Buffalo, New York. The home, as unfortunately with many county-run facilities, in 2012 lost about $2.8 million. This deal follows another recent sale of a nursing home in Ontario County, New York for about $1 million, which had operated with relatively barely any revenue above costs.

Both of these homes will be cutting out staff benefits, or letting go of certain staff altogether in order to cut costs. It remains to be seen whether the new owners of these nursing homes, as well as facilities sold to private interests in general, will be able to cut costs while still maintaining adequate levels of care. It will be important for state and federal regulators, where applicable, to keep tabs on these facilities and their performances as well as investigate complaints. And it is important for prospective residents and their loved ones to be aware of the facilities’ records, staffing levels, and quality of care offered to residents to avoid elder abuse.

See Related Blog Posts:

Elder-Against-Elder Abuse Draws Attention

Part 1 – Protests Continue in the Fight to Shut Down Alden Village North

January 12, 2015

Omnicare Faces False Claims Lawsuit Again

by Levin & Perconti

In the area of false claims and kickbacks when it comes to medical providers and specifically nursing homes, Omnicare, Inc. has been a headline-grabbing name in recent years. The company provides pharmaceuticals as well as “pharmacy consulting services” to nursing homes, and thus is a big player in the nursing home business. Its responsibility through this consultancy is to make sure that facilities provide the right medications for patients. In recent years the company has settled with the government over accusations of false claims as well as kickbacks, all of which are incredibly unlawful activities.

The company was accused of giving kickbacks to nursing homes in the form of discounts to ensure they would retain the nursing homes’ business. This also amounted to false claims since Medicare dollars from the federal government were involved since the facilities would accept this money and then turn around to pay it to Omnicare for its services. The company paid tens of millions in recent settlements with the government over these allegations.

Continue reading "Omnicare Faces False Claims Lawsuit Again" »

January 9, 2015

Senior Chicago Resident Dies from Building Fire

by Levin & Perconti

In the course of examining the numerous unfortunate cases of abuse and neglect of patients at nursing homes and long-term care facilities, sometimes other issues, even basic ones, get lost in the shuffle but are very significant when it comes to caring for patients. In addition to meeting adequate standards of care in accordance with government regulations and the ever-evolving patient bills of rights, nursing homes also have a duty to ensure even the most basic safety for its residents irrespective of medical treatment.

This includes making sure that the building that houses the patients is itself safe and up to the proper safety and fire codes; that all fire alarms and sprinkler systems function properly; and that evacuation protocols are designed to ensure residents are removed from the building in the event of fire or other imminent danger. In recent coverage about the deficiencies at Sauk Valley nursing homes, it was reported that in addition to negligence and a lack of care, some of the nursing homes even failed to properly follow building and fire codes.

Continue reading "Senior Chicago Resident Dies from Building Fire" »

January 7, 2015

Good News: Use of Antipsychotic Medications Wanes?

by Levin & Perconti

As we just recently covered, as recently as 2012 the Centers for Medicare and Medicaid Services (CMS) began a nationwide effort to push nursing homes and long-term care facilities to decrease their usage of antipsychotic medications to sedate and restrain patients. The use of antipsychotic medications for this purpose has long been a problem because they are often used in situations when they are not truly needed. Nursing home staff will use these drugs to keep dementia patients calm, when in fact only patients suffering from actual psychosis – such as bipolar disorder or schizophrenia – should even be considered candidates to receive these types of medications.

As recently reported, the Food and Drug Administration (FDA) has mandated “black box” warnings for antipsychotic drugs. This type of warning is exactly as it sounds – it tells the person intending to take it of all the side effects and potentially dire consequences. For example, a black box warning on antipsychotic medications may read “increased mortality in elderly patients with dementia-related psychosis.” Such warnings imply that these drugs should only be used in the most extreme circumstances. In spite of the risks of infection or death, NPR reports that nearly 300,000 nursing home patients are given antipsychotic drugs. The use of such drugs in unnecessary situations is a form of chemical restraint of the patient, and can be grounds for charges or claims of patient abuse and neglect.

Continue reading "Good News: Use of Antipsychotic Medications Wanes?" »

January 5, 2015

Nursing Home Fails to Maintain and Follow Status Codes

by Levin & Perconti

In the context of healthcare, hospitals commonly use a code status to indicate a patient’s condition, particularly during an incident or event. A code status also indicates what types of procedures or protocols can be used or followed to treat a patient depending on the type of event they are experiencing, such as a heart attack or a collapsed lung. This could include using electric shock paddles to get a heartbeat going again, possibly chest compressions for the same, injecting a certain drug to stimulate a part of the body, or possibly intubation to provide oxygen to the lungs.

The worst code status phrases that some may be aware of include “Do Not Intubate,” and “Do Not Resuscitate,” which likely means there is nothing more to be done for the patient. Those who have had experiences themselves or with loved ones in hospitals may unfortunately be familiar with these terms, as might fans of medical dramas on television. It is crucial that code status be well understood and carefully communicated, otherwise the wrong procedure could be performed and result in further injury, death, and the inevitable medical malpractice claim. Patients will also typically have the opportunity to convey what they want done in certain situations ahead of time, and unless they are incapacitated or unconscious, can change their minds at any point. For example, they may choose not to be resuscitated in certain scenarios.

Continue reading "Nursing Home Fails to Maintain and Follow Status Codes" »

January 2, 2015

State Ombudsman Program In Place to Address Concerns and Problems

by Levin & Perconti

There have recently been disturbing reports about the severe deficiencies and failures at various Sauk Valley nursing homes, encompassing facilities in multiple counties (Lee County, Whiteside County, Ogle County, and Carroll County, as well as one facility in Bureau County). Sauk Valley facilities has approximately a 65% rate of severe deficiencies, while the state of Illinois, which is one of the worst in the nation for nursing home care, has about a 25% rate. And on top of the abuse and gross neglect that occur, or at least are alleged to occur at these facilities, those who run the building fail to even adhere to building codes and fire codes, which is even more disturbing.

The state has the Illinois Long-Term Care Ombudsman Program, which was implemented pursuant to both the Federal Older Americans Act as well as the Illinois Act on Aging. The purpose of the program is to “protect[] and promote[] the rights and quality of life for people who reside in long-term care facilities (nursing homes).” Ombudsman duties include “informing residents and their families of their rights; resolving complaints; providing information on residents needs/concerns to their families, facility staff and their community; and advocating for good individualized care.”

Continue reading "State Ombudsman Program In Place to Address Concerns and Problems" »

December 29, 2014

Report Shows Problems Across State, Including Champaign County

by Levin & Perconti

The News-Gazette recently reported on an investigation conducted by the CU-CitizenAccess group in the Department of Journalism at the University of Illinois. This group researched and investigated 81 nursing homes across Illinois, and found that since early 2011 the Illinois Department of Public Health (IDPH) handed down fines totaling approximately $632,000 to 51 of those 81 nursing homes and facilities. As the article indicates, the homes studied are from different areas of the state (note in recent news and blog posts here that Lee, Whiteside, Ogle and Carroll Counties in particular had incidents with patients that led to substantial sanctions). And prior to this study, another investigation by the same group reported that, from 2006 to 2010, 93 nursing homes paid out over $1 million.

The continued problems to this date are notable because the state enacted reforms through the Illinois Nursing Home Safety Act in 2010. Nursing home owners and industry people cite a faulty rating system that does not accurately reflect the true level of overall care in nursing homes. On the flip side, however, and as we have examined previously, methods of evaluating nursing homes, such as Medicare’s five-star rating scale, have faced criticism largely because they rely on information and data self-reported by nursing home facilities. Naturally there is a conflict of interest here that was touched on in recent months in media reporting, since facilities may inherently be prone to over-report success and underreport failures in order to maintain high ratings. These ratings, which account for “staffing levels, inspection results and resident conditions” among other criteria, are published online on websites such as Medicare.gov. While 51 of the 81 homes in this particular study were fined in some way, 16 of these homes only received one star on the Medicare scale, and 18 facilities had two stars.

Continue reading "Report Shows Problems Across State, Including Champaign County" »

December 26, 2014

More on the Problems at Sauk Valley

by Levin & Perconti

We recently posted about the disappointing record attributed to nursing home facilities in Sauk Valley by a nursing home watchdog and advocacy group. In Dixon County, for example, a nursing home was cited after failing to properly observe a patient who required CPR, and no CPR was administered because of a disorganized and inaccurate file maintained on the patient that led aides to believe he should not be resuscitated. It was also found that the facility and others did not maintain up-to-date web pages as required by law.

The watchdog group, Families for Better Care, conducted a lengthy and in-depth investigation that yielded even more information than what we briefly touched on in a prior post. The majority of homes in the area were hit with at least one severe deficiency citation in approximately the last two years. Yet in multiple instances the homes’ fines were reduced in spite of the need for sanctions that could actually foment change in how they operate. The overall failures are disturbing in light of the fact that the nursing home industry is heavily regulated in the state of Illinois through both the Nursing Home Care Act as well as federal regulations tied to Medicare, Medicaid and any other federal programs. As reported, last year the state health agency employed 228 surveyors to investigate 4,575 complaints within Illinois.

Continue reading "More on the Problems at Sauk Valley" »