January 30, 2015

Nursing Home Owner Accused of Rape

by Levin & Perconti

A case in the state of Washington has caught attention for the heinous violation that a nursing home owner committed against one of his facility’s patients. We have constantly seen case after case of physical and verbal elder abuse, as well as negligence in treatment and attention, but cases of sexual assault and abuse are not always at the forefront of these nursing home-related stories. Of the various types of abuse and neglect that patients and residents can suffer, what occurred at the AA Adult Family Home in Auburn, Washington, is one of the most heinous, vile and unforgivable actions and betrayals of trust.

As was reported last month, hidden camera footage documented the 67-year old owner of the AA Adult Family Nursing Home raping an 83-year old female patient in her room. As one might expect, these accusations go beyond any type of civil or administrative remedy that the state could take, and the accused nursing home owner was taken into custody by police and charged with second degree rape. In addition, the other residents (there were about only a dozen total patients in the entire home) were moved to hospitals until they could be permanently settled elsewhere to continue receiving care. Those residents, who mostly suffered from some dementia, also underwent exams as a precaution to determine if they also had been victims of sexual assaults. As was also reported, the victim in this horrific attack suffered from dementia. While any nursing home resident can be subject to abuse and neglect by facility staffers, those that suffer from mental inhibiting ailments like Alzheimer’s disease or dementia are particularly vulnerable because it may be difficult for them to understand what is happening to them, and they have trouble articulating and reporting the abuse.

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January 28, 2015

State AG Takes Aim at Major Nursing Home Chain

by Levin & Perconti

We have covered time and again the importance of government agencies, state and federal, in investigating the performance of nursing homes, reporting publicly on violations, putting homes on probationary status, and even shutting them where necessary. These agencies also will put facilities on performance improvement plans that require them to curb abuses, stop negligence, and improve living conditions and care plans for patients, or face the loss of their license to do business and thus closure.

While state health and aging agencies largely handle these matters, as well as the United States Department for Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) for the federal government, it is also state attorneys general and the U.S. Attorney General that play important roles in holding nursing homes accountable. This can take the form of civil lawsuits to recover for misuse of federal or state funds, as well as even criminal charges for the very same or for heinous treatment of patients that amount to criminal violations.

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January 26, 2015

Texas Legislature Wants ‘3 Strikes and You’re Closed’ Rule

by Levin & Perconti

We previously posted on the importance of government agencies as well as advocacy and watchdog groups in keeping nursing homes and long-term facilities transparent, honest and law-abiding. Surveys, investigations either open or undercover, and the vetting and consideration of complaints of elder abuse from residents or loved ones are all important to this effort.

This reporting and investigatory structure is vital to keeping nursing homes honest and pushing them to improve quality of care to patients so that they may meet and exceed the standards set out by the law and regulations. In a report card released by a Florida-based advocacy watchdog group that reports on nursing homes around the country, the state of Texas was found to be the worst-ranked state in the entire United States, including all 50 states and the District of Columbia. The state of Illinois did not fare all that well in this comprehensive assessment, either. As far as Texas is concerned, however, the worst state in the union for nursing homes and long-term care facilities has at least one member of its state legislature demanding not just for better oversight or moderate crackdowns, but for threats of outright closure of homes that do not meet the proper standards.

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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.

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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).

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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.

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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.

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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.

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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.

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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.

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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.

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