Illinois Nursing Home Abuse Blog

The Illinois nursing home abuse lawyers at our firm were interested to come across an extended story from The Atlantic that delves into a range of issues affected nursing home care across the country.

The report details how care at most of these facilities remains institution-like. The author compared them to how asylums are run. All those who care about the well-being of our local seniors—including the Chicago nursing home abuse lawyers at our firm—have long voiced concern about the overall lack of commitment to resident well-being. We firmly believe that it remains imperative for owners and operators of local nursing homes to ensure that senior residents are given opportunities to actually flourish as human beings, instead of merely being housed.

This latest article essentially echoes the same sentiments. Encouragingly it seems that many establishments are heeding the call and trying to shift away from institution-like care. The call for a “culture change” has been around for a decade and a half or more. However, observers explain that real efforts to change how care is provided at these facilities only gained any actual momentum in the last few years.

This reformed approach “is based on a belief in person-centered care, in which the values and wishes of nursing home residents and those working directly with them are seriously considered and honored.”

In practical terms, this requires many different changes. They include fostering closer relationship between residents, more empowered staff members, and an overall more welcoming environment. Part of this involves more closely incorporating family members in care plans. More specifically, there is a call for actions like allowing pets to have a home in the facility, creating more opportunities for residents to perform voluntary tasks/jobs in the home, and providing more open meal plans.

All of this can both ensure residents lives are improved as well as help limit instances of nursing home neglect rooted in failure to account for resident’s overall well-being.

However, many challenges remain to full implementation of these efforts at facilities across the country. For one thing, some point to the complex federal regulations of nursing homes as a challenge. Of course, this is a double-edged sword. On one hand, it is vital that facilities not be able to skirt basic care requirements in order to maximize profits for owners at the expense of those living in the home. But on the other hand, paperwork details should not get in the way of ensuring the quality of life for seniors at these facilities is maximized.

The article author argues that “if we are serious about making nursing homes more comfortable and homelike, a review of existing regulations […] that impede culture change must be put in place.”

Our Illinois nursing home lawyers encourage everyone to read the entire article at The Atlantic to get a good idea of the complex issues involved in improving nursing home care overall. The story references the fear of nursing homes lawsuits. However, it is important to note that ensuring victim’s access to the civil justice system is not inherently incompatible with reform measures at these facilities. Enacting real reform at these establishments requires a groundswell of advocacy from residents, their loved ones, and other concerned community members.

See Our Related Blog Posts:

Levin & Perconti Named Personal Injury Law Firm of the Year By Lawyer Monthly

Levin & Perconti Nursing Home Abuse Lawsuit Filed Against Rosewood Care Center

As individuals age they often come to need a range of support to get by each day. Medical assistance is the most common need, as various ailments affecting seniors often necessitate close, even around-the-clock medical aid being available. Similarly, basic household support may be required. This is different than medical care in that is doesn’t require technical healthcare skills. Instead, when mobility and physical strength is lost seniors might need help with personal grooming, household chores, and similar aid.

Our Illinois elder abuse attorneys know that there is still another type of help that seniors often need as they age: financial planning and organization. As we have repeatedly explained, senior financial exploitation is a growing and incredibly robust problem. It is a reminder that part of the aid that seniors receive as they age must include help with money matters.

A Monterey County Weekly story touched on the prevalence of cons of seniors. The article is helpful in that is reminds readers of the fact that the recent economic recession hit many seniors particularly hard. Retirees often saw their savings decimated as the value of stocks and other assets plummeted. This threw many seniors, often unable to work to increase their personal revenue, in very difficult financial circumstances. Many of these seniors have had a hard time meeting basic financial requirements, like mortgage or rent payments. Add to that the rising cost of medication and other healthcare bills and it is not an overstatement to say that some of the most vulnerable seniors have to choose between basic life necessities. Our Chicago elder neglect attorneys appreciate that no one should be forced to struggle in this way in their golden years.

All discussion of senior financial exploitation should be within that context.

For example, in some circumstances seniors may have faced this exploitation by their own banks. The article argues that some lenders tricked confused seniors into taking bad (or even unnecessary) loans. Many seniors were not aware of the fine details of those loans and some particularly unscrupulous lenders took no time to explain those details. One elder abuse lawyer summarized that “those folks who have worked really hard all their lives are looked at as really ripe for the unscrupulous part of the community to get their assets away from them.”

This sort of abuse occurs in countless ways. For example, some seniors are renting. They often end up paying rent to landlords who themselves have already gotten foreclosures for their own failure to make mortgage payments. Seniors then unknowingly enrich landlords who themselves are not even properly owning the home.

What is perverse about senior financial abuse is that the very reason that seniors are targeted is that they’ve generally “played by the rules” to save and invest their resources. Their hard work is the very thing that makes them ripe targets for those seeking to take their money. An important way to prevent all of this is to properly plan for potential incapacitation in old age. If a plan is in place for a senior to receive the support they need when they age then there is a far lower chance that they will be taken advantage of down the road.

See Our Related Blog Posts:

New Way to Support Nursing Home Laws

Pilot Program Seeks to Improve Troubled Nursing Homes in Illinois

Our Chicago nursing home abuse lawyers work directly with seniors at long-term care homes and skilled nursing facilities. However, it is important to point out that elder abuse occurs in countless other locations, not just institutions or elder care communities. Sometimes the abuse outside of these spaces is very subtle and hard to catch. Usually, there is only actual accountability when the abuse boils over in some egregious circumstances.

For example, the Appeal Democrat reported last week on new elder abuse charges filed against a man for his abuse of an elder woman with which he apparently lived. The story explains how the 56-year old man in this case was arrested after an alleged physical assault on a 78-year old paralyzed woman. The details of the altercation are a bit murky, but alcohol-fueled anger appears to be at root of the problem.

The story does not indicate exactly what the living arrangement was, however the altercation was apparently based on disagreement over rent money. The man allegedly demanded that the senior woman return his portion of the rent money for that particular month. She declined, and this led to a more severe argument. Use of the home’s air conditioning may have played a role in the disagreement.

The man became more and more agitated; he eventually struck the woman several times in the face and forehead. Somehow the police were called to the home in the middle of this altercation or shortly afterwards. It was then that the man was arrested for his actions. Law enforcement officers noted at the time that there was a strong smell of alcohol on the man’s breath.

Each Illinois elder abuse attorney at our firm understands that these sorts of physical outbursts are often only a small part of on-going mistreatment. Without speculating on the details of this particular case, it is clear that many seniors in these sorts of living situations are often victims of repeated mistreatment. For example, seniors in these situations are bullied in various ways by those in a position of power over them. When a senior lives with another—often in situations where the other individual is supposed to provide daily support to the senior—then the possibility of one taking advantage of the vulnerable elder are prime. This exploitation can take many forms, from physically hurting the resident (as in this case) to slowly skirting financial responsibilities (such as refusing to pay full rent).

Each locality has state and federal regulators who are responsible for investigating various allegations of mistreatment against seniors. But, regulatory bodies are woefully understaffed and rarely have the resources to fully ensure the fair treatment of all local seniors, both in nursing homes and those in other living arrangements. That means that the accountability should fall even more heavily on all of us who in any way are in a position to ensure that a local senior—from a family member to a neighbor—are being treated properly. Little is harmed when one investigates further into potential harm. However, much can be lost when those suspicions are ignored.

See Our Related Blog Posts:

Chicago Nursing Home Lawyer Encourages Promotion of Elderly Quality of Life

Surveillance Cameras Important in Fight Against Elder Abuse

Financial exploitation of the elderly is likely the single most common form of elder abuse. Yet, much of this abuse goes unreported because it occurs in big and small ways on a daily basis. Our Illinois nursing home neglect lawyers know that like physical, sexual, and emotional abuse, the misconduct can be perpetrated by caregivers, strangers, friends, and even family members. It remains vital for good-intentioned outside observers to keep track of the seniors in their lives to ensure that none are taken advantage of by those seeking to make money at the expense of the senior’s vulnerability.

We know that most local residents who the victimized by elder financial abuse will not have their wrongdoers held accountability.

Depressingly, it seems that sometimes this sort of abuse is only caught when it involves vast sums of money and high-profile cases. For example, as a new article at Investment News explains, many headlines were made in connection to the potential financial abuse of well-known New York socialite Brooke Astor. Many allegations were tossed about regarding the conduct of her son, Anthony Marshall and various other financial professionals involved in her affairs. Eventually, Mr. Marshall actually faced various criminal charges for this conduct—he was sentenced to a prison term but remains free on appeal. In addition, his mother’s last will was rejected in favor of the terms of an earlier will because the court deemed the final will was signed under suspicious circumstances—it left much more money and control of the family wealth to Anthony Marshall.

Similar to the Brooke Astor case, much attention was also focused on the case of Liliane Bettencourt. Ms. Bettencourt was the heiress to a huge fortune from the family’s L’Oreal business. The total family fortune was estimated at $1.4 billion. However, there was much controversy as Ms. Bettencourt apparently tried to leave her entire fortune to her photographer. The woman’s daughter petitioned the court for guardianship of her mother in later years, claiming that the woman was being exploited or otherwise confused. Ms. Bettencourt was diagnosed with Alzheimer’s in her later years.

Of course, seniors with certain cognitive problems are particularly vulnerable to exploitation. The problems can take many forms. In high-profile situations with famous families and vast wealth, the dispute is often connected to wills and other inheritance issues. But that is just the beginning. Many other seniors are similarly exploited through complex scams, dubious loans, and sometimes outright theft.

Each Chicago nursing home abuse attorney at our firm understands the role that money plays as motivation in all forms of senior mistreatment—not just financial exploitation. Even regular nursing home negligence is often rooted in the pursuit for profit maximization on the part of nursing home owners and operators. No matter what the form, seniors deserve to have their own money protected and to be treated with a proper level of care by all those charged with their well-being. Failure in this regard should be brought to the public’s attention with the wrongdoers held responsible. Only then can basic accountability mechanisms work to keep other seniors safe.

See Our Related Blog Posts:

Editorial Lambasts Washington for Ignoring Elder Abuse

Elder Financial Abuse Reaching Crisis Levels, Say Researchers

According to the Madison-St. Clair Record a new Illinois nursing home neglect lawsuit has been filed in southern Illinois. The suit was filed by a former resident against a nursing and rehabilitation center in the area. The allegations made in the complaint suggest that the man was injured as a result of one of the most common types of negligence—inadequate supervision that lead to a fall.

Specifically the complaint filed earlier this month suggests that the man was sitting in his wheelchair at the facility while being left unattended. Unfortunately, the man fell from his chair, and as a result of the fall he claims to have torn the rotator cuff in his shoulder. Of course many seniors have a wide range of physical vulnerabilities, and so injuries that they sustain often have a domino-like effect on their health. Even when subsequent injuries are prevented, even relatively minor injuries can lead to severe pain, suffering, loss of mobility, and other long-term problems.

The legal documents filed by the resident in this case suggest that the nursing home was negligent in a range of ways. On one hand, the complaint suggests that had the man been properly supervised and protected, the fall from the wheelchair would not have occurred in the first place. In addition, the former resident suggests that the facility did not provide the senior with adequate medical care after the injury, complicating the problem and adding to the pain.

Each Chicago nursing home neglect lawyer at our firm appreciates that the issues raised in this suit are quite common across all Illinois nursing home neglect cases. Poor supervision is unfortunately an all too common form of negligence that leads to untold numbers of accidents and injuries at facilities across the area each day. The supervision problem itself can often be traced back to staffing problems. As we’ve often noted, many facilities simply do not have enough hired front-line care workers providing the actual hands-on support residents need to get by each day.

When a single care worker is pulled between dozens of residents with countless different needs it is far more likely that a resident will go unnoticed who should be watched. This is rarely the fault of the over-worked aide, however it is still a form a facility-wide negligence. The owners and operators of these homes must be held accountable for this sort of conduct that hurts residents.

Of course Illinois nursing home falls, like in this case, are perhaps one of the single most common forms of injury at these facilities. Unfortunately, a fall is often a catalyst that leads to other problems for the senior. For example, some individuals may become bed-ridden after the fall—either permanently or temporarily. As a result, they come to rely on the help of front-line care workers even more. However, with understaffing those care workers often do not attend to their needs as closely as necessary. In those cases, the resident may not be properly re-positioned, could have nutrition issues, and is at risk of dehydration. All of those factors often cause pressure sores to develop.

See Our Related Blog Posts:

Advocates Concerned About Inequality in Nursing Home Pressure Sore Rates

Signs & Symptoms of Nursing Home Abuse and Neglect

Sometimes it may seem like kicking a dead horse when our Chicago nursing home lawyers discuss the effect of low staffing on resident care. However, considering that so many facilities continue to be understaffed—in fact, most are—it remains important to continue the awareness about the consequences of not having enough staff members. All nursing home neglect attorneys can explain how failure to do so literally results in people dying who otherwise might still be alive.

Yet another study has reiterated the vital role played by having reasonable levels of front-line care workers at nursing homes. A story this week from Medicare Advocacy summarizes the findings. We have previously mentioned the underlying results of the study.

The research effort was conducted by experts at the Center for Retirement Research at Boston College. The analysis essentially sought to answer a question that had puzzled researchers in the past. When employment rates for the nation as a whole increase, why do mortality rates among seniors also increase? On its face it doesn’t necessarily make much sense. Clearly higher employment in the country doesn’t directly cause the deaths. However, there must be some other variable involved that correctly explains what is going on.

The researchers believe that they’ve reached an answer. They noted that “an expanding economy generates a greater scarcity of front-line caregivers in nursing homes, which may cause more death among the elderly.”

In other words, the elderly death rate increased may be attributable specifically to those in nursing homes. Because care workers at these facilities often do not receive very high wages or benefits, many of those workers leave those jobs when the economy is doing well and better opportunities are available. This analysis seems to match with demographic data which shows increased deaths among elderly woman when unemployment rates decline. Women make up a far larger percentage of nursing home residents, and so they are more serious affected by these issues.

Amazingly, the researchers were able to reach pretty specific conclusions about how unemployment rates affect front-line care worker stats and then nursing home resident’s health. Specifically they identified that for every 1% decline in unemployment rates there was a .4% increase in the mortality rate for older women.

Past research had identified how the overall employment rates effected employment of front-line care workers. These are the individuals who are actually working with residents day to day, providing them with all of their daily needs and in general keeping them safe. These front-line care workers are usually the ones who know each resident best, understanding their idiosyncrasies, risks, and unique needs. But these vital caregivers are not paid well, and they often leave for better jobs when the economy improves.

Our Chicago nursing home neglect lawyers know that when those workers leave it is the residents who suffer. This is true because the leaving workers are often not replaced or at least not replaced quickly. That means there are fewer eyes, ears, and hands providing a look-out to ensure all of the residents have the basic assistance they need. In addition, even when new employees are hired, there is often a learning curve with further negative implications for residents.

See Our Related Blog Posts:

Chicago Nursing Home Lawyer Encourages Promotion of Elderly Quality of Life

Surveillance Cameras Important in Fight Against Elder Abuse

The Denver Post reported this week on the end of a nursing home lawsuit in Colorado that resulted in a significant verdict for the family of a former nursing home resident. Unfortunately, the facts of that case mirror many that our Chicago nursing home attorneys have seen over the years of negligent care resulting in the deaths of unsuspecting seniors. It is yet another reminder of the continuing need to hold these homes responsible when their mistreatment causes pain, suffering, and injury. These facilities are unlikely to make the necessary changes on their own.

According to the story, the family of an 88-year old man alleged that poor care at the home led to his death. The resident entered the facility in May of 2009. He was suffering from Parkinson’s but still maintained much independence. He worked as a janitor at the home and was capable of walking on his own.

However, the family claims that he soon began suffered from a bedsore. The wound sapped his health, making him bedridden. He then stopped eating and drinking. The family argued that the facility did not provide proper care to prevent or treat the wound, and so it expanded. Other bedsores developed. One was so severe that it was the size of a baseball.

The family did not know of the problem until one aide confided in them that he thought the wounds were very severe. The aide explained that he was worried about getting fired, however, he spoke out because he was afraid that the man was going to die. Obviously, the family took immediate action and demanded that the man be taken directly to the hospital. Yet, the facility apparently protested. They claimed that the man could be cared for at the nursing home. The family eventually forced the man to be taken to the hospital where, on top of the bedsores, doctors found that he was dehydrated and malnourished. The man died shortly after, and the doctor’s linked his passing to the bedsores.

The family filed a nursing home neglect lawsuit and the case went to trial. The trial recently ended with a jury reaching a verdict for the family. They awarded them $3.2 million for the harm.

If you or a loved one may have been hurt in any way by mistreatment at these facilities, please remember that you have options. Our Illinois nursing home neglect attorneys are available to help families who suspect that they did not receive adequate care at a local nursing home.

The law demands that these care facilities meet certain requirements in the way that they provide for the residents who depend on them. Quite often those legal requirements are not met. In fact, some argue that there is an epidemic of poor nursing home care. However, the skirting of the law continues, because most hurt don’t actually come forward and press for their rights. That is why we continue to urge those affected in these ways to ensure accountability. Not only does this provide redress for the losses in your particular circumstances, but is also helps all other residents at the facility. You can be sure that there is rarely just one victim at a negligent home—mistreatment affects many seniors. However, even if just one of those hurt steps up, changes can often be demanded which will affect every senior in the facility.

It is important to remember that there are statute of limitations rules that apply to these cases. That means that there are time limits for filing suits. Do not delay; reach out to a legal professional today.

See Our Related Blog Posts:

Fox River Pavilion Nursing Home Death is Suspicious

Chicago Nursing Home Neglect Lawyers Reach settlement for Bedrail Entrapment Death

Last week the Trib Local Joliet had an article that provides more information about the state’s decision to revoke Hillcrest Nursing and Rehabilitation’s license. Some of our Joliet nursing home neglect lawyers have worked on cases involving residents at Hillcrest where inadequate care led to severe harm to unsuspecting residents. The facility has had chronic problems, being repeatedly unable to provide the level of care necessary to ensure that residents are kept safe, healthy, and protected.

Many different incidents and factors led to the likely closure of the facility. However, this latest story explains that two recent suspicious deaths in the last few months likely contributed significantly to the ultimate decision by the Illinois Department of Public Health to revoke the facility’s license.

The most recent incident involved a female resident who was found unresponsive in her room at the facility in late January of this year. Staff members found the resident sitting against a wall in her room with a coaxial cable wrapped around her throat and between her jaws. Investigations by the state public health department found that many red flags were raised by the death. For one thing, the report issued afterward indicated that the staff members at the home had no idea how long the resident how long the resident had been dead. That is because monitors at the home do not check on residents in their room.

Our Illinois nursing home neglect attorneys were shocked to read that in that particular incident, police officers discovered three burn pipes suggested that drug use likely occurred in the room. Staff members had no idea how long the drug-related items were in the room. This clearly indicates nursing home neglect, with facility employees seemingly failing to have even the most basic understanding about conduct in its own facility.

That death came only a few months after another highly suspicious incident. In late August a 37-year old resident was found dead in the facility. The coroner’s office later examined the victim and discovered the cause of death: drug intoxications from antidepressants drug prescriptions. Specifically, two of the four drugs that she had been prescribed combined to lead to the intoxication that took her life.

The death should not have been surprising, considering the same woman had been transported to a hospital when she was found unconscious a few weeks earlier. At that time the hospital notes indicated that the woman was treated for respiratory failure because of “narcotic overdose/opiate poisoning.” In other words, the facility was clearly on notice that there was a problem with this woman’s prescriptions. Yet, the facility kept such poor records, that it was virtually impossible for state health officials to check to ensure that the resident was receiving the proper dosage of the pills. All of this was on top of the fact that the IDPH report voiced concerns that there were many Vicodin pills and other drugs that were not accounted for or consumed by residents.

Each Joliet nursing home neglect lawyer at our firm knows that these two recent incidents are just the latest in a series of problems that have been found at the facility for years.

See Our Related Blog Posts:

State of Illinois Revokes License of Hillcrest Nursing and Rehabilitation Center

Levin & Perconti File Abuse Lawsuit Against Joliet’s Hillcrest Nursing and Rehab

The Presidents of the Illinois Trial Lawyers Association, Jerry Latherow, recently had an article published in the State-Journal Register discussing the merits of the civil justice system in our state. Unfortunately, when the civil justice system is discussed in a public way these days it almost always has to do with tort reform or otherwise critical attacks on the supposed harms caused by the civil law. Our Illinois nursing home abuse lawyers have helped many local residents seek fairness and accountability by using that system. We all should be proud of the way the justice system in our country affords all those hurt by others the right to a level playing field no matter how big or powerful the other side.

Yet, those big interests who are held in check by the civil justice system are constantly working to undermine the system. Each Chicago nursing home neglect lawyer knows that this includes big nursing home companies who try to shirk responsibility for the harms caused when inadequate care is provided to seniors at these skilled nursing facilities. Without the protections afforded by the civil justice system, these facilities—already driven by profits—will have even more reason to make policies to pad their own pockets. The care of the vulnerable seniors who depend on that care will only be made worse as a result.

Attorney Latherow echoed those thoughts in the recent article, explaining how the civil justice system demands fairness, accountability, and increased safety in so many areas. He noted the many recent headlines that suggest how big interests can cause harm to so many community members, from massive car recalls and prescription drug problems to financial institutions that leave consumers in difficult positions.

It is essentially uncontested that corporations are always driven by profit—after all, that is what business is all about. However, it is absolutely essential that that drive for profits not leave vast swaths of the community hurt in the process. This includes vulnerable nursing home residents who count on their facilities not to provide substandard care in order to make more money for shareholders.

Federal and state regulators do not have anywhere near the resources to ensure that the appropriate standards are upheld to protect consumers. The civil justice system fills in the gaps. As the article explains, “Each American has the constitutionally protected right to hold those who harm them responsible, whether it be another person or a large corporation. We are afforded this right in a civil court.”

Most community members understand how this plays out—both sides of the issues are given an opportunity to explain what happened and a jury of other community members makes a decision. Yet, this right is under attack. Big interests, including nursing home companies, the insurance industry, pharmaceutical companies, big tobacco, and others are trying to limit access to the jury and then limit what the jury can decide. Each Chicago nursing home abuse lawyer at our firm believes that we must stand up against these invidious attacks on a bedrock system of justice in our country. Fairness, safety, and responsible must be defended.

See Our Related Blog Posts:

New Way to Support Nursing Home Laws

Pilot Program Seeks to Improve Troubled Nursing Homes in Illinois

Money makes the world go round. In the nursing home world—as in all other large businesses—the drive for profits seems to dominate all decisions, including those that will affect the care provided to nursing home residents. Our Chicago nursing home neglect lawyers recently came across an article discussing th conduct of one large national long-term care facility chain that highlights this issue.

Take Part recently published an update on a recent high-profile class-action nursing home neglect lawsuit. Much news was made in recent years when nearly 42,000 residents joined in a class-action lawsuit against a large nursing home company—Skilled Healthcare. The suit alleged that the conglomerate which owned and operated many nursing homes provided negligent care to those in the facilities. A jury in the case eventually ruled against the company. They returned a verdict for the staggering sum of $677 million as a result of the near countless residents harmed by the company’s misconduct which led to nursing home neglect.

A large part of the problem was that the facilities in question were not abiding by state laws which mandate a minimum of daily personal care hours per resident. In particular, California law where the suit was filed mandates that each resident receive 3.2 hours of personal care daily. Yet, countless residents explained that the facility did not come close to providing that much care.

Following the $677 million verdict, the company worked feverishly behind the scenes to try to get the award lowered. Eventually the company and the plaintiff agreed to lower the amount to $50 million, so long as the facility also agreed to submit to frequent inspections by a “special auditor.” The hope was that the regular inspections would act as a measure to ensure that similar misconduct never again occurred.

What did the nursing home company do in response?

Instead of improving their standards and submitting to the inspections, they have worked to skirt the entire purpose of the settlement. According to a report in the North Coast Journal, the company decided to essentially outsource their management to a subcontractor. In that way, the company could still make money on the beds (they “rented” them to the subcontractor), but the maneuver allowed them to avoid being subjected to the new inspections.

In many ways these evasive actions are similar to those by many companies that seek to avoid accountability in legal cases with complex corporate structures. It often takes considerable effort to even figure out who owns what companies and who is making money for various facilities. This is all done so that those hurt by the company’s conduct struggle to figure out who is legally obligated to provide redress.

Unfortunately, each Illinois nursing home neglect lawyer at our firm appreciates that these sorts of money-driven maneuvers occur far too often across the country. The care of senior residents in need is rarely the #1 priority at these for-profit long-term care facilities. That is a shame.

An executive director for one elder care organization involved in the effort with this case summarized pithily that: “Let’s face it, nursing homes are all about money. You can’t touch their hearts on this stuff. You have to touch their wallets.”

See Our Related Blog Posts:
 
Poor Supervision Leads to Nursing Home Fall

Nursing Home Wandering Death Explained By Inside Source

That state of Illinois is in a financial pickle. For quite a few years policymakers in Springfield have been trying to better ensure the state lives within its means. The basic problem is something that all local residents understand—the state is paying out more money than it is taking in. When it comes to state government, the revenues come from a range of taxes, including state income and sales taxes. The expenditures include a wide range of government issues but some of the largest portions are things like payment for state employee pensions and healthcare costs for those using Medicaid.

Our Illinois nursing home lawyers appreciate that local seniors have a lot at stake when it comes to these issues. Proposed cuts to balance the budget and fix the state’s financial mess will undoubtedly affect many seniors. At the end of the day, certain changes might have to be made to ensure that the government remains solvent. Yet, it is vital that when all of the pros and cons of each cut are considered, the rights of vulnerable nursing homes be considered fairly.

A story last week from the Quincy Herald-Whig discussed certain proposed cuts and the effect that it might have on the state’s seniors—particularly how it might increase the prevalence of Illinois nursing home neglect and abuse.

The article explained how various nursing home employees picketed last weekend informally as a protest against the Governor’s proposed cuts to Medicaid. Those cuts would impact long-term care throughout the state. As one protested explained, “This could have devastating effects. It could cause some nursing homes to close.”

The proposal which sparked the outrage would eliminate $2.7 billion from state Medicaid payments. Of that total, about $237 million would be cut from funds that otherwise would have gone to state nursing homes. In addition, the Governor is hoping to lessen some of the damage from cuts by increasing the tax of each pack of cigarettes by $1.

The financial problems are twofold. Not only are current proposed expenditures far higher than we can afford, but there is already a backlog of unpaid bills. The state’s Comptroller recently reported that, amazingly, the state already has about $5.5 billion of bills that remain unpaid. These represent things that have already been purchased. However, that figure may actually be an under-accounting. When other state office bills are taken into account, the state may actually have about $9 billion in unpaid bills. Unpaid Medicaid payments are a large part of those overdue invoices.

Each Chicago nursing home neglect lawyer at our firm appreciates that these issues have very real effects on the lives of nursing home residents. For example, one nursing home aide reported that the state is already seven months behind in payments. The money shortage translates into day-to-day issues for these facilities, affecting things as simple as purchases of adult diapers and other necessary supplies. We understand that there are no easy options with these money issues. Yet, at the end of the day, the proposals have to be fair and honest. Vulnerable seniors need to have a voice in the process—even if not their own—to ensure that their issues are heard by policymakers.

See Our Related Blog Posts:

Steep Budget Cut Seen for Home Health Services for Seniors

Nursing Home Advocates Stand Against the “Balanced Budget” Amendment

The nation’s leading organization advocating directly on behalf of the country’s seniors has recently joined a nursing home neglect lawsuit related to the facility’s dangerous drug use. The underlying issue is one that each Chicago nursing home neglect lawyer at our firm frequently rails against: antipsychotic drug prescriptions. The class-action lawsuit specifically alleges that nursing home officials gave the powerful drugs to residents without the senior’s informed consent or that of their family members.

The California lawsuit claims that the state’s regulations were violated by the facility’s drug policy. In particular the law requires a nursing home to get consent from the appropriate party and to verify that the doctor giving the prescriptions has explicitly received that consent. However, attorneys in the suit claim that the defendant-doctor did not actually obtain the consent himself but instead relied on nursing homes to do it. This short-cutting would have been a violation of the law enacted to keep residents safe from unwanted medical intrusions.

The situation is actually two separate suits, one against the nursing home and one against the doctor. A nursing home neglect attorney working on behalf of the injured residents and their families explained that “The nursing home is literally the one that is putting the pill in the mouth and they are doing it without permission.”

There have been other class-action lawsuits around the country related to antipsychotic drug use. Yet, this is one of the first in which the AARP has intervened. The organization’s involvement will likely ensure resources are properly put into the effort, perhaps setting an example to other facilities throughout the country to change their protocol to ensure laws are followed and resident well-being is prioritized.

Of course this particular suit is related to an issue that is growing in important throughout the country. Our Illinois nursing home neglect lawyers frequently discuss the local residents whose lives are adversely affected by unnecessary or downright dangerous prescription drugs. Antipsychotics are popular among some because they may make residents easier to control—a form of chemical restraint that has serious ramifications of the quality of life of these seniors.

Of particular importance is the need to ensure residents with dementia or Alzheimer’s do not receive the drugs unnecessarily. Beyond simply affected these resident’s ability to engage with others around them without drug effects, for residents with degenerative cognitive conditions, the drug use may actually increase risk of death.

Consent issues are commonly implicated by this dangerous drug use. Because of the vulnerable nature of the residents, there is somehow a misunderstanding that being in a nursing home means that residents automatically consent to having drugs administered or in other ways lose some basic rights to make decisions about their own care. That is not the case. Seniors and their families are not ceding basic rights related to medical decision-making when they pay a facility to provide care to a vulnerable senior. When those consent rights are violated, the family members have the ability to hold the facility accountable for their misconduct.

See Our Related Blog Posts:

Medication Errors Pose Particularly Serious Risk to Seniors

Steve Levin Interviewed For Story on Antipsychotic Drug Use in Nursing Homes

The Star-Telegram reported this weekend on a unique case of a crime spree involving identity theft that affected literally dozens of nursing home, home healthcare businesses, and countless vulnerable seniors. For our Illinois elder abuse lawyers it is yet another remind of the need for those in a position to do so to keep a close eye on the finances and living conditions of seniors to ensure they are safe and secure. Nursing home negligence and lapses in care by at-home care providers are just the start of possible misconduct that can be perpetrated against these vulnerable community members.

This particular crime spree began when a nursing home aide had her purse stolen. She had noticed that her purse was gone when she was in the parking lot of the nursing home where she worked. The 25-year old woman reported the theft to local authorities. It was a stressful situation for the aide because she lost a wide range of documents, from her driver’s license and checkbook to her Social Security card and an ID card that identified her as a certified nurse’s aide.

The thief happened to be a former CNA herself, though because of identity theft crimes and two prior prison sentences, she couldn’t get a job as a CNA in the state if a background check was performed under her name. Unfortunately, the thief used the stolen ID to get jobs in nursing homes and various home health companies. Unfortunately, once employed at these agencies she had no intention of providing necessary care and earning an honest wage. Instead, she used the position to steal even more documents, engaging in senior financial exploitation, and then moving on to find more victims.

Our Illinois nursing home lawyers were shocked to learn about the complexity of the scheme, which ultimately lasted more than two years. In one case, a resident at a senior care facility had a $20,000 ring stolen—it has yet to be recovered. Many other residents at that same facility reported thefts. So far, authorities are still unsure all of the places that the criminal worked or who all was hurt by the misconduct.

Some have questioned the hiring practice of some of the nursing homes when criticizing how the scheme could have gone on for two years. For example, the identity thief never had a driver’s license in the name of the aide’s documents that she initially stole. Instead, she only had a piece of paper that said that she had a paid a driver’s license renewal. Investigators explain that a smart hiring official should have been alarmed by this situation and investigated further, instead of hiring the woman. Much theft and exploitation might have been prevented had the hiring officials at these senior care facilities conducted due diligence to ensure those they hired were not a threat to the seniors.

Another part of the problem is that the state, Texas, does not have all that accurate records about nursing aides. They are less regulated than actual nurses. Previous proposed laws sought to close the loophole but all of them were defeated. Changes may be made in light of this most recent crime spree, however.

See Our Related Blog Posts:

Editorial Lambasts Washington for Ignoring Elder Abuse

Elder Financial Abuse Reaching Crisis Levels, Say Researchers

One of the most pressing problems connected to nursing home neglect and abuse is overzealous antipsychotic drug use. The issue has been on the national radar for the last year or two, but that has not actually translated into concrete changes at certain facilities. Each Illinois nursing home neglect attorney at our firm knows that many seniors continue to receive these medications when it is harmful to them and when it has an overall negative effect on their quality of life.

Boston.com recently published an extended story that re-iterates the dangers of this unmitigated prescription use in nursing homes. The story of one woman is profiled. The senior lived at home until she was 80-years old. However, she developed Alzheimer’s that began to get worse. At times she would call her adult daughter in the middle of the night, not remembering where she was. For her own safety and well-being, her daughter realized that her mother needed the close care and observation that she could only get in a nursing home.

The daughter conducted a detailed search for the right facility. She eventually chose a facility close to her own home that had a special Alzheimer’s care unit. Unfortunately, what the daughter didn’t know was that the nursing home commonly prescribed powerful antipsychotic drugs to resident—even those with cognitive mental conditions like her mother who faced serious risks when receiving the medication.

The senior in this case soon began receiving the medication, even though she was not diagnosed for anything that the drug is recommended to treat. The side effects were brutal. The daughter became alarmed as her mother began having a growing number of falls and even seizures. Each Chicago nursing home attorney at our firm knows that many local residents have similarly had loved ones experience this situation.

It cannot be reiterated enough that the U.S. Food and Drug Administration has specifically issued a “black box” warning that states that patients with dementia who take these antipsychotic drugs have an increased risk of death. This “black box” warning is the most serious level of alert that the agency can issue. All local residents who have loved one with dementia should be explicit in ensuring that their loved ones do not receive these dangerous medications unnecessarily.

As nursing home neglect lawyers we know that it is particularly important for outside observers to hold nursing homes accountable on this issues, because, in general, these facilities have wide latitude to dispense these medications.

According to the Centers for Medicare & Medicaid Services, physicians at these homes are able to prescribe drugs even for purposes not approved by the FDA. However, that doesn’t mean that they should. In fact, the agencies still explain that in the majority of cases it is inappropriate for patients with degenerative cognitive conditions to receive antipsychotics. The drugs pose risks of lethal infection, cardiovascular problems, and the medication may lead to blood pressure dropping, blurred vision, dizziness, urinary issues, and abnormal heart rhythms. For these reasons, it is incredibly important for all those in charge of these decisions not to provide blanket prescriptions but to ensure medications are only given to residents when they do not pose serious side effects and are absolutely necessary.

See Our Related Blog Posts:

Medication Errors Pose Particularly Serious Risk to Seniors

Steve Levin Interviewed For Story on Antipsychotic Drug Use in Nursing Homes

Many senior care advocates suggest that the best way to combat nursing home neglect and abuse is simply to ensure that fewer seniors actually live in these institutional-like settings. After all, virtually all seniors would prefer to age in place anyway. Improving access to at-home care options is therefore an incredibly attractive option because it both eliminates the risk of nursing home mistreatment and actually enhances the overall well-being of the individual. Our Chicago nursing home neglect attorneys support this concept, and hope that more local residents have plans in place so that medical and financial resources will be available to allow at-home care.

However, it is important not to assume that seniors are automatically safe from mistreatment if they live at home. For one thing, caregivers who provide support to seniors in their own home must be held to the same level of accountable at nursing home aides. Tasks need to be completely in proper ways, and seniors need to be able to rely on the consistent support of those charged with helping them get along at home. In addition, there are actually some risks that might be even more prevalent when seniors are at home. This is perhaps most clear in the case of senior financial exploitation.

Seniors who live at home are more likely to face demands from those seeking to take advantage of them for financial gain. A recent post at the New Old Age Blog of the New York Times discussed this issue and the concerns of many that the actual scope of the problem is little understood.

The story explains how even professional fraud investigators remain unsure about the total number of seniors who fall victim to financial scams each year. That is because there is no reliable method of getting accurate figures. In general, the best estimates right now rely heavily on phone surveys, asking seniors if they’ve even lost money in one of these ways. This method is better than relying on official records from law enforcement, because it is well known that the vast majority of this abuse is never reported.

However, phone surveys themselves are not all that reliable. In fact, a National Victim Profiling study commissioned by the AARP explicitly sought to test the accuracy of these surveys. To do so, over 750 seniors were called who had actually reported being scammed to law enforcement officials. If the surveys were accurate then 100% of those called would have answered yes to questions of being scammed—after all, they had actually reported such abuse to the police. Yet, surprisingly, only 40% of seniors actually admitted to falling victim to a scam. That represents a large 60% error rate.

In other words, the study makes clear that most assessments about the total number of seniors falling victim to these scams probably drastically underestimate the scope of the actual problem.

Each Chicago nursing home neglect lawyers appreciate that this underreporting of problems is echoed in mistreatment within nursing homes. For a variety of reasons, including confusion, shame, and embarrassment, seniors often do not reported being mistreated. That makes it crucial for outside observers to keep a close eye on these individuals to ensure accountability is had when they are taken advantage of.

See Our Related Blog Posts:

Editorial Lambasts Washington for Ignoring Elder Abuse

Elder Financial Abuse Reaching Crisis Levels, Say Researchers

A recent Huffington Post story discussed the sad reality that most state and federal nursing home oversight programs do not do nearly enough to ensure care at these facilities remains at a reasonable level at all times. The article author expressed dismay that chronic nursing home neglect continues at facilities across the country even though efforts to improve care have been underway for decades. Each Chicago nursing home abuse lawyer at our firm appreciates that this state of affairs is yet another reason why it is crucial to have a strong civil justice system to ensure accountability.

As far back as 1987 the landmark Omnibus Budget Reconciliation Act signed by President Reagan for the first time sought to craft federal standards for nursing homes. This was the first explicitly set of federal requirements since Medicare and Medicaid were crafted to pay for long-term care services for seniors at nursing homes. The clear purpose of the standards was to ensure that the facilities which were receiving billions of dollars in state and federal funds were actually held accountable to ensure that residents “could attain and maintain the highest physical, mental, and psycho-social wellbeing.”

Yet, evidence suggests quite clearly that even a quarter century later those goals remain far from attained. There is a still a lot of work to do. Many argue that one of the main issues is the lack of proper oversight by state regulators. Facilities are often not pressed to actually make systematic changes which would improve the care for residents. This is perhaps most evident in staffing levels. For example, in Illinois new laws passed recently increased the level of nursing care that must be provided to each resident each day. Yet, those laws continue to be flaunted with many facilities not abiding by the requirement. Most facilities have faced no repercussions for violating the law, however, because the state accountability systems in place are woefully inadequate.

State regulatory bodies often do not have resources to provide the degree of oversight needed to actually meet their regulatory goals. There are too many facilities and too few agency staff members to ensure the job is done as thoroughly as necessary. Unfortunately, our Illinois nursing home neglect lawyers knowing that changes in staffing levels at state regulatory agencies are unlikely. Like many other states across the country, Illinois faces very tight budgetary challenges. Drastic proposals are being offered to cut major portions of state operations (including to Medicaid programs). In this environment, it is highly unlikely that more resources will be focused on public nursing home oversight.

Instead, the obligation of holding these facilities accountable for their care will continue to fall disproportionately to private citizens. Family members must remain on the look-out for all signs of mistreatment. When identified, the mistreatment must be brought to the attention of facility administrators as soon as possible. In addition, at times it may be appropriate for families to seek out the advice of an Illinois nursing home attorney to see what legal options might be available to force to facility to prevent future harms.

See Our Related Blog Posts:

Steep Budget Cut Seen for Home Health Services for Seniors

Nursing Home Advocates Stand Against the “Balanced Budget” Amendment

Our Illinois nursing home neglect lawyers have been forcefully fighting against federal tort reform legislation that would take away rights from medical malpractice victims as well as those who receive inadequate care in nursing homes. The dangers of the measure are clearly visible on its face. But if any more support is needed, one need only look at specific states where similar measures have passed.

Take Texas.

Fox News Dallas-Fort Worth recently profiled various families in Texas who have been adversely affected by the legislation. One of those families had a loved one who died as a result of nursing home neglect. Three years ago the couple was at the bedside of their loved one (the woman’s father) when a nurse forced medication in the senior’s feeding tube using a syringe. The family claims that the liquid went into the man’s lungs. They explain that they saw him kicking his arms and legs struggling after receiving the medication because he was essentially drowning. They report with anguish that they literally saw the life leave him. He passed away shortly after the receiving the medication.

An investigation into the allegations of nursing home neglect conducted by the state’s Board of Nursing found that the nurse committed a string of errors. In addition, they found that the facility administrators directed the nurse to wrongly alter her medical records.

The family has wanted to file suit to hold the facility accountable for the conduct, however the limits on the non-economic damages make it economically unfeasible to pursue the case. Even before the law passed, there was always high legal cost associated with pursuing these cases. Conducting investigations, taking depositions, getting legal experts, and other requirements are expensive and must be bore by the plaintiff. Yet, when possible damage awards are decimated by arbitrary laws, those costs essentially make it impossible to feasibly pursue certain cases, like this one. Our Chicago nursing home abuse lawyers know that the result is that vast amounts of mistreatment that otherwise would lead to accountability go without any punishment.

The costs of this legislation are very significant for thousands of families.

Yet, these measures continue to be pursued in large part because of misguided assumptions about potential benefit of the laws. Members of the community are convinced to support these measures by claims of health care costs savings by essentially immunizing some medical providers from real liability. The evidence clearly demonstrates that those supposed cost saving are illusory.

Records from Texas bear this out. For example, health care insurance costs for residents have actually increased faster than the national average in the state since the enactment of tort reform laws. This is the exact opposite of claims that insurance rates will go down when the legislation passes. Instead, the real winners of the tort reform laws have been insurance companies who have been able to cut their payouts significantly and maximize their profits considerably. Similarly, many large health industry companies have been able to face less accountability for their errors without having to lower the actual costs of medical care.

See Our Related Blog Posts:

Impartial Organizers Lining Up Against House Resolution 5

H.R. 5 Medical Malpractice Proposals Shot Down By Committee Testimony

According to the NJ News, the family of a woman who claims she was victimized by intentional nursing home abuse has released a video showing some of the abuse. The senior in the case was paralyzed and lived at the long-term care facility until her death over a year ago. The victim’s family was shocked when they learned of the abuse that the woman was forced to endure in her last months.

The story on the situation suggests that at least one person has been charged in the incident. However, the family members of the victim explain that video shows that more employees mistreated the woman. The family in this case first installed the “granny cam” when they noticed suspicious bruises on their loved one. The explained that they complained to the nursing home officials but nothing was done. In addition, the family had called state officials in an attempt to get accountability; however that also did not result in timely action. Each Chicago nursing home abuse lawyer at our firm knows that local families have discovered mistreatment in the same ways, after uncovering bizarre wounds on their relative during visits.

Like many local seniors, the woman in this case first entered the long-term care facility after suffering a stroke seven years earlier. As the years wore on the family became more and more suspicious about the treatment that she was receiving. The family started using the video camera about a month before the senior actually passed away. The video shows egregious treatment.

The video allegedly shows at least one nursing home aide physically and emotionally abusing the 87-year old resident. At one point the recording reveals a worker saying “Lady, why don’t you die.” In addition, the tape also shows a caregiver striking the senior for no reason and removing her oxygen mask without authorization.

The one aide implicated so far was fired immediately after she was arrested for the elder abuse. Right now she has been charged with abandonment, assault, and neglect of the elderly. It is unclear if any other aides are under suspicion or may face charges down the road. The family explained that they were shocked when they saw the tape, because the abusive aide had always seemed friendly. They never suspected she would be capable of something like this.

The family in this case—the daughter and grandson of the woman—have filed a nursing home neglect lawsuit against the facility for the abusive care received by their loved one. The camera footage will obviously play an important part in the suit. Our Illinois nursing home neglect attorneys have worked on cases where video recordings helped show what actually happened. No matter what, it is absolutely essential for those who suspect mistreatment at a local home to take action. Complaints and suspicions should be directed to facility officials. State officials should be notified. Legal professionals should also be sought out if necessary to ensure legal rights are protected and full accountability is demanded. That is the only way to ensure that the mistreatment stopped and other residents are protected.

See Our Related Blog Posts:

Chicago Nursing Home Lawyer Encourages Promotion of Elderly Quality of Life

Surveillance Cameras Important in Fight Against Elder Abuse

Nursing home abuse and nursing home neglect are often used interchangeably. However, each generally refers to injury caused by others with different degrees of culpability. Abuse is usually intentional. This involves care workers who intentionally physically, sexually, or financially harm a senior. In these situations the care workers know exactly what they are doing and consciously decide to harm the elder in their care. This is distinct from nursing home neglect which usually does not refer to intentional harm but inadequate care that ultimately leads to harm. Care workers in these situations do not necessarily know that a resident will be harmed by their actions (or lack of actions), but the harm occurs all the same.

Each Chicago nursing home lawyer at our firm understands that negligent conduct is a more far-reaching problem, because it likely occurs in big and small ways in nearly all local facilities. This is because one of the main reasons for neglect is the issue of understaffing. In an effort to maximize profits, many long-term care facilities do not have enough direct care workers in the facility at any given time. This means that residents are not necessarily getting the close care that they need. Pressure sores, malnutrition, dehydration, falls, resident-on-resident attacks, and other harms often befall residents in those situations.

Money is a root problem in so many cases of Illinois nursing home neglect. That means that changing to funding schemes that affect these homes may trickle down and affect that actual care at the home. For example, proposed cuts to the Illinois Medicaid system are raising the concerns of many local senior care advocates for that very reason. Most seniors in long-term care centers rely on Medicaid support to help pay for the high-cost of these skilled nursing facilities.

A recent letter published in the Chicago Tribune by a representative for the Center for Long-Term Care reform touched on the potential consequences of the cuts. The letter argues that while cuts to the Medicaid are motivated by a need for cost savings, the actual consequences of the actions may result in even more expensive care. The letter pointed to the consequences of similar actions in Michigan. An article on the Michigan example found that Medicaid cuts “were associated with increases in adverse outcomes; ER visits, hospitalization, and permanent [nursing facility] placement.’

In other words, cuts to the program hit those with disabilities and seniors the hardest. The health of these community members suffered, ultimately resulting in more expensive care being needed.

Each Illinois nursing home neglect lawyer at our firm appreciates that one of the big concerns about the proposed cuts are changes to the eligibility rules for Medicaid community-living waivers. Residents who need help may no longer get it. This may very well have serious consequences with medical needs being untreated until they develop into much more serious (and costly) problems.

According to the Tribune letter, there are also serious legal implications by these cuts. Following a landmark U.S. Supreme Court case, the state is required to provide community-living options for certain individuals with disabilities. Changes to the Medicaid system may eliminate that option, perhaps sparking yet another lawsuit.

See Our Related Blog Posts:

Medicaid Fraud Targeting Vulnerable Chicago Senior Citizens

For-Profit Nursing Homes May Be Overcharging Medicare

Yesterday we discussed the demographics inside nursing homes and the fact that many local elderly residents would prefer to age in place rather than move into a long-term care facility. Each Chicago nursing home neglect lawyer appreciates that fact that few seniors prefer to be in these facilities anyway, which is what makes their mistreatment at the home that much worse.

As the total number of seniors grows and resources dwindle, it will become increasingly important for local residents to have access to alternative forms of long-term care. Considering the current amount of Illinois nursing home neglect, without huge changes in the running of these facilities there will likely be much more neglect when more and more seniors enter these homes in need of long-term care. Obviously one way to fix the problem is to improve the quality of care at all of these facilities. That is a worthy goal that must always be pursued. However, in addition, it is important to also work on ways to keep seniors from being forced to move into these homes in the first place.

Fortunately, there are a growing number of businesses that cater to this need and some changes in the works with programs like Medicaid which might allow more seniors to age in place who otherwise might not be given the chance. However, it is important not to assume that proper care is guaranteed to be provided just because one receives support at home instead of a nursing home. Elder neglect, mistreatment, and exploitation can occur at one’s own home as well. In fact, when perpetrated by friends and family members, this sort of mistreatment may actually be even more common than abuse in long-term care facilities.

For this reason, it is crucial to ensure that at-home care agencies be researched so that families understand the standards that are applied to all workers who will be involved in providing the services.

Unfortunately, not all at-home aides have pure motives. For example, just this weekend the Chicago Tribune reported on an at-home care worker who was charged with senior financial exploitation after stealing from an elderly resident for whom she was supposed to be providing at-home care. According to the story the employee worked for Help and Home, Inc. and was hired by an 83-year old Englewood resident to clean her home. However, according to the charges filed, the woman used the opportunity to take the senior’s checkbook. She made out a range of checks to herself (a total of eleven) while forging the senior’s name. She then cashed the checks, trying to take a total of $1,400 from the unsuspecting senior. The theft apparently took place over a period of about two months at the end of last year.

As with choosing a nursing home, our Chicago senior care lawyers remind all local seniors and their families to ensure that due diligence is part of all senior care choices—from picking a nursing home to choosing at at-home aide for cleaning chores. It is sad that so many local residents view vulnerable seniors as a way to enrich themselves. Yet, it is better to do a bit more research than necessary at the outset to ensure that seniors feel comfortable in not being taken advantage of in any way while allowing another into their home to provide the support that they need.

See Our Related Blog Posts:

Steep Budget Cut Seen for Home Health Services for Seniors

Nursing Home Advocates Stand Against the “Balanced Budget” Amendment