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The story of the death of 8 residents at the Rehabilitation Center at Hollywood Hills in the wake of Hurricane Irma has saddened our country. How could a nursing home lose power and leave residents to suffer in over 90 degree temperatures with just a few portable air conditioning units? Before news broke that the facility had a laundry list of violations and lawsuits, Levin & Perconti’s own Steven Levin was interviewed on national news channel HLN about the magnitude of the situation (watch his interview here). Steven Levin told HLN’s Carol Costello “Where was the staff? How could they not be on notice that they would have a power failure in this type of situation? And what, if any, precautions had they made in the event of a power failure. Forget the power failure. They knew there were going to be extremely high temperatures in this area at this time.”

Now, sadness is giving way to anger as news outlets have reported that the nursing home has a long history of violations, lawsuits accusing the facility of abuse and neglect, as well as prior citations for a faulty generator. The lack of a backup plan for a power outage at the nursing home speaks to the facility’s utter disregard for the health and safety of their residents.

Florida Senator Gary Farmer told ABC 10 that the state needs to strengthen the laws for nursing homes. According to Farmer, “We’ve insulated these nursing homes through deregulation in this state, and that’s how things like this can happen.” Stories of nursing home abuse and neglect and health and safety citations frequently go unknown by the public for many reasons. Nursing homes can be quick to settle lawsuits to keep them out of the public eye, and citations are only found by residents, their loved ones, and the public when they know exactly where to search. Citations can be cast aside by remedying the problem and paying a fine to the state Department of Health or the Centers for Medicare and Medicaid Services (CMS). It was only after the 8 deaths that the state, under Governor Rick Scott’s order, shut down the nursing home.

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PHI National, an organization focused on the direct care workforce, released its annual report on the current landscape of the work place for direct care employees such as nursing assistants. Before providing their most recent findings, PHI National opens with this statement: “The poor quality of nursing assistant jobs makes it difficult for nursing homes to attract and retain enough workers to meet demand.” Why are nursing assistant jobs in nursing homes considered so difficult to fill and why is it so hard to keep good employees? The biggest factors go hand in hand. Nursing assistant wages in nursing homes are notoriously low. PHI National reveals that the national average is $11.87 an hour. The work of taking care of residents with a myriad of complex mental and physical diagnoses is both physically and emotionally demanding, so much so that the average nursing assistant is 3.5 times more likely to be injured on the job than other American workers. When you pile endless responsibilities onto the plate of someone making less than $12 an hour, it should come as no surprise that you have a profession filled with overwhelmed, overworked, and emotionally drained employees. This is when mistakes are made and accidents happen. This is when the elderly are neglected, abused, left alone for hours, left in bathtubs overnight, fall while trying to use the bathroom, wander without being stopped, are giving the wrong medication, and develop pressure sores.

Chronic Understaffing Causing Employee Burnout and Resident Abuse and Neglect

Before we address the findings from PHI National’s recent report, we must address the driving force behind the trend in high patient to nursing assistant ratios. To put it bluntly, the cause is greed. The majority of nursing homes in the U.S. are privately owned, many by equity groups who view them as investments. The tragic heat-related deaths we recently witnessed at the Hollywood, FL nursing home after Hurricane Irma finally showed the world that money and profits are valued more than the health and safety of the elderly. In fact, it was only after the death of 8 residents from the Rehabilitation Center at Hollywood Hills that several other south Florida nursing homes without air conditioning began moving residents.

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With an ongoing criminal investigation and at least 2 wrongful death lawsuits underway against Rehabilitation Center at Hollywood Hills, information is beginning to come to light that shows the nursing home and its owner purposely hid a power outage that left residents without air conditioning, causing 8 deaths and leaving many others hospitalized for respiratory distress and dehydration. As news broke of the tragedy on Wednesday, Levin and Perconti founding partner Steven Levin told HLN’s Carol Costello that a Florida nursing home who knew to expect high temperatures at this time of year and left their residents “vulnerable to something as simple as a power failure or an air conditioning breakdown is inexplicable. I can’t imagine what defense or excuse they could offer for a tragedy of this proportion.”

No Backup Plan

Initial reports stated that 5 residents were found dead, but as the day progressed, 8 residents were declared dead and nearly 150 were evacuated, with at least 12 in critical condition at Hollywood, Florida-area hospitals. The story became even more unbelievable when reporters quickly pointed out that less than 50 feet away was unaffiliated Regional Memorial Hospital. As the first residents began arriving there, the hospital’s staff quickly realized what had happened and volunteered to take part in caring for and transferring patients from the facility. Hollywood police and Florida Governor Rick Scott are demanding answers. According to a statement by Governor Scott’s office, “At no time did the facility report that conditions had become dangerous or that the health and safety of their patients was at risk. In fact, on Monday, September 11, Department of Health staff advised this facility to call 911 if they had any reason to believe that their patients were not safe.” The first indication of distress didn’t come until an anonymous 911 call was made around 3 a.m. on Wednesday, September 13, two days after the Florida Department of Health was told nothing was wrong.

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This morning, Levin & Perconti’s own Steven Levin, one of the country’s first nursing home abuse and neglect attorneys, was interviewed about the tragic deaths of 8 nursing home residents on HLN’s Across America with Carol Costello. Rehabilitation Center at Hollywood Hills, a nursing home in Hollywood, Florida is currently under criminal investigation for the deaths of 8 residents who were found early this morning after spending the days since Hurricane Irma in 90+ degree temperatures during a power outage that left them without air conditioning.

In a press conference later today, Broward County authorities said that 6 residents have been confirmed dead and 115 were evacuated and sent to other facilities, 12 of whom are in critical condition at area hospitals. As the day progressed, the total was reported to have grown to 8 confirmed victims.

David Neal, a reporter for the Miami Herald, told HLN that portable air conditioners and battery-operated fans were being used, but that anyone who lives in hurricane-prone Florida knows that they cannot beat temperatures as high as they’re currently facing.

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At the request of two residents, Hurricane Harvey evacuees from Lake Arthur Place Nursing and Rehabilitation in Port Arthur, Texas, have been granted a temporary restraining order against the facility and its parent company, Senior Care Centers. A KFDM/Fox 4 live report on August 30 showed Lake Arthur Place residents in wheelchairs with their feet and lower legs submerged in water. An employee told reporter James Ware that 70 people ‘needed to get out of here.’ She said many were bedridden, food was scarce, and that they needed help dispensing medication and giving care.

The petitioners, Jo LeBoeuf and Harding Guilbeaux, were eventually safely evacuated, but not before fearing for their lives. Jo LeBoeuf’s daughter, Tonya Petix, described arriving to the facility to check on her mother. Worried for her mother’s health and safety, she took a boat to Lake Arthur Place where she found herself in water up to her chest. She made her way inside where water was already flooding the facility and witnessed patients lying around with hands dangling off their beds into the cold, smelly water.

Petix says her mother cried with relief when she saw her. Jo LeBoeuf, who suffers from dementia, Parkinson’s Disease, COPD, and high blood pressure, was left sitting in water for 19 hours with very little to eat or drink. Tonya Petix also said that when she pressed Lake Arthur Place employees about the plan for evacuation, they referred her to their parent company and said they were relying on the National Guard. She also says that the local police department arrived with a group of volunteers to help evacuate residents but that the nursing home declined their help.

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On September 5th, Ryan Gruenenfelder, Manager of Advocacy and Outreach for the American Association of Retired Persons (AARP) Illinois, appeared on Chicago Tonight with Phil Ponce to discuss the organization’s opposition to pre-dispute arbitration clauses in nursing home contracts. Gruenenfelder said that the Centers for Medicare and Medicaid Services’ (CMS) sudden support of arbitration clauses for nursing homes is detrimental to the 1.4 residents who currently reside in America’s nursing homes.

‘AARP Wholeheartedly Disagrees’

Gruenenfelder discusses how CMS and nursing home arbitration advocates have referred to claims of abuse and neglect as ‘frivolous lawsuits.’ He cites the recent audit from the Office of the Inspector General of the Department of Health and Human Services that found that Illinois has the highest rate of unreported nursing home abuse and neglect of any state. Gruenenfelder fears that most, if not all, nursing homes will ‘take advantage’ of CMS’s endorsement of arbitration clauses, leaving nursing home residents and their loved ones without the opportunity to choose a facility that does not require them to sign away their constitutional right to sue.

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The National Adult Maltreatment Reporting System (NAMRS), the reporting system for adult protective services groups, has released findings from its first ever study on adult maltreatment. The data was gathered from voluntary submissions from adult protective agencies across the country for fiscal year 2016. Of 56 states and territories, 54 contributed data. The data recently released is just a fraction of the multi-part report and more data is expected to be released in coming months.

Adult Physical Abuse and Neglect the Top Two Offenses

Of the 53 states that reported, 100% reported neglect, while 96.2% reported physical abuse. Sexual abuse was reported in 88.7%. The majority of cases of abuse and neglect were called into a state hotline or call in number dedicated to investigating reports of elder maltreatment. In Illinois, the Department on Aging operates a 24-hour confidential Elder Abuse hotline (1-866-800-1409), where anyone who suspects maltreatment of an elderly person in any setting is encouraged to call and report evidence or suspicions of abuse.

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A recent study by the RAND Center for the Study of Aging found that over half of Americans will need to turn to nursing home care in the future. With high numbers of baby boomers, higher rates of dementia-related conditions, and shorter hospital stays, experts predict that most of us will require some sort of skilled nursing care either at home or within a facility. The news is difficult for those of us who will face the decision of how to care for ourselves or loved ones as we age, but also for taxpayers, as the demand placed on Medicare and Medicaid will be enormous.

The study predicts that most will have short nursing home visits, which researchers anticipate will be mostly covered out of pocket. The problem lies in long term care that they expect 5% of the adult population to require. The average out-of-pocket costs for a long term stay at a nursing home averages $47,000. This does not include the portion of services covered by private insurance or Medicare and Medicaid. The study’s lead researcher, Michael Hurd, says that Medicaid seems to be the best option for those facing long term nursing home care, a scenario he describes as “the best of a not-very-good situation.”

Dr. David Katz, president of the American College of Lifestyle Medicine, told Medline Plus that a healthy lifestyle is the best bet to cut down the risk of chronic diseases that require nursing home care.

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Another lawsuit has been filed against Missouri-based Midwest Geriatric Management Healthcare (MGM), the same nursing home group that was recently sued after a woman suffering from Alzheimer’s was left to die overnight in a whirlpool tub.

In the most recent case against MGM, 72 year old Robert Baehr was given medication intended for a fellow resident of Bent-Wood Nursing and Rehab Center in Florissant, Missouri. A Centers for Medicare and Medicaid Services investigation revealed that a nurse at the facility switched the records of Mr. Baehr and another resident who was admitted on the same day. As a result, Robert Baehr received antibiotics and diabetes medications that he did not need. It was Glyburide, a medication intended to lower blood sugar in diabetics, that ultimately caused his death. The medication forced Robert Baehr’s blood sugar level so low that he was found unresponsive twice in two days. In the first instance, he was able to be quickly revived, but the next day he had to be transferred to a local hospital where he never recovered.

Robert Baehr, a husband of 44 years, a father and grandfather, had planned to complete rehabilitation at Bent-Wood Nursing and Rehab and to be back home with his loved ones in time for the holidays. Sadly, the nursing home’s inability to keep track of their residents’ charts and medication lists caused his death.

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Pennsylvania’s Attorney General is arguing against his state’s dismissal of a lawsuit that attempted to fight Golden LivingCenters’ deceptive advertising. Attorney General Josh Shapiro says that the chain purposely understaffs its facilities in order to ensure higher profits, a practice that makes it nearly impossible for them to meet advertising claims that promise best in class care. Among their claims? “Best in the world” and “Strongest known to man.”

The court dismissed the suit saying that the chain, owned by Golden Gate National Senior Care LLC, was partaking in typical ‘puffery’ involved in many advertising campaigns. Shapiro, however, is afraid that allowing the chain to get away with deceptive advertising is opening the door for other major nursing home chains, industries, and corporations to follow in their footsteps. He is currently working on an appeal against the state court’s dismissal.

Understaffing: The New Normal