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In November, a video was released to the public that showed 89 year old WWII Veteran James ‘Jack’ Dempsey’s cries for help go ignored by 3 members of Northeast Atlanta Health and Rehabilitation nursing staff. The video shows Jack Dempsey paging a nurse at 4:34 a.m. on February 27, 2014 while struggling to breathe and gasping ‘help me’ multiple times. A nurse finally responds after 8 minutes, ignoring his labored breathing and casually checking tubes and turning off his nurse call light before exiting the room.  After that, the video shows the nurse supervisor and a CNA coming to check on him and laughing while attempting to start oxygen. He appears to be lifeless and the nurses show no sense of urgency typically associated with a code situation. Mr. Jack Dempsey, a man who managed to survive war and live to the age of 89, died that night, alone and afraid in an Atlanta nursing home. The camera was placed in his room by his son, who said that his father was scared of living in a nursing home, and the camera was an attempt to alleviate his fears.

This week, two nurses and one CNA were indicted by an Atlanta grand jury on an array of charges, including murder. All 3 were charged with concealing a death. Loyce Picquet Agyeman, a licensed nurse, has been charged with murder, neglect to an elder person and concealing a death. Wanda Nuckles, a licensed nurse and nurse supervisor, has bee charged with depriving an elder person of essential services and concealing a death. CNA Mable Turman has been charged with neglect to an elder person and concealing a death.

Thanks to News Station, Video Made Public, Police Become Involved

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Illinois has long been called out for having some of the country’s highest eviction rates for the vulnerable residents of long-term care facilities, with some local homes nearly doubling the amount of involuntary discharges over the last year. Most disturbing of all is that these homes wrongfully evict residents who are suffering debilitating and sensitive diseases like dementia and Alzheimer’s. Many residents will be left abruptly at a family member’s doorstep, outside homeless shelters, and in hospital waiting rooms, creating a complete disruption in the care they need to continue thriving.

Again, this year, patient advocate groups, lawmakers, and families have plans to push back since involuntary discharges remain the top complaint filed against Illinois nursing homes. In fact, Illinois’ long-term care ombudsman’s office has reported there were 911 such complaints received by its office in the fiscal year ending June 30, 2017. Legislation introduced in the General Assembly in 2017 under House Bill 3392 and Senate Bill 1624, would have given long-term care ombudsmen more authority to advocate on behalf of individuals and possibly lessen the amount of involuntary discharges. The proposed bills didn’t receive a full vote in the House or Senate.

Medicaid Coverage Creates Timely Opportunity for Homes to Evict

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LP-long-term-care-ratings-blog-300x207AARP has reviewed all 50 states and the District of Columbia to highlight progress and pace of change, as well as identify needs for the improvements of long-term care services and support systems for older adults, people with physical disabilities (those who cannot perform daily activities on their own because of physical, cognitive, or chronic health conditions), and family caregivers. The scorecard, Picking Up The Pace of Change, shows that although many states have made some advancements in care scenarios, most systems aren’t changing fast enough to support the growing trends the baby boomer generation will demand within the next decade.

The scorecard ranks states based on their performance in these five main categories:

  • Affordability and access
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With national opioid addiction rates at an all-time high, civilians, lawmakers, and loved ones of victims are all calling for stricter controls on the extremely addictive medications. The ability to obtain opioids such as fentanyl, morphine, oxycodone, and other drugs is surprisingly easy and many who find themselves hooked on the drugs had their addiction begin with a doctor-prescribed prescription for some sort of pain management. If drug companies are being asked to reevaluate marketing tactics and distribution methods of opioids, then prescribers themselves should also be forced to closely examine how frequently and to whom they are prescribing pain killers. Doctors in hospitals, clinics, private practices, and nursing homes, as well as dentists, oral surgeons and anyone else with prescribing ability should all be held to the same standard. The pharmacies that dispense these drugs, whether free-standing (independent stores or local, regional, or national chains) or in-house (within hospitals), need to be tracking prescriptions vigilantly, but also monitoring how they are dispensed to the actual patient and how they are stored within the facility.

Last April, Levin & Perconti founding partner Steven Levin was interviewed by ABC 7 Chicago about an incident that sounds like a plot from a tv mystery. An anonymous person mailed a box of fentanyl patches to ABC 7 I-Team investigative reporter Chuck Goudie with a note that read “these lay around like candy.” The package was stamped Oak Park, Illinois, but the box of fentanyl patches was prescribed to a patient at Westchester Health & Rehabilitation that died two weeks after the prescription fill date. The pharmacy that supplies the nursing home with its prescription drugs fills ‘drug carts’ that are kept on site at Westchester Health & Rehab, and asks that the nursing home use the cart to store medications and lock them up when not in use.

While the sender of the package is unknown, it is clear that they wanted to let someone with a voice know that the ease of getting their hands on opioids at the nursing home was quite easy. Nursing homes with lax standards for keeping track of opioid inventory may just be ideal grounds for a thief to swindle these coveted prescription painkillers. In fact, during his interview, Steve Levin told ABC 7 that properly securing prescription drugs in nursing homes has been a long-standing problem, despite strict federal and state laws that dictate how they are prescribed, dispensed, and stored.

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A study led by Washington state nonprofit group, Washington Health Alliance, recently concluded that in just one year more than 600,000 patients received medical treatment they didn’t need. Examples of treatment overuse included annual cervical cancer testing, lab work before elective procedures, or annual electrocardiograms and other heart tests for people who don’t need them.

To identify the issue of medical overuse or overtreatment, the group collected information from its All-Payer Claims Database for approximately 2.4 million commercially insured lives in the state of Washington using a tool called the Health Waste Calculator. The calculator is a part of the Milliman MedInsight suite of analytic tools and software designed to help identify and quantify overused health care services. The software was designed after health care spending estimates indicated that overuse could account for as much as one-third of total health care spending in the United States and contributes to the expensive rise in the cost of healthcare for all Americans. From the initial review, the group was then able to examine the cases of 1.3 million patients in Washington state who received one of 47 tests or services that medical experts flag as overused or unnecessary.

Study highlights include:

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A study of skilled nursing facility ratings combined with individual nursing home staff interviews found that long-term care facilities who improved their overall quality rating by just one star saw a jump in admissions.  The study, recently published in the American Journal of Health Economics and led by Assistant Professor Marcelo Coca Perraillon of the Colorado School of Public Health, found that the relationship between an admissions increase and the acquisition of a star was stronger for nursing homes that were already rated 3 or 4 stars out of the possible 5 according to the Centers for Medicare and Medicaid Services’ (CMS) rating system. Specifically, nursing homes who went from 3 stars to 4 stars saw a 4.7% admissions gain. Nursing homes who went from 4 stars to 5 stars saw a 2.1% admissions gain. The study team cautions that if nursing homes are aware of the correlation between gaining a star from CMS and an admissions increase, that this knowledge likely encourages middle-to-upper-ranked facilities to beef up the services and quality of care they provide in order to gain a better rating.

Through interviews with nursing homes staff, Professor Perraillon and his researchers found that nursing homes who were rated just one star seemed to care the least about boosting ratings, which Professor Perraillon theorizes is likely because they can get away with little to no improvement and still draw residents. Their analysis of star ratings revealed these one star facilities were more often than not in low income areas and had a higher level of Medicaid residents than private pay and Medicare residents.

Among the other conclusions made by Professor Perraillon and his team through their research:

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Trust is at the center of many resident/nursing home relationships. This trust can make it hard for residents and their families to believe nursing home staff would abuse their power. The sad truth is: nursing home abuse towards residents can show up in many different ways, including physical, emotional, mental, or through financial wrongdoings, often leaving families worrisome and anxious about the possibility of a loved one being injured, ignored, left without proper medical care, or taken advantage of.

The Associated Press recently highlighted the issue of elder financial abuse in a January 29, 2018 story. The news organization reported that a former nursing home supervisor in West Virginia had been sentenced to one year and one month in federal prison for embezzlement, after admitting to diverting residents’ payment checks into a bank account dedicated for nursing home expenses. Once the deposit was made, the employee would write checks to herself and forge signatures to make the checks usable. A federal court in Charleston found the thirty-five-year-old woman guilty of mail fraud and ordered her to pay more than $81,000 in restitution.

Examples of Elder Financial Abuse

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Lead health officials seem to agree that this season’s flu is extremely dangerous and contagious, making aging care facilities, where people share spaces and depend on others for hygiene care, a prime location for the virus to spread. In New Zealand, seven elderly people died at a nursing home when a large-scale influenza outbreak swept through the facility and targeted 123 residents.

In addition, around 3,500 people die of the flu each year across the U.S., typically affecting the elderly and very young children most severely. The World Health Organization has confirmed nearly 12,000 flu-related hospitalizations from October 1 to January 20, with thousands more expected as the flu season peaks in the U.S. and around the globe. While safeguards and policies can’t always keep nursing home residents from becoming infected, they can help lessen the impact and reduce the risk of further flu-related sicknesses.

3 Most Common Flu Complications for Elderly Patients

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Illini Restorative Care, a senior living facility owned by Genesis Health in Silvis, Illinois (the quad cities), was fined $250,000 in September when a CNA reported that a colleague posted a topless picture of a male resident on social media. The female CNA told investigators from the Illinois Department of Public Health that she was on a social media site on her cell phone and put it in her pocket when the resident needed her attention. She says she unknowingly took the photo and posted it to her social media account. Genesis reported that it fired the CNA for violating their cell phone policy, which forbids employees from carrying their cell phones into resident’s rooms, and that they were the ones to report the violation to IDPH.

Not an Isolated Incident

In 2015, ProPublica published a report on the number of known instances of employees posting resident photos on social media. At that time, there were 47 known incidents between 2012-2015. As of June 2017, the number of reported cases had increased to 65. One of the violations detailed by ProPublica happened at Rosewood Care Center in St. Charles, IL. In that case, an employee posted a video of a co-worker slapping a 97 year old resident in the face while the resident cried for them to stop. Rosewood reported that the two employees were fired. The other reports came from all over the country, with another incident occurring in Peoria, and several in Wisconsin.

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As part of a program to increase pay for the lowest-paid workers within long term care facilities and nursing homes, the state of Massachusetts earmarked $35.5 million in 2016 to help compensate these employees.  The Boston Globe reported earlier this year that much of the pay actually went to boosting the salaries of high-level executives within nursing homes. Although the claim is being disputed by nursing homes throughout the state, MA Representative Nick Collins is pointing a spotlight on Kindred Nursing Centers, who took the payout and then announced shortly after that they would be closing 5 facilities and laying off 600 more employees in their facilities in Boston, Canton, Dedham, and Needham, MA. Kindred has denied the allegations and has vowed to work with officials on an investigation.

Kindred Selling Off Facilities to Humana and Private Equity Firms

Kindred Nursing Centers is a chain of rehabilitation and nursing centers based out of Louisville, KY. There are currently 13 Kindred-owned companies in the state of Illinois, including 2 hospice centers in Arlington Heights and Oak Brook, 5 Kindred at Home companies, and 6 Kindred Hospitals which function as extended care facilities that promise to provide hospital-level care.