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It looks like trouble for HCR ManorCare. The nursing home giant, the country’s second largest chain, was recently abandoned by the private equity firm that has owned the company for the last 10 years. The firm, Washington, D.C.-based Carlyle Group, had already sold off nearly all of the real estate associated with ManorCare in 2011.

Rumors of problems at ManorCare began over 2 years ago when the U.S. Justice Department filed a lawsuit against the chain for billing Medicare for ‘medically unreasonable and unnecessary services.’ While the chain has attempted to blame the fraudulent charges on a greedy few rather than on a corporate moneymaking scheme, that hasn’t prevented many high level ManorCare executives from leaving the company. Unnamed sources within ManorCare have recently revealed that the company owes close to $400 million to investors for senior loans. Senior loans are particularly important because borrowers are legally obligated to repay this type of debt to a lender before paying any other creditors. In light of these revelations, several vendors have recently abandoned relationships with ManorCare, a sign that the chain’s financial issues are leading to a bankruptcy filing and potential closure of facilities.

ManorCare Well Known but for Many of the Wrong Reasons

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The widow of a Charleston, West Virginia man is suing the nursing home that allowed her husband to allegedly leave the facility without pants in 42 degree weather in March 2015. The widow, Patsy Rowe, alleges that Princeton Center LLC was negligent in its training of staff on how to properly supervise and care for residents suffering from mental disabilities. Due to his elopement from the facility, Mr. Rowe suffered injuries that ultimately led to his death in October 2015.

The case is a sad reminder of the frequency of wandering and elopement from nursing homes. Elopement specifically refers to a resident leaving the facility unnoticed, while wandering refers to the ability of a resident to move freely throughout a facility without adequate supervision. Both instances can be tragic for a resident who suffers from limited physical or mental capabilities. Nursing homes and care facilities are directly responsible for the supervision of its residents and are required to meet the specific needs and care requirements of each person. Oftentimes, lack of staff and improper training on safety measures are to blame for a resident being able to wander through or altogether leave a facility.

The Chicago, Illinois nursing home abuse and neglect attorneys of Levin and Perconti have successfully handled numerous cases of wandering and elopement from facilities, including a $1 million verdict for the family of a woman who wandered unnoticed from her room and died from a 5th story fall from a window in her nursing home.

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There are perfectly valid reasons to evict, discharge, or transfer someone from a nursing home: A resident has recovered and no longer needs specialized care, a resident has become a threat to staff or other residents, or if at a private facility, they are unable to pay for the services provided. But what about residents who are evicted without any reason? The practice, referred to as involuntary discharge, is on the rise and nursing homes in Illinois are guilty of it. In fact, the number of involuntary discharges from Illinois nursing homes has more than doubled in the past 5 years.

In a May 26th article on NPR.org, Illinois and Maryland were both called out for their high eviction rates. Maryland’s attorney general, Brian Frosh, has filed a Medicaid fraud lawsuit on behalf of the state against one particular chain of nursing homes, Neiswanger Management Services, alleging that they are guilty of seeking reimbursement for discharge planning services that it never provided. Discharge planning requires nursing homes to discuss plans of an eviction with a resident and their loved ones, as well as preparing detailed records for the resident to give to their next facility or care provider. According to the attorney general, the particular chain that has been named in the lawsuit has eviction rates that are 100x higher than any other nursing home in the state of Maryland. Why are the eviction rates so much higher at a Neiswanger-owned facility than at others in Maryland? The state believes it’s due to the reimbursement rules for Medicaid vs. Medicare. Medicare reimbursement is only good for the first 100 days of long term care treatment. Once residents transition to Medicaid, they’re less attractive to the facility because reimbursements under Medicaid are also lower. Frosh noticed that many of the evicted residents had been evicted right as their 100 day Medicare reimbursement period was ending, proving that Neiswanger wanted to empty beds to take in more Medicare residents.

Not only were residents wrongfully evicted, but many, including those suffering from dementia, were left on family members’ doorsteps, at homeless shelters, and in hospital waiting rooms.

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What little hope remained that arbitration clauses would disappear from nursing home admission paperwork is now gone. Friday, June 2 was the deadline for the Trump Administration to submit paperwork to continue the appeal of a Mississippi Supreme Court judge’s decision to block a ban on nursing home arbitration clauses.  Instead, the administration decided to withdraw from the fight.

An Attempt to Restore Justice

Last September, the Centers for Medicare and Medicaid Services (CMS) released their updates to nursing home regulations for the over 15,000 facilities that currently receive Medicare and/or Medicaid support. One of the biggest changes was a ban on mandatory arbitration clauses in nursing home admission paperwork. An arbitration clause requires a potential plaintiff to agree to forgo a trial by jury and work with an arbitrator who will attempt to get both sides to come to an agreement on a settlement. The problem, besides the fact that it forces vulnerable Americans to waive their seventh amendment right to a trial, is that nursing home arbitration typically favors the defense by allowing them to select the arbitrator. Evidence has shown that when nursing home disputes are settled by arbitration, the outcome tends to be more positive for the guilty party and not the injured victim.

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A recent meta-analysis of 8 studies conducted between 2005-2016 has revealed that 27% of nursing home residents are infected with some form of antibiotic-resistant bacteria. The findings were published last week by Medline Plus, the National Institute of Health’s educational website.

Nursing Homes: A Perfect Breeding Ground for Bacteria

Antibiotic-resistant bacteria, often referred to as superbugs, are worrisome to health care providers and nursing home residents and their loved ones because of the impact they can have on weakened immune systems. Nursing homes are considered a breeding ground for superbugs for various reasons. Unlike a hospital, nursing homes allow most of its residents to frequently come and go, share various spaces and rooms and even share food.  Close living quarters, coupled with the fact that many of these powerful bacteria cause little or no symptoms, allow superbugs to be spread easily. Hand washing is considered the primary method of infection prevention, but controlling and preventing the spread of these superbugs will require more than just soap and water. Infection control experts believe the study’s findings have created a valuable opportunity for nursing homes to increase staff and resident education of infection prevention and control.

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A study conducted at Harvard’s T.H. Chan School of Public Health revealed a 1.5 lower risk of death in older adults following discharge from one of the 4,500 facilities considered a teaching hospital in the United States.  The study, conducted between 2012-2014, relied on data from 21 million Medicare hospitalizations and found that in the 7, 30 and 90 days following discharge from these hospitals, the rate of death was lower than after discharge from a non-teaching or community hospital.

While 1.5% might not seem like a huge difference, lead study author Dr. Laura Burke noted that it results in 58,000 fewer deaths a year and accounts for one life in every 84 patients being saved.

It is unclear why outcomes are better at teaching hospitals for that age range, although many speculate that it could be access to greater technology and resources than at community hospitals. As it stands now, treatment at a teaching hospital in our country is more expensive than at other facilities. Certain health plans have even restricted the ability of its members to receive treatment at a teaching hospital, due to the increased cost of care.

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Windsor Nursing and Rehabilitation Center of Duval, TX has just been named in a lawsuit by the family of an 83 year old woman suffering from Alzheimer’s who was mocked by an employee in a video posted on Snapchat. In March, Certified Nursing Assistant (CNA) Carlos Alberto Santa Cruz, 33, noticed the resident had dried feces on her hand while she was sleeping. He then used his cell phone to film himself tickling the woman’s nose with a feather in order to get her to wipe her face with her dirtied hand. He used text captions to write disparaging remarks about the woman and then posted the video to his Snapchat account. Snapchat is an app that allows users to take pictures and record videos with different sounds and image filters and share them publicly or only with select users. Reports say that someone ‘familiar’ with Santa Cruz told the family of the existence of the video.

A Denial and A Criminal Record

When the victim’s family confronted Windsor Nursing & Rehab with the video evidence, the nursing home attempted to deny that the video could’ve been made at their facility. The lawsuit also names Windsor’s parent company, Regency Integrated Health Services, as a co-defendant, stating that they are both responsible for hiring someone with a past criminal record, for failing to properly supervise their employee, and for failing to notify authorities of the abuse when it was brought to their attention. Instead, the family personally notified authorities who then arrested Santa Cruz for assault by contact.

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Earlier this month, the daughter of a Virginia woman was awarded $300,000 in damages after a wrongful death trial against the nursing home where she had fallen 8 times in less than a year, plus another fall that ultimately caused her death in August 2012.

The deceased, 87 year old Alice Allen, fell in her room at Colonial Manor on Pocahontas Trail in Williamsburg, VA. She suffered a subdural hematoma and was not taken to an emergency room until the next day, despite taking blood thinners. A nurse who served as an expert witness for the plaintiff stated during trial that “Any prudent nurse with an unwitnessed fall with a possible head injury on [a blood thinner] would be sent to the emergency room immediately following the fall. Time is of the essence.”

The nurse also testified that it did not appear that the facility had a well developed plan for fall prevention or treatment, which was evident by the number of falls Ms. Allen had endured and by the manner in which she was treated after her fatal fall in August 2012.

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The family of a woman who died after suffering from malnourishment, dehydration and a urinary tract infection (UTI) is suing Alton Rehabilitation and Nursing Center in Alton, Illinois. The lawsuit alleges that before her death in June 2015, Judith Bates was visibly sick and was not sent to a hospital for treatment, despite lowered oxygen saturation, an abnormal heart rate, breathing difficulties, lethargy, low blood pressure, and excessive sweating. She had also lost 42 pounds in less than 6 weeks. By the time she was tested for a UTI on June 24, 2015, Ms. Bates’ condition had deteriorated and she died the next day.

For-Profit Nursing Home Rated Much Below Average

Alton Rehabilitation and Nursing Center is a privately-owned, for-profit nursing home located in the southern Illinois town of Alton. The nursing home is owned by Integrity Healthcare of Alton and according to Nursing Home Compare, the rating system developed and maintained by the Centers for Medicare and Medicaid Services (CMS), the home is rated 1 out of 5 stars. A one star rating is considered much below average. The facility received one star for its health inspection, one star for its staffing practices, and two stars (below average) for quality measures.

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Cahokia Nursing & Rehabilitation Center in Cahokia, IL, is yet again defending themselves against a lawsuit filed by the family of a resident. According to the lawsuit, Pauline Purifoy, 86, died in April 2015 from multiorgan failure and septic shock. In the days leading up to her death, Ms. Purifoy was suffering from a painfully severe urinary tract infection that was left untreated. As the pain progressed, Cahokia Nursing & Rehab did not notify Ms. Purifoy’s doctor, instead choosing to treat her on their own. When their efforts didn’t work and Ms. Purifoy was becoming physically and vocally agitated, they resorted to lorazepam, a benzodiazepine used to treat anxiety, seizures, and insomnia. The Illinois Department of Public Health made a visit to Cahokia and saw Ms. Purifoy covered in her own urine, feces, and vomit and forced the facility to contact her physician. The physician ordered her to be transferred to a local hospital, during which time she died in the emergency room.

Cahokia Nursing and Rehabilitation on Federal Watch List

Just this past January, the Centers for Medicare & Medicaid Services (CMS) released their latest list of Specialty Focus Facilities, those nursing homes that are considered severely deficient and in danger of losing federal funding. We analyzed the list and found 3 Illinois facilities named, one of which was Cahokia Nursing & Rehabilitation Center. Shockingly, Cahokia Nursing & Rehab had just been upgraded to the ‘shown improvement’ category of Special Focus Facilities after a December 2016 visit by CMS.