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nursing home neglect

Payroll Records Indicate Nursing Home Staffing Shortages Create Serious Gaps in Patient Care

Only recently did the Centers for Medicare & Medicaid Services (CMS) begin collecting and reviewing daily payroll records from more than 14,000 nursing homes. The publishing of the data became required by the Affordable Care Act of 2010. Kaiser Health News recently analyzed the submissions and caught that most U.S. nursing homes have been operating grossly understaffed and reporting a false review of average employee shifts. Kaiser claims these nursing homes had:

  • Significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends when personnel cared for nearly twice as many residents as normal.
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James Burkhart, the former CEO of American Senior Communities (ASC), Indiana’s largest nursing home chain, has just been sentenced to nearly 10 years in federal prison.

“Obsessed with Money”

From 2009 – 2015, Burkhart and several other high-ranking ASC executives engaged in a moneymaking scheme that included kickbacks and overcharging vendors, charges to which Burkhart pled guilty. Burkhart and his associates made $19.4 million during that time period, with $10 million taken from Indiana’s public health system.

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The Elder Justice Coalition is reacting to a July 7th New York Times article that outlined just how extensively nursing homes have hidden low staffing numbers. The advocacy group is calling for an immediate congressional review of staffing practices within nursing homes.

Actual Payroll Data Reveals Staffing Crisis

The article, investigated and published in collaboration with Kaiser Health News, was based off a review of payroll hours submitted to the Centers for Medicare and Medicaid Services (CMS).  The actual hours made news not only because they show a serious crisis in terms of resident to staff ratios, but also because up until recently, nursing homes had supplied their own staffing data to CMS. With the new payroll-based submission process, nursing homes have no ability to fudge numbers.

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Just last week, the Pennsylvania House of Representatives voted down extending the Medical Care Availability and Reduction of Error Act (MCARE) to nursing homes and assisted living facilities in the state. Among other provisions, the MCARE Act currently caps punitive damages against doctors, hospitals, and healthcare providers to 200% of the amount awarded for compensatory damages in medical malpractice lawsuits. The latest version of the bill sought to limit punitive damages against nursing homes to 250%. Punitive damages are dollars awarded to a victim with the intent to punish the party responsible for causing injury. Punitive damages are also intended to deter the likelihood of similar incidents occurring in the future.

Damage Caps: A Solution to a Non-Existent Problem

Robert L. Sachs, Jr., a Pennsylvania personal injury attorney, told the Penn Record that nursing homes are “asking for protections that already exist, and they’re asking for protections…as a cure for a problem that hasn’t even been diagnosed.” Sachs goes on to challenge Pennsylvania nursing home defense attorneys to pull up 5 awards composed of large punitive damages.

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A 29-year-old former nursing home aide has been charged with second-degree manslaughter after failure to follow his training on using lifts caused the death of an elderly resident.

Foot Nearly Broke off From Victim’s Body

On September 10, 2017, Francisco Javier Ramirez was aiding 100 year old Evelyn Augusta Schweim with bathing at Sunwood Good Samaritan Center in Redwood Falls, Minnesota when she fell and fractured her foot so severely that it nearly separated from her body. Despite participating in two lift trainings, including one just a month before, Ramirez raised the swing chair lift to nearly 5 feet, three feet above the maximum height allowed for transferring a patient from the bathtub. He also was assisting Ms. Schweim alone, another violation of the facility’s protocol for transferring residents.

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Hidden VA Nursing Home Care Data Published

According to USA Today and The Boston Globe, the Department of Veterans Affairs (VA) has been tracking and withholding data on the quality of care at VA nursing homes for years. Because of this alleged fail, resident veterans and their families may not see the bigger picture regarding the quality of care services provided or performed. Families may also be withheld vital health care information to assist in making support decisions. On June 25, 2018, the national news outlets published the ‘hidden’ information from 133 VA nursing homes using reports obtained from internal DVA documents. The review concluded that for the 46,000 veteran residents across the U.S., more than two-thirds of their VA nursing homes were “more likely to have issues related to serious bedsores and residents who will suffer serious pain, than their counterparts in private nursing homes across the country.”

Unlike the VA, private nursing homes are required to submit timely reports on the care they provide to measure quality, inspection issues and staffing. That data is then publicly posted on a federal website for families to use when researching a facility for their loved one.

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Symphony of Buffalo Grove, a 200-bed, for-profit rehabilitation facility in suburban Chicago, is being sued for alleged neglect that led to the death of a resident. The deceased, Librada Jacob, was admitted to the facility in June 2016 and over the course of the next 15 months became dehydrated and malnourished, suffered multiple falls, and developed several pressure ulcers. She died in September 2017, shortly after her 81st birthday.

All residents of rehab and skilled nursing facilities are to be admitted with a care plan that, in part, provides detailed information on how to maintain their physical and mental well-being, including necessary therapies, a fall risk determination and necessary fall prevention methods, a detailed list of current medications, as well as a nutrition plan. The lawsuit alleges that Symphony of Buffalo Grove failed to follow and update Ms. Jacob’s care plan.

Symphony Facilities Make IDPH’s Violations List

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Starting next month, two new quality tracking measures will be included in Nursing Home Compare, the Centers for Medicare & Medicaid Services (CMS) nursing home information and rating system. Hospitalization rates for long-term nursing home residents will now be tracked and reported publicly on the site, as well as staffing data for non-nursing staff. Both categories are considered by CMS to be critical for determining the level of care being provided at nursing homes.

For each nursing home participating in Medicare and Medicaid, Nursing Home Compare currently includes 6 general categories of information, divided into tabs.

  1. General Information: Name, location, number of beds, affiliation (non-profit, hospital-affiliated, etc)
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nursing home violations

New Report Shows Serious Care Violations and Doubled Fines For 56 Illinois Nursing Homes

The Illinois Department of Health produces quarterly reports on nursing home violators. The most recent report, dating January 2018 thru March 2018, highlights more than 50 Illinois facilities determined to be lacking in patient care abilities related to the Nursing Home Care Act, a statute that provides nursing home residents and their families with the assurance that proper and safe care will be received.

Some violations heightened with a serious high-risk designation, and all homes received fines of no less than $1,000 while others reached more than $50,000 fines for issues that caused actual harm or immediate jeopardy to residents. Several problems were related to infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients caused by lack of support or inexperienced, overburdened staff. These violations may result in an official recommendation for decertification to the Department of Healthcare and Family Service, or the Secretary of the United States Department of Health and Human Services. Facilities included in this report are:

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The rules are changing yet again for nursing homes who have been negligent, and not for the better. On June 15th, the Centers for Medicare & Medicaid Services’s Safety, Quality, and Oversight group sent a memo to state survey agency directors telling them to lighten up on nursing home punishments. The theme of the memo seems to be more “keep things moving” rather than “fix things for the long run.” The new rules will go into effect on July 15th.

Prior to the new changes, nursing homes who had any health or safety violations were punished in accordance with federal guidelines. Now the decision of how and when to punish facilities is being put into the hands of CMS’ regional offices, with the exception of a handful of circumstances.

Enforcement of Punishments for Immediate Jeopardy Violations