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Posted in Advocacy, Dementia Care, OBRA as standard of care

The White House launched a new website at, meant to serve as a one-stop shop for information on government agencies that serve older Americans and their families.  The Centers for Medicare and Medicaid Services pledged to improve the care received by more than one million nursing home residents nationwide by updating guidelines that dictate the standard of care that nursing homes must provide in order to qualify for government payments. Those guidelines were last updated in 1991. Currently, 1.5 million people live in more than 15,000 nursing homes and other long-term care facilities, according to a news release.

The Department of Health and Human Services also delivered a new national plan for Alzheimer’s disease, revealing actions that the federal government would take in the coming year to address a form of dementia which affects 5.3 million Americans. These actions include launching a $4 million campaign to teach older adults about changes in their brains and expanding research to find an effective treatment for the disease by 2025.

“Coumadin is the most dangerous drug in America.”

Posted in Advocacy, Medications, Trial themes

The Washington Post had a great article on the dangers of blood thinners in nursing homes.  Coumadin is often given to residents with abnormal heart rhythm, which increases the risk of stroke, but the drug must be carefully calibrated: too much, and you can bleed uncontrollably; too little, and you can develop life-threatening clots.  The drug interacts badly with certain foods and medications, particularly antibiotics, and it requires regular blood tests to ensure it’s working as intended. The test measures the time it takes for blood plasma to clot.

“When nursing homes fail to maintain this delicate balance, it puts patients in danger. From 2011 to 2014, at least 165 nursing home residents were hospitalized or died after errors involving Coumadin or its generic version, warfarin, a ProPublica analysis of government inspection reports shows. Studies suggest there are thousands more injuries every year that are never investigated by the government.”

Periodic inspections document hundreds of additional errors that were caught early enough to prevent serious harm, but the real toll is likely much higher, experts say. A 2007 peer-reviewed study in the American Journal of Medicine estimated that nursing home residents suffer 34,000 fatal, life-threatening or serious events related to the drug each year. North Carolina data shows moremedication errors in nursing homes involving Coumadin than any other drug.

Last year, the Department of Health and Human Services identified Coumadin and other anticoagulants as one of the drug categories most frequently implicated in “adverse drug events,” calling on government agencies to work on solutions. In a statement, the CMS, which is part of HHS, said it is raising awareness of such events, training its inspectors to do a better job at identifying them and working with nursing homes to prevent them.


Happy 50th Birthday to Medicare and Medicaid!

Posted in Advocacy, Medicare

ThinkProgress had an interesting article on the 50th anniversary of Medicaid and Medicare.  President Lyndon B. Johnson signed Medicaid and Medicare into law 50 years ago today. Simply, Medicaid provides health insurance for poor Americans, and Medicare provides insurance for Americans over 65 years old. In 1966 a large portion of seniors were uninsured. Today, nearly all seniors have health insurance. These programs have kept millions of Americans out of poverty and saved huge amounts in health spending.



Rapist Caught in Act

Posted in Abuse and Neglect, Staffing, Trial themes

Bucks County Courier Times reported that Christopher Frederici, a 41-year-old nurse’s assistant, is accused of raping a 93-year-old dementia patient at Silver Lake Nursing Home and Rehabilitative Center nursing home and threatening to kill a coworker if she reported him.  The coworker caught Frederici in the act of sexually assaulting the elderly woman on April 13.  But the employee did not report what she saw for several weeks after Frederici threatened to kill her, according to a probable cause affidavit. The woman waited until May 10 to report the incident to her nursing supervisor, police said.

The employee reportedly told police that she was assigned to care for the 93-year-old woman while working the 3 p.m. to 11 p.m. shift on the day of the assault.  She told police that during several of her checks on the woman she found Frederici in the room with the door open.  He was not assigned to help the woman that night.  He reportedly told her he was watching TV.  At about 9 p.m., she was in her bed with Frederici standing next to it and the privacy curtain was closed, the nurse’s assistant said in the affidavit.  During her final rounds for the day, the employee went to check on the elderly woman, but this time she found her door closed. When she entered the room and opened the privacy curtain, she saw Frederici engaged in a sex act with the resident.

After Frederici realized someone was in the room, he immediately moved away from the resident and pulled up his pants, police said. The “shocked and embarrassed” employee told police she then ran out of the room without confronting Frederici.  The employee subsequently spoke with Frederici, telling him what she saw and she made him promise never to do that again.  The female employee said Frederici promised he wouldn’t, but that she had already decided to report what she saw to her nursing supervisor.  But before she got that chance, Frederici allegedly confronted her, and made a threatening gesture by motioning the edge of his hand across his throat. So she didn’t say anything out of fear, police said. But over the next few weeks, the employee claimed that she was increasingly worried about the safety of the elderly woman, other residents as well as herself, so she finally reported the incident to her supervisor.

A Bristol Township detective then interviewed Frederici, who allegedly claimed that the elderly resident had kissed his stomach “because she loved it so much.”

Frederici is charged with rape of a mentally disabled person, indecent sexual assault of a person with a mental disability, and related sex crimes as well as felony witness intimidation.

Emeritus CNA Takes “Funny” Cell Phone Video of Elder Abuse

Posted in Abuse and Neglect, Staffing, Trial themes

Metrowest Daily News reported that two caregivers at Emeritus at Farm Pond were arrested on May 5, 2014 and charged with elder assault after police were informed of cell phone videos showing them abusing elders at the facility. The shocking part- they recorded the abuse themselves. Damaris Diaz, 18, admitted to police that she filmed herself abusing residents because she thought it was funny.

The police launched an investigation on April 20, 2014 after being alerted to the existence of the cell phone videos. The disturbing videos show Diaz assaulting a 78 year-old woman with Alzheimer’s, hitting her arms, pinching her nose, and flicking her ears. Another video found on her phone showed the woman partially nude. Yet another video showed her colleague, 25 year-old Samuel Ayekple, striking a 71 year-old man with Alzheimer’s in the face and on the buttocks.

Both employees posted $1,000 bail and pled not guilty after their arrest. Emeritus stated that they have also launched their own internal investigation.


Wandering leads to Tragic Death

Posted in Abuse and Neglect, Staffing, Trial themes

KHOU reported the tragic and preventable death of a blind man in his 60s found dead after wandering away from his nursing home. Police said the man’s body was found by a jogger about a mile from the facility in a grassy area off Interstate 35.  Neighbors are asking why the man was out by himself to begin with.    A man who lived a few feet from the center did not want us to show his face or give his name, but said he often sees River City Care residents wandering the neighborhood, alone.

“I’m not surprised at all because we see people coming out of there with no one attending them, no one watching over them,” said the neighbor.  River City Care Center, the facility the man lived at, refused to comment about how he was able to get out of the facility without permission.  When KENS 5 reached out to the River City Care Center about how the man got out of the facility, they said a corporate spokesman would return our request for comment.  So far, no one has.

“These people, the sick people, they do what they want,” said Maria Rufina Marciante, River City Care resident. “They push the door to go outside. And they can’t do nothing if there’s one nurse or two nurses to take care of all the 60 people.”


Golden Living Centers Sued by Pa. AG

Posted in Abuse and Neglect, Advocacy, Regulatory enforcement, Staffing, Trial themes

The Newton Patch reported the Pennsylvania Attorney General has filed legal action against national for-profit chain Golden Living Centers, a nursing home company with 36 locations statewide, for failing to provide basic services to “elderly and vulnerable” residents.  Golden Gate National Senior Care LLC manages and operates Golden Living Centers which operates 300 locations nationwide in 22 states. The legal action asserts Golden Living violated the Unfair Trade Practices and Consumer Protection Law by deceiving consumers through its marketing practices.

AG Kathleen G. Kane says residents at Golden Living Centers were left in soiled diapers for extended periods of time, were at risk for bedsores and were not routinely bathed, were often not escorted to meals as required, sometimes missed meals entirely and staff falsified records.  “The company advertised it would keep its residents clean and comfortable while providing food and water at any time. But its facilities were understaffed, leaving residents thirsty, hungry, dirty, unkempt and sometimes unable to summon anyone to help meet their most basic needs, such as going to the bathroom,” the legal action asserts.

Kane said the company preyed on the most vulnerable to make a profit. “These facilities promised to provide the care needed by residents and then failed to meet residents’ most basic human needs. That is simply unacceptable,” she said.

Interviews with residents’ family members and former certified nursing assistants who worked at Golden Living facilities revealed a widespread pattern of understaffing and omitted care. Those allegations include the following:

  • Continent residents left in diapers because they were unable to obtain assistance going to the bathroom.
  • Incontinent residents left in soiled diapers, in their own feces or urine, for extended periods of time.
  • Residents at risk for bedsores from not being turned every two hours as required.
  • Residents not receiving range of motion exercises.
  • Residents not receiving showers or other hygiene services as required.
  • Residents being woken at 5 a.m. or earlier to be washed and dressed for the day.
  • Residents not being timely dressed in order to attend their meals.
  • Residents not being escorted to the dining hall and sometimes missing meals entirely.
  • Long waits for responses to call bells or no responses at all.Staff, under the direction of management or fear of management, falsifying records to indicate residents received services when in fact they did not.
  • Improved staffing when state inspections occurred, leading to deceit about the true conditions at the facility.


Medicaid Expansion Would Save Lives and Money

Posted in Advocacy, Medicare, senior care, Tort Reform

As part of the Affordable Care Act’s provisions, expansion of Medicaid benefits has become available to all state governments that accepted the deal in 2014. Many states, however, are declining to participate in the expansion, despite the fact that it would be allocating tax dollars, already given to the federal government by the states, back to their poorest residents to cover their Medicaid costs. The plan outlined in the ACA provides for 100 percent of the funding of the expansion through 2016, and 90 percent of funding through 2022, which would go towards providing those who fall into the Medicaid eligibility gap with health insurance. Qualifying individuals whose total income falls up to 138 percent of the federal poverty line would then be covered with the health insurance they need so they won’t have to rely solely on over-capacitated free health clinics for health care.

While it would seem that any state governor would welcome a chance to provide healthcare for their most underprivileged residents, many governors are actually declining to accept the funds for Medicaid expansion because it is a provision of President Obama’s Affordable Care Act. South Carolina, North Carolina, and Georgia are among the 19 states that currently are not expanding Medicaid. These 19 states in total represent 6 million Americans, who would be eligible for coverage under the expansion, who are not receiving health insurance because their states have failed to expand the program. South Carolina, North Carolina, and Georgia have 292,000, 593,000, and 682,000 residents, respectively, who will go without health insurance because of the states’ failure to accept the expansion.

Recognizing that this is a partisan issue, many Senate Democrats have begun to ask their Republican governors to put politics aside and “do the right thing” by expanding Medicaid in their states. Proponents of expansion say that everyone will save money by insuring individuals who would otherwise cost hospitals billions of dollars by seeking treatment without health insurance.  Supporters of expansion are still calling for a change of mind (and heart) by the governors who are against the effective policy.

Perhaps White House Principal Deputy Press Secretary said it best when he said, “The states that have blocked Medicaid expansion face a consequential choice: They can score short-term political points by attacking the Affordable Care Act and blocking Medicaid, or they can take action to save taxpayer dollars and extend access to thousands of citizens to quality affordable health care. For those politicians with the courage to put the interests of their state and their citizens ahead of politics, it shouldn’t be a tough choice.”

Police Need Your Help

Posted in Advocacy, Staffing

WRAL reported that Cary, North Carolina police are asking for the public’s help to identify two women who posed as nursing assistants to steal jewelry from residents at two retirement communities.  The first thefts happened July 4 at Cary Senior Living while the second incident happened July 11 at SearStone.

In both cases, police say the suspects entered the care centers wearing scrubs and went door-to-door checking for unlocked apartments. Neither woman wore any official identification, and other employees did not stop them or ask them any questions.

Police released surveillance photos and video showing the two women. One woman is described as 25 to 35 years old, between 5 feet 1 and 5 feet 5 inches tall with a medium build and dark hair. Her hair was pulled into a ponytail and she wore sunglasses on her head.  The second woman was also between 5 feet 1 and 5 feet 5 inches tall with a medium build. She was between 45 and 55 years old and wore a conductor-style hat with glasses. Police said she spoke with a heavy accent.

“Never hesitate to ask for proper identification from anyone in the service industry, and always keep your valuables locked up and out of plain view regardless of where you live,” Cary police Capt. Randall Rhyne said in a statement.  Anyone with information is encouraged to contact the Town of Cary Police Department at 919-469-4012 or file a report anonymously with Cary Crime Stoppers at 919-460-4636.


Injustice of Mandatory Arbitration

Posted in Advocacy, Arbitration

John Suthers wrote an excellent editorial on the dangers of mandatory arbitration in nursing home admission paperwork.  Below is a copy of the editorial.

“A great injustice is taking place in this country: the use of pre-dispute binding arbitration clauses in nursing home admissions contracts by the nursing home industry. These clauses provide that victims of abuse and neglect in nursing homes give up their right to a jury trial. This directly undermines the spirit and intent of the Nursing Home Reform Act of 1987: to improve the quality of care and clinical outcomes for our most vulnerable citizens.

Elderly nursing home residents and their spouses are being pressured or mislead into signing arbitration clauses, frequently when they lack the mental capacity, authority or true willingness to do so. If arbitration was a level playing field and fair to both sides without any negative repercussions to the resident or family, does anyone really believe that the nursing home industry would feel the need to so aggressively enforce them and seek to bury these provisions within 50 pages of admissions materials?

Arbitration provisions lead to protracted litigation, not faster results or less expensive resolution of cases. The nursing home industry uses them to stall cases, take appeals and delay justice. An elderly surviving spouse may not live long enough to see justice when nursing home corporations take this approach.

In my experience as an attorney who has represented victims of abuse and neglect in nursing homes, arbitration provisions lead to the provision of poor care. Residents who have not signed arbitration provisions typically receive better care because the facility has a greater incentive to meet their needs. Arbitration clauses insulate the nursing home industry from liability, and with that protection, nursing home corporations feel free to cut costs, reduce staffing and sacrifice the quality of care.

There is only one way that arbitration can be fair and truly voluntary: that is to prohibit the use of pre-dispute binding arbitrations altogether. In other words, if and when a dispute arises, the parties may thereafter choose to arbitrate the case if they so desire.

The Centers for Medicare & Medicaid Services (CMS) is presently considering changes to the Federal Regulations that govern the operation of nursing homes, including a proposal regarding arbitration. There is a 60 day comment period during which citizens can go, and let the government know that arbitration should be prohibited in nursing homes. CMS, in seeking to protect our elders and promote the quality of care in nursing homes, should ban pre-dispute binding arbitration clauses. It is the fair and equitable thing to do.”

Mr. Suther’s arguments are validated by the AON Report – done at the behest of the LTC insurance industry in 2013 – that lays out all the many reasons why it’s good for the industry and bad for consumers and victims of neglect and abuse.

The review concludes:

• Average total cost for claims resolved with arbitration agreements in place is 16% lower than for claims resolved without arbitration agreements in place.  20% of claims are rejected with no payments made.

• It is unclear whether claims resolved with arbitration agreements in place resolve more quickly than claims that are resolved without arbitration agreements in place.