South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

The Des Moines Register reported the investigation and charges filed against Emeritus (one of the nation's largest senior living companies) for operating an unlicensed assisted living facility and misrepresenting their licensure status to the public.  Emeritus at Silver Pines is a Cedar Rapids home licensed as a residential care facility that can provide personal assistance and supervision, but no nursing care.  Over the past 30 months, the owners of the 72-bed facility have allegedly promoted the home as an assisted living center that is authorized, equipped and staffed to provide residents with a relatively high level of medical assistance and care. The Iowa Department of Inspections and Appeals has temporarily barred the home from accepting new residents, imposed a $13,000 fine and ordered the owners to hire a new administrator.

Emeritus is the nation's largest assisted-living company, with annual revenue of $900 million. It operates 308 senior-living communities in 36 states, with a total potential capacity for 32,300 residents. The chain recently purchased an additional 140 homes from the bankrupt Sun West chain of care facilities.

Emeritus could face criminal charges for falsely claiming to be a state-licensed assisted living center.  It's a crime in Iowa for a company to falsely claim that it's a state-licensed assisted living facility, h, and the Iowa Department of Inspections and Appeals plans to refer the matter to county prosecutors for consideration of criminal charges.

Disabled Iowans - some near death and in need of constant supervision or skilled nursing care - signed contracts with the home that specifically described the facility as "licensed by the state of Iowa as an assisted-living facility." In some cases, residents were referred to Emeritus by physicians who were led to believe that the home was licensed to provide skilled nursing care.

Company records indicate the home has been charging each of the residents up to $3,800 per month in fees. In at least one instance, it allegedly charged a resident $10,000 as a nonrefundable "move-in fee."

The company's false claims should have been uncovered in March when inspectors visited the home.  Emeritus was cited for having two residents whose medical needs could be met only by an assisted living center or a nursing home. The home promised that in the future it would only admit people who were suitable for a residential care facility. In July, inspectors revisited the home in response to a complaint and saw the problem was much larger in scope than they had previously believed. For at least 30 months, the home had been holding itself out as an assisted living center. Some of the residents were being treated for cancer, kidney failure and severe dementia. Some were receiving hospice care.  In all, 17 residents were judged to be in need of care above and beyond what could be legally provided by the home.

State inspectors determined the home's new administrator, hired just a few weeks before, had no education or experience pertaining to the management of a residential care facility and didn't meet the minimum legal requirements to run such a facility.

The home's website and automated telephone system continued to promote the home as "the assisted living community of choice."

Emeritus Senior Living owns two other Iowa care facilities: Northpark Place Senior Living Community in Sioux City, a residential care facility the company purchased on Aug. 5, and Emeritus of Urbandale, a fully licensed assisted living facility that has faced numerous sanctions from the state in the past 18 months.  At one point, the Urbandale facility's on-call registered nurse was a company official who lived in Urbana, Ill., a six-hour drive away.

One employee of the Urbandale facility allegedly admitted to inspectors that she had destroyed a patient's medical records and then created new, fictional reports to conceal the fact that a dying resident's children had to administer medication to their parent on several occasions because no nurse was available in the facility.

The Urbandale home has also been cited for housing a violent individual who assaulted and sexually fondled other residents over a period of several days until police were called and he was escorted from the building.

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 Ken Teegardin had a traumatic time finding care for his father in Georgia so he created his own website (http://www.AssistedSeniorLiving.net) with the goal of presenting the widest variety of senior care options (especially nursing homes) with objective information.

He has spent a lot of his personal time compiling a comprehensive list of senior care options so that others will have better support than he did when he had to make the critical decision.  The site is:
- The most comprehensive senior directory on the web. Users can search by care type, location, organization name, review status and more.
- Totally unbiased. The directory is based on government data combined with other independent sources. It is NOT a paid-inclusion corporate site so every senior care organization gets fair exposure.

The site features:
- Location based search - His advanced Geo-location search shows the nearest 50 senior care options to any desired location based on a zip code, city, or street address. Click on the map and get instant driving directions to each option.
- Hot lists - Users can build a custom list of possible services and print that list with full contact information.
- Complete listing information - We provide full contact information, photos, costs, and other details (where available) so users can compare apples to apples.
- Safe usage - There is no data taken about users. The goal of the site is share information, not to gather sales leads.
- Reviews - The site includes both positive and negative reviews.

AssistedSeniorLiving also donates $1 to non-profit senior care organizations for every review created.
 

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Grace Miller is an 87-year-old resident of Dorchester Senior Center, a south suburban assisted living facility in Dolton, Ill.   Miller claims she was unfairly and forcibly evicted from her home for a second time.  The 87-year-old says she moved from Nebraska into the Dorchester Senior Center as a part of what she believes to be her spiritual ministry.   Miller served in the military during World War II.   Dorchester Senior Center is managed by the daughter of town's mayor, whose name is Angelic Lewis.

Miller says the trouble started after other residents began to join her in complaining about the facility and how it is run.  Miller received a non-voluntary removal in March but appealed it and was allowed to stay.  Residents say Miller-- who must use a wheelchair-- was ordered by Lewis to be handcuffed and restrained after she, once again, complained about the food served at the facility.  At the demand of the nursing home, police forcibly removed her from her unit at an assisted living community because of what she calls a vendetta against her by the facility's manager.

"They literally cuffed my feet and cuffed my hands and lifted me out of my chair, and I want you to know, before they cuffed by hands, I took a swing at one of them. I think I slapped one of them pretty good," Miller said.

 Witnesses claim Lewis then had officers take Miller to a Hammond, Ind., hospital for a psychiatric evaluation.  When Miller returned to the Dorchester the next day, she discovered the locks to her apartment door had been changed and that she had been evicted by the management company hired by the village to run the facility.

Several residents claim the Dorchester has been cited for violations by the Illinois Department of Public Aid more than a half-dozen times since January.

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There were a couple of articles mentioning Emeritus bid for bankrupt Sunwest.  Long Term Living Magazine's article here.  Oregon Live also had an article here with links to the history of the Sunwest saga.

Emeritus Corporation, a national provider of assisted living and Alzheimer’s care services, was the only bid received in the Sunwest bankruptcy action.  The purchase to acquire 149 communities formerly operated by an affiliate of Sunwest Management is a joint venture between Emeritus, Blackstone Real Estate Advisors VI, L.P., and Columbia Pacific Advisors, LLC, an entity affiliated with Emeritus’ Chairman and Co-CEO.  

The transaction includes up to 149 communities with a total estimated purchase price of approximately $1.3 billion, which is comprised of debt assumption of approximately $1.0 billion and the balance in a combination of cash and membership interests.  Blackstone will contribute approximately 80% of the remaining equity requirements with the balance split evenly between Columbia Pacific and Emeritus.  The Blackstone Group bid $1.25 billion Monday to buy 145 senior living centers from Salem-based Sunwest Management.   Emeritus anticipates that its initial contribution will be a minimum of $17.4 million, including other contributions for working capital and capital expenditure requirements, and would increase to as much as $34.2 million if there is no participation by existing Sunwest investors.

At least 15 lenders to various Sunwest entities objected to the sale. Many of the Sunwest's banks have objected to the entire restructuring, which prohibited them from repossessing the collateral -- individual assisted-living centers -- put up by the Sunwest affiliates after they defaulted on their loans.

Blackstone made the offer to purchase Sunwest in August 2009. It partnered with Seattle-based Emeritus Senior Living, which will take over management of the Sunwest facilities.

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Teresa Jackson was kind enough to write the below blog entry.  Teresa Jackson writes on the subject of OnlineNursePractitionerSchools.

Very often in life, we’re forced to do things we would rather not do, and sending a loved one to a nursing home is one such decision that we make because it’s the most practical thing to do. We’re unable to provide them with the care and comfort that they need, and they are bound to be more comfortable in an environment where they can interact with people of their own age and spend their last days in relative peace. Nursing homes are refuges for old people whose families cannot care for them because of various reasons, and when you choose one for your loved one, you do so with the utmost care. Even so, there may come a time when you’re forced to consider a change, simply because:

• Your loved one is not satisfied: A nursing home is home to the elderly, one where they hope to live out their last days in peace and quiet. So unless they’re completely satisfied with the care they’re receiving and are able to relate to and interact with the other members of the home, your loved ones are bound to be unhappy. If this is the case, then it’s time to think of a change, even though it might be inconvenient or more expensive. The idea behind sending your loved one to a nursing home is to keep them in relative comfort even though you’re not able to look after them. So if they’re not satisfied for some reason, you must consider a change.

• It’s too far to visit regularly: You’re bound to want to visit often if you’re close to your loved one, but if the commute is too difficult to make, your visits become few and far between. Relationships go downhill when they’re not fostered, so if you value the one you share with your loved one, it’s time to move them to a place closer to home so you and your family can visit often.

• There is evidence of mistreatment: When you know or even suspect that your loved one is not being treated well at the facility, it’s definitely time for a change. You can complain all you want and hope that they’re going to be treated better, but in general, the quality of treatment in the short term shows what you can expect in the long term. So if you want your loved one to be happy and treated with the respect and dignity they deserve during their twilight years, it’s best you move them to another nursing home when you know they’re not being given the care they need.

Changing nursing homes is a little difficult, especially if it involves a significant amount of cost and time on your part. But when it comes to ensuring the comfort and mental peace of your loved one, you must do what’s necessary.

By-line:
This guest article is written by Teresa Jackson, she writes on the subject of OnlineNursePractitionerSchools . She invites your questions, comments at her email address : teresa.jackson19@gmail.com.
 

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This guest post is contributed by Kitty Holman, who writes on the topics of Nursing Degrees . She welcomes your comments at her email Id: kitty.holman20@gmail.com.

The New York Times had an article about the process of choosing a nursing home for your loved one. This can be a long and difficult process for people, and there are certain things to remember as you work to find a home that fits your needs.

1. Collect the data. The Centers for Medicare and Medicaid Services collect data annually on nursing homes across the country, assembling information about everything from health inspection rankings to staffing reports on more than 15,000 institutions. A great way to get started in this is by using the Nursing Home Compare tool at Medicare.gov.  However, it's important to remember that federally issued rankings of nursing homes only reflect the home's performance during a very brief period, so the quality might have changed since the report was issued. Additionally, Medicare's grading system stipulates that only 10 percent of a state's nursing homes can receive the top rating of five stars, so a high-quality home might get four stars for no reason other than that it missed the arbitrary cutoff point.

2. Visit repeatedly. It's impossible to get a sense of what a nursing home is like from just one visit. In order to better understand life at a particular home, it pays to visit several times, over different days and at different times of the day. This way, you can get an overall feel for the place. Medicare.gov also provides a helpful PDF checklist  you can take on visits to record what you see, hear, and smell. For instance, are staff and residents busy interacting, or is the place quiet and reserved? Does it smell like food, or cleaning supplies? Are there noticeable stains or broken fixtures? This is also your chance to talk directly with the nursing home's management, including the head physicians. If they can't make time to speak with you, it might be a good idea to move on and look at another home.

3. Ask the right questions. If you're placing a loved one in a nursing home, make sure to ask the facility's staff about "person-centered care" and "consistent assignment." The former is a term that means residents will be able to set their own schedules, including meal times and when they wake up. The latter means that the same team of physicians and assistants will deal with the same patients in each shift. This provides a feeling of continuity for residents and allows them to develop relationships with their caregivers.

4. Check their reputation. Every state in the country has a federally funded ombudsman overseeing long-term care who works as an advocate for nursing home patients. Your state's ombudsman will be able to help you find out more about nursing homes in your area and whether there is additional survey information on the facility in question. They can also tell you if any complaints have been filed against the nursing home. The National Long-Term Care Ombudsman Resource Center can help you learn more about your local ombudsman.

 

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IQ Nursing Homes is pleased to offer comprehensive nursing home abuse statistics, reports, articles and information on its website. Nursing home abuse is a serious problem throughout the country, and it often goes unreported because the victims cannot communicate that they are being mistreated. By reviewing the resources available at IQNursingHomes.com, friends and family members of nursing home residents can educate themselves about this issue and act as advocates to protect their loved ones.

Nursing home abuse can take many forms, including physical abuse, sexual abuse, financial abuse, and emotional abuse. When nursing homes are understaffed or caretakers fail to receive proper training and supervision on the job, seniors may not get the level of care that they need and deserve. The effects of nursing home abuse can range in severity from discomfort to serious injury, and even wrongful death. Bed sores, broken bones from falls, dehydration, and malnutrition are just a few of the life threatening conditions that can result from neglect and abuse in nursing homes.

IQ Nursing Homes includes detailed articles and videos that provide an overview of the types of nursing home abuse, as well as a list of warning signs that may indicate that abuse is taking place. It is important to note that nursing home abuse and neglect can be difficult to detect and may be missed if a concerned family member is not watching out for their elder relative. In some situations, a nursing home resident may be afraid to seek help because of threats made by the abusive staff member. In other cases, the victim may be physically or mentally unable to communicate that he or she is suffering from nursing home abuse.

Visit today to learn more about nursing home abuse. A national nursing home directory, a database of nursing home and elder care facility ratings, and a guide to choosing the right nursing home are also available to help you ensure that the facility you trust your loved one’s care to is reputable and safe.

If you suspect that a loved one is the victim of nursing home abuse or neglect, you may want to consider speaking to a nursing home abuse lawyer about how to protect your loved one’s rights. IQ Nursing Homes offers a Free Case Evaluation for those interested in pursuing a potential nursing home abuse lawsuit.

About IQ Nursing Homes

IQ Nursing Homes has partnered with nursing home abuse lawyers and nursing home neglect law firms throughout the country with the goal of putting a stop to the victimization of the elderly. By holding negligent staff members accountable for their actions and making it financially devastating for nursing homes to allow abuse to occur, it is our hope that this pattern of nursing home abuse can be put to an end. Visit to review articles, videos, and legal resources related to nursing home abuse and neglect and receive a Free Case Evaluation.

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As a follow up to yesterday's blog entry about U.S. News & World Report's rankings of nursing homes is another article from U.S. News about Special Focus Facilities (SFF).  Among the 15,547 nursing homes in the full set of U.S. News rankings, 131 are tagged as "Special-Focus Facilities."  These homes have been singled out by the state where they operate and by the federal Centers for Medicare and Medicaid Services as nursing homes with long histories of subpar or inconsistent health inspections. Here's more about SFFs:

What makes a nursing home an SFF?
A history. A single event, even a serious one such as spoiled food that sickens several residents, isn't enough. But similar findings in three consecutive inspections are one of three required SFF flags. The second is that a deficiency affected or could have affected many residents. The third is that the problem remained unresolved on follow-up inspections.

Does 131 truly reflect the number of troubled homes?
Many more could and should be added to the SFF list, say nursing home experts. But the roughly $1 million budgeted as the federal share of the cost of the extra SFF analysis and monitoring will cover no more than 135 homes. Each state can designate a number of SFFs based on its total count of nursing homes. California, for example, can submit six homes (the maximum) and Vermont one.

Should I remove my loved one from an SFF?
Not necessarily. Moving a resident who has grown used to the rhythms and routines of a home can be upsetting, even traumatic. If you are generally satisfied with the level of care, says CMS spokesperson Mary Kahn, it's better just to be watchful. "One family member who is attentive and an activist," she says, "can go a long way toward ensuring their loved one receives good care."
 

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U.S. News & World Report issues the best and worst nursing homes every year based on federal and state inspections, surveys, and required data on staffing.  Here is the most recent article.  The rankings are only as good as the investigators which in most cases is poor.  On a given day, 1.5 million people are living in the nation's 16,000-plus nursing homes, and in a typical year more than 3.2 million Americans will spend at least some time in one. 

The U.S. News rankings rely on Nursing Home Compare, a program run by the federal Centers for Medicare and Medicaid Services. CMS analyzes information on all homes enrolled in Medicare or Medicaid.  The homes also receive ratings of one to five stars in each of three areas: health inspections, nurse staffing, and measures of care.

At Nursing Home Compare, you can search for a specific home or for all homes in a particular state or within a certain distance of your city or ZIP code. But you can't assume that all five-star homes, or those with three or four stars, are of the same quality. There are so many homes in each rating—1,855 in the five-star and 3,661 in the four-star categories alone—that the range of performance is bound to be very wide. Nor can search terms be combined if, say, you want only five-star homes within 50 miles of a specific city.

America's Best Nursing Homes addresses these and other issues. Homes are presented in tiers within each star category, based on their total stars in all three of the major areas. The topmost tier, for example, consists only of five-star homes that got 15 stars. The next tier down is five-star homes with 14 total stars, and so on.

Here are more details about the measures that go into the CMS ratings.

Health inspections. Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months. They also investigate health-related complaints from residents, their families, and other members of the public. "Health" is broadly defined, as is evident in the 180-some items on the checklist. Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents' rights and quality of life, and proper skin care. A home's rating is based on the number of deficiencies, their seriousness, and their scope, meaning the relative number of residents who were or could have been affected. Deficiencies are counted that were identified during the three most recent health inspections and in investigations of public complaints in that time frame. State inspectors also check for compliance with fire safety rules, although their findings do not factor into the CMS ratings.

Nurse staffing. Even the best nursing care is not enough if there are too few nurses to spend much time with residents, so CMS determines average nursing time per patient per day. Homes report the average number of registered nurses, licensed practical nurses, licensed vocational nurses, and certified nurse aides who were on the payroll during the two weeks prior to the most recent health inspection and their number of hours worked. The information is compared with the average number of residents during the same period and crunched to determine the average number of minutes of nursing time residents got per day. 

Quality measures. Nursing homes have to furnish the latest three quarters of clinical data showing the status of each individual Medicare and Medicaid resident in 19 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair. The Best Nursing Homes rankings and Nursing Home Compare display data for each home on all 19. The ratings, however, are based on 10 that are considered the most valid and reliable, such as the two above and measures related to pain, bedsores, and mobility.

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Anderson Independent Mail posted an article by Lee Bowman and Thomas Hargrove/Scripps Howard News Service about a statistical analysis of the federal government’s first-ever ratings of nearly 16,000 nursing homes.  The study revealed some comon sense conclusions including an uneven level of quality across the nation and shows how complicated it is to find a good nursing home.

The Scripps Howard analysis of the Centers for Medicare and Medicaid Services’ Nursing Home Compare system shows that:

In Institutions run by for-profit corporations, which account for about two-thirds of all nursing homes, generally get lower scores than those run by nonprofits groups.

Homes with more nursing staff per patient, which also tend to be run by nonprofit groups, generally do better in the ratings.

Homes with more than 100 beds tend to get lower scores in all categories, including health of residents and levels of nursing care.

Ratings are lowest in Southern states, particularly for nursing care and registered-nurse staffing, and highest for homes in the Northeast.

Slightly more than 20 percent of nursing homes nationwide have been regularly given the lowest ratings, and 12 percent to 13 percent have received the top rating.   

While more than 500,000 Americans die in nursing homes each year, more than 2 million return home after a nursing-home stay of less than three months.

CMS collects data on all nursing homes that care for Medicare or Medicaid patients and displays the information at www.medicare.gov/NHCompare. The system, implemented late last year, includes everything from fire safety and food preparation to rates of residents suffering from bedsores.  Even CMS officials agree that while the same criteria are used for the inspections, the focus and depth of the assessments may be different from state to state, so the ratings of different facilities should not be compared across state lines.

The rating system is on a scale from one star to five stars. Five stars indicate that a nursing home ranks “much above average,” four stars are “above average,” three are “about average,” two are “below average” and one is “much below average.” Rankings are updated every three months, and some data are revamped monthly.

There are about 15,700 nursing facilities listed on Nursing Home Compare.

Health-care advocates say data on nursing-staff levels — self-reported by home administrators and including time spent on administrative chores as well as actual patient care — don’t give a clear picture of the care being provided.

“Even though we’re skeptical about some of the information, it’s the best starting point available for research,’' she said. “But people need to understand that the stars may not reflect what they’ll find inside a facility.   “Unfortunately, for many families, they’re lucky if they get 24 or 48 hours before a (hospital) discharge to make a decision. That’s not enough time to do much homework, but at least the ratings and the other information on the site might help you rule some facilities out.”
 

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