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

USA Today had a great article on the excessive number of nursing homes that receive taxpayer money but refuse to meet the minimum requirements for quality of care.  The requirements are basic and necessary services, and fundamental safety and food standards. Personal hygiene, responding to call bells, fresh foods, hot water, taking vital signs, etc----basic stuff but because of greed and short-staffing one in five of the nation's 15,700 nursing homes have consistently received poor ratings for overall quality.

More than a quarter-million patients live in homes given another set of low scores within the past year, according to data released today by Medicare, which first released the star ratings of the nation's nursing homes in late 2008. The ratings are derived from inspections, complaint investigations and other data collected mostly in 2008 and 2009.

USA TODAY found that all 50 states and the District of Columbia have homes with poor ratings from one year to the next.  And dozens of those facilities are the only nursing homes for miles.

Late in the Bush administration, the Centers for Medicare & Medicaid Services began assigning nursing homes one to five stars for quality, staffing and health inspections, as well as an overall score. Nearly all homes that repeatedly received few overall stars — one or two stars — were owned by for-profit corporations, the data show.

"The issue is the owners have to take responsibility for the consequences" of poorly performing homes, says Larry Minnix, CEO of American Association of Homes and Services for the Aging.

The newspaper's analysis found the lowest-rated homes had an average of 14 deficiencies per facility, which can include quality-of-life measures and safety violations.

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The Billings Gazette had an article proving that for-profit nursing homes provide less quality care than non-profit nursing homes.  A disproportionate number of Montana nursing homes rated below average by the government are operated by for-profit corporations, an analysis shows.   Almost 60 percent of the state’s skilled-nursing facilities awarded one or two stars by Medicare are for-profit entities, according to information available on the government’s Nursing Home Compare Web site.  For profits tend to cut corners and decrease staffing for profit and bonuses.

Medicare rates nursing homes on a five-star scale using data collected during annual inspections. Facilities are also scored on their staffing levels and how they perform on certain quality measures. Some 26 of Montana’s 90 nursing homes earned one or two stars in the most recent analysis. One star is “much below average” and two stars is “below average,” according to Medicare. 

“I don’t think it means a lot,” said Jerry Smyle, vice president of operations for Lantis Enterprises Inc., which owns 12 for-profit nursing homes in Montana.

Of course, he doesn't.

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St. Louis Today had an article about a criminal enterprise masquerading as a nursing home.  Luckily they got caught and the company pleaded guilty to fraud and will pay $1.6 million in fines and restitution.

When the Texas-based Cathedral Rock Corp. bought 11 Missouri and Illinois nursing homes in 2001, owner and CEO C. Kent Harrington told employees that residents were the first priority and would get "extra-special treatment."

The real priority was packing elderly and disabled clients into those homes — including five in the St. Louis area that were understaffed and provided substandard care, according to court documents and federal prosecutors.   Until 2005, the services "were grossly inadequate" and represented "a complete failure of care," Assistant U.S. Attorney Dorothy McMurtry said in court.

It also settled a whistle-blower civil lawsuit filed by nurses in 2003 that triggered what officials said was a relatively rare criminal prosecution of a nursing home over poor care.

Five Cathedral Rock-owned companies that ran those homes agreed to pay $1 million in criminal fines and penalties, and $628,000 in the civil settlement.  The companies will be formally sentenced in April, likely to some term of probation in addition to the fines and penalties.  So no one is going to jail for defrauding the government, stealing from medicare and medicaid, and directly causing the deaths of dozens of residents!

Among the claims was that the homes' staff doctored patient charts, falsified drug records and failed to give necessary medications. Some residents suffered from bed sores. Others wandered away. One ended up on a roof. One was found days later. One died after falling from a window.  The homes were repeatedly cited by regulators, fined and penalized.   Officials said the homes filed corrective plans but then failed to comply or "misrepresented" their efforts to comply.

"FTB (fill the beds) is everything," read a 2004 e-mail from a Cathedral Rock regional vice president to another executive. "Whereas compliance is important and cost control is as well, CENSUS is to be your primary focus," the e-mail read.

In 2004, Cathedral Rock had 2,600 beds in 25 nursing homes and assisted-living facilities in Missouri, Illinois, Texas, Ohio and South Carolina, Harrington said at the time.

Its website currently lists 1,308 beds in 15 homes in Texas and New Mexico. A spokesman said it no longer operates facilities in Missouri or Illinois.

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I saw this press release from Brown University.  Interesting conclusions based on data.

Hispanic senior citizens are living in nursing homes in ever-increasing numbers, but they face a gap in their quality of care compared to white residents, according to new research from Brown University. 

A team led by Mary Fennell, professor of sociology and community health, found that Hispanic elderly are more likely than whites to live in nursing homes of poor quality. These residences are often faced with structural problems, staffing issues and financial trouble.

Details will be featured in the January 2010 edition of Health Affairs. The research follows up and expands upon a landmark 2007 study, also published in Health Affairs, suggesting that blacks are more likely than whites to live in poor-quality nursing homes. Vincent Mor, chair of the Department of Community Health, was a lead author in that study and is a co-author in the new work looking at nursing home care for Hispanics. Temple University was also a partner in the previous research.

Fennell said the paper is the first full-scale analysis of its kind to attempt to look broadly at Hispanics in nursing homes — what kind of nursing homes they live in and how care at those facilities compares to nursing homes which care mostly for white elderly people. She said the data revealed a sharp disparity in care.

"The most shocking finding is the pervasiveness of disparities in nursing home care that are primarily white, compared to nursing homes that are a mix of whites and Hispanic residences," Fennell said.

Fennell said the findings, in part, reflect a departure from prior patterns of elder care among Hispanic families in the United States. Traditionally, the group has used formal long-term care services less frequently than any other U.S. ethnic group. They had also been less likely than white or black residents to live in nursing homes. In Hispanic households, elder care has traditionally been handled by adult daughters at home, but acculturation and financial issues have forced a growing number of young Hispanic women into work outside the home.

As a result, Fennell said, the loss of home caregivers is occurring even as the growth of the elderly Hispanic population rises dramatically. The authors estimate that more than 5 percent of the current Hispanic population is elderly, a number that is expected to quadruple during the next 10 years. That number should rise to 4.5 million by 2010, according to Fennell and her team.

Fennell and her colleagues found that the overall use of nursing homes has declined since 1985, but the racial/ethnic mix of the national population of nursing home residents has shifted. From 2000 to 2005 — the period of data used in the study — the percent of Hispanic residents increased from 5 percent to 6.4 percent, but the percentage of non-Hispanic white residents dipped from just under 83 percent to 79.4 percent.

Nursing home residents are coming increasingly from the lower end of the socio-economic scale, Fennell said, lacking resources for better quality care in assisted living facilities or elsewhere.

Fennell argues that the impact of substandard nursing home care is a complex issue. Residents admitted to nursing homes have often already endured hospitalizations or a health issue that required expensive, high-level care. Once admitted, the individual is then often caught in a spiral of long-term lower quality of life, multiple episodes of poor health and ongoing chronic conditions without a way out.

"People with resources can get into very good places or alternatives for nursing home care," Fennell said. "Everyone else is left with not-very-good facilities that are not performing well."

Fennell is hoping that both federal and state policy-makers pay attention to the data as they shape health care reform policy.

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Lexington Herald-Leader had an article about Kentucky indicting nursing home employees for neglecting a resident and trying to cover it up.  A nurse and two nursing assistants have been indicted in connection with a case of neglect at Creekwood Place Nursing Home in Logan County.

One of the nursing assistants, Melissa L. Lyon, was trying to transfer a patient into bed on her own, even though the patient's care plan called for two people to lift the person.   As a result, the patient suffered a fractured leg.   After the incident, Lyon and the other nursing assistant, Destiny W. Duncan, "concealed the true facts of the incident," the news release says.

The nurse, Barbara A. Moore of Beechmont, "did not call a physician or family member or check on the victim, all of which caused the victim prolonged suffering and pain," the release states.  Each of the women was indicted on a single count of knowing abuse or neglect of an adult, a Class C felony. 

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Jackson Free Press had an interesting and scary article about presidential contender Haley Barbour's flip flopping on Medicare and history as a lobbyist and Tom Delay's indictment for illegal campaign donations.   When Haley Barbour was head of the Republican National Committee from 1993 to 1997, he loathed Medicare, and tried to gun it down in the GOP “Contract with America.”  By 2000, Barbour had returned to his lobbyist job at Barbour Griffith & Rogers, and had dramatically flip-flopped on Medicare, then lobbying for more federal tax dollars to be directed into the program. 

The Alliance for Quality Nursing Home Care Inc. was formed in 2000 as a corporate coalition of 14 of the country’s largest for-profit nursing home companies to help ease the way for the corporate consolidation of the nursing-home industry.   The coalition opposed Medicare cuts and government regulation of nursing-home standards and consolidation, and, perhaps most vitally, wanted low caps on the lawsuit damages the companies had to pay for abusing and neglecting nursing-home residents. The coalition paid top dollar to ensure the election of candidates who agreed with its agenda.   It directed impressive campaign donations to mostly Republican candidates around the country who would, in turn, honor the wishes of one of the country’s most tenacious industries.

That resolve is how a check for $100,000 written three years ago this week ended up illegally funding Republican candidates for the Texas statehouse.  That’s also how that canceled check ended as a primary exhibit in the case of State of Texas v. Thomas Dale Delay et al.

Unlike Mississippi, the state of Texas has long taken campaign-finance violations seriously, especially donations coming from outside the state to try to tell Texans what to do, and how to vote.  Violation is a felony, punishable by hefty fines and up to life in prison.

Rep. Tom Delay appears to have put considerable effort into circumventing that law. The former bug exterminator from Sugar Land became majority leader of the U.S. House of Representatives by his complicated web of political friends and family members including his own wife, Christine, and daughter, Danielle Ferro.

Delay has run a creative maze of schemes since the mid-1990s to get Republicans elected to office and “keep Republicans in lockstep,” using “threats and incentives,” as The Wall Street Journal characterized his style in June 2004.  He has been investigated five times and brought before the House Ethics Committee for his strong-arming of fellow members of Congress, trying to use donations to a children’s charity for a donor cruise, rewarding check-writers with face time with GOP stars, and other irregularities.

What prompted a grand jury of his home-state peers to indict him in September and again earlier this month on conspiracy and money laundering charges was his Texans for a Republican Majority Political Action Committee, known as TRMPAC.  Delay used the PAC to collect illegal corporate contributions (a third-degree felony) from January 2001 through the end of 2002 from corporations and then slip the money to 2002 candidates for the Texas statehouse (a first-degree felony). Much of the money was used to fund a last-minute campaign blitz—another violation of Texas law.

In return, the donors had a laundry list of demands—including tort reform and a blind eye to their consolidation plans.  The nursing-home industry, with its heavy reliance on government payouts for profits, is ripe for exploitation. And stories about the internal workings of nursing-homes aren’t exactly sexy enough for front page news.

“What we have seen is these corporations evolve to trying to shield themselves from liability or from paying taxes in such a way to finagle the law in ways no one imagined just a few years ago,” said Mississippi Rep. Jamie Franks, a lawyer and Democrat from Mooreville who is leading an effort to more closely monitor Mississippi’s nursing home industry.  “It’s amazing what high-dollar lawyers and high-dollar accountants can do.” He added: “And high-dollar lobbyists. You can throw that in there, too.”

What those high-dollar strategists did in 2000 was form the Alliance for Quality Nursing Home Care Inc., so that the industry giants—for-profit nursing homes that were members of the American Health Care Association—could pool their resources to overcome regulations regarding standard of care and limit lawsuit damages in as many states as possible and, ultimately, on the federal level in order to supersede state law.

The Alliance heavily lobbied the federal government to increase Medicare payments because for-profit nursing homes take more money from Medicare than Medicaid, which tends to sustain their competitors, the non-profit nursing homes. 

In October 2002, the Alliance invested in Delay’s scheme to pack the Texas statehouse (and thus Congress) writing a check for $100,000 to TRMPAC, dated Oct. 18 and signed by Alliance leader Stephen L. Guillard of Harborside Healthcare Corp. in Boston. On Oct. 21, Chris Winkle—then the chief executive of Mariner Health Care in Atlanta—met state Rep. Tom Craddick, R-Midland. They talked about the need to limit liability in lawsuits against nursing homes; then Winkle presented Craddick with the check, which TRMPAC deposited two days later. On Oct. 24, the Alliance contributed another $300,000 to the Texas Association of Business, an employers’ group that is now also under indictment in Texas for allegedly helping collect and launder illegal contributions.

After the 2002 election, in which 21 additional Republicans were elected to the Texas statehouse, Craddick became speaker of the Texas House of Representatives, and the Legislature quickly gave industry its desired “tort reform”—including $250,000 in non-economic damage caps and special provisions to shield nursing homes—that would become the model for industry efforts in other states, such as Mississippi in 2004 (which ended up compromising on $500,000 damage caps).

Ironically, it was one of the alleged conspirators who exposed the scam. The Texas Association of Business, or TAB, could hardly contain its glee over its success, reporting in a newsletter to members that it “blew the doors off the Nov. 5 election, using an unprecedented show of muscle that featured political contributions and a massive voter education drive.” And as the Wall Street Journal reported, its president, Bill Hammond, a former Texas legislator, bragged to the media that the group had used corporate money to finance a $2 million advertising campaign backing Delay’s slate of candidates.

Watchdog groups like Texans for Public Justice in Austin took notice and started following the money, ultimately finding that TRMPAC’s tax return showed that it had raised $1.5 million to help with the state races—and that $600,000 had come from corporate donations. Travis County District Attorney Ronnie Earle started investigating TRMPAC’s activities after Texans for Public Justice filed a complaint based on the revelations on the tax returns.

In September 2004, the indictments began when a Travis County grand jury handed down 32 indictment counts against TRMPAC and TAB and their leaders, as well as against eight companies that had supplied corporate funds, including State Farm Insurance, AT&T, the Union Pacific Railroad and the Alliance for Quality Nursing Home Care. On May 25, 2005, District Judge Joe Hart ruled in a civil case brought by 2002 Democratic candidates against TRMPAC that the use of corporate funds had violated the Texas Election Code.

On Sept. 28, 2005, the grand jury indicted Tom Delay and associates Jim Ellis and John Colyandro for conspiracy in the illegal scheme, and then on Oct. 3, a different grand jury indicted Delay on two new charges of money laundering.

Other friends of TRMPAC and its donors, such as now-Gov. Haley Barbour—who lobbied for the Alliance until he left his hefty stock in Barbour Griffith & Rogers in a reversible blind trust so he could take over the governor’s mansion in Mississippi—are distancing themselves from the beleaguered Alliance, if not from Delay.   It is not in dispute, that Barbour was lobbying in his client’s interest to block Medicare cuts at the same time that his client was presenting a $100,000 check to Craddick. (The $300,000 check from the Alliance to TAB followed a few days later.)

Andrew Wheat, the research director of Texans for Public Justice, balks at the idea that Barbour was not privy to the Alliance’s agenda—especially since his lobbying firm represented three of the corporate TRMPAC donors (the Alliance, Kindred Healthcare and Reliant Energy)—lobbying contracts worth $440,000 to Barbour Griffith & Rogers in 2002 alone. Barbour’s clients gave more money to TRMPAC than any of the other 10 lobbying firms who were represented. He was CEO of Barbour Griffth & Rogers and representing the nursing homes when the Alliance was created in 2000.

The Alliance’s agenda is one that is wreaking havoc in states like Texas, Arkansas and Mississippi, where its members control much of the nursing-home business and are now getting their way, thanks to a nationwide corporate realignment, consumer advocates say. The changes in the historically tightly regulated nursing-home industry are profound.

Franks points to the December 2004 sale of Mariner Health Care for $1.05 billion to National Senior Care, owned by New York real estate investor Harry Grunstein. Harry is Leonard Grunstein's brother.  Leonard Grunstein is partners with Murray Forman.  Harry sold Mariner’s assets to cover the costs of the acquisition, reducing the worth and assets of Mariner to $12 million and, critics say, operating the nursing homes more like rental units. “It basically became a real-estate transaction rather than a group caring for vulnerable adults,” Franks said. He added that, now, the nursing homes seem to be escaping accountability with these transfers. “There is no background check to find out whether they are financially solvent, or good corporate citizens. They simply transfer the license,” he said.

Because it is the licensee that is regulated, the process of stripping that licensee of its assets is essentially a tricky end run, allowing the real-estate owners, such as Grunstein, to escape liability. This, combined with the increased “tort reform” damage caps sought by the Alliance, insulates the corporate owners from the regulatory safeguards that are meant to protect patients and the elderly.   In turn, those licensees are now defaulting on money owed to vendors in states like Mississippi. And because assets are being ripped away from the nursing homes themselves, they end up with little to be sought in lawsuits brought by the vendors looking to be repaid.

One unpaid Mississippi vendor is the law firm Brunini, Grantham, Grower & Hewes in Jackson, which is suing Mariner for $951,915.17 in legal fees for defending the nursing homes. In the complaint, filed in Hinds County Chancery Court, Brunini describes Mariner’s “leveraged buyout” scheme, which it alleges is “fraudulent.”   Franks points to hearings in Arkansas, called by a Republican and a Democrat, that just concluded that the state has ended up with “no” regulatory power over these companies, due to their maneuvering. “This is not partisan,” Franks said. “It’s a consumer issue. It’s about protecting vulnerable citizens and our tax dollars.”

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McKnight's had an article about a decision in Colorado regarding the enforcement of an arbitration clause in a nursing home case.  The Colorado court ruled that a healthcare proxy does not have the authority to sign an arbitration agreement on behalf of a nursing home resident.  Under Colorado law, a healthcare proxy is only empowered to make medical decisions on behalf of another, including “provision, withholding, or withdrawal of any health care, medical procedure, including artificially provided nourishment and hydration, surgery, cardiopulmonary resuscitation, or service to maintain, diagnose, treat, or provide for a patient's physical or mental health or personal care,” the Bureau of National Affairs reported.

In the case of Lujan v. Life Care Centers of America, Colorado, Alvin Lujan signed an arbitration agreement, waiving jury trial rights, when admitting his mother, Estella Lujan, to the Life Care Centers of America nursing home. She died three days later, and a wrongful death claim was filed against the facility. Life Care Centers argued that admission to a nursing home is a medical decision and, therefore, the Colorado law applies.  But the Colorado Court of Appeals determined that the signing of an arbitration agreement does not fall under the specific definition of the authorities given to a healthcare proxy. As a result, the Lujan family had the right to sue the facility.

In October, the Nebraska Supreme Court arrived at a similar decision regarding the roll of patient surrogates
 

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There have been several articles about the recent sale of nursing homes by CapitalSource.  The articles are unclear about which nursing homes will be sold.  Below are links and information from several articles.

McKnight's wrote that CapitalSource, commercial lending company to many nursing home chains, will sell off its long-term care interests to Omega Healthcare Investors in a deal valued $860 million.   The sale covers a CapitalSource lease portfolio that includes 143 long-term care facilities.  Under the deal, Omega Healthcare Investors, which already owns or holds mortgages for 254 skilled nursing and assisted living facilities, will assume $529 million in asset-related debt, and give CapitalSource $280 million cash and $51 million in OHI stock.   A second article from McKnight states that CapitalSource Inc.,sold the last of its nursing home interests. This marks the company's exit from the skilled nursing ownership business.  The latest sale takes CapitalSource out of nursing home ownership, but it says it will continue to provide financing for owners and operators of long-term-care facilities.

CapitalSource sold the 37 nursing homes to an undisclosed buyer for an all-cash price of $100 million, the company said in a statement. The money will be used to pay down debts associated with the properties. The sale is part of a wider sale of its net lease portfolio, including the already disclosed divestiture of 143 skilled nursing facilities to Omega Healthcare Investors, Inc. CapitalSource will continue to provide financing for owners and operators in the long-term care industry, according to a company spokesman.

This final sale, along with the Omega sale and a Department of Housing and Urban Development mortgage financing deal, should net CapitalSource $495 million. The company said it would use these revenues to reduce the balance on its syndicated bank facility and add to overall company liquidity. The additional liquidity should put the company in a position to expand its healthcare lending franchise, the CapitalSource release said.

The Washington Post had an article on the sale stating that CapitalSource needed help to relieve the debt acquired during the recession.  CapitalSource is a specialty financing companies that has been hit hard by the credit crisis and the recession. Auditors at Bethesda-based American Capital issued an opinion earlier this year that the firm was in danger of not continuing as a business.  The company has disappointed analysts this year because of higher-than-expected losses on its loans to businesses and commercial real estate developers.

CapitalSource, which makes loans from $10 million to $100 million to nursing homes, said selling its 180 nursing homes is part of its transition to a bank. The company earlier this year changed its status from a publicly traded real estate investment trust to a bank.  James Pieczynski, who runs CapitalSource's health-care lending business, and Steven Museles, the company's chief legal officer, will become co-chief executives.

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NCCNHR (formerly the National Citizens' Coalition for Nursing Home Reform) is a 501(c)(3) nonprofit membership organization founded in 1975 by Elma L. Holder to protect the rights, safety and dignity of America's long-term care consumers.   NCCNHR issued the following Bulletin:

The health care reform bill passed by the House of Representativesbefore includes not only sweeping health insurance reforms but also nursing home transparency, criminal background checks on long-term care workers, and a voluntary payroll deduction system that would provide benefits for long-term care services. The bill, H.R. 3962, the Affordable Health Care for America Act, can be downloaded at http://thomas.loc.gov.

As expected, the bill includes-without amendment-nursing home transparency provisions requiring:

1)  Public disclosure of individuals and entities that own, govern, operate, finance, provide services to, and/or control the nation's nursing homes.

2)  Compliance and ethics programs and internal quality assurance programs in nursing homes, and pilot projects to test ways to improve oversight of chains.

3)  Collection and reporting of staffing information based on payroll data, including hours of care per resident day, turnover and retention rates, and facility expenditures for wages and benefits.

4)  A review of Nursing Home Compare and addition of information about sanctions against facilities and the number of adjudicated crimes occurring in them.

5)  A categorical breakdown of expenditures on cost reports to show how much facilities spend on direct care versus other expenses.

6)  An improved state complaint process to help protect complainants against retaliation.

7)  An increase in federal civil monetary penalties and a process to hold CMPs in escrow during appeals (although only after an independent informal dispute resolution process was completed).
8)  Adequate notification when facilities decided to close, including the option for the government to continue reimbursement until relocation was achieved.

9)  Training of nursing assistants in dementia care and abuse prevention.

10)  The bill would authorize a program of national criminal background checks on all long-term care workers who have access to residents or patients--from those who provide in-home long-term care services to nursing home employees.

H.R. 3962 also incorporates the Community Living Assistance Services and Supports (CLASS) Act to create a national voluntary social insurance system through which enrollees who became disabled (after paying into the system for at least five years) could purchase community-based long-term care, services or supports. Nursing home residents who were Medicaid beneficiaries could retain 5 percent of their benefit, in addition to their personal needs allowance, for their personal use while the remainder was applied to the cost of their care. (See page 1562 of the bill.)

Last-minute efforts to add the Elder Justice Act to H.R. 3962 were not successful. The EJA is in the health care reform bill passed by the Senate Finance Committee.

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There have been several articles about the lawsuit filed against Everett Rehabilitation and Care Center that neglected a resident's penis until it rotted off.  See articles here, here, and here.

A lawsuit has been filed against a Washington state nursing home accused of neglecting Charles Bradley's penile infection.   The lawsuit states that Bradley was taken to an emergency room, where doctors discovered his penis had decayed, leaving only a gaping wound. He died 18 days later, in March 2008.   The lawsuit cites an investigation by the state Department of Social and Health Services, which shows the nurse told a manager in November 2007 that the man had a wound on his penis. Staff noticed that Bradley's skin was breaking down while changing his diaper in November 2007.  The records say the manager forgot about the report and neglected to properly care for the wound.  Though staff notified a care manager, that manager failed to notify Bradley's doctor. Instead, the manager went on a three-week vacation and when she returned she forgot about the nurse's report.

Bradley's family claim staff at the nursing home left a wound on the elderly man untreated for months. Nursing home records allege that staff changed the man's diaper daily and provided him weekly baths between November 2007 and March 13, 2008.  During the four months that followed the initial notice of the wound, Bradley's genitals essentially broke apart bit by bit while the elderly man steadily lost weight.   By allowing Bradley's injury to fester and worsen for months, the nursing home and parent company SunBridge Healthcare Corp. violated a promise to care for him. "They trusted that the nursing home would provide the care they said they would provide," family spokesman said Wednesday. "We're not talking about extraordinary care. We're talking about basic daily needs."

An investigation conducted by the center's director of nursing "did not find any impropriety" by staff. State regulators, though, issued the center a citation for failing to meet quality of care requirements set by federal law.  The state determined that the home failed to meet a federal standard for care. The man didn't receive timely medical attention and the facility failed to notify his family or his doctor of changes in his health, the state determined. 

"There was no evidence the facility had contacted the resident's physician … to allow for timely medical intervention," the state investigators said in an investigatory report provided by DSHS. "There was no evidence the facility had contracted their social services department or the resident's family."  A financial penalty was not assessed.

“They definitely should have seen it. There was no documentation that his penis was beginning to fall off,” Gooding said. “We believe they chose not to put it in the records.”  Sounds like a cover up but no monetary fine was issued!

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