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

The Chicago Tribune had an article based on the article in the Des Moines Register about the story of a nursing home resident with brain damage.  A hospital has sued the nursing home that transferred the brain-damaged patient and then refused to take him back.   Broadlawns Medical Center officials say the nursing home transferred patient Edward Weatherman to the hospital in October 2008. Weatherman was debilitated by brain damage from an accident four years before his death in May 2009 at age 56. Broadlawns' lawsuit says the nursing home sent him to the taxpayer-supported hospital for stabilization after he "suffered an episode of dementia and combativeness."   Broadlawns officials say when Weatherman's condition improved, the nursing home wouldn't take him back. He died earlier this year. The suit seeks $76,000 in reimbursement for the hospital's costs, plus punitive damages.

Now, the Iowa Department of Inspections and Appeals is looking into the allegation that Granger Nursing and Rehabilitation Center broke state and federal laws regarding patient transfers.

An independent advocate for patients said incidents like the one that happened at Broadlawns are becoming more common amid a shortage of proper facilities for Iowans with serious disabilities or mental disorders.

Weatherman winded up at the Granger nursing home in early 2008. She said the administration  wasn't satisfied with payments from Medicaid and Medicare, public insurance plans that covered his costs.  Several times during his stay at the Granger nursing home, Edward Weatherman needed to go to a hospital to have his medications adjusted. His sister said he normally went to Mercy Medical Center in Des Moines, which is a private facility. But then nursing-home staff members told her they were sending him to Broadlawns, a public hospital.

"I said, 'What? Why is he going to Broadlawns?' " she said. "They didn't really have an answer."

Lora Weatherman said she wanted her brother to go to Mercy because his records were there. She said the nursing home overruled her wishes, even though she was his legal guardian. She said Broadlawns staff members called her about a week later and said that her brother was ready to return to the nursing home, but that the nursing home wouldn't take him.

"I went to the nursing home, and no one would talk to me," she said. By the time she got there, the staff had his belongings packed, she said. A janitor helped her carry them to her car.

Lora Weatherman said her brother spent most of his last months in Broadlawns' psychiatric wing, even though he didn't have psychiatric problems. She was glad to hear this week that the hospital was suing the nursing home for its actions.

"People shouldn't be treated like that," she said.

Werning said nursing homes may only discharge residents for one of three reasons: if the patients can't pay for their care; if the patients become violent; or if the patients' symptoms deteriorate beyond the facility's ability to care for them.

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KRGV.com out of Texas had an article about a resident who was evicted and abandoned by his nursing home and left outdoors for hours. Bonifacio Rodriguez was left sitting on his front porch  when a neighbor discovered him.  The neighbor says a nursing home van dropped him off at his ex-wife's house, but there was nobody home at the time. Fortunately, she notified the police and tracked down his family. His daughter was shocked.

Jennifer Leon says, "My dad got three strokes, he always walks with holding his hand. He doesn't have that much balance. He could have fallen. If he'd walked he could have fallen. What would have happened?"  Rodriguez's daughter says she's filing a complaint with the state.

An administrator at the Village Care Center, where Rodriguez was a resident says, “The nursing home puts medical and physical safety as their top concern."   Yeah, right.

There was another article in WPTC.com out of Florida about a ManorCare nursing home trying to evict a resident who suffered a stroke.   According to witnesses ManorCare did exactly what it said it was going to do and loaded up Thai Hodges and drove her to the Westgate Tabernacle homeless shelter at night.   Fortunately, the shelter refused to allow the nursing home to dump her there.

Her daughter, 27-year-old Alexis Hodges, just got out of the Navy and was living in Virginia. Out of the blue she says she received a call from the Boynton Beach Nursing Home where her mother is staying and the facility said she had to go immediately.

"They said very heartlessly that it wasn't their problem," Hodges said. "They said she wasn't staying there another night...that was going to be it."   Hodges said her mother Thai is only 55 years old and, up until July, had been a surgical coordinator at a local hospital. But she suffered a stroke and has since been paralyzed.

"I begged and pleaded with them to give me a few days to find some place for her," Hodges said.

"I'm concerned now with her safety and her care and how its going to be," she said.

What's worse is Westgate Tabernacle said this kind of abandonment is not uncommon- and is only getting worse. "Hospital dumps is what we call them," Negley said "I've seen people wheeled in here in a wheelchair, placed on a chair and then they take the wheelchair away."

Hodges said the hospital that treated her mother- Bethesda Memorial-originally sent her to ManorCare.

ManorCare was given a two out of a five star rating from the Center for Medicare and Medicaid.

ManorCare's Delray Beach facility received only a one star.

 

 

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The West Virginia Gazette had an interesting article on a nursing home's attempt to evict a mentally ill resident from the facility.  The judge has ruled that 77-year-old Helen Shank gets to stay at Golden Living Center in Morgantown...for now.  Medicaid must continue providing nursing home care for Shank, who is mentally ill and also a "brittle diabetic".

West Virginia Department of Health and Human Services tried to take federal Medicaid benefits away from Shank, despite recommendations by several of her physicians and psychiatrists. 
Shank has lived in the Golden Living Center since October 2004. But last year, a DHHR evaluator said she no longer qualified for nursing home care.

Dr. Ward Paine, a physician who treated Shank at the Golden Living Center, said she would be at a "very high risk of hospitalization" if she were released from the home.  Others agreed, including: Dr. Pamela Sullivan, another physician who saw Shank, and Dr. Janis Boury, a psychologist and case manager who gave Shank a mental-health evaluation in June 2008.  Dr. Logan Graddy, a psychiatrist at West Virginia University Hospital, diagnosed Shank as suffering from developing dementia, "a severe, persistent and progressive psychiatric illness."

In his ruling, Judge Kaufman wrote, "The U.S. Congress defined a nursing facility as an institution which is primarily engaged in providing ... health-related care and services to individuals who because of their mental or physical conditions require care and services which can be made available to them only though institutional facilities."   Shank's failure to meet "the minimum five daily living deficits," which do not include any psychological problems, does not make her ineligible to receive Medicaid benefits under federal guidelines, Kaufman ruled.

Once again, the nursing home industry proves that they are more concerned about making money than providing the care thier residents need.

 

 

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NJ.com had an interesting article discussing how nursing homes are dumping Medicaid residents after the residents spend their life savings on care and treatment.   The article mentions May Hunish whose family decided to move her to the Maurice House, an assisted living facility in Millville, because after spending her $150,000 in savings on rent and care, they could ultimately switch to Medicaid to continue paying for her stay.  But in the spring of 2007, after spending nearly all of her savings and applying for Medicaid, things changed. Officials at the Maurice House told the former Bridgeton resident that she would have to move to a smaller space or leave.   While in the hospital for a fracture after a preventable fall caused by the home's neglect, she got an eviction notice the company operating the Maurice House said it would not accept Medicaid and she was being discharged for non-payment.  Four days later, Hunish died.

According to state officials, Hunish wasn't the only person forced out of a facility by Wisconsin-based Assisted Living Concepts Inc. (ALC) while attempting to switch to Medicaid, even after the company promised that they could.   The New Jersey Public Advocate issued a report that found that the company, which operates eight assisted living facilities in southern New Jersey, evicted, or threatened with eviction, dozens of residents who tried to switch to Medicaid after spending down their life savings all in an effort to boost shareholder profits.

From interviews with 111 current and former facility residents and their families, the department found that officials at the facilities routinely told tenants that they could switch to Medicaid and would not be evicted, including residents that would likely be ineligible for Medicaid, a government-administered program offered to residents with low-income or low-resources.   The public advocate said the company was deceptive and its actions caused residents to suffer "financial, physical, and emotional harm as a result."

"The bottom line: the company pursued a policy of keeping elderly residents until they drained their life savings, and then washed their hands of them," said state Public Advocate Ronald K. Chen.  According to state figures, a private pay resident would pay $3,390 a month at one of ALCs facilities; comparably, ALC would receive $2,780 for a Medicaid resident, under 2007 rates.

The Public Advocate's office was alerted to the company practice through resident complaints to the state's ombudsman. Officials there have been working with the state Department of Health and Senior Services, which determined that discharging residents violated the "certificates of need" for the eight facilities, part of the licensing process in which the company stated in writing that it would not ask residents to leave because of "spend-down situations," state officials said.

 

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Seattle Post Intelligencer had an article about the recent increases in evictions in nursing homes.
Contact the Washington Long-Term Care Ombudsman program, call 800-562-6028, or visit ltcop.org/index.htm if you need help.  The article reveals one example where a woman was evicting and died shortly after being evicted.  Henderer grew depressed and refused to leave her room for meals. As her move approached, she quietly asked her guardian: "Why can't I just die here?"  Three days after moving out, Henderer's congestive heart failure worsened. A month later, she died.

Health care costs rise (along with corporate profits) despite Medicaid rates not increasing.  Quality of care gets compromised and nursing homes are forcing out sick, elderly and frail residents who cut into profits because they are too expensive to care for.  No official data exist on eviction counts, but discharge complaints have climbed to record highs.

The Washington Long-Term Care Ombudsman program handled more than 700 such complaints last year, nearly a 50 percent increase over the year before. Nationally, discharge-related complaints have more than doubled in a decade -- to 12,000 in 2007, according to the U.S. Administration on Aging.

Another woman evicted from West Woods wandered outside one night before her move, barefoot and in a nightgown, saying she wanted "to fall down and die in the cold," Ryan said.

In Grays Harbor County last year, an evicted mentally ill man left his boarding home a week after moving in, and was found dead near some railroad tracks. In other areas, evicted residents have ended up in homes nearly a hundred miles away from loved ones.

In 2007, Seattle University forced out 115 residents when it decided to convert its nursing home into office and class space. Three months later, 14 of the residents had died.

Social workers have a name for such a swift decline after a move: "transfer trauma."

Homes can legally evict a resident who fails to pay, becomes dangerous or has needs a home can't meet.   Federal law bars nursing homes from kicking out residents solely because of Medicaid so they often find some other excuse. Advocates say many homes find ways to bend the laws such as the broad "can't meet needs" reason to force out difficult or expensive residents.

One of the most common types of eviction is when homes send a resident to the hospital and refuse to take him back, in a practice that resident advocates call "dumping."  Advocates say that dumping rarely occurs to private-pay people, but to Medicaid residents such as Florence Wade, who had lived at the Regency at Tacoma Rehabilitation Center for roughly three years.

In January, Wade, 85, went to the hospital for pneumonia and a urinary tract infection. The nursing home refused to take her back, saying she had been uncooperative with caregivers in using a hydraulic lift to move her.   The home then accused her of not doing a "bed hold" -- which she never had to do in the past -- and said the room was gone anyway. Someone else had moved in. The eviction left Arnold with one stressful option: a nursing home 45 minutes away -- too far for regular visits from friends and family.

With assisted living costing residents $3,000 to $6,000 a month, and nursing homes costing up to $10,000 a month, homes still claim they lose money on each Medicaid resident. On average the state pays out about $5,000 a month for a nursing home resident,

 

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WBALTV.com had a story about a nursing home patient who was threatened with eviction from her facility because she couldn't pay her bill has been allowed to stay.  The WBAL TV 11 News I-Team detailed the story of Melanie Conaway, a multiple sclerosis patient. A nursing home called Future Care Northpoint in Dundalk was about to discharge her against her wishes because of an alleged outstanding bill.

Conaway said she wondered about her future, where she would live and who would handle her health care needs. "There is nothing I can do," Melanie Conaway told I-Team reporter Barry Simms on Thursday. "All they did was come in and say they haven't received the full payment, so I can't stay here any longer."  But under a last-minute settlement, Conaway will remain at the nursing home.

The whole dispute focused on a $300 a month payment -- alimony Conaway is supposed to receive from a divorce settlement. The funds are considered income and must be used for her nursing home stay, Simms reported.

By law, Future Care may have the legal (but not the moral) right to evict Conaway because the unpaid debt had grown to $2,500, but the nursing home finally agreed (after the story went public) to give Legal Aid time to pursue a claim against her ex-husband and possibly garnish his wages.

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The Honolulu Advisor had a terrible story about a nursing home resident evicted and left at the emergency room of a hospital days before Christmas.  The 81-year-old woman was confined to a wheelchair wearing only a hospital gown.

Florence Ko told The Advertiser she had no idea what was happening and where she would be staying when she was taken from Nu'uanu Hale, where she had lived since July 2007.  "I wish someone (at the nursing home) had the courage to tell me what was going on," Ko said in a brief interview last week from her bed at the 'Aiea facility.

When she was left at Straub, Ko had no personal belongings except her purse, which contained less than $3 and her cell phone — but not the charger, according to members of her church who have been helping her.

The Department of Human Services, the agency that investigates elder abuse, called Nu'uanu Hale's actions inappropriate and was referring the matter to the Department of Health, which licenses Hawai'i nursing homes.

Nu'uanu Hale was one of six Hawai'i nursing homes last month to receive the poorest rating possible from the federal government in a newly created system for publicly assessing quality of care at the nation's roughly 16,000 homes. The nursing home received a single star out of a possible five.

First Unitarian members, who have been helping Ko in recent years as she became increasingly less mobile because of polio-related ailments, and the family have been trying to get Medicaid to cover Ko's long-term-care bills, just as the government insurance program does to some degree for income-eligible seniors, the church members said. Ko's application, however, has twice been rejected, they said. Even though she received regular income from Social Security and an annuity, the amount wasn't enough to cover her nursing-home tab. 

Church members said they were told Ko was taken to Straub to get treatment for an anxiety problem. While she was there, she used her cell phone, clearly upset about not knowing what was happening. But the line abruptly cut off during their conversation and the lay minister couldn't reach her friend after that.

Ko, an articulate, feisty woman with a head full of white hair and an occasional memory lapse, said she had thought her financial situation with Nu'uanu Hale was going to be resolved. Yet when she returned to her room after physical therapy on Dec. 17, her personal belongings had been piled on a gurney and people were cleaning her room, she said.

"To just kind of toss you out — that's it," she said. Later that day, Ko's belongings were placed under a tarp outside Nu'uanu Hale, where church members later retrieved them.

Because Ko's finances apparently did not allow her to qualify for Medicaid but were too little to cover her nursing-home tab, she is part of a growing "gap group" that increasingly will have a tough time affording the long-term care they need as they enter their 70s, 80s and 90s, experts say. 

 

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The Wall St. Journal had an article recently that made me think about the future of helath care when the baby boomers enter the nursing home industry.  Will there be a revolution in health care?  Will for profit chains dictate how the old and frail among us will conclude their lives? 

A nursing home in California wants to evict Jasmine Nguyen, a 32-year-old dependent on a ventilator to breathe and the facility's staff for her daily needs, and a dozen other residents in similar situations replacing them with short-term residents that bring more profit.

Across the country, nursing homes are forcing out frail and ill residents. While federal law permits nursing-home evictions in some circumstances, state officials and patient advocates say facilities often go too far, seeking to evict those who are merely inconvenient or too costly. Residents with dementia or demanding families are among the most vulnerable, particularly if -- like Ms. Nguyen and the other Lodi residents -- they depend on Medicaid to pay their bills, the officials and advocates say.

Assisted-living facilities have sprung up as alternatives for those who don't require nursing-home care but need assistance with things like taking medications or bathing and dressing. Each state regulates the industry differently, so eviction policies vary. But many states simply require facilities to give four- to six-weeks' notice, with no appeal guaranteed.

In Florida, for example, the state's 2,400 assisted-living facilities must give residents 45 days' notice before evicting them, but don't need to provide a reason or appeal process. 

No national figures on assisted-living evictions exist, but discharge-related complaints recorded by the federal Administration on Aging more than doubled in the decade before 2006, rising 177% -- nearly twice the growth for complaints overall.  Some attorneys are turning to federal fair-housing rules and the Americans with Disabilities Act to help assisted-living residents stay in their homes. They argue that those laws require all landlords, including assisted-living companies, to make reasonable accommodations for disabled residents, and prohibit them from evicting residents because their condition worsens.

And evictions may be even more widespread, since some eviction attempts are resolved without formal complaints. Residents may not know they can appeal or may be too ill to do so or fear retribution.  Federal law -- enforced by the states -- says residents can be discharged involuntarily for just six reasons: if they are well enough to go home; need care only available elsewhere; endanger the health of others; endanger the safety of others; fail to pay their bills; or if a facility closes its doors. Even so, nursing homes must give residents at least 30 days' notice, explain their appeal rights, and put together a plan to make sure the move doesn't harm them.

Even an orderly eviction can carry grave risks for the old and ill. Studies suggest "transfer trauma," or relocation-stress syndrome, can spur depression and weight loss and increase the risk of falls.

For example, the nursing home trying to evict Jasmine Nguyen, Lodi Memorial Hospital, told her and a dozen others that they would have to move by June 30 because the nonprofit organization was closing the facility -- for renovations.  All 13 residents were "sub-acute" patients, most of them dependent on ventilators or feeding tubes, or with other conditions requiring significant extra care.

Lodi Memorial told the state it planned to replace them with patients recently discharged from its hospital -- who typically require shorter-term care covered at a higher daily rate by private insurance or by Medicare. (Medicare pays for up to 100 days in a nursing home following a hospital stay of at least three days.)

In April, after Lodi Memorial sought state approval, administrators were told that they knew when accepting the sub-acute residents that they would need extensive care, probably for many years, and it couldn't simply stop. Moreover, the state said in a letter, "your facility is not ceasing to operate as you are not surrendering your license."

The nearest nursing home certified to care for patients like Ms. Nguyen is about two hours away with traffic, says Jasmine's 23-year-old sister, Mary. Their mother, Kim Nguyen, who runs the family nail salon in nearby Stockton, visits Jasmine twice a day.

 

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Dan Frith wrote the following blog article about improper evictions in nursing homes.  The Wall Street Journal ran an interesting article on August 7 about America's nursing homes wrongfully discharging residents. The article states that one in seven discharges from Washington, DC area nursing homes are improper.

Why are nursing homes wrongfully and illegally kicking out their residents? What else...money! You see most (approximately 70%) of nursing home residents are Medicaid beneficiaries and Medicaid sets the reimbursement rate for their stay. Medicare, which pays a higher rate, is usually only available for about 100 days of care in a nursing home. Nursing homes want the higher income provided by Medicare, long term care insurance, or private pay by the resident. They don't want the low rates paid by Medicaid.

Under federal law a resident can be discharged only for the following reasons:

1. The resident is well enough to go home.

2. The facility can no longer provide the care needed by the resident.

3. The resident is endangering the health or safety of others.

4. The facility closes its doors.

5. The resident (or Medicaid, Medicare, etc.) fails to pay the bills.

Know your rights. Don't let nursing homes kick out your loved ones just because they desire to make more money.

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William C. Lhotka of the St. louis Post-dispatch wrote an article about a Judge preventing a nursing home from evicting a resident from a nursing home.  Below is an excerpt of his article:

A judge has barred an Ellisville nursing home from discharging a resident in a billing dispute because of the possible traumatic effects of transferring her to another care facility.  The judge found for the family of Barbara H. Lindsay and against Bethesda Long Term Care Inc. which operates Bethesda Meadow.  The ruling means the nursing home cannot move Lindsay to another nursing home when Bethesda alleged Lindsay's family owed the company past due bills.

Lindsay's son Douglas contended that the bill was erroneous and that his mother was too fragile to move.   Jacqueline Levey, attorney for the Lindsays, argued before Vincent that "any nursing facility wishing to expel an elderly or disabled resident can simply manufacture a series of grossly inaccurate billing statements."

Bethesda lawyer James W. Erwin had contended that some billing errors by Bethesda didn't negate the failure of the Lindsay family to make payments.  On the day before the hearing in October, the Lindsay family paid its bill in full. Nonetheless, the nursing home proceeded with the discharge, said Levey, the family's lawyer.

Vincent cited medical testimony in his order that Barbara Lindsay "is very fragile and has very little strength." The judge said the nursing home provided no evidence that "a safe and orderly discharge could be accomplished."

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