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

Lexington Herald Leader reported the guilty pleas of Moses Young, assistant director with the Office of Inspector General, and Sharon Harris, a state-employed nurse who covered up the inappropriate relationship and unethical behavior they had with at least one nursing home operator.  Kentucky investigators learned they each lived in Lexington homes owned by Ralph Stacey Jr.  At the time, Stacey owned Garrard Convalescent Home in Covington.

An April 1 indictment against Young alleged that Young lived rent-free from July 2005 to March 2008 in a condominium owned by a third party in violation of state ethics rules, identified in documents only as "R.S."  A plea agreement said Young admitted that he and others made bogus rent receipts and presented them to a federal grand jury. sIn exchange, the indictment alleged, Young provided R.S. with inside agency information and instructions that would assist R.S. in passing inspections and obtaining favorable treatment with regard to administrative actions of the Cabinet for Health and Family Services. In exchange for the guilty plea, prosecutors said they would drop the charge related to Young allegedly providing inside information.

In her plea agreement, Harris admitted that she had "watched as others fabricated the receipts to thwart a criminal investigation." Her plea agreement said she told an FBI agent in April 2009 that she knew the rent receipts Young provided were genuine because she had personally delivered the receipts over time to the landlord.

Why didn't they arrest Ralph Stacey for bribery or something?

 Maybe this article from the Kentucky Lexington Herald Leader explains why. The Herald-Leader examined the industry's campaign donations following stories earlier this summer that revealed systemic gaps in the state's handling of abuse and neglect cases at nursing homes.  The nursing home industry gave at least $1.8 million to Kentucky politicians over the last decade while lobbying against bills that would require them to hire more direct-care employees, face higher fines for violations and abide by stronger precautions against elder abuse, among others.

Nursing home reform bills usually are assigned to the House Health and Welfare Committee, where they perish.  Committee chairman Tom Burch is invested in a real estate trust that includes nursing homes. Burch's former House aide, Eric Clark, now is chief lobbyist for the Kentucky Association of Health Care Facilities, the group representing for-profit nursing homes, and runs its political action committee, which has given at least $90,750 in campaign donations since 2005.  U.S. Senate Republican Leader Mitch McConnell gets more of the industry's money than any other Kentucky politician, at least $266,350 over the last decade. McConnell does not support nursing home reform.

The Kentucky Association of Health Care Facilities gives annual awards to nursing homes that raise the most money for its political action committee, with special emphasis on companies that use payroll deduction to collect the money from employees.

In 2008, for instance, Barren County Health Center in Glasgow won an award from KAHCF for "most contributions raised overall per bed" for its region. That same year, the same nursing home received a Type A citation — the most serious — from the state after a resident choked to death on a fried chicken dinner.

Overall, KAHCF honored four nursing homes and consultants Wells Health Systems that year for their political fund-raising, according to the group's 2009-10 Membership Directory and Buyer's Guide.

The majority of the industry's campaign money goes to Kentucky's congressional delegation. The industry's national group, the American Health Care Association, reports spending more than $1.1 million so far this year lobbying Congress on Medicaid payments and rules that would require public disclosure of the size of nursing homes' direct-care staffs and how much they are paid, among other items.

Also, the Herald-Leader in July reported that Type A citations issued against nursing homes by the state sometimes sit in Conway's office or with local prosecutors for more than 18 months while officials decide whether to pursue criminal charges.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The AP had an article about the federal program that identifies problem nursing homes.  The program brings extra scrutiny to poorly performing nursing homes but leaves out hundreds of troubled facilities, investigators report.  The Centers for Medicare and Medicaid Services identifies up to 136 nursing homes as "special focus facilities" subject to more frequent inspections because of their living conditions. In every state except for Alaska, there are between one and six such facilities. But investigators said four times as many homes, or 580, should be considered among the nation's worst.

Sen. Herb Kohl, the chairman of the Senate Aging Committee, said it indicated to him that the special focus is too limited. At the least, he wants more explicit warnings about nursing homes as people study quality ratings on a Medicare Web site, Nursing Home Compare — http://www.medicare.gov/nhcompare

The report being released Monday also suggests adjusting the methods used to identify the worst performing nursing homes. The home now under special attention are the worst performing in their state. But not all states are created equal when it comes to nursing home quality. Comparing the homes nationally would ensure that scarce resources go to inspecting the nursing homes that truly need the most attention.

Some states have far more poorly performing nursing homes than are designated as special focus facilities.   Investigators also found that the worst-performing ones tend to be for-profit facilities affiliated with a chain of nursing homes. They are more likely to be a larger facility, averaging 102 residents, while other nursing homes not identified as among the worst had 89 residents on average.

Nationally, there are about 16,000 nursing homes. So the 580 homes that GAO describes as the worst-performing represents almost 4 percent of the nation's nursing homes.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

People always ask us why DHEC and other enforcement agencies don't fine facilities who neglect and abuse residents.  There is no one explanation.  Lack of enforcement tools.  Lack of qualified investigators.  Nursing home lobbying and campaign contributions.  Lack of media scrutiny.  I saw an article recently in the Journal Star discussing the limits placed on fines and the importance of monetary fines on quality of care and deterrence.  

The article starts with a simple proposition:  "When a nursing home resident's minor injury is left untreated and progresses to a major infection that ultimately kills her, the facility responsible should pay a stiff price.  When one resident beats another in a nursing home cafeteria because there's no staff member there to stop it, or when a male resident's catheter isn't checked and he gets a serious infection that still has him hospitalized, or when an octogenarian slides out of her wheelchair and is found dead with its seatbelt around her neck because nobody is watching, there ought to be fines that send a message that that's intolerable. And when a resident who takes a tumble complains of dizziness and head pain only to be told her problem will get checked out at an eye exam the next day, there ought to be strict accountability - especially when she ends up dying that next day."

That seems pretty straightforward and full of common sense but how do you decide what is a fair and reasonable fine?  Most states limit the amount of fines that a facility must pay.

A recent  ruling from a judge held that the Illinois Department of Public Health's is limited in fine amounts because State law appears to limit the fines the state can levy for these violations to $10,000 per incident.  The Legislature should amend state law to permit higher fines for abuse and/or neglect. The penalties must be severe enough that negligent nursing home operators will improve the conditions.

The article ends with some basic truths:  Most facilities are understaffed or suffering from burn out.  "Many homes don't staff above the minimal level required by the government, and the difference is often readily apparent. Adding to the problem is the high turnover rate in a workplace that can pay poorly yet require phenomenal dedication in bleak conditions. It's often worse in troubled facilities. It's a tough and trying job in the best of situations."

The residents of nursing homes are society's most vulnerable. They deserve a dignified and safe environment in which to live.   Increased fines, additional investigators, and improved staffing requirements would go a long way in providing the elderly and infirmed the care they need.

• Email This
• Print
• Comments
• Trackbacks
• Share Link