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

Contra Costa Times had an article about the class action lawsuit against Skilled Healthcare Group Inc that has been in trial for 7 months.  The case is to insure proper staffing in nursing homes which benefit the residents and the overworked employees of the nursing home.  The main issue in the trial is how to properly count the number of hours a person works.

Skilled Healthcare, along with its subsidiary Skilled Healthcare LLC, owns 22 nursing homes currently under scrutiny.  Whether the nursing homes maintained staffing levels required by the state is at the heart of the trial, which lasted more than 100 days. California law mandates that nursing homes provide a minimum of 3.2 hours of care per resident, per day.

One of the plaintiffs' attorneys, Michael Thamer, who specializes in corporate abuse, said that the case is not about documents, but a matter of patients getting their needs met. Thamer said that if one thing controls the activities of a major corporation, it is the budget.

”The message from the top is simple: Stay beneath the budget,” Thamer said in his closing argument before making way for Wroten. “This corporate greed is what has kept the defendant from adequately staffing their facilities.”

Skilled Healthcare, which filed for bankruptcy in 2001, has been growing steadily over the past five years. The company has since bought up nursing homes in Texas, Kansas, Illinois, Missouri, New Mexico, Nevada and California.

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Here is another article (from The Orange county Register) about how nursing homes used increased funding to pad their bottom line instead of increasing staffing.  Nursing homes were supposed to use the increased funding to hire more staff and increase the hours per patient.  One again, greed and profits take precedence over the care provided to nursing home residents.

Covenant Care's facilities are among hundreds of California skilled-care centers that received $880 million in additional compensation from the state since 2004 to increase staffing and wages at homes that serve Medi-Cal patients. An analysis by the non-profit newsroom California Watch found that 232 of those homes statewide slashed staff and let nursing ratios fall below the state minimum despite receiving the additional funds.

St. Edna and 12 other homes run by the Aliso Viejo-based Coventant chain were among those that stood out: They accepted $15 million in additional compensation from the state but still cut caregivers, California Watch found. Meanwhile, Covenant Care rewarded facility leaders with bonuses based, in part, on new profits.

The company's marketing promises the "highest quality of care" and a staff that treats consumers as "family." But St. Edna's overall service is rated "much below average" on the California Department of Public Health website – the lowest rating given. Staffing at the facility fell 5 percent between 2004 and 2008, settling below the state minimum of 3.2 hours per patient.

St. Edna received 119 citations and warnings over the past three years, compared with a state average of 54.

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There were several articles the past couple of weeks regarding Illinois' new  law improving the safety and staffing in nursing homes. Lawmakers unanimously approved legislation that would raise the standards of care and safety in Illinois' troubled nursing homes. See articles from the Chicago Tribune here and here.  The law reflects the 38 recommendations of Quinn's Nursing Home Safety Task Force, which was formed last fall in response to a Tribune investigation into attacks, rapes and murders in the subset of facilities that mix aggressive and vulnerable residents.

The law would require nursing homes to increase staffing levels, meet higher standards before admitting patients with serious mental illness, tighten existing criminal background checks, psychological screenings of incoming nursing home residents, and segregate the most dangerous residents in secure units where they should receive more monitoring and treatment. 

Among the bill's other key provisions is a mandate that nursing homes admitting people with serious mental illness obtain a new certification demonstrating that they can and will effectively monitor and treat those residents. The new standards for those homes would require the homes to have sufficient staff, including psychiatric professionals, on a 24-hour basis; training of staff on "managing aggression and crisis prevention"; and substance abuse programs.

The bill also would establish a database that would track violent incidents inside the homes. It would add safeguards to ensure the informed consent of residents administered psychotropic drugs. And it would expand the state's ability to deny operators permits to open new homes if they run facilities that have repeatedly violated safety standards.

Lobbyists for the nursing home industry agreed to increase nursing staff levels in the next four years to 3.8 hours of daily nursing care for each resident who needs skilled care, up from the current minimum of 2.5 hours. Quinn's task force had recommended 4.1 hours.

It took tense negotiations and an eleventh-hour deal to strike a historic bill that aims to undo a half-century of failed policies and end a legacy of violence in which nursing home residents were raped, assaulted and murdered.

I wish South Carolina lawmakers were open to the idea of protecting residents and reforming nursing home care.

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Chicago Tribune ran an article about the federal investigation into another corrupt business scheme involving nursing home operators.  Dr. Roland Borrasi told co-workers he made cash payoffs to prominent nursing home operators in exchange for access to a lucrative pool of patients.  Federal prosecutors, who last year secured the conviction of Borrasi for taking more than $500,000 in kickbacks from Rock Creek, did not specify which nursing home operators Borrasi allegedly paid.  The article centers around the greedy Esformeses and their relationship to Borrasi.  The Esformeses were part of a group of "businessmen" that previously paid the U.S. Justice Department $15.4 million to settle civil claims of kickbacks and health care fraud stemming from a Florida patient-brokering case. They deny wrongdoing though. 

Lynn Madeja, Borrasi's medical biller and mistress, told government agents that Borrasi had said: "I got to give Philip [Esformes] $1,000 or $10,000." To use Esformes' patients, Borrasi told her, he "had to make it up" with cash, said Madeja, who assisted authorities in their investigation. Borrasi said "it was Esformes' way or no way," Madeja's statement said.

In addition, the medical director of Rock Creek Center psychiatric hospital, Dr. Naseem Chaudhry, told federal agents about a conversation in which Borrasi allegedly said he was upset because Rock Creek owed him $200,000. "He was concerned because he needed to give half of it to Esformes," Chaudhry said. Chaudhry pleaded guilty Wednesday to a count of health care fraud.

Abhin Singla, a member of Borrasi's medical group, told investigators "Esformes controls the flow of patients in and out of his nursing homes to ensure that he is receiving the maximum allowed benefit."   Singla was with Borrasi when Esformes called and told Borrasi to admit at least five nursing home patients to various hospitals. Borrasi quickly did so without asking about their conditions.  Borrasi told Singla "someone would find something wrong with the patients to justify the admissions," Singla said.   Singla stepped forward to help because he was appalled by the "fraudulent use of public health care dollars and compromise to patient care."

Esformes, who operates nursing homes Florida as well as Illinois, denies invovlement but his attorney attacked everyone's credibility.   One of Esformes' numerous defense attorneys, Michael Pasano argued that "Borrasi stands convicted," and the co-workers who quote him had no direct knowledge of any a lleged payments and are biased and "lack credibility,".

But former Rock Creek discharge planner and social worker Kimberly Reevas, who helped authorities unravel the scheme, told agents Philip Esformes was often at the hospital and was deeply involved with hospital staff in steering patients to his facilities.

At one meeting, Reevas said, Esformes explained to Rock Creek social workers the type of patients they should send to each of his nursing homes. According to Reevas, "Esformes further instructed the social workers to only send patients with public aid, public aid pending, disability, or Medicare."

 Clearly they were gaming the system and were more concerned by maximum profit and greed then the care provided by the overworked and underappreciated staff.
 

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The Indianapolis Star has found that many of Indiana's nursing homes employ fewer critical staff members than are needed to care for their residents. The newspaper found that staffing levels are low at the state's large number of for-profit nursing homes. The Star also found that those for-profit nursing homes dominate the ranks of Indiana's most poorly performing homes.

The newspaper reviewed thousands of pages of nursing home documents and analyzed data compiled by regulators and provided by the industry.  Its investigation found a system that tolerates nursing homes that skimp on quality to maintain profits. It found that pay and benefits are low, especially in for-profit homes.

State lawmakers should initiate minimum staffing requirements. The amount of time certified nursing assistants spend with residents in Indiana is less than in any other state and the District of Columbia. The Star said that the number of hours these critical caregivers -- the ones who must get residents into wheelchairs, bathe them, change their bedding and feed them -- devote to each resident is just 15 a week. Their tasks are so grueling and pay and benefits so low, the turnover rate for nursing assistants in Indiana is a stunning 93 percent annually.  Lack of adequate staffing may have been a contributing factor in a South Bend nursing home where staff failed to keep a cut on woman's leg clean. The Star reported the leg became so infected it had to be amputated. The woman later died from the infection.

The South Bend Tribune had an editorial opinion about Indiana nursing homes.  The editorial bemoans the lack of quality care provided in a majority of nursing homes in Indiana. The editorial emphasizes regulatory oversight and enforcement to turn around the sad state of long-term care in Indiana.  Enforcement of existing state and federal regulations is an issue that can and should immediately be addressed. Efforts to ensure compliance with regulations have eroded. Financial penalties so often are reduced on appeal that breaking the rules makes more profit than following them.

28 percent of Indiana's nursing homes were assessed the lowest overall rating. It placed Indiana among the 10 worst states in the nation. St. Joseph County ranked even more poorly than the state as a whole. Now, overall conditions for 40,000 of the most fragile Hoosiers appear even more bleak. The system requires a complete overhaul.

A Government Accounting Office report released last August identified 52 Indiana nursing homes, or about 10 percent of all those in the state, among the 580 "most poorly performing" in the nation. Not a single long-term care facility was decertified in 2008, the final year covered in the dismal GAO report.

During a five-year period ending in 2008, state health inspectors said the percentage of Indiana homes cited for problems that placed residents in jeopardy or resulted in actual harm grew from 32 percent to 45 percent -- nearly twice the national average.

State regulation that fails to standardize good care defrauds the public. It is unconscionable that legislators continue to ignore the scandal.   The standards for protecting the health and safety of long-term care residents are, indefensibly, lower than those aimed at the well-being of the rest of us. When a patient claims abuse, for example, police aren't typically called and an investigation may not even begin for a week or more. REAL Services notes an area nursing home kitchen was granted 30 days to clean up mouse feces in food; it wasn't shut down like we'd expect a restaurant would be.

Medicaid, funded by state and federal dollars, picks up about two-thirds of the annual $1 billion cost of long-term care in Indiana. The needs of those whose personal welfare is at stake must be considered as seriously as the wishes of the state's powerful nursing home lobby. 

If there is to be improvement, the state must intervene forcefully. Indiana must address these life-and-death issues. The pressure on families, care providers and government can only increase as the baby boomers age. Failure to act would be shameful.
 

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L.A. Times had an article about the obvious importance of staffing in providing quality care in nursing homes.  The cornerstone to quality care in a nursing home is staffing.  Those with larger staffs tend to have less turnover, more stability and are more likely to meet the needs of all the residents.

"There is some very persuasive data showing staff simply can't perform all of the responsibilities they have unless there is an adequate ratio of staff to residents," says Janet Wells, policy director for the National Citizen's Coalition for Nursing Home Reform, a reform-activist-advocacy organization.  Homes should be staffed to provide at least 3 1/2 to four hours of care per resident in a 24-hour period, says Larry Minnix, chief executive of the American Assn. of Homes and Services for the Aging, a nonprofit organization that represents not-for-profit elder-care facilities. Some may need to offer four to five hours daily depending on the conditions of the residents.

To assess staffing levels, Pat McGinnis, executive director of California Advocates for Nursing Home Reform, recommends visiting at a time when a facility is most likely to have maximum staff on duty (like at lunch, the biggest meal of the day).  Telltale signs of understaffing include diners with food trays who are not eating because they are not receiving necessary assistance, residents sitting idly in common areas or their rooms with nothing to hold their attention, call buttons going unanswered, and development of pressure ulvers.

Visiting during mealtime is also a good way to gauge food quality. Weight loss can be dangerous to the elderly, so food should look and smell appetizing.  Some of the more progressive homes have buffet lines rather than the "school lunchroom program," in which residents shuffle through with trays, Minnix says. "Food is the most looked-forward-to institution for many people, especially those confined to a home," he says. "You should ask about snacks and what kind of weight loss-weight gain program they have."

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Heather Johnson was kind enough to write a guest post for the blog.  We thank her for her contribution, and appreciate her expert advice.

How to Pick a Nursing Home for an Alzheimer’s Patient

Any family that’s been afflicted by having a member stricken by Alzheimer’s disease knows how immensely difficult and trying it can be. Many times it’s so hard because the person with Alzheimer’s disease is in perfect physical health. This makes the family so much more hesitant to put the relative in a nursing home because it seems like nothing is wrong and we want to believe that. However, we also know that as the disease progresses they can’t perform the daily activities safely and responsibly. It puts such a strain on the family that eventually the only choice is to look for a nursing home. This brings up the major issue of finding a place that can provide the care we demand. It can be an arduous search and here a few tips to help you as you look for that special place:

1. Staff ratios are of the utmost importance. Alzheimer’s disease patients need more direct care than your standard nursing home. Given the unpredictability of the disease and the actions of the afflicted it’s dire that they receive as much dedicated care as possible. Make sure the facility can guarantee at least a ratio of five patients to one caregiver.

2. Pay attention to the building’s architecture. Many Alzheimer’s disease patients have trouble making sharp corners. They do better with rounded hallways that don’t require sharp turns. All hallways should have hand railings to further assist patients with walking.

3. Group activities are important. Check to see that the facility offers small group activities instead of large ones. Alzheimer’s disease patients react much more favorably to working in groups under four than they do in larger groups.

4. Talk to relatives with family members already in the facility. This is sometimes the best way you can determine if the facility is the right place for your loved one. They will shoot you straight and answer your questions directly and honestly instead of a coordinator who needs to toe the company line and always put a positive spin on the facility’s deficiencies.

5. Discover what kind of experiences the patients can expect. There are many new techniques that some nursing homes offer their patients that help alleviate some of the accompanying discomforts that go hand-in-hand with those who suffer from Alzheimer’s disease. Aromatherapy and experimenting with dimmer lighting are a couple examples of ways nursing home deal with the anxiety that many suffer from on a daily basis.

By-line:

This post was contributed by Heather Johnson, who writes on the subject of Cruise Ship Nursing. She invites your feedback at heatherjohnson2323@gmail.com.

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