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

The State-Journal Register ran a story about the surprise visit at a Jacksonville nursing home.  More states should make random unannounced visits more often to check for violations of state law and regulations. The visit was the 11th such sweep in Illinois nursing homes in the past several months.  

Five former sex offenders were living at Golden Moments (among 50 residents) but were being housed in their own individual rooms, as required by a 2006 state law that required background checks of all residents.  Based on its own preliminary analysis of sex offenders’ backgrounds, the nursing home believes no one at Golden Moments is being put at risk by the ex-offenders’ presence.

Golden Moments was fined $50,000 by the state earlier this year for poor care connected with the Oct. 3 death of a 74-year-old resident who choked on food.

A Chicago Tribune series about rapes, attacks and murders at Illinois nursing homes proved that many residents with outstanding warrants were living in the facilities. The series prompted Gov. Pat Quinn to create a Nursing Home Safety Task Force, and the Illinois House and Senate have passed a bill designed to help reform the nursing home industry.

Senate Bill 326, which soon will be sent to Quinn’s desk for his signature, would set up a pilot project in which nursing home residents would be fingerprinted. That project would allow nursing homes to check on outstanding warrants.

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NBC Connecticut had a tragic article about the outrageous condition of West Rock Health Care Center in New Haven.  Inspections by state investigators uncovered deplorable living conditions.  The West Rock Health Care Center closed its doors on May 14 after the findings.

Anthony Pinto has owned West Rock Health Care since 1998, but last year he ran out of money and had to file for bankruptcy. Pinto blames the Department of Public Health for closing him down.  Inspections found 37 pages worth of violations. Patients were found in beds that were "unmade and with an accumulation of soiled sheets," according to the Department of Public Health.  Residents’ hair was found to be "quite greasy and unkempt," according to the state report. It found "the facility failed to ensure medications were administered timely for four of four residents reviewed." Linens that were worn thin and brown; boxes of medical records soaked in pooling water; and a nurse who cleaned an open ulcer with the same "fecal smeared washcloth" used to clean the patient.

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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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There were several articles about the lack of investigation by Texas regulators on nursing home complaints.  The Star-Telegram ran an article.  MySanAntonionews.com ran article.  Also American Statesman had one too.

Interviews with families and advocates and a review of thousands of pages of public records by the San Antonio Express-News show some of the city's most frail and vulnerable residents are suffering at the hands of their caregivers. Yet state officials allow troubled nursing homes to continue operating with little or no penalty.

The lack of oversight comes at a human cost. Elderly residents were left for hours in their own urine and feces. Infestations of cockroaches and rats plagued some facilities. Employees yelled insults at residents and handled them roughly. Nursing home staff stole medication and administered the wrong drugs to residents. State inspectors found dirty feeding tubes and broken medical equipment.

The state received nearly 16,200 reports of poor treatment last year in Texas, but most — about four out of five — were unsubstantiated by investigators, who often arrive at the nursing home weeks after receiving the complaint.   When investigators do cite facilities for serious problems, nursing home operators rarely face sanctions. In some cases, the state repeatedly threatened to suspend or revoke the licenses of facilities with chronic problems, yet Texas rarely took action against those nursing homes. Often, a facility promises to do better, state regulators back off, and problems crop up again in a troubling cycle.

Meanwhile, serious complaints against nursing homes have increased in Texas . Complaints about problems that put residents in “immediate jeopardy,” the most serious type of complaint, rose 26 percent since 2006, to more than 950. Complaints of “actual harm,” the second most urgent type of complaint, rose by 10 percent since 2006, to nearly 6,300.

Faced with alarming delays in investigating nursing home complaints, the state is creating teams to speed up scrutiny. State nursing home investigators blew their deadlines to investigate complaints of "high potential of harm" against residents in 66 percent of investigations in fiscal 2009.   In such complaints, mental, physical or psychosocial harm is possible, though not imminent, and an investigation must be initiated within 14 days. 

In response, the Texas Department of Aging and Disability Services will put together teams to speed the state's response. Next month, the department will begin to hire 35 new investigators.

Complaint investigation teams are being set up statewide. Made up of nurses, nutritionists, social workers and general investigators, the teams will be dedicated solely to conducting investigations of complaints and self-reported incidents.

This month, the department plans a two-week blitz to investigate 1,550 complaints at more than 300 facilities, a department spokeswoman said.

The department regulates 1,196 nursing homes statewide and investigated 16,200 complaints and incidents last year.

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The DesMoines Register had one of the most disturbing articles I have ever read.  Daniel Larmore is the chairman of the board that oversees Iowa's nursing home administrators.  That board is charged with licensing and disciplining Iowa's nursing home administrators — but it has taken no action against an administrator in two years.   He characterized the sexual abuse of a resident in his facility as a "meaningful" relationship that caused no harm to the resident.  How dare he say such an irresponsible thing.  Who the heck does he think he is.

Larmore was the administrator at the Harmony House care center in Waterloo.  State records show that Larmore himself faced allegations from the state inspectors in 2004 — and was never investigated or disciplined by the board.  The incident resulted in a $3,500 fine against the facility, a detailed report of the inspectors' findings should have been sent to the Iowa Department of Public Health, which would have passed the information on to the board for its review.  It is unclear whether Larmore's case was ever sent to the board for consideration. But Larmore has also acknowledged to the Register that the board failed to review some cases that were sent to the board for potential disciplinary action.

In June 2004, the Iowa Department of Inspections and Appeals alleged that Larmore failed to properly investigate and respond to complaints that a female nurse aide had repeatedly engaged in sex with a brain-injured, 29-year-old male resident of the home. The aide's co-workers had witnessed several suspicious encounters between the resident and the aide, and had reported their concerns to supervisors. At one point, the resident's roommate complained, saying the two seemed to be having sex on the other side of a privacy curtain.

State inspectors accused Larmore of making little effort to investigate the matter when an employee first voiced her suspicions. The state also alleged he failed to separate the resident and the aide once the complaints were made. The aide finally confessed to having sex with the resident.   In a written response to the state's allegations, Larmore argued that sex between the caregiver and the resident did not cause injury or harm to the resident.  The resident had a brain injury and clearly could not have given consent.

Larmore wrote: "The relationship was initiated by, and was meaningful to, (the resident). ... The presented situation was one of mutual interest of a (resident) and a caregiver and, although inappropriate, did not present potential or actual harm to the consumer due to the reciprocal fond relationship."

In Iowa, a professional caregiver who engages in sex with a nursing home resident can be criminally charged with dependent-adult abuse. Larmore acknowledged in his response to the state that after the first concerns were voiced about intimate or inappropriate contact between the resident and the aide, he didn't talk to other employees or to the victim. In May, before Larmore resigned as Harmony House administrator, he fired nurse aide Tina Turner, 29, for allegedly having sex with a resident of the home and providing the man with marijuana.

Turner denied the allegation. One of her co-workers alleged Turner confessed to disconnecting the man from his ventilator so he could inhale the drug, saying, "I didn't want to kill him or anything. I just wanted to get the dude high."
 

So this SOB covers up the sexaul assault of a brain damaged resident and fails to properly investigate of prevent it and he gets rewarded by becoming the chairman of the group that investigates Administrators?  Are you kidding me?
 

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The State Journal-Register had an interesting article about how Illinois is challenging a decision by a Sangamon County Judge Zappa that puts a $10,000 limit on nursing home fines, but the ruling already has affected dozens of cases statewide.  Zappa issued his ruling in a case involving Peoria’s Rosewood Care Center, which had appealed a $25,000 fine stemming from the death of 95-year-old Katherine Martin in 2006.  Zappa found that the department violated state law and bypassed administrative rules when it began to impose fines of more than $10,000 several years ago. He barred the department from enforcing fines of more than $10,000 in past cases that remained pending and any future cases.

Public Health officials believe state law allowed them to boost fines to $50,000 whenever they determined that bad care directly caused a resident’s death. The department in 2006 also began issuing fines of at least $20,000 when residents sustained serious injuries connected with bad care.  High fines rightly punish and deter bad behavior, and promote better care.

Fines involving 40 Illinois nursing homes have been reduced, with the facilities agreeing to pay $10,000 or less, since the Feb. 13 decision.  I bet the facilities jumped at the chance to pay less than $10,000.   State officials are considering reducing individual fines that exceed $10,000 in more than 80 other cases going back to 2006.

The Department of Public Health hasn’t decided yet how to proceed in a pending case against Woodstock Residence, now known as Crossroads Care Center, in which the Woodstock nursing home was fined $300,000 — a record level — in May 2008. State regulators have investigated five suspicious deaths there, as well as a former employee who allegedly used drug cocktails on residents.

The article cited a few examples of cases in which fines against nursing homes have been reduced to $10,000 by the Illinois Department of Public Health because of Sangamon County Judge Leo Zappa’s order in February. These cases remain pending, and a final amount to be paid hasn’t been negotiated:

* Maryville Manor, Maryville: Original fine was $40,000, stemming from an Aug. 6, 2007, inspection that detailed a range of problems including multiple bedsores and pressure sores on residents, a lack of recreational activities and a situation in which a nurse’s aide resigned after injectable anti-anxiety medicine prescribed for a resident was found in the aide’s possession.

* Evergreen Nursing and Rehab Center, Effingham: Original fine was $25,000, stemming from a March 22, 2006, investigation into the June 22, 2005, death of an 84-year-old resident who suffocated after becoming caught in a bedrail that had a piece missing.

* Dearborn Court, Kankakee: Original fine was $30,000, stemming from a Sept. 4, 2007, investigation into the alleged physical assault of a 64-year-old female resident by two employees of the nursing home on Aug. 15, 2007. The employees allegedly hit the resident with plastic hangers, tied her up with a belt, punched her in the head and stomach and tried to choke her.

* Peachtree Estates, Jonesboro: Original fine was $20,000, stemming from a July 15, 2008, inspection that said the facility failed to obtain prompt medical attention for a 73-year-old female resident who fell and sustained a head injury June 19, 2008. About a month before that injury, the resident had fallen and broken her left arm; she also fell on June 20, 2008.

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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.

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We have many people call us asking for advice on how to choose a nursing home. Many of the people seeking advice want to rely on Medicare's star ratings.  We are not convinced that these star ratings give an accurate assessment of a nursing home's ability to provide good care.  The ratings are primarily based on surveys and investigations done by the Department of Health and Environmental Control (DHEC).  Well, the problem with that is DHEC tells the facilities when they are going to investigate or conduct a survey giving the facilities time to get their best nurses in the facility, to staff more than typical, and make sure all the documentation is revisited and changed if lacking.  

When abuse or neglect is reported, the state's investigations procedurally favor the facilities. Violations must be actually found in the facilities' own documentation, which are very self-serving. We cannot rely on the state for enforcement of regulations that are designed to protect residents and ensure proper care.

The key to quality of care is competent, compassionate, and well-trained staff.  They are less likely to get burnt-out and more likely to stay in the job thus lowering turnover rates which are detrimental to residents especially those with dementia.  The reality often is that staff who complain about resident neglect don't remain employed.  Fortunately there are laws to protect workers from retaliatory firing, but many employees still fear losing their jobs by speaking up.  Regulations exist to protect residents from neglect, but residents and employees fear retaliation. Many times families aren't aware neglect is occurring. Facilities lie and cover up to protect themselves from liability.

There are no "good" facilities here.  Unfortunately the best that one can hope for is "average" — with most "below average."  It is tragic that our area does not have "above average" facilities available. We should be outraged. Our tax payer money is going to these facilities. instead of providing quality care and adequate staffing, the facilities send the money to "management" companies that are owned by the same people who own the nursing home and don't actually provide any services.

Our community needs to make it less profitable for nursing homes to neglect our elderly. A society is ultimately judged by how it treats its most vulnerable members. At this time civil actions are the only effective solution. The state won't do it.
 

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The Dallas News had an article about the role that Ombudsman's office has in advocating for nursing home residents.  The article stresses the importance of their role and the breadth of their power and responsibility. However, it all depends on the State's funding and the specific Ombudsman's knowledge of the regulations and standard of care.

The article revolves around Jennelle Dixson who is a nursing home ombudsman who looks out for residents too frail or too afraid to speak up about problems such as inattentive caregivers, dirty bedding and long delays in getting medication.   Ombudsmen are among the most important watchdogs of the nursing home industry.  The frequent prods and nudges they give nursing home administrators can have almost as much influence on the quality of care as the annual inspections that government regulators make.

The Senior Source, the nonprofit agency that runs the state's long-term ombudsman program in Dallas County, sends ombudsmen to 63 nursing homes at least once a month and 160 assisted-living communities at least twice a year.  Dixson checks on more than 1,000 residents in 17 nursing homes throughout Dallas. She visits most of the homes weekly. 

Forty-three percent of Americans who reach 65 can expect to spend time in one of the nation's 15,281 nursing homes. The average stay is almost 2 ½ years.

Though ombudsmen often meet an uncooperative administrator, their visits sometimes produce results because most nursing homes prefer to resolve issues before they escalate into black marks during state inspections. Last year, the Senior Source's ombudsmen received 8,600 complaints about nursing homes and 600 complaints about assisted-living communities in Dallas County.

Swanson says complaints involving abuse or serious neglect go to the Texas Department of Aging and Disability Services, the state agency that inspects and regulates nursing homes and assisted-living communities. "The most common complaint we receive is that caregivers take too long to answer residents' call buttons," Swanson said. "Patients may wait an hour for aides to escort them to the bathroom."   This lack of response often results in falls when residents attempt to make it to the bathroom without assistance.

I don't doubt that Mrs. Dixson is a caring ombudsman who benefits residents under her jurisdiction but the Ombudsman in South Carolina do absolutely nothing for the residents.  They do not act like advocates and often defend the actions or inactions of the nursing homes all the time stating "that is what my boss tells me to do."  The ombudsmen in South Carolina do not feel they have any power or right to tell the nursing homes how to provide care to the residents. If that is true, what is the point of their existence?  South Carolina needs to train the ombudsmen and give them the power and authority to challenge the nursing homes to prevent neglect and abuse.

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Koco.com,  a news website from Oklahoma City, had an article about a resident being physically abused with video evidencing significant bruises.  The article states that the resident's family is looking for answers after a woman was found covered in bruises while she was staying in a Norman nursing home.

The workers at the Whispering Pines Nursing Home said Carol Crow, 60, was injured when she fell but did not provide any details to support this conclusion.  The family doesn't believe the injuries could come from a fall. The family is offering a reward for information because the Department of Human Service has refused to investigate.

"It was very traumatizing. She just cried the whole time," said Julie Glass, Carol's daughter. "She had bruising all the way around her face, all the way completely down her chest and around her neck."

"Her story is that a man knocked her down, got on top of her and beat her unconscious," said Jack Crow.  The family said they took their story to DHS, which sent them a letter saying that it wouldn't open a case because there was no indication of abuse.

The Crow family offered a $2,500 reward for information. They posted signs around Norman and in front of the nursing center. The sign posting led to a confrontation with Whispering Pines representatives.

"I'm angry at the fact that I don't know what they're covering up," said Glass. "The people that are left there have no one. They have no one to protect them."

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