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

Lexington Herald-Leader have been running a series of great articles on the failure of authorities to investigate complaints or for the facilities to report complaints and incidents.  See also article from WLWT.  The article uses the death of Ruby Goode as an example of lack of reporting, investigating, and prosecuting neglect and abuse of vulnerable adults.

The death of Ruby Ethel Goode in a nursing home was one of more than 100 incidents over three years in which Kentucky nursing homes were cited for violating state regulations. Few of those cases were prosecuted as crimes. When Brenda Goode Woitke learned that her 93-year-old mother had died in the Calvert City Convalescent Center, she assumed that she had died of natural causes.  But the death of Ruby Ethel Goode was far from natural or peaceful. She was found on the floor with her head stuck between the side rail of the bed and the mattress, her neck unnaturally stretched.

Not only did officials at the Western Kentucky nursing facility fail to tell Woitke how her mother died, but they intentionally hid the facts. A nurse told others "not to talk about this to anyone because they would all get in trouble," according to a state citation issued to the nursing home after Goode died.  "There was no evidence the family, the physician, the administrator, or the director of nursing were immediately notified" of how Goode, known as Ethel, died, according to a Type A citation, which is issued by state regulators when there is an immediate threat of death or injury to a nursing home resident.

Goode's own doctor said that if he had been told about the circumstances of his patient's death he would have contacted the coroner himself.  After a local newspaper reported how her mother had died, she walked into the office of Paducah lawyer Richard Walter and said: "I just want to know what really happened."

The civil lawsuit that was filed as a result has been settled for an undisclosed amount. Through the civil process, Woitke learned that the facility had not thoroughly assessed whether her mother — who had memory problems, was at a high risk of falls and frequently slid to the bottom of her bed — should be left alone with her bed rails up.

"It's not about the money," Woitke said. "The truth of the way my mother died was withheld from me deliberately. I don't want this to happen to another family."

But when prosecutors reviewed Goode's case, they said there was not enough evidence to charge anyone with a crime — even though regulators said the nursing home failed to adequately assess whether Goode should be placed in a bed with side rails. The citation even said that might have prevented her death.

A Herald-Leader examination of 107 Type A citations issued over a three-year period by the Kentucky Cabinet for Health and Family Services Office of Inspector General found a number of gaps in the system that mean few nursing home deaths are ever prosecuted as neglect or abuse. They include:

■ Police and coroners are rarely notified of nursing home deaths or serious injuries.

■ Although the state sends all of the most serious nursing home regulatory violations to the attorney general's office, that office can only prosecute with the permission of local prosecutors. And local prosecutors say they seldom hear about the cases.

■ The attorney general's office misplaced or never received at least five citations issued by the cabinet from December 2006 through 2009.

The responsibility for criminal prosecutions involving long-term care facilities is spread over several agencies, with no single authority as overseer. That results in confusion and finger pointing among officials who do not want their offices blamed for not protecting the elderly.

The inspector general says it's the attorney general's responsibility to review nursing home citations and determine whether a crime was committed. The attorney general says that the inspector general or Adult Protective Services office can notify local police or prosecutors when criminal activity is suspected.

The 107 citations involved 18 deaths and 30 hospitalizations. Seven of the type A citations resulted in criminal charges. Eight cases are still open.

Cases where no charges were filed included those at facilities where a man wandered away and froze to death; a patient who was not monitored lost 87 pounds in 19 days and was later hospitalized; and a patient who fell and broke her hip but did not receive medical attention for seven hours.

The examination also found that nursing home employees who are prosecuted seldom serve jail time.

Much of the problem, experts said, can be attributed to the lack of a central authority to oversee investigations and prosecutions of incidents at nursing homes.   Advocates for the elderly, family members and attorneys say that nursing home deaths and injuries are not often scrutinized as potential crimes because the victims are elderly and often have serious illnesses.

If many of the same things happened to children, there would be a public outrage, said Kathleen Quinn, the director of the National Adult Protective Services Association, a trade group for adult protection workers.

Most nursing home incidents "are not investigated at all," said Dr. Barbara Weakley-Jones, Jefferson County coroner and a former state medical examiner who first noted Kentucky's lack of attention to nursing home deaths in a 1991 study. "Unfortunately some nursing homes try to cover up what happened," she said.

Experts say criminal prosecutions in nursing home cases are difficult. Even if it seems clear that a crime was committed, it may not be certain which staff member or members did it. And elderly residents often cannot tell what happened.

Consider the case of Aden Owens, a construction worker who suffered a closed head injury at age 61 when a concrete slab collapsed. He entered Sunrise Manor Healthcare and Rehabilitation in Somerset in 1999. But his family became concerned about bruises he received — 114 injuries of unknown origin over seven years, the family alleged in a civil lawsuit.

Stephen O'Brien III, a Lexington attorney who represents Owens' son Bryan, said Owens' worker's compensation carrier required him to be at Sunrise Manor. The family spent several hours a day at the nursing home and in 2006 placed a hidden camera in his room.The videotape showed a nursing assistant pulling Owens' hair, twisting his fingers and striking his hands.  Another nurse's aide is seen striking him, jerking him by his neck and placing a knee on his chest while changing his diaper.   After Owens fell out of bed, an aide left him on the floor while changing his bed, the videotape shows.

Bryan Owens said he couldn't understand why his father's case wasn't prosecuted, while in another case, three nurse's aides caught on a hidden camera abusing an elderly woman at Madison Manor nursing home near Richmond in 2008 were prosecuted and convicted.

In the Madison Manor case, one aide was found guilty of abuse after she roughly handled 84-year-old Armeda Thomas. Another was convicted after she ate Thomas' food and said in records that Thomas ate it.

One key difference between the cases — Thomas' case received widespread media coverage. Owens' didn't.

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The Winston-Salem Journal had an article about Clemmons Nursing and Rehab Center possibly losing the ability to be reimbursed by Medicaid and Medicare for failing to follow OBRA regulations and other standards of care.  Clemmons is facing federal and state claims that it isn't properly caring for residents after investigators found that employees injured a patient by carelessly picking her up out of a wheelchair and throwing her onto her bed.  The state's investigation cited concerns about residents' physical and mental health and said the nursing home failed to comply with its policies and procedures, such as filing timely reports on incidents.  The center also was cited by the state for not properly observing residents' medication regimens and not properly cleaning some female residents' genitals.

Medicare may no longer make payments to the center for new inpatient services, and would only make payments for up to 30 days for patients admitted before June 19.  However, federal and state agencies have in the past extended the compliance deadline, depending primarily on whether the facility shows initiative in addressing deficiencies.

Clemmons is operated by Forsyth Health Investors LLC. The center has 120 beds and 71 residents.  The center also received a notice, dated June 1, that its state certification was in immediate jeopardy. 

The state agency recommended to Medicare that the center be fined a civil penalty of $10,000 for each incident.  A survey by the federal Medicare and Medicaid agency, released in December, gave the center two out of five stars, with five being the highest. The rankings focus on three categories -- health inspections, staffing and quality measures.

See full report here.

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The News-Gazette had an article about the state investigation of an incident in which a female patient at Champaign County Nursing Home suffered an injury that went undetected (or covered up) and died several days later.  The incident has led to a chain reaction of investigations, reports and findings that have resulted in $50,000 in fines against the nursing home, the loss of some Medicare and Medicaid funding and the potential loss of all Medicare and Medicaid funding.

Two other visits to the nursing home by public health inspectors – one on April 2 and another on April 29 – found more problems at the facility. In the April 2 inspection, it was determined that the nursing home did not follow its own policy in handling an allegation lodged against an employee.

Also that day, the inspector determined that the nursing home staff "failed to provide appropriate treatment and services to maintain or improve abilities in toileting and transfers" for four residents.

The April 29 inspection found that nursing home staff failed to use proper equipment when transferring three patients. In the most serious case a 91-year-old patient suffering from dementia broke her hip after she stood up from her wheelchair and fell. The woman was supposed to have had a personal safety alarm on her wheelchair.

In the incident which set off the series of investigations, a patient identified only as R7 slipped out of a chair while in a lounge area, but apparently was caught by a certified nurse aide.

"CNA slid under (R7) and pulled her onto her lap ... (R7) denied pain .. did not hit head ... did not hit w/c (wheelchair) or w/c pedals. (R7) talking and laughing with staff ... able to move arms and legs without a problem or pain ... Body check done with no areas of redness noted," said a report identified as a "late entry," and dated Jan. 25. It is not clear whether the incident occurred that day or earlier. There was no other documentation of the fall before Jan. 25.

By Jan. 29, however, nurses noticed bruising on the woman's right leg and right hand. A physician ordered the woman be taken to an unidentified hospital. There, an emergency department attendant said the woman's "right leg has progressively increased in size with diffuse ecchymosis (bruising) ... It does appear (R7) struck her head." There was an "incredible amount of blood lost in the leg," an emergency department physician said. It "took a lot of fluid and blood to fix (R7's) anemia/shock which resulted in CHF (congestive heart failure)."

The woman died on Feb. 4. The Public Health investigation of the incident, dated Feb. 25, found the nursing home neglected to properly care for the patient in at least four ways:

– "By failing to implement existing policies on Falls, Lab and Diagnostic Test Results, Laboratory Testing, Orders for Anticoagulants, Anticoagulants and Change in Resident's Condition or Status;"

– "By failing to notify the physician in a timely manner of high laboratory values, neglected to identify a fall, to notify the Physician/Nursing staff of the fall and implement post fall monitoring;"

– "By failing to assess and monitor significant bruising as a side effect of anticoagulant therapy and a fall;" and

– Neglecting "to notify the Physician of the significant bruising in a timely manner, but continued to administer anticoagulants to R7."

The nursing home has allegedly instituted changes in response to the public health findings. For example, training will include special attention to reporting falls. "An episode where a resident lost his or her balance and would have fallen were it not for staff intervention, is a fall. In other words, an intercepted fall is still a fall," said a memo.

And when employees are accused of mistreatment of residents, a memo says they "will be removed from resident contact immediately until the results of the investigation have been reviewed by the administrator or designee. Employees accused of possible mistreatment shall not complete the shift."

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WKYC.com had an article on the lack of investigation into sexual assaults in Ohio nursing homes.  The Ohio Attorney General's Office received 158 complaints of sexual violence against elderly and disabled residents of long-term care facilities in Northeast Ohio since January 2006, but only two of those cases ended with a conviction, a Channel 3 News investigation found.

Most of the complaints were forwarded by the Ohio Department of Health, which received 324 complaints statewide, alleging rape and other sexual abuse of residents in nursing homes, residential care facilities and assisted living facilities.

The article discusses several cases and convictions but prosecutors blame the unreliability of the victim's testimony due to their age and dementia.

By law, nursing homes are required to report sexual abuse of residents to the state health department. The health department tries to find cases that aren't reported by examining patient files during annual inspections of long-term care facilities.

But as The Investigator Tom Meyer found, sex abuse cases can still slip through the cracks because long-term care facilities don't always document abuse.

"We see a concerted effort to under-report, to not document things that are significant," said David Krause, an attorney who has sued several facilities for sex abuse that was never reported. "They don't want people to know that it happened at their facility."

Alison Renko, a forensic nurse who treats sexual abuse victims, said family members and caregivers can uncover sexual abuse of elderly and disabled patients by looking for behavioral changes if an employee or another resident comes into the room during a visit.

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MYFox9 had an article about the Minnesota Department of Health's investigation into the wandering death of a resident who froze to death.  The investigation revealed that the Jones-Harrison assisted living facility was guilty of neglect in the death of a patient who wandered outside last November.  The cause of the patient's death was listed as hypothermia from cold exposure.

Staff carelessly lost track of the woman with dementia on the evening of Nov. 21.  The family member said when she arrived at Jones-Harrison on the morning of Nov. 22, police had still not been called and the patient hadn't been seen inside the facility in 16 hours. Staff members were unable to locate the woman and were confused about her whereabouts before finding her around 10:30 a.m. the next morning frozen, with no pulse, near a parking garage. 

The report concluded that the resident walked through a gate door that was left open.  A maintenance worker leaving around 4 p.m. the day of the incident left the gate unlocked. The worker admitted to leaving it unlocked for his own convenience, using it to get to quickly get to his car in the cold weather.  There was no explanation why another staff member did not see that the gate was unlocked or how the resident was able to leave the facility without anyone noticing.

The nursing home did not effectively manage its resident register to keep tabs on patients, and staff did not initiate the missing persons protocol in a timely manner.

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The Star Tribune had another great article about State health investigators' conclusion that Providence Place is to blame for the death of a resident who rolled down a stairwell in her wheelchair last May and died.  The Minnesota Health Department said the woman died because the facility failed to change the resident's care plan after she had twice previously tried to open the door to the same stairwell. The second attempt came 30 minutes before the woman died.  Nursing homes have a duty to keep residents safe and prevent foreseeable injuries. 

According to the report:

The woman, who suffered from anxiety, depression and other behavioral problems, had a history of wandering around the facility and trying to open doors. A few weeks before the fatal fall, an employee saw the resident inside the stairwell and pulled her out. The employee reported the incident to a registered nurse on staff. On the day of the fall, the woman was found on the concrete stairwell landing, face-down and strapped into her wheelchair. Efforts to resuscitate her by staff members and paramedics failed.

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The Daytona Beach News-Journal had a tragic story about a 76-year-old resident at a DeLand nursing home who went for 12 hours without treatment after she broke her shoulder and both her legs in a preventable fall.  The incident under investigation started when a patient fell out of bed at 5 a.m. Friday as her bedding was being changed.  The patient, whose identity was withheld by police, was put back into bed after the fall. But it wasn't until after the next shift came on -- at 4:42 p.m. -- that emergency workers were summoned to attend to her injuries. She was taken to Halifax Health Medical Center in Daytona Beach where she was admitted.

The incident is under review by the Agency for Health Care Administration, which is charged with overseeing 31 nursing homes. Records with the state agency show that at its last inspection in October, nine deficiencies were cited at the facility that is owned by Graystone Healthcare Management, which operates 28 nursing homes in Florida, Indiana and Ohio. Among the citations: accident hazards and food storage.

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Tulsa World had an article about a nursing home employee who reported neglect and abuse at a nursing home, and was subsequently fired from her job despite her affirmative duty to report such incidents.  This is outrageous.  This employee did exactly what she was supposed to do and the nursing home fired her for it.  She is now suing Cimarron Pointe Care Center and one of its contractors for wrongful termination.  Is it any wonder why many nurses look the other way when residents are abused and neglected?

In the lawsuit, Harris said she worked as a housekeeper at the facility. She was paid by Health Care Services Group, a Tulsa company contracted by the home to provide cleaning services, and supervised by nursing home staff.   During her employment, she observed numerous instances of improper care of the home's residents.

"Mrs. Harris observed a male resident who had been left in his own waste for so many hours that he had feces caked on to his leg from his hip to below his knee, and had wet himself at least one time."   She saw the man sitting in his waste and reported it to her supervisor, the head nurse and two nurse's aides. Her supervisor sprayed deodorant in the man's room to cover the smell. The aides said they would leave him for the next shift.

"Two and a half hours later, he was still sitting in his own waste," Harris said. "He couldn't say nothing. I would always talk to him. He would just light up when I went to clean his room. It's heartbreaking when you see a resident not being taken care of."

Also, an elderly woman paralyzed from the waist down was left in her own waste, Harris said. She rolled out of the bed and into the hallway to get someone to change her soiled garments and the nurses "just laughed at her," Harris said.

"On another occasion, Ms. Harris brought the needs of another female resident to the attention of the nursing staff. The resident's needs were ignored, prompting the resident to write a letter to her family saying goodbye, in anticipation of death from neglect," the petition states.

Another female resident, who was unable to sit up alone, was left on a bench in the shower. She fell and hurt herself, the petition said.

Harris reported each instance of neglect or abuse to the facility's staff.  The home's administrator and a supervisor from Health Care Services Group of Tulsa, the contractor that paid Harris, fired her.   Of course, Cimarron Pointe Care Center denies any improper care of its residents. It also states that Harris was employed by Health Care Services Group, so the nursing home isn't responsible for her termination.   However, Ms. Harris was told that the only basis for her termination was her reporting of the abuse.  Ms. Harris had not done anything else to merit termination, and no other basis for termination were discussed or even suggested."

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Numerous media outlets have discussed the recent report from the Inspector General that shows that 92% of all nursing homes violate the standards established by the federal and state governments.  ABC News had a good article here.

A government report released found extensive problems in America's nursing homes. Nearly one in five of the nearly 15,000 nursing homes examined were cited for violations that put patients in immediate harm in 2007.   92 percent were cited for some type of deficiencies during each of the last three years.

The quality of care in nursing homes was the focus of those deficiencies. Experts also found that  far too many residents waited too long to get the help they needed.

"Very few of these deficiencies ever result in a financial penalty," said Wes Bledsoe, founder of A Perfect Cause, a non-profit group that advocates for the reform in long-term care. "And if they do, they are not collected. The system has no teeth."

"It's a priority for me in this office because sometimes it's a double crime," New York State Attorney General Andrew Cuomo said. "First of all, it's a fraud against the taxpayer. In many cases, taxpayers are actually funding these organizations and these institutions and they're being defrauded. And secondly you are literally affecting the most vulnerable in our society. And that's our first priority -- to protect those people who literally can't protect themselves."

This week's report revealed that for profit homes are actually more likely to have problems than facilities run by local governments or non-profits despite having more resources and making substantial profits.
 

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