Articles Posted in Elder Abuse

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Elder Abuse and Neglect: On February 26, 2009 the Department of Health & Human Services, Center for Medicare & Medicaid Services released the results of the most recent survey of Vista Hospital of Riverside, located in Perris, California. The results reveal shocking examples of neglect.

The California Department of Public Health, the agency charged with surveying the facility for Medicare, reported “serious deficiencies.” As a result, the Department of Health & Human Services determined that:

“the deficiencies, either individually or in combination, substantially limit the hospital’s capacity to render adequate care to patients or are of such character as to adversely affect patient health and safety . . .”

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The Ombudsman Services of Northern California, an organization dedicated to creating a corps of compassionate advocates for residents in long-term care facilities believes that state budget cuts to its ombudsman program will lead directly to an increase in cases of elder abuse and neglect.

This year the organization, which tracks approximately 1,600 nursing homes and assisted-living facilities, lost two-thirds of its staff due to shortfalls in the state budget. According to Joan Parks, nursing facilities are already taking advantage of the lack of oversight.

“Our monitoring in these homes was seen as a form of prevention,” Parks said.

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U.S. News & World Report is out with an article on the common problems found in U.S. nursing homes in an interview with attorney Eric Carlson, author of 20 Common Nursing Home Problems. As a nursing home abuse lawyer, I found the article enormously helpful; particularly the answer to the first question, which I think is the most important:

What can consumers do to best protect themselves up front?

Be aggressive about questioning a prospective home about staffing and staff training. A nursing home generally receives $4,000 to $9,000 a month for the care of one resident, so it should be responsive to both residents and potential customers. Talk to residents and visitors without nursing home staff hovering nearby. Visit several times, at different hours and on different days. Make at least one visit at mealtime. Examine inspection reports. Each nursing home that accepts Medicare or Medicaid payment is inspected approximately once a year. And the National Citizens’ Coalition for Nursing Home Reform offers a consumer guide to getting good care in a nursing home.

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California ombudsman Nona Tolentino’s job is to investigate cases of suspected elder abuse in nursing homes. Her conclusion after years as in the business: be afraid, be very afraid.

The biggest problem Tolentino faces is trying to prove the allegations. “I call it the conspiracy of silence,” she said, because many nursing home residents and their family are reluctant to talk about, frequently out of concerns of retaliation or being evicted from the facility. Tolentino believes strongly that nursing home residents have fundamental rights to be free from physical and verbal abuse, unnecessary restraints, or involuntary seclusion.

Tolentino is mostly right. If one were to visit the local office of the California Department of Public Health and pull the file of any large nursing home in the region where they lived, they would be startled by the number of complaints made and investigated. More troubling, however, would be the realization that the vast majority of complaints are “unsubstantiated;” meaning the investigator could not prove the allegations are true.

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Three California nursing home employees were arrested yesterday for allegedly injecting 22 residents with mood-altering drugs to keep them quiet and restrained. According to the criminal complaint, a nursing director, a pharmacist, and a physician drugged the residents in order to keep them compliant and easier to care for. Three of the patients died.

“These are powerful medications that were given, in some cases against people’s will, primarily for management, not health reasons,” said California Attorney General Jerry Brown. “It’s unconscionable behavior and it’s certainly not what people expect when they entrust their parents or grandparents to a skilled nursing home.”

The allegations in the criminal complaint are appalling, including residents becoming “zombie-like” and unable to eat or drink for days, causing severe malnutrition and dehydration. The three residents who died were Fannie May Brinkley, Eddie Dolenc, and Joseph Shepter. At least one civil lawsuit has been filed as a result of the deaths, and more are expected.

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Lemon Grove Care and Rehabilitation (San Diego County) has received the state’s most severe citation after the burn-injury death of a 74-year-old resident. State investigators found that the facility failed to adequately supervise the resident, who caught fire while smoking at the facility. According the reports, the woman was sitting in the designated smoking area trying to light a cigarette when her jacket caught fire. She died 10 days after suffering her injury.

The nursing home has been issued an “AA” citation and a fine of $80,000.00, which it intends to challenge in Superior Court. Lemon Grove Nursing and Rehabilitation received two Class B citations last year (click here), and is currently under investigation for separate allegations of neglect in a case being handled by Walton Law Firm LLP.

Walton Law Firm LLP represents individuals and families throughout Southern California in cases involving nursing home abuse and neglect. All consultations about a case are free and confidential.

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The Des Moines Register reviewed 81 bonus payment programs in over 30 states and found that numerous nursing homes with a below-average care giving rating were receiving quality-of-care bonuses. The newspaper looked at eight federal bonus programs in states where regulatory violations by a nursing home do not automatically disqualify a nursing facility from receiving a bonus. The eight programs analyzed are costing taxpayers $313 million per year.

By way of example, the Grace Living Center in Oklahoma earned approximately $96,000 in bonuses during the last year despite federal records that show the home has been cite for more violations than the state or national averages. Toby Edelman of the nonprofit Center for Medicaid Advocacy called the bonuses “preposterous,” and pointed out the incongruity of the government taking money from bad facilities by issuing fines, then returning the money in the form of a bonus. “It just doesn’t make any sense,” Edelman said, “it’s totally confusing to consumers.”

Legislation approved earlier this year says the bonuses will continue at least through June 2009.

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A study just released by the Inspector General of the Department of Health and Human Services reports that 94% of all nursing homes nationwide were cited for violations of federal health and safety standards during 2007. Approximately 17% received deficiencies or citations for issues which caused “actual harm or immediate jeopardy” to residents. These deficiencies were for such things as bedsores, medication errors, lack of nutrition/dehydration, abuse and neglect of residents.

In total, inspectors received 37,150 complaints nationwide. Surprsingly, only one-fifth of the verified complaints involved the abuse or neglect of patients. The remainder were for adminsitrative issues or those related to the physical premises.

Another telling statistic is that 94% of for-profit nursing homes were cited whereas only 88% of non-profit nursing homes were cited. For-profit also received an average of 7.6 deficiencies per home whereas non-profits averaged 5.7 per home.

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The New York Times is reporting this morning that 90% of all nursing homes were cited for violations of federal health and safety standards. Approximately 17% of U.S. nursing homes had deficiencies that caused actual harm. As mentioned in this blog previously, nursing facilities that operate “for-profit” were more likely to have problems than non-profit homes.

Federal inspectors received 37,150 complaints in 2007 about nursing home conditions, the bulk of which involved bed sores, abuse and neglect of residents, medication errors, and nutritional issues. Failure to sufficiently staff was noted as a particular concern in the report, including the allegation that nursing homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.” Not surprisingly, researchers learned that elderly patients receive better care at homes with a higher ratio of nursing staff members to patients.

The U.S. has approximately 15,000 nursing homes, housing nearly 2 million people. Under the laws of most states, including California, these homes are inspected once a year.

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On Wednesday, the Senate Finance Committee approved two bills which will help prevent neglect and abuse of elderly persons.

A frequent source of abuse are caregivers who are repeat violent offenders. A bill (S 1577), sponsored by Sen. Herb Kohl (D-Wis.), would create a nationwide background check system to screen long-term care employees for a history of abuse or a violent criminal record prior to hiring.

A seven-state pilot program established under the 2003 Medicare law already exists and would be expanded by this bill. The bill would provide as much as $160 million in grants over three years to states which seek to participate in the program. This law would help keep violent offenders from working in nursing homes with particularly vulnerable elderly patients.

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