Wednesday, November 10, 2010

CMS Proposes to Require LTC Facilities to Have Written Agreements With Hospice

The Centers for Medicare and Medicaid Services plans to require long-term care (LTC) facilities to have written agreements with hospice providers clearly describing which services each entity will provide to nursing home residents.

"We believe there is a lack of clear regulatory direction regarding the responsibilities of providers in caring for LTC facility residents who receive hospice care from a Medicare-certified hospice provider, which could result in duplicative or missing services," CMS said in an Oct. 22 Federal Register notice.

The proposed rule, which mirrors requirements established for hospice providers in June 2008, is intended to ensure that both entities are held equally responsible in the written agreement, CMS said. Delineating responsibility for key services would not only ensure continuity of care but guarantee appropriate care is provided to nursing home residents in a timely manner, the agency added. The rule would apply to both Medicare skilled nursing facilities and Medicaid nursing facilities.

The rule also would require LTC facilities to report to the hospice administrator all alleged violations involving mistreatment, neglect, abuse or misappropriation of resident property by hospice personnel.

CMS Proposes to Require LTC Facilities to Have Written Agreements With Hospice

Is Elder Abuse America's Dirty Secret?

According to Ken Connor of, "The plight of elderly Americans has been a top concern of the Center for a Just Society since our inception in 2005, and as senior citizens comprise an ever increasing percentage of our nation's population, the need is greater than ever to draw attention to a little discussed, little known epidemic in American health care. According to a new study released this month by the American Association for Justice (AAJ), eldercare abuse in America has escalated from a shameful problem to a full-blown humanitarian crisis. As the report illustrates, our nation's looming demographic boom will pose more than a financial challenge for our society – it will pose a moral challenge that is just as important: What kind of care and treatment does our society consider appropriate for its most vulnerable members?

Often, nursing home conditions were so reprehensible and so degrading that – were they unearthed at daycare centers or even federal penitentiaries – members of Congress and the media would be crusading for reform. The AAJ's report is rife with illustrations: A nursing home resident whose leg was amputated after becoming infested with maggots; an Alzheimer's patient who died trapped in a freezer; a Florida nursing home resident who suffered from multiple falls, severe weight loss, multiple pressure sores, infections, dehydration, and eventually death by starvation; patients at a home in Illinois who were given antipsychotic drug injections "assembly-line style" as a means of "chemical restraint;" and an elderly nursing home resident who was sexually assaulted in the middle of the night at the hands of an orderly who was an ex-con.

If something major doesn't change, and change soon, this is the kind of fate that awaits multitudes of Americans expected to join the ranks of the institutionalized elderly in the coming decades."

Elder Abuse: America's Dirty Secret

Parkside House investigation panellist frustrated at lack of available sanctions - Local

A MEMBER of the panel that examined the serious neglect of five elderly people at a Northampton nursing home has expressed “frustration” that action cannot be taken against homes on the basis of Serious Case Reviews.

Joanne Geddes is on the board of Northamptonshire Safeguarding of Vulnerable Adults (SOVA) after being invited to join following a Serious Case Review into the death of her father at a nursing home in Moulton in 2008.

She was also one of a panel of independent members who held a Serious Case Review, released this month, into the cases of five dementia residents who were neglected at Parkside House nursing home in Northampton last summer and later died within two weeks of each other.

Parkside staff identified by the inquiry were waiting to hear if they will be disciplined by their professional bodies but no legal action can be taken based on the in-depth review by health and council officials.

Mrs Geddes said she was frustrated that, in all such cases, no powers existed to bring privately-run care homes to book for serious neglect. She said: “It would be nice if something more could happen when a Serious Case Review makes its findings because it’s a thorough investigation.

“It was clearly, clearly wrong what happened to my dad but there was no case. How can that be right? I can’t believe that situation exists still.

“Residents are not protected in the way they should be and I think that’s a big hole. I said to the home they had failed in their duty of care but there was nothing I could do to take things further. I do find it a bit frustrating that more can’t be done. It’s not just the SOVA board; there’s no legislation to allow you to prosecute the people responsible and make the changes I’d like to see.

“I’d like to see someone accountable for what happened to my dad, either an individual or an organisation.

“People at Parkside and my dad were treated badly. If the same happened to a 15-year-old boy there’d be a consequence but, in these cases, there doesn’t seem to be.”

Parkside House investigation panellist frustrated at lack of available sanctions - Local - Northampton Chronicle & Echo

State lawsuit vs. Bowes owners near end

ELGIN — Another chapter in the story of the now-closed Bowes Retirement Center is nearing an end.

The state expects that an injunction will be granted next week to prevent the former owners of the northeast-side facility from operating another unlicensed nursing home.

“Because the facility is closed and out of business, this will be the last step in the case,” said Maura Possley, spokeswoman for the Illinois Attorney General’s Office.

“We would only pursue further action if they open somewhere else without going through the necessary licensing process,” she said.

Bowes, at 105 N. Gifford St., was shut down and emptied of residents in late September. The closing was the result of an impending mortgage foreclosure in Kane County and a motion for injunction filed by the state. The motion for injunction filed in July 2009 accused Bowes’ owners of running the facility as an unlicensed nursing home and putting the health and safety of its residents at risk.

The closure marked the end of more than two years of efforts to draw attention to and fix nagging problems at the facility, officials said — problems that ranged from unsanitary conditions to reports of neglect and abuse of its elderly residents.

Bowes’ owners — Angel and Bell Corp. of Palos Heights, Ardent Home Health Care Inc. and Benjamin and Angelina Guzman — are accused of operating Bowes under the guise of a retirement center. Although Bowes advertised that it provided living quarters for independent adults, the state’s suit claims that during 2008 and 2009, several residents there needed assistance to bathe, eat, take medications and move — services that can be provided only by a licensed nursing facility.

Last month, a professional liquidation company was named the new caretaker of the now-vacant Bowes Retirement Center property.

Chicago-based Realization Advisors Inc. was appointed by a judge to secure the historical east-side facility from vandals and ready the property for sale.

“We will be doing two things, basically: safety and security first, and secondary, maximizing recovery,” Michael Kayman of Realization Advisors said.

According to court documents, Angel & Bell Corp. et al advised their bank — Mutual of Omaha — in September that Bowes would close and be empty of tenants by Oct. 1.

“They are really very good people. They just ran into some financial trouble,” said Lawrence J. Stark, one of the Guzmans’ attorneys.

Stark mentioned after a court appearance this week that he thought a company in Ohio had expressed interest in purchasing the center and converting it into a bed-and-breakfast.

Kayman, however, said Realization Advisors did not know of any interested parties. In addition, Kayman said, the foreclosure proceedings need to be complete before the property could be sold. He did not anticipate that would happen before the end of the year.

Assuming the state’s lawsuit is resolved at the next court date, scheduled for Wednesday , the attorney general’s office will monitor Angel & Bell Corp. to ensure the company does not open any more unlicensed nursing homes in the state, Possley said.

“To do that, we would rely on complaints from the public, residents, family members or the Illinois Department of Public Health,” Possley said. “And, of course, if we receive a complaint, we will aggressively investigate.”
State lawsuit vs. Bowes owners near end

Carers face neglect charges

TWO carers at a Wigan nursing home have, between them, been charged with 18 counts of ill-treatment or wilful neglect of elderly residents.

Sam Rigby and Lynne Parkinson were employed at Alexandra Grange Nursing Home, Wigan, where the alleged neglect is said to have taken place.

Both pleaded not guilty to all charges when they appeared before Wigan Magistrates’ Court.

Rigby, 25, of Dovedale Crescent, Ashton, is charged with seven counts of ill-treatment or the wilful neglect of seven different residents, six between January and July this year and one between April and November last year.

Lynne Parkinson, 54, of Belle Green Lane, Ince, is charged with 11 counts of wilful neglect or 
ill-treatment, between September last year and July this year, although the alleged incidents are 
not thought to be linked.

The women were both given conditional bail.Carers face neglect charges

Nursing home cited after wheelchair fall

A Minnesota nursing home was cited for neglect after a resident with dementia was found lying under her wheelchair at the bottom of a flight of stairs in July, according to a report released Tuesday by the state Office of Health Facility Complaints.
At Westwood Health Care Center in St. Louis Park, certain residents at risk of wandering are fitted with electronic wristbands that lock exits when they approach them. After a resident was found at the top of a stairwell one day, she was given a wristband. Eight hours later, she was in an area of the facility without the automatic locks when she wheeled away from an activity, fell down seven concrete stairs and probably fractured two ribs.
The facility disagreed with the investigatory findings but took corrective measures.

Nursing home cited after wheelchair fall

Judge throws out motion for mistrial in Skilled Healthcare case; court also grants injunction against nursing home company

A Humboldt County, CA judge threw out a motion for a mistrial in the class action lawsuit against Skilled Healthcare on Friday, signaling another wild day for the company's stock.

The motion, filed earlier this month by defense attorneys, alleged misconduct by one member of the jury that returned a $677 million verdict against the company on July 6. Defense attorneys called the amount, which remains the largest jury verdict in the United States this year, “annihilating,” and immediately took action to have it overturned.

In response to the motion, plaintiffs' attorneys filed a handful of declarations from other jury members dismissing the alleged bias and serving as a basis for Judge Bruce Watson to deny the motion. In his ruling, Watson stated that he found no evidence of juror misconduct and no grounds for a mistrial, causing a flurry of events on Wall Street, with shares dropping as low as $2.46, down from $3.25 the day before.

The company -- one of the largest nursing home chains in the country with 78 facilities and some 14,000 employees -- has seen its stock decline since the lawsuit was brought to court last November after documents showed the nursing facilities to be in violation of statewide staffing requirements.

Healthcare industry analyst Sheryl Skolnick said the news should not come as a surprise when the recent declarations filed by other jurors, all of which denied any potential bias, are taken into consideration.
”Proving misconduct is a tough thing to get done in a case like this,” said Skolnick, an analyst with CRT Capital Group in Connecticut, who has been following the case closely. “I'm not surprised at all.”

In addition to the denial of the motion, the court issued a permanent injunction that orders all Skilled Healthcare facilities to comply with the minimum staffing requirements mandated by California statute. Effective immediately, each of the 22 facilities implicated in the suit is to maintain 3.2 nursing hours per-patient, per-day.

A third party will be appointed to monitor that each facility complies with the law, and any costs associated with that will be paid by the defendants, according to court documents.

Plaintiffs' attorneys, based out of Eureka, would not comment on the decision, except to say that it will not effect a scheduled court date next week. Phone calls to the office of defense attorney Kippy Wroten in Southern California were not returned before deadline.

The two teams of lawyers are due back in court on Tuesday, when the court will hear additional arguments on motions filed earlier this month. Skolnick said that despite all the recent filings, which include a motion to have Watson recused from the case and a separate one seeking a new trial, the future for Skilled Healthcare does not appear to look much different than it did one month ago.

Parties in the case agreed to enter into mediation on July 15, and will not say if a settlement has been reached. Many in the investing world have predicted the company will file for bankruptcy under Title 11 of the United States Bankruptcy Code, which would leave the future of Skilled Healthcare nursing homes in California and elsewhere in question.

”At this point, the case looks like it's going forward,” Skolnick said, adding that a final judgment could be looming if a settlement cannot be reached. “Once that happens, there really is no other choice than to file for bankruptcy.”

Judge throws out motion for mistrial in Skilled Healthcare case; court also grants injunction against nursing home company

Antipsychotic drug use for dementia patients is questioned - The Boston Globe

Nearly 2,500 nursing home residents in Massachusetts were given powerful antipsychotic drugs last year that were not intended or recommended for their medical condition, a practice that is more common here than in most other states, according to a Globe analysis of federal data.

Worrisome use of drugs at nursing homes Data collected by the federal Centers for Medicare and Medicaid Services show that 28 percent of Massachusetts nursing home residents were given antipsychotics in 2009. Of that group, 22 percent - or 2,483 - did not have a medical condition that calls for such treatment.

That rate was the 12th highest in the nation, according to the federal data.

The use of such drugs is especially worrisome in nursing homes because a substantial number of residents suffer from dementia, a condition that puts them at greater risk of death when given antipsychotic medications.

The drugs, also known as “‘psychotropics,’’ were developed to treat people with severe mental illnesses such as schizophrenia, not dementia, which is the progressive loss of memory or other intellectual function than can result from aging or Alzheimer’s disease.

Twice in the past five years, federal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, including increased confusion, sedation, and weight gain.

Scott Plumb, senior vice president of the Massachusetts Senior Care Association, the trade group representing the state’s 440 nursing homes, said Massachusetts’ consistent ranking as one of the heaviest users of psychotropic drugs indicates much more training is needed in nursing homes.

“We recognize the number is too high,’’ Plumb said, “and we are working to try to bring it down.’’

As the nation ages - up to 14 million baby boomers are expected to develop Alzheimer’s disease or a similar dementia - the drugging of such vulnerable patients takes on increasing urgency. While there has been much focus on the increasing use of antipsychotic drugs among children - highlighted by the recent overdose death of 4-year-old Rebecca Riley - much less attention has been paid to the similar problem among seniors.

“Way too many patients in nursing homes are treated with antipsychotics purely to sedate them or to control behaviors that are difficult for the staff,’’ said Robert A. Stern, an Alzheimer’s specialist and brain researcher at Boston University School of Medicine.

“To the defense of nursing homes and nursing home staff,’’ Stern said, “they are indeed understaffed, they are indeed under-trained, and it takes an awful lot of well-trained people to manage the difficult behaviors that can be exhibited by people with dementia.’’

While there is no barometer for what is considered an appropriate amount of antipsychotic use in nursing homes - and there is no law governing the matter - specialists in caring for the elderly note that the use of antipsychotics is much lower in some homes than others, and in some states than others.

They also point to the federal government’s recent legal action against the largest provider of drugs to nursing homes in the United States. The company, Omnicare, agreed in November to pay $98 million to settle charges that it took kickbacks from Johnson & Johnson to recommend the drug maker’s products, including the antipsychotic Risperdal. The government said Omnicare persuaded physicians to prescribe the medication to dementia patients with behavioral problems. A government suit against J&J is pending.

Raia helps train nursing home staff in behavior management techniques that can ease agitation and the need for the drugs - skills and training that, specialists say, are often lacking in nursing homes in Massachusetts and across the country. In these homes, he said, as many as 80 percent of the residents are on antipsychotic drugs.

“And then I walk into a good place, one with training, and see 2 or 3 percent on these medications,’’ he said.

A nursing home’s track record for antipsychotic use often is a good predictor for future patients, according to new research from the University of Massachusetts Medical School. The scientists analyzed data from 1,257 nursing homes nationwide and found that patients newly admitted to facilities with some of the highest rates for prescribing antipsychotics are 37 percent more likely to receive the drugs than patients entering homes with the lowest prescribing rates.

Nicki Solomon of Norwood has seen those highs and lows. In 2007, she placed her mother, Corinne, in a nursing home. Although the retired surgical nurse suffered from dementia, she was still able to feed herself and converse clearly, but she had lost her short-term memory, was sometimes agitated and anxious, and would wander off.

Solomon said the nursing home, High Gate Manor in Dedham, asked her permission to prescribe her mother an antipsychotic but didn’t explain the potential side effects. Within weeks, Solomon said, her mother was transformed into someone she didn’t know.

“My mother was out of it all the time. She was asleep and noncommunicative,’’ Solomon said. “She was smothered.’’

She had been given Seroquel, Solomon said, one of the drugs that federal regulators months later would specifically warn against for dementia patients.

High Gate, citing patient confidentiality laws, declined to comment on Solomon’s care.

In June 2008, Solomon transferred her mother to a Needham nursing home that specializes in using alternatives to medication in caring for dementia patients. Her mother rebounded, she said, living another 15 months before her death last November.

Alice Bonner, the state’s top nursing home regulator as director of the Bureau of Health Care Safety and Quality, said “culture change,’’ including a growing consumer movement that focuses on more closely involving families and patients in care decisions, can lower the use of psychotropic drugs.

“We can do better, and use fewer drugs, and do more with behavioral interventions by changing the way we deliver care in nursing homes,’’ she said. Her agency is developing a brochure for nursing homes to give new residents and their families, encouraging them to ask y about the medications prescribed.

For Sharlene Hemp, a North Andover resident who says her father died from side effects of psychotropic drugs just 34 days after entering a nursing home, the answer is legislation. Her father had Alzheimer’s, but she said the family was never told about the medications nor of the potential lethal side effects, until after his death in 2001.

Hemp persuaded her state senator, Steven A. Baddour, to file legislation that would require all Massachusetts nursing homes and their prescribing physicians to obtain written permission from a patient’s health care proxy, which is often a family member, and a court appointed guardian before using antipsychotic medications. A public hearing was held on the bill in January, and it remains in committee.

“When you put a loved one in a nursing home, you are putting your trust in the nursing home and the doctor,’’ Hemp said. “But you don’t know when they go in that they are given all these drugs, and especially dementia patients, because they can’t tell you what they are given.’’

Kay Lazar

Antipsychotic drug use for dementia patients is questioned

Polk County Jury Awards $114 Million against Nursing Home

A Polk County jury has handed down a $114 million verdict in a nursing home abuse case that resulted in an elderly woman's death.

This could be the largest verdict ever in Polk County.

Juanita Jackson, 76, was placed in IHS of Florida, Auburndale, in March 2003 for rehabilitation. The company is now known as Auburndale Oaks Healthcare Center. Trans Healthcare Inc. and Trans Healthcare Management operated the nursing home at that time.

The suit contended that the nursing home staff knew Jackson was at risk for falls but did not put proper preventative measures in place and she fell within two weeks of being admitted. She suffered a closed head trauma and fractured her upper arm, injuries from which she never fully recovered, according to the suit.

When Jackson's family moved her from IHS in May 2003, she had become malnourished and dehydrated and had multiple bedsores. She died July 6, 2003.

The case was filed in the Tenth Judicial Circuit Court in Polk County in 2004
Polk County Jury Awards $114 Million in Nursing Home Lawsuit

Nursing home operator ordered to pay $43.5 million in wrongful death lawsuit

A Georgia jury Friday ordered a Sandy Springs lawyer and nursing home operator to pay $43.5 million in a wrongful death lawsuit.

The payment is to go to the estate of a man whose family said negligent care led to his death at a Rome nursing facility that had been cited for repeated state and federal violations.

Attorneys for the plaintiff said the verdict against George D. Houser is believed to be among the highest in state history against a nursing home operator.

Earlier this week, Houser, 62, filed for bankruptcy protection, listing total assets of between $20 million and $100 million.

The verdict is not the end of his legal troubles.

Houser, who operated Forum Group Corp. and its subsidiary, Forum Group at Moran Lake Nursing Home and Rehabilitation Center in Rome, faces federal charges filed in April in which he is accused of bilking the Medicare and Medicaid programs of more than $30 million.

According to the federal indictment -- in which his wife, Rhonda Washington Houser, 46, also is charged -- those Medicare and Medicaid payments were supposed to go toward care of residents at Houser's three nursing homes.

Instead, federal prosecutors allege the Housers funneled the money to purchase luxury cars and real estate, including a $1.3 million Atlanta home for George Houser's ex-wife.

No trial date has been set for the federal case, said Patrick Crosby, a spokesman for the U.S. Attorney's office in Atlanta. Houser's attorney in that case, Christopher P. Twyman, did not return a telephone call seeking comment.

He represented himself in the three-day wrongful death trial, which was heard in Floyd County Superior Court in Rome. He could not be reached for comment because after the verdict he was immediately taken to the county jail on a contempt of court charge. He was ordered to spend 48 hours in jail.

No one appeared to be home at his Hammond Drive N.E. residence in Sandy Springs.

In the 52-page wrongful death complaint, filed in March of last year, Loretta Terhune, whose 80-year-old father, Morris Ellison, died April 17, 2007, charged the nursing home failed to provide adequate care.

Her father, who was admitted to the facility a year earlier, fell numerous times, breaking his hip in one instance, according to the lawsuit. The nursing home also did not notify Ellison's doctors or family of his injuries.

"Mr. Houser, through his companies, systematically drained the money and resources from his nursing homes [and] caused all sorts of shortages of food, water and medicine and basic supplies," said Stephen G. Lowry, one of Terhune's two attorneys. "He was severely neglected at the time of his death, malnourished and severely dehydrated."

At trial, a nursing home director testified the facility lacked the funds to pay its staff, do laundry and pay bills.

The Georgia Department of Human Resources' Office of Regulatory Services conducted numerous inspections of the facility over several years. The agency closed it and terminated all federal funding after a May 23, 2007, inspection found "Moran Lake’s deficiencies constituted violations of state and federal regulations, nursing home regulations, Georgia state health regulations, and National Fire Protection Association Life Safety Code Standards."

Nursing home operator ordered to pay $43.5 million in wrongful death lawsuit  |

Wrongful Death Lawsuit Against Nursing Home Results in $43.5M Verdict

Wrongful Death Lawsuit Against Nursing Home Results in $43.5M Verdict

Nursing home in Kentucky issued four citations

The Kentucky Cabinet for Health and Family Services issued four citations to Hilltop Nursing Home reports the Commonwealth Journal. The nursing home in Science Hill was issued Type A citations, the most severe of its kind, issued for incidents of abuse and neglect at care facilities such as Hilltop. The incidents occured n July 2, August 18, September 1 and September 22 and included a resident with mental retardation and chronic obstructive pulmonary disease observed walking away from the facility on the roadway in 93 degree temperatures; knowingly employing an individual on two separate occasions who was listed on the Kentucky Nurse Aide Abuse Registry and failing to provide supervision for a resident with a known history of ingesting potentially harmful household chemicals. home in Science Hill issued four citations