December 12, 2014

Millions of Elderly Abused Each Month Around The World, UN Health Agency Reports

A sobering report released by the World Health Organization (WHO) this week highlights the systemic levels of abuse that the world's elderly population encounters each month. The United Nations News Centre reported that millions of elderly disclosed significant levels of abuse across the world. These numbers are worrisome for two reasons. First and foremost because they illustrate the widespread and rampant abuse of the elderly population, but also because there are likely many amongst the elderly population whose abuse is never reported for fear of reprisal or inability to report their abuse. As a result, untold numbers of elderly nursing home residents and those being cared for around the world are forced to suffer silently.

The World Health Organization details that abuse in institutions, such as nursing homes, may include "physically restraining patients, depriving them of dignity (by for instance leaving them in soiled clothes) and choice over daily affairs, intentionally providing insufficient care (such as allowing them to develop pressure sores), over- and under-medicating and withholding medication from patients; and emotional neglect and abuse."

The report went onto note that here in the United States, in a survey of nursing home staff, thirty-six percent had witnessed at least one incident of physical abuse of an elderly resident or patient in the previous year; ten percent admitted to committing at least one act of physical abuse towards and elderly patient; and forty percent of staff had admitted to psychologically abusing patients. Taken together, this report showcases a worrying trend that nursing home abuse may only be getting worse throughout the country and world.

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December 9, 2014

Illinois Nursing Home Employee Hits Resident, Must Appear In Court

All too often employees of nursing homes throughout the State of Illinois are being accused and even criminally charged with abusing a nursing home resident in their care. Just this last week an employee at the Champaign County Nursing Home in Urbana, IL, was given a notice to appear in court after allegedly striking a 74-year-old resident at the nursing home last month. This unidentified employee, a certified nursing assistant, allegedly punched the resident in the arm. While the report goes on to note that the resident, prior to being punched in the arm, had punched the employee in the chest, there is no reason for the employee to react in the manner that she did.

In fact, the resident who punched the female employee was known to have Parkinson's and dementia, as we all as a history of combative behavior while receiving morning care. If anything, this report highlights exactly why it is necessary to have a stringent screening process of nursing home employees at the outset. It is understandable that the employees at the nursing homes are placed into an environment that is less than enviable, but it is important that these employees also understand that each and every nursing home resident is different and their conditions may cause combative and often times violent behavior. Employees must be taught and understand how to react properly to the behavior of residents in their care.

This is because employees are placed into a position of trust and care. While many residents may lash out or not understand their actions due to the onset of such terrible conditions such as dementia and Alzheimers, it is even more important that employees who care for them understand these conditions and the behavior that may accompany these conditions within residents. This is not necessarily excusing the resident for his behavior towards the certified nursing assistant, but is merely highlighting that employees need to be properly educated and vetted on how to react in these situations. Responding to violence, by a resident, with violence is the worst thing a caretaker could do.

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December 5, 2014

ILLINOIS NURSING HOME STAFF ACCUSED OF ABUSE

According to a recent newspaper report, an employee at an Illinois nursing home has been given a notice to appear in court after allegedly striking a 74-year-old resident on November 24, 2014. The employee has been suspended. A State's Attorney said she is investigating whether to file a criminal complaint against her.

The report indicates that the incident was documented in an internal memo from a nursing home manager. The memo states that a 74-year-old resident with a diagnosis of Parkinson's and dementia was being washed up with the assistance of two CNAs and a nurse. While being washed up, the resident punched one of the CNAs in the chest. The CNA that was hit reacted by punching the resident in the upper arm. No immediate injury or bruising was noted. The other CNA and nurse witnessed the incident. It is questionable that this behavior by the CNA could be justified as self defense given the medical status of the resident.

The sheriff's office was notified. The CNA was not arrested, but was given a notice to appear in court later this month. The incident also will require reporting to the Illinois Department of Public Health.

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December 1, 2014

Racial Disparities In Nursing Home Care

We previously reported that a Center for Public Integrity investigation revealed how a federal website administered by the Centers for Medicare and Medicaid, called Nursing Home Compare, has not been accurately reporting staffing levels at nursing homes across the country. This was due to a reliance on information self-reported by facilities rather than Medicare reports that reflect more accurate staffing levels. In some cases homes were self-reporting more than double their actual staff level, and the problem is particularly pronounced in many southern states. Such discrepancies led to inaccurate reporting on the Nursing Home Compare website, which is meant to provide information on nursing homes such as ratings, investigation-related information, and staffing levels for consumers to use in searching for the right facility. The Center for Public Integrity investigation also revealed that staffing levels were particularly lower in nursing homes that served minority communities of residents.

The report revealed majority-white nursing homes have about 34% higher staffing levels than facilities with mainly African-American residents, and how those same homes had 60% higher staffing level than nursing homes mainly comprised of Latino residents. According to the statistics, "[h]undreds of majority-black homes" nationwide reported through Nursing Home Compare that their registered nurses provided on average just over 30 minutes of care time to each resident every day. However, according to the Medicare reports, this figure was really only about 20 minutes per day. In some Latino nursing homes the average time spent on care per day was only 10 minutes.

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November 21, 2014

Conflict and Violence among Nursing Home Residents Widespread

A recent study by lead author Karl Pillemer, professor of gerontology in medicine at Weill Cornell College of Medicine in New York shockingly reveals that aggression among residents of nursing homes is widespread and "extremely high rates of conflict and violence" are common. In fact, Professor Pillemer discovered that one out of every five residents living in the nursing facilities studied was involved in at least one "negative and aggressive encounter" with another resident within a four-week period of time. These disturbing findings were made public earlier this month at the annual meeting of the Gerontological Society of America in Washington, D. C.

The study, the first of its kind to look at the scope of negative aggression between residents, was conducted by researchers who examined patient records at ten nursing homes in the state of New York, interviewed staff and residents, and directly observed and recorded incidents of conflict, abuse or mistreatment. According to CommonHealth, of the more than 2000 nursing home residents involved in the study, researchers found that "16 percent were involved in incidents of cursing, screaming, or yelling; about 6 percent in physical violence such as hitting, kicking, or biting; one percent in "sexual incidents, such as exposing one's genitals, touching other residents, or attempting to gain sexual favors"; and 10.5 percent in events" labeled "other," such as, residents entering rooms uninvited or rummaging through others' belongings.

Often the reason for such aggression is due to obvious health problems, such as dementia, which can cause an individual's behavior to be less inhibited. However, there are other factors that are believed to contribute to conflict and violence among nursing home residents as well. The study found "higher rates of mistreatment in more crowded facilities, and in areas within facilities where residents were more densely gathered" and "higher rates of resident-on-resident aggression in nursing homes with lower staff-to-resident ratios." Professor Pillemer also notes that nursing home staff can become blind to the problem because of its frequency, which contributes to the problem, and that aggression between residents is cyclical in nature in that this negative behavior and its effects are "contagious." In other words, "[s]eeing these incidents causes other residents to be fearful, anxious, concerned--and that can lead to more of the behavior."

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November 12, 2014

INVESTIGATION FINDS NURSING HOME CARE LEVELS LOWER THAN REPORTED

A recent investigation performed by the Center for Public Integrity, a nonprofit, nonpartisan investigative news organization in Washington D.C., found that U.S. nursing home patients may not actually be receiving the high levels of care that their families believe they are receiving. In their investigation, the Center for Public Integrity ("Center") found that staffing levels, which are self-reported by nursing homes to the Nursing Home Compare website, were widely inaccurate and inflated. The Center was able to come to this conclusion by analyzing the self-reporting nursing homes' annual financial reports. These financials proved to investigators that the number of staff employed, especially skilled nursing staff, would be impossible based on the nursing homes' yearly financials.

The study found that the exaggerated staffing levels reported by nursing homes occurred for all types of positions, but were especially inflated for registered nurses, the most skilled and highest paid of nursing home staff. The center determined that 80 percent of facilities reporting their staffing numbers reported higher registered nurse staffing levels on the public website than those the Center found in its review of the cost reports. Even more alarming was that more than 25 percent of nursing homes throughout the country reported staffing levels which were double the level actually reported in the nursing homes' financials.

These discrepancies raise two very fundamental concerns regarding the self-reported staffing numbers. First, many consumers throughout the country, including Illinois, rely on the Nursing Home Compare website when choosing a nursing home for their family members. Second, and perhaps more importantly, academic studies have shown that the amount of care, especifically care provided by registered nurses, strongly correlates with residents' quality of care. Put another way, the lower number of skilled nursing staff at a nursing home, the more likely that injury and even death may occur.

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November 7, 2014

Illinois Ranked Eighth Worst State for Nursing Homes; Receives "F" Grade

Families for Better Care recently released its "Nursing Home Report Cards" for 2014 and the results for Illinois are not good.

Illinois was ranked 44th out of 50 states and the District of Columbia for Nursing Home Quality, or 8th worst. Furthermore, Illinois received a failing grade of "F" and lowered its ranking from last year by two spots, falling from 42nd to 44th.

Families for Better Care determines its rankings by analyzing staffing data from the Kaiser Health Foundation, evaluating performance indicators from the Center for Medicare and Medicaid Services' Nursing Home Compare and tracking complaint statistics from the Office of State Long-Term Care Ombudsman. The main factor that contributes to quality of care is staffing. As the report states, "the difference between quality nursing home care and subpar care boils down to an average of 22 extra minutes of direct care per resident daily."

Some appalling statistics stand out from this study. Nursing homes in Illinois average less than 2 hours and 15 minutes of direct resident care per day, leading to an "F" grade under the Direct Staffing Care Hours category. Also notable is the fact that one quarter of nursing homes in Illinois reported having a "severe deficiency", leading to a "D" grade under that category.

Should you or a loved one have concerns or questions regarding treatment or conditions at a nursing home or long-term care facility, please contact our experienced attorneys at Ed Fox & Associates today for a free consultation.

October 31, 2014

NURSING HOME STAFF CHARGED WITH CRIMINAL ABUSE AND NEGLECT

Three former employees of a nursing home owned by Genesis Healthcare have been criminally charged based on allegations that they abused and neglected two women.

The three former employees were hit with multiple criminal charges after being accused of abusing residents at the nursing home. State Police and other agencies engaged in an investigation of the nursing home where the alleged abuse and neglect occurred, leading to the criminal charges. One employee faces 14 counts each of criminal abuse and knowingly abusing or neglecting an adult. That same individual has also been charged with two counts of wanton endangerment.

The second employee was charged with four counts of criminal abuse in the first degree and of knowingly abusing or neglecting an adult in the first degree. That individual also faces fourth degree assault charges and two counts of second-degree wanton endangerment. A third employee also has been charged with the same crimes. All of the defendants have pleaded not guilty.

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October 30, 2014

LONG-TERM CONSEQUENCES OF FALLS IN NURSING HOMES

The long-term consequences of frequent falls in nursing homes are not always immediately apparent. A recent study published in the medical journal JAMA Internal Medicine found that half of residents who suffer a hip fracture after falling either pass away or lose mobility completely. Researchers at the University of Pennsylvania's Perelman School of Medicine observed more than 60,000 nursing home residents who were hospitalized for hip fractures in a four-year period. The researchers found that residents above the age of 90, and those who did not undergo surgery for the fracture, were most likely to pass away or become disabled.

Most of the nursing home residents observed for this study were able to move around on their own before they suffered a hip fracture. Six months after hospitalization, about one in three nursing home residents had passed away. A year after the injury about half of the patients had died. Moreover, those who survived suffered from many different types of disabilities. Among the residents who survived, nearly 30% had to depend on others to help them get around, to get in and out of bed, and to perform personal hygiene. This significantly restricted their ability to participate in nursing home activities so they spent more time in bed, which increased their risk for developing other. This reinforces the need to focus on preventing falls in the first place.

Families with a loved one in a nursing home should be aware that, if a fall does occur and the patient suffers a hip fracture, they are unlikely to return to their pre-injury health state. It may also be helpful to encourage residents to undergo surgery for the fracture, even if they express hesitation. In these and other areas, families should begin planning for the future care of their loved one, who may become newly dependent on nursing home staff to get around.

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October 19, 2014

Centers for Medicare & Medicaid Services' five-star Nursing Home rating system to be Overhauled

President Obama recently signed into law the Improving Medicare Post-Acute Care Transformation Act (IMPACT), which means that soon when trying to locate a nursing home for yourself or a loved one, CMS' rating will actually reflect the quality of the facility. At the present time, Medicare relies on self-reported and unverified information from nursing homes as well as its own citation data to rank facilities. Thus, comparing nursing homes ranked by Medicare on its website primarily depends on the accuracy and completeness of the information provided by the facilities. These self-reporting practices have been often criticized leading experts to question CMS' rating system as a true indication of the quality of care provided by the nursing home facilities.

Medicare's five-star rating system came under fire after an August 2014 report was released by the U.S. Department of Health and Human Services Office of Inspector General. The report found that in a random sampling of 245 nursing homes, only fifty-three percent (53%) of allegations of abuse or neglect were reported as federally required. These findings clearly indicate the unreliability of nursing home facilities' self-reported data upon which the five-star rating system is based.

Changes in the rating system are scheduled to begin in January and will include adding measurable data. For example, nursing homes will be rated on the percentage of residents re-admitted to a hospital and the percentage receiving antipsychotic drugs. CMS will also start gathering data regarding staffing numbers and turnover rates directly from payroll records rather than relying on a facility's self-reported numbers. Cheryl Phillips, M.D., LeadingAge's senior vice president of public policy told Long-Term Living Magazine that "[t]he inclusion of verified staffing information based on payroll data is especially important, as staffing levels are often the best proxy [indicator] for quality."

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October 16, 2014

Nursing Home Chain to Pay $38 Million Dollars in U.S. Settlement

In a stunning victory that will hopefully have widespread ramifications across the country, a skilled nursing home chain has agreed to pay $38 million dollars to resolve ongoing allegations related to resident care. Extendicare Health Services, Inc., owners of nursing homes in eight states, including Wisconsin and Indiana, were accused by the United States Government of substandard care in 33 of its skilled nursing homes. These allegations stem from a federal government investigation into Extendicare between 2007 and 2013.

A number of allegations were made against the quality of care at Extendicare which led to the charges by the federal government. Namely, they were accused of failing to provide appropriate care, follow safety protocols or maintain enough skilled nurses. As a result, the government insisted that they wrongfully billed Medicare and Medicaid for such substandard care. Even more alarming is the effect this substandard care had on nursing home resident at the facilities throughout the country. Investigators found that these lapses in appropriate care "resulted in head injuries to residents, falls, bed sores and fractures." They also found that many residents suffered from malnutrition, dehydration and infection.

As acting Associate Attorney General Stuart Delery rightfully stated, "protecting this nation's vulnerable populations, including our seniors, has been and continues to be one of this department's highest priorities." We at Ed Fox & Associates commend the government for stepping in to help end the pattern of neglect and abuse many residents were threatened with and experienced on a day-to-day basis at Extendicare facilities. It is our hope that this multimillion dollar settlement will go a long way in correcting the issues highlighted by the federal investigations. Not only will extendicare be required to pay $38 million dollars, but it will also be required to enter into a five-year, chain wide compliance agreement with the Department of Health and Human Services. As part of this compliance agreement, the company will be required to hire an independent monitor and make other changes necessary to correct the issues reported by the federal government.

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September 12, 2014

Illinois: Cameras in Nursing Homes?

Concerns surface over whether or not video cameras should be used in nursing homes to monitor staff's behavior towards residents as proposed by Illinois Attorney General, Lisa Madigan. Cameras could help deter nursing home abuse and neglect and hold those responsible when abuse or neglect occurs. The Attorney General's office is drafting a bill which would allow video cameras and audio recording devices in nursing homes as long as residents consent and they or their family can cover the costs.

Although agreeing that cameras can be helpful in cases where the resident consents, many elder care advocates are concerned about the privacy of seniors in cases where consent is difficult to determine. Many residents of long term care facilities are mentally impaired, such as those residents whose mental capacity has been affected by a stroke, claims a representative of suburban Cook County for the Legal Assistance Foundation, a senior advocacy organization. No one knows if those residents who require help in getting dressed or changing a diaper would want to be recorded.

However, Madigan and supporters of the proposal say that cameras are appearing everywhere these days, so why not allow them in nursing homes. The recordings from the cameras or audio devices would be allowed in court and anyone who tried to tamper with or obstruct the devices would be penalized under the proposal. It is no surprise that abuse and neglect in nursing homes is a growing concern. According to the attorney general's office, the Illinois Department of Public Health receives 19,000 calls per year alleging abuse or neglect and responds to about 5,000.


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September 5, 2014

New Illinois Law proposes minimum direct care nurse hours

Our Chicago Nursing Home abuse firm has been tracking recent legislative activity within the United States Senate and House of Representatives. Congresswoman Jan Schakowsky (D-IL 9th District) has proposed a bill that, if put into effect, would require long-term care facilities to use the services of at least one registered nurse to provide "assessment, surveillance and direct care to residents 24 hours a day, 7 days a week." This program would apply to Medicare and Medicaid nursing homes and skilled nursing facilities.

Schakowsky introduced her bill on July 31, 2014. Under present law, Medicare and Medicaid nursing homes and skilled nursing facilities are only legally required to have a nurse on duty for eight hours a day. Low staffing levels can lead to elder abuse or neglect. We at Ed Fox & Associates have handled a wide variety of cases in nursing homes, especially with regards to issues of abuse and neglect of nursing home residents.

Congresswoman Schakowsky also recently sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Mariyln Tavenner urging CMS to fully implement the provision of the Affordable Care Act which requires nursing home staffing information be obtained through a payroll data collection system. In the letter, Congresswoman Jan Schakowsky wrote "People who need nursing home care for themselves or their loved ones are looking at staffing levels to see whether the services they need will be there. They deserve to have reliable data and it is time that CMS acts to meet the requirements of the law".

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September 2, 2014

Reports of Elder Abuse rise in DuPage County

As DuPage County's demographics have changed, so have the number of reports of elder abuse. As documented in the Doings, a Chicago Sun-Times Publication, as of halfway through 2014 DuPage County has already reported 297 cases of elder abuse. In the fiscal year of 2013, DuPage County reported 467 cases of elder abuse. If this pace continues, DuPage County would have over 100 more reported cases of elder abuse in 2014 as compared to 2013.

DuPage County has not determined the exact cause of this increase in pace of elder abuse reports, but a 2013 change in Illinois law may be considered a factor. Out of the 297 reported cases thus far in 2014, 37 of these reports involve alleged abuse against disabled individuals.

It is important to note that nursing home abuse may not only take place in substandard nursing homes. Abuse can also take place from caregivers within ones' own home. Abuse can include, but is not limited to, physical abuse, neglect, emotional abuse, confinement or even sexual abuse.

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August 22, 2014

Federal Inspector General Finds That Nearly 25% of Nursing Homes Fail to Report Abuse or Neglect Allegations

The United States Department of Health and Human Services' Office of the Inspector General (OIG) has released its findings related to an investigation surveying approximately 250 nursing home care facilities throughout the United States. While this survey is a small cross-section of all nursing home care facilities within the entire nation, its findings are deeply troubling. The investigative report concluded that only seventy-six percent (76%) of the nursing homes maintained policies that address federal regulations for reporting allegations of abuse or neglect. Additionally, only fifty-three percent (53%) of care facilities actually reported the findings of any investigation completed in response to allegations by residents or their loved ones concerning abuse or neglect at the hands of a care provider at the nursing facility, as federally required.

Of those nursing home facilities complying with their federal requirements of reporting abuse and neglect, a total of 149,313 allegations of abuse or neglect were brought to the attention of the OIG in 2012. Of all these reports, abuse was the most common type of allegation, accounting for half of the allegations in 2012. Even more alarming than the significant number of allegations reported are those that fail to be reported. Very often, when this occurs, the individuals being abused or neglected suffer in silence.

The purposes of these reporting requirements are clear: to ensure the safety of nursing home residents and create a mechanism by which there is complete transparency within the nursing homes when it comes to allegations of abuse and neglect, and any subsequent investigative findings into the allegations. That being said, this study clearly indicates that further measures need to be implemented to ensure complete compliance by all nursing home facilities across the country. The OIG, in this investigative report, recommends that the Centers for Medicare & Medicaid Services (CMS) guarantee that nursing home facilities:

(1) Maintain policies related to reporting allegations of abuse or neglect;

(2) Notify covered individuals of their obligation to report reasonable suspicions of crimes; and

(3) Report allegations of abuse or neglect and investigation reusults in a timely manner and to the appropriate individuals, as required.

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