Jonathan Rosenfeld's Nursing Homes Abuse Blog : Jonathan Rosenfeld's Nursing Homes Abuse Blog | Lawyer & Attorney : Strellis & Field Law Firm | Bed Sores, Senior Neglect, Elder Abuse, Sexual Abuse: Chicago, Illinois

As the number of older adults increases, families are faced with the question of where their parents and grandparents will receive the best care. 

The answer for many families is to keep their family members at home. Many older adults who live at home require home health services, home nursing services, and in-home support services in order to maintain a high quality of life. 

Although home care nursing affords seniors more flexibility, the lack of a structured setting makes them particularly susceptible to elder abuse, neglect, and financial exploitation-- especially at the hands of unqualified or dangerous in-home caregivers. 

About 7.5 million individuals receive long-term care at home because of an acute illness, long-term health condition, permanent disability, or terminal illness according to the American Association for Long-Term Care Insurance. This is significantly more than the 1.5 million individuals in nursing homes and 1.1 million individuals in assisted living facilities who receive similar care for the same types of conditions. 

In order to protect individuals who receive health services at home, some states such Illinois, have passed laws to protect seniors who receive care in their homes.  Illinois' Home Health, Home Services, and Home Nursing Agency Licensing Act (210 ILCS 55) ensures that people who receive home health services, home nursing services and in-home support services at their residence are granted consumer protection and quality care. The Act establishes and enforces standards for services and care. 

In addition, all home nursing agencies must be licensed by the Illinois Department of Public Health as one or more of the following entities: home health, home nursing, and home services agencies. One requirement for licensure is compliance with the requirements of the Health Care Worker Background Check Act (225 ILCS 46), which helps protect frail and disabled citizens through a criminal background check of health care workers. A licensee of an agency that violates of the Home Health Licensing Act may be subject to penalties or fines of $100 per day starting on the date of the violation and ending on the date the violation is corrected. 

No doubt about it, legislation applicable to home nursing certainly provides a foundation for patient safety.  Nonetheless, as the demand for home nursing continues to grow, many companies that provide home nursing care will cut corners with respect to screening and training their workers in order to satisfy the demand.

If your loved one has suffered an injury or abuse at the hands of a home care worker, you should immediately report the situation to law enforcement.  Many of these tragic situations give rise to civil lawsuits against these home care agencies.  As always, you can talk candidly with our lawyers about your legal options for free.  Only if we are successful recovering money on your behalf, will we accept a fee. (888) 424-5757

Sources:

Illinois General Assembly: 210 ILCS 55 Home Health, Home Services, and Home Nursing Agency Licensing Act

Illinois General Assembly: Administrative Code, Part 245 Home Health, Home Services and Home Nursing Agency Code

Illinois General Assembly: 210 ILCS 46 Health Care Worker Background Check Act

Medical News Today: New Study Reports Three Times More People Receiving Health Care Support at Home Rather Than in Nursing Homes or Assisted-Living Facilities

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For families and individuals who provide care for older adults, adult day care centers or adult day services can be an important tool in providing adequate care. Providing round-the-clock care for an elderly loved one can be a huge, but worthwhile time commitment.

Adult day care centers can provide a much needed break for caregivers, while offering elderly adults therapeutic services.

Adult day service is the direct care and supervision of adults 60 years of age and over in a community-based setting for the purpose of providing personal attention and promoting social, physical, and emotional well-being in a structured setting.

Adult day care can serve an alternative to nursing homes depending on the focus of the facility (social or health services). These facilities provide services to adults with physical or mental impairments for the purpose of restoring or maintaining their ability to care for themselves. They can serve as an alternative to nursing home care when 24-hour nursing care is not medically necessary or when nursing homes are against the wishes of the individual or the family.

The State of Illinois does not require licensing or certification for adult day care providers. The Department on Aging Community Care Program (CCP) does not include provision for adult day care other than those stated in the Administrative Code (building, fire, health, and safety codes and standards, environmental barrier codes, and food service sanitation and vehicle codes).

In addition, the Illinois Department of Public Health has the authority to conduct performance reviews of adult day care centers in Illinois. The Provider Performance Review includes reviewing a sample of client and employee files to evaluate compliance with administrative rules and ensure that the center adheres to policies and procedures set by the Department.

The following are services that the Department requires adult day care centers to provide:

• Activities of daily living (ADL) assistance
• Health education and counseling
• Health monitoring / health-related services
• Medication administration (administered by an appropriately licensed professional)
• Nursing services
• Social services
• Transportation

Optional services include:

• Physical therapy
• Occupational therapy
• Speech therapy
• Skilled nursing services

Illinois, like most states, does not stipulate a specific staffing requirements for adult day care; only require only that each adult day service provider have adequate personnel in number (at least two people) and skill to provide for program and financial administration, nursing and personnel care services, nutritional services, planned therapeutic/recreational activities, and transportation to and from the service site. There are suggested staffing ratios: two staff for every 1-12 clients, three staff for 13-20 clients, four staff for 21-28 clients, and one additional staff person for each 7 additional clients.

As the population of older adults increases, the use of adult day care services can help provide necessary services to improve their the lives of older adults without having to institutionalize them in nursing home facilities.

For more than 30 years we have championed the rights of the elderly in all settings: hospital, nursing home, assisted living and day care.  If you or a loved one was injured or abused in an adult day care setting, you may have legal rights that include a claim for monetary damages.  Let us put our experience to work for you. 

Free consultation.  A track record of results for people like you. (888) 424-5757

Thank you to Heather Keil, J.D. for her assistance with this important topic.

Resources:

U.S. Department of Health and Human Services – Regulatory Review of Adult Services
U.S. Department of Health and Human Services – Regulatory Review of Adult Services: Illinois
National Respite Network & Resource Center: Adult Day Care 

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Families looking for facilities to care for their loved ones in North Carolina may begin having an easier time selecting an adequate adult day care or assisted living facility after the state implements a new rating system.  Similar to the well-publicized Medicare-rating system for nursing homes, North Carolina will rate assisted living centers and adult group homes on a four star system.

Unlike a current three-star system currently in place, the four-star system is intended to more accurately categorize facilities according to the quality of the care they provide.  Additionally, the newer rating system is intended to penalize facilities for providing inadequate care for stemming from problems such as medication errors and patient wandering.

Not surprisingly, some industry groups believe the new rating system may not provide a complete picture of each facility.  In this respect, I could not agree more.  No rating system-- no matter how well conceived-- can take the place of an in person visits (and preferably visits).  

Nonetheless, I certainly am a fan of any system that can help families with the difficult decision of what facility to select for a loved one.  As a lawyer who handles cases involving abuse and neglect in a group home setting, I wish other states would implement more intensive regulations of these facilities to protect our elderly population.

Read more about the new rating system for group homes here.

Related:

Are Group Homes A Viable Alternative To Nursing Homes?

Nursing Home Rating System Reveals Inferior Care Provided At For-Profit Facilities

What Is It Like To Live In A 1-Starred Nursing Home?

One year after the implementation of the Medicare nursing home rating system, where do we stand?

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Nursing home facilities often house young and middle-aged residents suffering from mental illness (including schizophrenia, depression, and bipolar disorder) with older nursing home residents.  In some cases, this has led to violence against already frail elderly residents. 

Younger mentally ill people now make up more than 9% of the nation’s almost 1.4 million nursing home residents.  Last year, there were almost 125,000 young and middle-aged adults with serious mental illnesses living in nursing homes in the United States.  This was a 41% increase from 2002, when only 89,000 mentally ill people ages 22 to 64 lived in nursing homes.  The federal government helps pay for nursing home residents’ care under Medicaid so long as the facility’s mentally ill population stays under 50%.  If the population of mentally ill residents is above 50%, the facility is classified as a mental institution and is no longer eligible to receive funds under Medicaid.   

Illinois has the highest number of mentally ill adults under age 65 living in nursing homes.  This is in part because Illinois only has 1,480 public hospital beds for mentally ill patients since the state shut down seven state-run mental hospitals since 1980.  Under federal law, nursing homes may only admit mentally ill patients if the state has determined that the person needs the high level of care the nursing home can provide. 

Mentally ill nursing home residents are often younger and stronger than the elderly nursing home population.  This leaves elderly residents less able to protect themselves when younger mentally ill residents suffering from behavioral problems and become aggressive and violent.  There are also correlations between nursing home residents suffering from dementia and increased aggression despite antipsychotic drugs. 

Elderly nursing home residents are already at greater risk of injury because of frail or weak bones, underlying disease, and weakness.  In addition, many nursing home residents are bed-bound, restricted in movement, or in wheelchairs, also making it more difficult for them to remove themselves from potentially dangerous situations involving mentally ill residents.   

In May 2008, a Chicago nursing home resident (Ivory Jackson – age 77, suffering from Alzheimer’s) at All Faith Pavilion was beaten with a clock radio by his roommate who was almost thirty years younger.  Mr. Jackson later died from his injuries.  The attacker, who had a history of aggression and “altered mental status,” was ruled unfit to stand trial and now resides in an Illinois state mental hospital.  All Faith Pavilion was fined $32,500 for failing to prevent the deadly assault. 

In January 2009, a 21-year-old mentally ill nursing home resident suffering from bipolar disorder with aggression was charged with raping a 69-year-old fellow nursing home resident at a facility in Elgin.  The mentally ill resident was admitted to the nursing home facility despite a history of violence and was left unsupervised even after telling staff that he was feeling sexually frustrated. 

In light of recent violent episodes (assaults, rapes, and murders) occurring in nursing homes, Illinois lawmakers have organized a Nursing Home Safety Task Force to improve Illinois’ nursing home system and ensure the safety of residents.  The Task Force hopes to deliver recommendations for improving the state nursing home system to Governor Quinn by January. 

What can you do?

If you are concerned about the living conditions of a loved one, here are some simple suggestions:

• Ask the facility about their policy with respect to accepting patients with criminal backgrounds and/or mental illness.
• Look at your state's sex offender registry, many states offer the opportunity to input a specific address-- such as a nursing home-- to see if any convicted offender live there
• Visit a facility multiple times before placing a loved one there.  Does it seem safe?  
• Check with your local police and see if any reports of violence have been reported at the facility.
• Report all violence to the police immediately

Sources:

Medical News Today: Patient Groups Tackle Stigma Attached to Bipolar Disorder and Other Mental Illnesses With New Tools

The Gerontologist: Mental Health Correlates of Aggression in Nursing Home Residents With Dementia

MSNBC: Mentally Ill Endanger Nursing Home Patients

US News: Health Buzz: Mentally Ill in Nursing Homes

Illinois Nursing Home Safety Task Force

Associated Press: Task Force Targets Violence in Illinois Nursing Homes

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One of the things I do each morning is to look through my google reader account to see the new updates regarding nursing home news and information.  Today, I glanced through the news stories to find another unfortunate report regarding the alleged abuse of a patient at an Ohio nursing home.  You can read about this report of nursing abuse here. 

As I read the article, where abuse was alleged to have occurred at Heartland Lansing Nursing Home, I realized how deceptive the names of nursing homes can be to the general public.  In the case of Heartland, it is part of the nursing home behemoth, HCR Manor Care. 

Yet by looking at the name alone most people, including most of the residents at the facility, likely have no idea that Heartland Lansing Nursing Home is actually owned by ManorCare.  Further confusing the matter is that ManorCare operates nursing homes around the country under the Heartland, ManorCare and Alden Courts surnames.

Why don't large nursing home chains want to lend the parent companies name to individual facilities? 

I am open to ideas, but I firmly believe large nursing home operators carefully name (and re-name) facilities with the intent of shielding the parent company from possible liability in the case of an injury or death.  Additionally, these knock-off names are also used to give an appearance that many of the facilities are small mom-and-pop operations as opposed to being operated by a health care conglomerate controlled with decision makers thousands of miles away.

The name-game gets much more complicated when it comes to other national nursing home chains.  For example, Kindred operates 14 nursing homes in Ohio all with different names and all without any signal to the pubic that Kindred owns and operates these facilities.  

While I may be making a big deal about the names of nursing homes, the fact is that the names are crucial when it comes to naming responsible entities in a legal proceeding.  In this respect, there can be little doubt that a number of lawsuits get dismissed or a parent company evades responsibility because the name of the facility where the alleged negligence occurred throws off the injured party.

The corporate ownership behind the names can be even more complex and confusing.  Many corporate owners have split up all aspects of the daily operation of nursing homes into different entities and --- you guessed it--- all with different names.  In some cases of corporately owned nursing homes, parent companies have successfully evaded responsibility for the actions of their employees by hiding under these shell companies.

All this is to say, is that many nursing home operators have become extremely sophisticated when it comes to using 'legal loopholes' to avoid responsibility for specific acts.  Consequently, a thorough examination of each nursing home's corporate structure must be analyzed prior to initiating any legal proceeding.

Related Nursing Homes Abuse Blog Entries:

Golden Living Sells All Its Arkansas Nursing Homes

Investors To Gain From Increase In Elderly Population

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The Richmond Health and Rehabilitation Complex, otherwise known as 'Madison Manor' has been added to the Special Focus Facility List following the disclosure of a videotape nursing assistants at the facility physically abusing, failing to provide food and failing to clean an 84-year-old resident at the facility in August.  The family of the woman placed a hidden camera in the woman's room after they discovered more than 30 unexplained bruises on her body during a visit. 

The Kentucky Attorney General filed criminal charges against three of the CNA's involved in incident and one has already pleaded guilty. Madison Manor dismissed all three employees following the filing of criminal charges.

This incident is not the sole reason for Madison Manor's placement on  the government's watchdog list.  According to Beth Fisher, spokeswoman for the Cabinet of Health and Family Services, Madison Manor's "history of non-compliance over the past three years" was the primary reason the facility was added to the Special Focus Facility List.

In 2008, Madison Manor received 25 citations related to resident care compared with the Kentucky average of 7 deficiencies per facility.  In addition to Madison Manor, there are two other Kentucky nursing homes on the watch list: Cambridge Place in Lexington, and Britthaven of Somerset.

A list of Special Focus Facilities can be found here.  Facilities on the list are inspected twice as frequently as other nursing homes.  If the facilities consistently fail to improve their facilities they risk losing government funding-- essentially forcing most facilties out of business.

Read more about this troubled Kentucky nursing home as reported by the Lexington Herald-Leader here.

About Extendicare

Extendicare Homes Inc. is national owner and operator of nursing homes based in Milwaukee, WI.  Extendicare runs 268 facilities across the country that provide services for more than 30,000 residents.  Nearly all of Extendicare's nursing facilities have higher-than-average scores for health deficiencies and safety violations.

Related Nursing Homes Abuse Blog Posts

Videotape Reveals Abuse In Kentucky Nursing Home

Nursing Home Negligence Lawsuit Filed Against Extendicare

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As a father of an active toddler, I am well versed in the importance of keeping close tabs on him at all times.  We keep a video monitor on him to make sure he doesn't harm himself.   Video monitoring has even gone to the streets in Chicago where police can monitor street traffic in crime ridden areas.

The time has come for monitoring to take the jump to nursing homes.  "Granny Cams" as Attorney David Terry describes in the Nursing Home Abuse Lawyer Blog would be an important part of protecting our nursing home residents from nursing home abuse from nursing home employees and co-residents.

While cameras have caught abusive workers in the act, utilizing video technology as a regular part of nursing home care seems the a reasonable thing to do.  I join David's endorsement of installing 'granny cams' to safeguard nursing home residents. 

Hey David, can I get a cut of Granny Cam's royalties?

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Think the term 'nursing home abuse' is made up by lawyers?  Cameras don't lie...

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A former employee of a state-run group home for mentally disabled people was banned today from working in the health care industry after pleading guilty to a charge of negligent cruelty to a person. Gerald Guay,was sentenced by Judge Gary White in Superior Court in Hartford to a five-year suspended prison sentence, three years' probation and 100 hours of community service. White also ordered that Guay refrain from working in hospitals, nursing homes and other care-giving businesses.

"You can't work in health care at all," White said.

According to the Bloomfield Police Department's arrest warrant application, Guay tormented and tortured Christopher Stockton, a 38-year-old resident of the Brown Street home who has severe autism and other developmental disabilities, including an inability to speak.

According to the affidavit, Stockton's mother, Alice Stockton, first brought her suspicions to the attention of the state Department of Developmental Disabilities more than two years ago, when her son began to suffer seizures that coincided with the beginning of Guay's employment in the home.

Alice Stockton was told there was nothing that could be done because there was no proof of abuse, according to the affidavit. Eventually she began to periodically take an audio recording what was happening in the room that her son had to himself, according to the affidavit.

On Dec. 18, 2007, Alice Stockton activated the recorder in his room, but did not immediately listen to what transpired. Three days later, she picked up her son and brought him to her home in Windsor for the weekend. When she tried to brush his teeth, she noticed a laceration and a hematoma on the inside of his mouth, she told police.

On Dec. 23, Alice Stockton listened to the recording and heard Guay entering her son's room shortly after she left. In the recording, Guay is heard swearing at Christopher Stockton and threatening to "bash his head in" several times, according to the affidavit.

On the recording Guay can be heard, in an expletive-filled tirade, threatening to beat Christopher Stockton and make him eat the toilet if he doesn't stop flushing it, according to the affidavit.

Why didn't authorities act quicker in this situation?  The fact that Ms. Stockton brought evidence of her disabled sons injuries to authorities attention and without any results is sickening.  These prosecutors should look for another job if they put the burden of obtaining evidence in the hands of a disabled person's mother.

Read more about this incident here.

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It makes sense.  If members of the nursing home staff are satisfied with their job, treated appropriately, receive good job benefits, they will be happier and their happiness will likely be translated to better patient care.  On the other hand, look closely into the eyes of any employee at struggling company-- you can sense their stress, their frustration and their anger.  In this sense nursing home patients and staff have interests that are very much aligned with each other. 

In nursing home owner's desire to squeeze every cent of profit out of their facility, nursing home staff and residents are the ones who are ultimately harmed.  In some respects many nursing home residents and the people who care for them on a daily basis are very much in the same boat.  Just as a nursing home resident may likely have few alternatives to living out the remainder in an undesirable facility; many people employed by the nursing home have few alternatives as well.  For many nursing home workers, they have little or no education, many are immigrants who possess few job skills. 

Many of the nursing homes that frequently have episodes of patient falls, pressure ulcers, medication errors and physical abuse of residents also happen to be the facilities that pay their employees the least.  Is this a coincidence?

Clearly, if there really is a desire on the part of nursing homes to improve patient care, they should first look improving morale of the nursing home staff.   Give the staff a $1.00 per hour raise, pay them overtime, give them some flexibility in their schedule, throw in a benefit or two-- before you know it overall patient care may begin to improve. 

For a more information on the correlation between employee satisfaction and patient care look here.

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We've discussed how nursing homes often provide poor care.  Nursing home residents often suffer from bedsores, medication errors, inadequate nutrition, falls and physical abuse.  Not to mention the nursing home residents pay handsomely for the privilege of subjecting themselves to these potentially deadly problems. 

Emily Brandon, of U.S. News and World Report , did a nice job reporting on programs available to seniors to allow them remain independent and out of nursing home facilities.  While the services detailed below may not be available in all areas, they give an idea of they types of programs available to seniors to provide assistance in their daily lives.

Transportation:  Seniors at Sunset Neighborhood in New Hartford, N.Y. can get a door-to-door ride to a doctor's appointment, shopping, restaurants, or errands.  The charge for the service is $450 to $725 yearly based on the services requested.

Home Maintenance: Capital Hill Village in Washington, D.C. employs volunteers to do basic home maintenance for light bulb changes, vacuum bag changes and moving of furniture. If the request requires more skill, the group has contracted vendors to provide discounted services.

Meals: Sunset Neighborhood does grocery shopping for its members every three weeks,  Other developments will have meals delivered or have scheduled meal sign-up which allow for seniors to enjoy each others company while eating at alternating homes.

Health Assistance: Many communities have daily telephone check-in's.  Others have plans in place for neighbors to actually ring each others door bell.

The above are simple examples of community sponsored care that enables seniors to remain independent.  The above can be implemented in any area where the services are desires.  Moreover, the above examples of care are not expensive. 

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Star-systems, internet searches and recommendations from friends are all good places to start when looking for a long-term care facility for an elderly family member. None of them take the place of doing things the old-fashioned way...going out to a facility and looking for oneself. A hands on approach when looking at facilities is the only way to to ensure the pictures in the brochures are for real.

This article chronicles an 84-year-olds struggle to find a decent facility.  Unfortunately, even with the aid of his daughter, finding an adequate facility was difficult. The elderly man learned the hard way that many facilities are not what they appear. After the elderly man suffered severe weight loss, urinary tract infections, dehydration, malnutrition, pressure sores and low blood sugar, due to poor care at a carefully chosen facility, the father and daughter were forced to renew their search for a place for him to live and thrive. Fortunately, the family made a record of this substandard care. The incidents of abuse and neglect were reported to the Illinois Department of Public Health. 

Read the complete Chicago Sun Time article here.

If you believe that a family member or friend has suffered abuse or neglect at a long-term care facility report it to the Illinois Department of Public Heath. The elderly in these facilities have rights. Call 1-800-252-4343 today to make a report.  A call reporting the incident initiates the process.  Then a State representative will go out to the facility and conduct a thorough investigation.
 
Make sure you have the following handy before making the call:

• The name, date of birth and social security number of the person for whom you are making the report
• The name and address of the facility where the incident took place
• A concise version of what actually occurred
• The date and time of the incident
• Provide specific detail of the injury
• Make the report as soon after the incident as feasible to ensure the investigators have access to witnesses

You may report these claims anonymously or you make provide your name. Similarly, if you provide your name you have a right to be copied on the investigation's completion.

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