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

Last fall, we discussed the problems state inspectors found at Emeritus at Crossing Pointe, a Florida nursing home, that posed an immediate threat to resident safety.  During an inspection at the nursing home, inspectors discovered:

• An 82-year-old patient who died after staff failed to provide her heart medication for four days
• Inaccurate resident counts by facility managers
• Residents with infected bed sores (also called decubitus ulcers, pressure ulcers or pressure sores)
• Neglected patients- some Alzheimer's patients had toe nails so long that they curved around their toes
• Falsified medical records
• Staff administering the wrong medications to patients that resulted in injury

The living conditions were so poor that Florida officials banned the facility from accepting new patients.

Now, it seems Emeritus officials have officially thrown in the towel at this facility.  After months of attempting to improve the living conditions at the facility, Emeritus officials have elected not to re-new the facilities nursing home license.  Now, the skilled nursing facility will transition to a 'senior housing' facility. 

Although the change in facility designation may seem like a minor change, the reality is that the change in designation of the type of facility is significant from a regulatory standpoint.  As a senior living facility, the facility will no longer be subject to any of the regulation imposed by the state of Florida on nursing homes such as inspections.

No word yet as to whether the Emeritus Corporation will retain control over the facility as it transitions to a less structured care environment. 

As a nursing home lawyer, I continually see poorly performing facilities attempt to re-name, re-organize and re-categorize themselves as problems arise.  In some cases, the re-vitalization of the facility provides a fresh start.  Unfortunately, most situations involving freshening up sub-par facilities simply means a change in window dressing.  Too often, I see these re-newed facilities continue with the pattern of poor care that got them in trouble originally. 

Consequently, it is important for families to learn as much as they can about nursing homes and assisted living facilities before placing a loved one there.  In addition to researching the corporation itself, it is important to ask direct questions to administrative staff regarding the history of the facility.

Read more about this Florida nursing home here.

Related Nursing Homes Abuse Blog Entries:

Admissions Suspended At An Emeritus Assisted Living Facility Following The Discovery Of: Medication Errors, Bed Sores & Falsified Medical Records

Another Iowa Assisted Living Facility Chooses To Abandon Its License

Pesky Government Regulations No Problem For Assisted Living Facility In Iowa

Now That We Rate Nursing Homes, Is It Time To Rate Other Adult-Care Facilities?

What causes bed sores?

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Sadly, the most recent episode of the sexual assault of nursing home patient at the hands of convicted felon-- who happens to be a fellow patient--- occurred last week in a Florida Nursing Home.  57-year-old Larry Donneal Evans, admitted to the sexual assault of a disabled female patient at the nursing home. 

The nursing home staff caught Mr. Evans in the act of assaulting the disabled woman and immediately reported the incident to police authorities. In addition to admitting to his inappropriate behavior, Mr. Evans stated that he did not stop his groping because the woman never said 'stop'. 

Prior to his admission to the nursing home, Mr. Evans served four years in jail for violently resisting an officer and possession of cocaine. 

To the left, is a photo of Mr. Evans that was taken by the Pinellas County Sheriff Department.  Read more about the sexual abuse of a nursing home patient here.

I'm getting sick of hearing about these type of sexual assault cases involving nursing home patients.  Facilities need to implement more protective measures to assure patients remain safe from the predatory acts of their fellow patients.  If facilities can not assure the safety of all patients, people with criminal backgrounds should never step foot in these facilities.

Related Nursing Homes Abuse Blog Entries:

Atleast 50 Convicted Sex-Offenders Living Freely In Illinois Nursing Homes

In Wake Of Sexual Assault Of Elderly Woman, Chicago Nursing Home & Administrator Named In Civil Lawsuit

Sexual Assaults In Nursing Homes, Not Exactly A Pleasant Topic-- But Is An Issue That Needs Attention

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Lots of chatter on Twitter over the weekend about Thai Hodges, a disabled woman who was taken to a homeless shelter by the good folks at ManorCare after her funds had apparently dried up. Hodges was admitted to ManorCare for rehabilitation and skilled nursing care after she suffered a stroke and became paralyzed.

The good news about the story (if there really is any) is that Sylvia Negley, the shelter coordinator realized that Hodges was clearly in need of medical care and refused to take her in and sent her back to the nursing home for additional care.

Negley says the transfer of patients from hospital and nursing homes is on the rise.  "'Hospital dumps' is what we call them,"Negley said.  "I've seen people wheeled in here in a wheelchair, placed on a chair and then they take the wheelchair away."

Can nursing homes do this?

If a nursing home accepts Medicare funding (the overwhelming majority of facilities do), then they are obligated to comply with its rules. 

Section 483.12(a)(2) Transfer and Discharge Requirements:

The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless:

(i) The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;

(ii) The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility;

(iii) The safety of individuals in the facility is endangered;

(iv)The health of individuals in the facility would otherwise be endangered;

(v) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. For a resident who becomes eligible for Medicaid after admission to a nursing facility, the nursing facility may charge a resident only allowable charges under Medicaid; or

(vi) The facility ceases to operate.

In this case, it sounds as though ManorCare acted recklessly in discharging a disabled patient who obviously needed skilled nursing care.  However, in cases where a medical condition is less acute, it may be within the facilities rights.  As we see the nursing home population grow and additional economic pressure put on these facilities, I'll bet we see more situations such as this in the future.

Read more about the dumping of a Florida nursing home patient here.

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Good nursing homes do exist.  In fact, there are many dedicated facilities throughout the country dedicated to the compassionate care of the elderly. 

In an era where we are bombarded with horrific descriptions of nursing home abuse and neglect, it was a pleasure to come across Jane Brody's personal accounting of the Miami Jewish Health System-- one of largest nursing homes in Florida. Ms. Brody's article, 'Nursing Homes That Belie the Bad Image' appeared in the New York Times and may be viewed here.

The Miami Jewish Health system is a huge, 20-acre complex in Southern Florida that cares for a variety of young and elderly patients with a diverse range of medical needs.  In fact, the facility is designed to provide such a broad range of medical treatments, that the patients truly never need to leave the facility confines.

Unlike, many 'generalized' nursing homes, Miami Jewish Health Care Systems offers:

• An acute care hospital
• Short and long-term skilled nursing care
• Rehabilitation services
• A dementia clinic
• Psychiatric clinic
• Pain care center
• Recreational activities
• Respite care
• Religious services
• Assisted living services
• Hospice care
• Care for children with cerebral palsy

Although the lack of specializations may appear to be a bad idea, a recent article in the Journal of the American Medical Association concluded that continuity of care- where the same physician oversaw medical care both in and out of a hospital setting; speeded recovery, cut costs and reduced re-admissions to hospitals in the elderly population.

Amazingly, 85% of the patients at the 492-bed-facility, are recipients of the Florida Medicaid program which reimburses the facility $205 per day.  To cover the difference between what Medicaid reimburses and the 'actual cost' of care, the facility raises money through contributions and grants.

Finding A Good Nursing Home In Your Area

Weather you are looking for a nursing home in Florida or across the country, Ms. Brody's article cites some useful advice proposed by Jeanne M. Hannah in her book 'Taking Charge: Good Medical Care for the Elderly and How to Get It".  As the daughter of a victim of nursing home neglect, Ms. Hannah's suggestions are particularly well taken.

• Investigate Nursing Home Deficiencies: Check to see if the nursing home has violated federal nursing home standards at the Nursing Home Compare Website. (I also suggest checking on the facility via your state's department of health's website as well)
• Choose Quality Over Location: Avoid the temptation to place a loved one in a facility simply due for convenience sake.
• Monitor the Care: Be vigilant in checking on your loved one as frequently as possible.  Vary your schedule to make sure they are being cared for even on weekends and holidays.
• Assist At Meals: One of the best ways to assure your loved one stays healthy is to make sure they eat and drink.  It they need assistance hire an assistant to help them eat.  All Many nursing home patients are susceptible to dehydration and malnutrition.
• Hire a Geriatric Care Manager: Sure it may seem like a luxury, but if you can not personally look after your loved one, a care manager can act as a patient advocate and liaison between the nursing home and family.  The National Association of Professional Geriatric Care Managers has a searchable directory by location.

Related:

High Staff Turnover Rates Plague Most Nursing Homes

Eden Or A Warehouse? You Choose.

Nurses Admit To Problems At Nursing Homes

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Many families of nursing home patients have been lead to believe that 'non-profit' facilities provide better care that their 'for profit' peers.  As we recently discussed, studies do generally confirm that non-profit facilities provide superior levels of care.

Nonetheless, if you ever need a reminder that every facility-- regardless of its tax status, must be evaluated on an individual basis, take a look at this article from the Palm Beach Post.

The Post article chronicles how Maxcine Darville, managed benefit herself and her family to the detriment of the patients at her facilities.

As the CEO of the Okeechobee Council on Aging, Darville managed to reel in an annual salary of $404,000-- more than two times the state and federal average for CEO pay at non-profit nursing homes.  Ms. Darville's company operates Glades Health Care Center and The Riverfront Nursing and Rehabilitation Center-- two nursing homes with a poor records for providing quality care to their patients.

Despite obvious safety violations at Darville's facilities, the Post's investigation clearly determined that she has little interest in investing money for facility improvements.  Among the Post's findings:

• Assistant CEO, Joanne 'Jody' Watson (Darville's daughter) was paid $200,000 plus $23,000 in expenses from two councils in 2007.  In 2008 she received $160,000 for her work.
• The director of maintenance, Gary Watson (Darville's son) was paid $118,000 in 2007.
• Darville spent more that $30,000 in personal expenses.  She receives $1,200 per month from her company to board an unnamed 'visiting executive' in her residence.
• The Okeechobee Council on Aging proudly lists a woman who has been deceased for more than two years.

Medicare's Rating:

Riverfront Nursing and Rehabilitation Center

Glades Health Care Center

Related:

Caring For The Elderly Pays... Especially If You Own The Nursing Home

Does Pulling Medicare Funding From Underperforming Nursing Homes Help Residents?

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

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State investigators have set an October 25th deadline for the Englewood Health Care center to correct conditions deemed to be unsanitary.  During a recent inspection, investigators found mold and leaking water in several patient rooms.  These unsanitary conditions were particularly bothersome to inspectors due to the fact that a substantial portion of the nursing home patients suffered from 'respiratory illness".

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For the more than a year, residents at Charlotte Harbor Healthcare in Port Charlotte, FL were intentionally monitored by hidden cameras camouflaged beneath ceiling tiles.  The cameras were discovered when investigators from the Florida Agency for Health Care Administration (AHCA) were inspecting the facility for mold earlier this year.  The feeds from the cameras were routed to the administrator, Thomas Bell's office.

Bell told AHCA representative that the cameras were there 'to prevent theft'.  Despite Bell's assertion, no theft-related incidents had been reported at Charlotte Harbor.  Residents were never informed on the cameras presence.  AHCA is evaluating the circumstances and may impose a fine for this cleat violation of privacy.

Is it realistic to expect privacy in a nursing home setting?  Too often were forget that nursing homes are 'home' for more than one million people in the United States.  True, most of the people are elderly and many of them face serious medical conditions-- but every effort should be made to promote as home-a-like setting as possible. 

Read more about this situation involving a violation of privacy in a Florida nursing home here.

Related Nursing Homes Abuse Blog Posts:

Invasion Of Privacy; Two Kentucky Nursing Homes Cited After Employees Use Cellular Phones To Take Photos Of Residents

New Law May Improve Privacy In Nursing Homes 

'Dignity Training' Ordered For Staff In New York Nursing Home After They Humiliate Residents Who Need Assistance With Toileting

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The family of a 68-year-old nursing home resident who wandered from the facility to his death, has filed a nursing home negligence lawsuit.  The family of Antoine Saintil recently filed the lawsuit against Broward Institute For Long Term Care after Antoine want missing from facility on Christmas day.  Search efforts by the facility to find Antoine were unsuccessful.  By the time authorities found Antoine in a waterway, two miles from the facility, he had apparently drowned. 

Antoine Saintil's family faced a difficult decision that many families face every day when they placed him in the Florida nursing home--less than a month prior to his death.  However, the family realized a recent stroke left Antoine disoriented and beyond their ability to care for him. "Because my dad was sick and we didn't want to keep him in the house.  He needed health-care.  He needed someone to help him like doctors, nurses and therapist," said daughter Julie Saintil.

There is no excuse for a nursing home's failure to keep residents who are prone to wandering from leaving the premises of the facility.  Nursing homes that house people, such as Antoine, who are prone to wander or elope should have the following safeguards in place to ensure the safety of each resident:

• Door alarms
• Window locks
• Door locks
• Bracelets that track each resident's location
• Adequate staff to look after residents
• Have contingent plans to locate residents who may wander from the facility

There is no obligation on the part of nursing homes to house every person who seeks out the facility's services.  However, when the nursing home agrees to house a resident who is disoriented or has dementia, the nursing home is implicitly agreeing they are able to properly care for the individual and is responsible for providing proper care.  Read more about this wrongful death lawsuit here.

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The Florida Agency for Health Care Administration and the Department Of Health and Human Services have ordered the Key West Convalescent Center to improve the care it provides to its residents or it will be forced to closed its doors.  Among the charges of abuse and mismanagement of funds charges, the nursing home is accused of:

• Abuse of a 39-year-old HIV patient.  The patient claims nursing assistants mistreated him while giving hie a bath.  The nursing assistants failed to properly clean the man's open wounds allegedly causing him extreme pain.

• Allowing a nursing home resident to operate his wheelchair backwards posing a threat to the safety of himself and others.

Unless the nursing home administration makes changes to correct the conditions cited in the report by December 11th, the facility will lose federal funding.  80 residents will have to find a new place to live and receive care.  Like most nursing homes, the Key West Convalescent Center likely relies on federal funding for most, if not all of its operating budget.  Read more about this incident of nursing home abuse involving a florida nursing home here.

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A shameful tale of a nursing home neglect recently was reported in Florida.  As amazing as this sounds, the Florida Nursing Home was cleared of criminal neglect charges by the Florida Attorney General when a nursing home resident was found to have maggots in both eyes. 

The Attorney General, investigating the case blames their inability to prosecute the case on the lack of physical evidence available.  "There was no way to pin down the origin of the maggots,"  according to Sandy Copes, communication director for the Florida Attorney General.  Further hampering the attorney general's ability to bring charges was the fact that no physical evidence could be collected from the resident's room as it had been cleaned by the nursing home.

For those unaware, maggots are the larval form of a fly.  In this case, the nursing home obviously allowed a number of flies to accumulate in this residents room.  The nursing home also allowed the flies to lay eggs in the patients eyes.  I certainly appreciate a prosecutor who is hesitant to bring charges because of a lack of evidence, but even without the physical evidence, it certainly seems like a strong case could be made against this nursing home for criminal neglect.  Who else is to blame for maggots in a nursing home resident's eyes?

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This article in the New Press, a fort Myers, Florida, newspaper caught my attention.  The article by Janine Zeitlin, uses statistics to prove what many close to to the elderly already know- elder abuse and elder neglect is a dirty little secret.  Most cases of elder abuse and elder neglect go unreported. When cases are discovered they are difficult to prove.

According to the article, the Florida Department of Children and Families found that adults make up about 18 percent of their abuse cases.  The real extent of abused senior abuse may never be known. Unlike minors where the state may forcefully intervene in a potentially abusive situations, if elders refuse to get help there is little authorities can do.

Another complicating factor in learning the full extent to elder abuse is that many elderly don’t go to the doctors that often, and that might be the only time they’re out of their homes. Elders in nursing homes and long-term care facilities are similarly isolated from the general population.  Rarely do nursing home residents venture into the community.  

Even with obstacles in place authorities do what they can to discover situations involving elder abuse and neglect.   The Department of Children and Families discovered a case of nursing home abuse and neglect involving a 90-year-old woman at Johnson Hall Home.  Although the woman had a large infected sacral wound that had evolved, the facility did not provide her medical attention. The department also used its investigative resources to discover a case of neglect which lead to death involving a 95-year-old nursing home resident.

The above situations demonstrate the need to report nursing home abuse and neglect.  If you suspect the mistreatment of a nursing home resident, you can contact your local department of public health and make a report.  In most situations, the report may be done anonymously.

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You never know who may turn up at your local nursing home...unfortunately.  68-year old, David 'Daddy Dave' Green was recently discovered as a resident at Florida nursing home. Mr. Green had been on the run for 8years following his escape from an Ohio jail.  Mr. Green is not your ordinary nursing home resident, as he is currently listed as one of America's top 15 most wanted fugtives. Read more about this nototius nursing home resident here.

Nursing home residents have a right to a safe and violence free environment.  If a facility knew or should have known of a residents violent tendancies and they commit a violent act against other residents, the nursing home should be held accountable.

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A man admitted to Azalea Court Nursing and Rehabilitation Center for rehab for a broken leg, soon realized he was getting more than rehab at the facility he chose to help him- maggots.  The maggots were seen in an open wound during a dressing change.  Azalea Court's complaint and inspection reports from the past several years did not reveal any glaring problems. Investigators from the State Attorney’s Office visited Tuesday.  Read more about the maggots here.

This is a prime example of neglect nursing homes.  Nursing homes are required to provide the best care possible for their residents.  The failure to clean and open wound is a clear case of patient neglect.

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