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For many elderly and disabled residents of Tennessee, help completing day to day tasks can make a huge difference in their quality of life and happiness. Thankfully, Tennessee’s Choices in Long-Term Services and Supports (or Choices for short) program offers a crucial service to help care for adults (age 21 and older) with a physical disability and seniors (age 65 and older). The program provides services to assist eligible residents with daily living activities in their homes, on the job, or in their communities. These daily activities can include home-delivered meals, pest control, household chores, but also services like a personal emergency response system call button that can be used to get help in an emergency. The program allows the disabled and elderly to lead productive lives and stay involved in their local communities, but also provides these services in nursing homes if needed.

While the Choices program provides important benefits to many residents of Tennessee, there is currently a severe shortage of caregivers that is affecting thousands of people in need. Caregivers in the Choices program are required to be hired by managed care organizations, or MCOs, but as of late caregivers have missed appointments with citizens needing their services. Many times, a local senior center has accepted a contract from the government to provide citizens these crucial services. However, the Tennessee Justice Center in Nashville, which fights for those without a voice, recently sent a letter to the state requesting an investigation of just how many MCOs fail to provide regular and timely home based services. It is crucial that MCOs take responsibility for hiring the necessary number of caregivers to provide services to citizens in need, but they must also ensure that caregivers are properly trained and certified.

In a particularly striking example, Knoxville citizen, Army veteran, and cancer patient Joseph Davis’ caregiver missed multiple consecutive appointments at his home in the month before his passing. Joseph Davis’s wife June was unable to assist her husband, and relied on the assigned caregiver to help provide crucial services for Joseph. Their son Matt was forced to miss work frequently without notice to help care for his father when his assigned caregiver missed appointments. The lack of certified caregivers available to assist Joseph Davis receive the care he needed placed a huge burden on him and his family.

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Staffers from the Special Investigations Division of the House Government Reform Committee recently reported that between 1999-2001, 30% of nursing homes across the United States were cited for some form of abuse. In total, 5,283 nursing homes and similar facilities were cited for more than 9,000 instances of abuse. While these are staggering figures, they do not take into account the numerous other violations that were not caught.

The abuse reported came in many forms. Examples include bedsores, providing insufficient medical care, malnutrition, dehydration, accidents, poor sanitation, and improper hygiene. Of the 9,000+ instances of abuse, more than 1,600 were bad enough to cause “actual harm to residents or to place the residents in immediate jeopardy of death or serious injury,” according to the report. Some incidents were more serious than others. Some of the most serious involved sexual and physical abuse. Review of the violations revealed residents were hit, slapped, punched, choked, and kicked. Others suffered verbal abuse coming from nurses and other staff members.

Why does abuse like this continue to occur? Safety organizations have been asking this question for decades. Many nursing homes are understaffed, which means nurses and employees are forced to work long shifts. This can lead to mental errors, such as giving a patient the wrong medication. If a nurse must cover someone else’s post, he or she may forget to check on a patient at necessary intervals. Further, overworked employees can become frustrated easily, and physical abuse can manifest itself if an employee takes that frustration out on residents. Inadequate staffing can occur for a multitude of reasons. One is a limited supply of qualified nurses. Another is if a nursing home deliberately places its profits over the well-being of residents and chooses to save money by hiring less staff.

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A Missouri man has filed suit against St. Sophia Health & Rehabilitation Center, a facility located in Florissant, MO, claiming the nursing home allowed his mother to die after leaving her in a hot tub for eight hours. Geriatric Management runs this nursing home, and they own 22 nursing homes across four states. The victim, 88, suffered from Ahlzheimer’s, dementia, depression, heart disease, hypertension, and muscle weakness, among other medical conditions. The lawsuit accuses St. Sophia of understaffing, claiming the facility did not provide sufficient support for all patients in the home, which allowed his mother to remain in the hot tub unattended. After her death, government officials investigated and inspected St. Sophia, finding that many residents were in “immediate jeopardy.”

Understaffing is a major issue at nursing homes across the country. While nursing homes are required to provide sufficient resources to properly care for their patients, this does not always happen. Instead, some facilities deliberately choose to place profits over people, knowing they can save money by hiring less staff members. Other times, nursing homes simply cannot find enough qualified workers who have the necessary skills and training, such as a certified nursing assistant (CNA).

An understaffed nursing home can create a chaotic environment. Without enough staff members, those who are employed may feel overwhelmed and exhausted. This can lead to mistakes like failing to check on patients when required, medication errors, and leaving patients unattended for long periods of time, similar to the 88-year-old Missouri woman with difficulty moving/walking being allowed to remain in a hot tub for eight hours without anybody coming to check on her. It can also lead to frustration among staff members that be taken out on the patients. Nursing homes should provide compassionate care, but overworked, tired, and stressed employees are more likely to abuse patients or use chemical restraints to deal with patients whom they feel are unruly.

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ThinkstockPhotos-531917486-SmallJune 15 is World Elder Abuse Awareness Day. Over the past year, almost 1 in 6 elderly people experienced some form of abuse, including psychological, financial, neglect, physical, and sexual, according to figures published by the World Health Organization. The organization collected data from 52 studies in 28 countries.

Psychological abuse is the most common form of elder abuse, according to the World Health Organization. Under this form of abuse, a caregiver will call an elderly person names and take other steps to embarrass them, degrade them, or prevent them from seeing friends and family members. Financial abuse involves mishandling an elderly person’s money or assets, such as when a nursing home fraudulently bills the patient for unnecessary medical treatment. Neglect entails failing to meet a resident’s basic needs in order for that person to live properly, including nutrition, cleanliness, and medical care.

Elder abuse is a hot-button issue worldwide, as the number of people aged 60 is expected to double by 2050. Organizations across the world are trying to increase awareness of elder abuse and highlight how prevalent it is, as one study estimated that only 1 in 14 cases of elder abuse actually get reported to authorities. Certain elderly people are embarrassed to report the abuse, while others think that nobody would believe them. For patients with cognitive disorders or dementia, they simply may not remember the abuse even taking place, which makes them physically unable to report it to somebody else.

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When we place our aging or sick loved ones in nursing homes, we trust that they are treated respectfully and carefully. Though we cannot always physically be there with them, we take extraordinary steps to ensure their safety and well being. However, abuse still occurs, and at shocking rates. What’s worse is that most cases of abused are never actually reported. One way to eliminate this problem is to place cameras in nursing home rooms to hopefully end elder abuse.

Recently, a camera strategically placed in a Massachusetts nursing home caught a violent case of elder abuse on tape. The footage shows a 93-year-old resident of Wingate Healthcare being tossed around her room. Two nursing home employees pulled the resident by her hair across her room and flung her into her wheelchair. The two staff members can also be seen threatening the resident with their fists. The victim weighed under 100 pounds and suffered from dementia.

As soon as the footage was revealed, Wingate fired the staff members. The two are both expecting to face charges of assault and battery on a person over the age of 60. According to reports, Wingate has been extremely cooperative with authorities and has conducted an independent investigation in the matter.

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A nursing home in Memphis, Tennessee, is losing patients and staff members as it is being cut off from Medicare and Medicaid reimbursement funding for patient services. The nursing home is Signature HealthCARE at St. Francis, which also has been fined over $1.2 million for failing to meet certain minimum standards. This nursing home received poor grades on multiple Medicare surveys, leading to an overall rating of two out of five stars.

Of the areas surveyed, the nursing home performed worst in health and fire safety inspections. In its most recent health inspection in September 2016, 15 health deficiencies were noted. This number was far above the average number of deficiencies for Tennessee facilities, 5.1. It is also more than two times the national average of 7.2.

Signature is a large nursing home chain. It is based in Louisville, Kentucky. Overall, Signature operates more than 120 nursing homes in the United States, including five in the Memphis area. According to reports, nursing home residents began to transfer to other facilities when news broke that Medicare and Medicaid would no longer be reimbursing the nursing home for services performed for the residents. As of March 2017, around half of the facility’s beds were not being used. This has prompted the nursing home to lay off staff members. The nursing home has said it will appeal the reimbursement decision.

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A sudden death in a Michigan nursing home has sparked a statewide investigation with potentially significant consequences for the nursing home. The nursing home in question, Medilodge of Grand Blanc, has been providing long term skilled nursing care and short term rehabilitation services to the Eastern Michigan area for years. Recently, a male patient was found unresponsive, and investigators are wondering why.

The male resident, who has not been named in reports, was found unresponsive at Medilodge in late 2016. He was rushed to a nearby hospital where he was pronounced dead. The cause of death was not disclosed but is under heavy speculation. The suspicious circumstances surrounding the sudden death have led to an investigation by the Michigan Protection and Advocacy Service (MPAS). The MPAS is a state-appointed group assigned to investigate cases of abuse and neglect against the state’s disabled population.

MPAS also has the authority to file lawsuits on behalf of the state, which is precisely what was done in this case. The lawsuit filed by MPAS alleged that the deceased had physical and neurological disabilities and that he was not receiving adequate care in light of his circumstances. Lawyers for the group requested records from Medilodge in January 2017 but its request went unanswered. MPAS then, for the second time, requested records roughly two weeks later, also to no avail. After the second request, a lawyer for Medilodge stated he was in the process of complying with these requests but pleaded that he needed more time. The case is currently in the early stages of litigation.

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IMG_2473-CopyOn Thursday, April 6, 2017, Nahon, Saharovich & Trotz sponsored and served dinner at Ronald McDonald House of Memphis for patients of St. Jude Children’s Research Hospital and their families. 15 attorneys from our Memphis office served Chinese food from Mulan Asian Bistro to approximately 100 people throughout the night. A great time was had by all, and we appreciate Ronald McDonald House providing us with this opportunity to give back to our community.

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Elder abuse is a widespread but often under-reported problem. Studies show that only 1 out of every 14 cases of elder abuse are ever reported to the proper authorities. This statistic comes at the heels of data showing that citizens of the United States, and the world, are getting older. Worldwide, the percentage of adults aged 65 years or older is expected to triple to 1.5 billion people by 2050. In a recent survey, over 25% of Americans polled agreed that the growing number of aging adults is a major problem.

Currently, the elderly make up 15% of our nation’s population, and as mentioned above that number is expected to keep rising. If the trend of elder abuse and neglect continues to go unchecked, coupled with our growing population of elderly adults, more Americans will be subject to abuse in their lives. Abuse can take many forms including physical, financial, or sexual abuse.

Lawmakers in Tennessee and throughout the United States recognize the troubling trend of increased elder abuse are taking steps to ensure that our older adults are receiving the protection they deserve. In 2016, Tennessee lawmakers introduced legislation that created Vulnerable Adult Protective Investigative Teams in Tennessee, whose goal is to protect elderly and vulnerable adults. One way of accomplishing this goal is to promote information sharing between government agencies across the state.

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Healthcare fraud, specifically through programs like Medicare and Medicaid, is a major problem in the United States. In fact, it is one of the most prevalent types of insurance fraud committed each year. It is estimated that Medicaid fraud amounted to approximately $140 billion in 2016, while Medicare fraud was very close behind. So who foots the bill and gets hurt when fraud is perpetrated? In the situation of health insurance fraud in nursing homes, the victims are our loved ones.

Medicare coverage is broken into sections, starting with Medicare Part A. Part A covers inpatient hospital care, skilled nursing facilities (i.e. nursing homes), home health care services, and hospice care. Medicare is designed to assist persons over 65 years old and those who are disabled pay for medical expenses. For instance, an individual in a nursing who must undergo a procedure would only pay a percentage of the total cost. The remainder is billed by the medical provider to Medicare, who pays the provider an amount negotiated in advance for the specific procedure performed.

Medicare fraud can occur in a number of different ways. Some of the most common occurrences of fraud include phantom billing and kickback fraud. Phantom billing is probably the most obvious and widely committed type of fraud. This type occurs when healthcare providers bill Medicare for unnecessary medical procedures or procedures that are never performed. Unnecessary procedures can cause side effects that cause complications with a patient’s existing medical conditions. Billing for unnecessary medical equipment or tests also constitutes phantom billing. Kickback fraud refers to when another individual or facility receives some form of “kickback” for assisting in Medicare fraud. This could be criminals who steal patients’ Medicare numbers and data or medical providers receiving money for making false diagnoses or needlessly recommending a patient to another facility that will engage in financial fraud.