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Skyline Healthcare, a national nursing home chain, is the subject of a new investigation conducted by NBC News. At one point, Skyline operated nursing homes across the country, more than 100 facilities in 11 states, including Tennessee. However, in the last few years, several have shut down entirely amid allegations of abuse and patient neglect.

Joseph Schwartz of Brooklyn, New York, started Skyline after selling an insurance business. He continued to purchase nursing home facilities and expand into new states. Over the years, many of his properties faced accusations of neglect, uncleanliness, under staffing, and failing to properly monitor residents. Skyline properties have faced issues across the country, from Massachusetts to Arkansas to South Dakota.

One Skyline property forced to close was in Memphis, Tennessee – Ashton Place. Skyline took over the facility in September 2017, and by November 2017, a resident with an amputated leg was taken to a local emergency room. Upon admission, nurses noted he had been lying in feces and found maggots and gangrene in his leg. The resident passed away two days later, prompting a police investigation. Staff admitted that Skyline ownership directed them to move from electronic record keeping to paper record keeping. Poor record keeping was a red flag to investigators.

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Nationwide, nearly 15,000 nursing homes accept benefits and payments from Medicare and Medicaid. Nearly 10,000 of these homes are for-profit facilities, 4,000 are non-profit, and 1,000 are government-owned. Overall, most facilities average between 100-199 beds, and the next highest percentage of nursing homes average 50-99 beds. Facilities that receive Medicare and Medicaid must follow stringent guidelines set forth by the Centers for Medicare and Medicaid Services (CMS). To be eligible to receive these benefits and funding, they must agree to be subject to inspections by CMS investigators and employees.

When it comes to evaluating a nursing home for a loved one, data regarding inspections is publicly available. Inspection results can be accessed online. Facilities in all states are rated on numerous factors, such as Health Inspections, Staffing, and Quality Measures. Below are common violations for nursing home facilities.

Understaffing

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iStock-921617900-LargeMost nursing homes, skilled nursing facilities, and long term care facilities accept health insurance payments from Medicare and Medicaid. To be able to receive these types of federal funds, they must agree to follow guidelines set forth by the Centers for Medicare & Medicaid Services (CMS) on a variety of topics. CMS is part of the U.S. Department of Health and Human Services. CMS also has the authority to conduct inspections of the facility and their practices.

Approximately 6,000 people are employed with the Centers for Medicare & Medicaid Services. A large role of CMS is to conduct inspections of nursing home facilities and look into almost all aspects of their operations, ranging from residents’ health, fire safety, staffing levels, quality of care, billing, HIPAA compliance, and more. In each category surveyed, a nursing home can be rated between 1-5 stars. CMS also strives for complete transparency by allowing prospective residents and their families to compare nursing home facilities in their area in order to make the best possible choice.

Nursing homes nationwide can be compared among the following categories:

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Currently, there are more than 15,000 nursing homes located across the entire United States. These facilities serve more than 1.4 million elderly residents each year. Over half of these nursing homes are for-profit entities. Much goes into running a successful nursing home – ownership and management must comply with proper hiring standards, Medicare/Medicaid requirements, invest in equipment, and implement services which could include counseling, mental health, rehabilitation, physical therapy, diet and nutrition, dementia/memory care, and pharmaceuticals/medication. With so many moving parts, the most important goal, patient health and well-being, can fall through the cracks.

While we all want to care for our loved ones, sometimes it is not possible – physically, emotionally, or financially. Dealing with a sick or elderly loved one can be difficult, and when nursing home facilities make promises to treat our friends and family well, we expect them to live up to them. Abuse or mistreatment can start out small but turn into a big problem if unaddressed. When visiting your loved one, whether he/she is a parent, grandparent, spouse, sibling, friend, or relative, it is important to always look for signs of potential misconduct. Sometimes they can be explained away, but other times they cannot.

1. Bodily changes

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The elderly population is increasing in the United States, as life spans are longer than ever. According to the Population Reference Bureau, there were more than 46 million people older than 65 years old in the United States in 2016. By 2020, that figure is estimated to increase to 98 million, which means that segment of our population would jump from 15% of the total population to 24% of the total population.

In future years, the Population Reference Bureau predicts a significant increase in the level of nursing home care needed to serve our elderly population. In 2010, approximately 1.3 million people over the age of 65 required nursing home care. By 2030, that number could increase to 2.3 million. Care for elderly people with Alzheimer’s is also expected to increase. In 2013, 5 million elderly Americans were living with Alzheimer’s. By 2050, there will be an estimated 14 million people with that condition.

With the number of people needing nursing home or long-term care expected to increase, nursing home admission statistics are bound to follow. A problem in nursing homes now is when staff members, including aides, nurses, and Certified Nursing Assistants (CNAs), subject residents to different forms of abuse. One of the biggest ways of mistreating a resident is by committing emotional abuse. Emotional and psychological abuse take place when one acts in a manner that causes emotional pain and distress, and it can include verbal assaults, threats of abuse, harassment, or intimidation, per the National Council on Aging.

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Nashville Long Term Care & Rehabilitation Center is a skilled nursing facility located on the northwest side of Nashville, Tennessee, whose website says their facility “enables patients to receive the care they need with the dignity they deserve.” The facility holds 419 certified beds and is operated by Louisville, KY-based operator Signature HealthCARE LLC. The facility has recently been in trouble with the Tennessee Department of Health, who conducted a recent investigation into conditions at the facility. The investigation concluded on October 19, 2017, but an onsite complaint survey took place at the facility from September 25 to 28. As a result of the investigation, the Tennessee Department of Health has ordered Signature HealthCARE LLC to pay two state civil monetary penalties totaling $7,500. The fine stems from surveyors who found violations of administration and resident rights during the inspection.

As a result of the violations found during the investigation, the Nashville Long Term Care & Rehabilitation Center is also barred from admitting new patients. A special monitor was also appointed to review the nursing homes operations. The Center boasts a staffing rating of above average from Medicare.gov, but has an overall ranking of 2/5 stars, or “Below Average.” The facility has a health inspection rating of 1/5 stars, or “Much Below Average”, and received a federal fine of $67,925 on March 26, 2015 for a serious citation. The facility does have an above-average staffing level, which is not the case for all elderly assistance programs in Tennessee, as many have fallen short of caregiver staffing requirements. The facility’s CEO does note that star ratings factor in surveys from the past three years, and some problems that have been fixed can still count against the facility. However, it is important that patients, their families, and loved ones know a nursing home’s past performance and deficiencies when selecting the best care option.

Nursing homes often provide essential care for those who need help completing day to day tasks or managing medications. Families and loved ones of the elderly often place their trust with facilities like the Nashville Long Term Care & Rehabilitation Center to protect and care for their loved ones. Nursing homes have a duty to follow state and national standards for care, and to ensure that patients are treated with respect and given a high quality of life. Sometimes nursing homes and other care facilities don’t live up to these standards, and patients can suffer neglect.

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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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June 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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