Articles Posted in Nursing Home Investigation

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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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Elderly adults in the care of a nursing home or assisted living facility are vulnerable to many different forms of abuse. For example, a caregiver may physically abuse a patient, including kicking, punching, or assaulting them. Sexual assault or molestation is another form of physical abuse. Patients can also suffer physical injuries as a result of malnutrition or dehydration. Further, improperly administering medication could increase an elderly patient’s risk of falling and injuring themselves. Emotional and psychological abuse, along with financial exploitation, are also considered forms of elderly abuse in Tennessee.

Without being able to constantly supervise a loved one, it can be difficult to know if a nursing home resident is being treated appropriately. Further, many elderly adults suffer from a form of mental or physical handicap which makes it difficult for a family member or caregiver to know if abuse is taking place.

To protect our elderly population, Tennessee has enacted the Tennessee Adult Protection Act. Under the Act, all nursing home employees, including physicians, social workers, and nurses, are mandated to report any reasonably suspected instances of abuse. Any person who knowingly fails to report abuse will be charged with a misdemeanor. This strict requirement reflects Tennessee’s commitment to protecting the elderly. Often times, self-reporting is the only way abuse is detected and stopped.

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Nearly all nursing home residents depend on health insurance coverage to provide essential services including medical care, nutrition, and hygiene. Typical insurers that provide such coverage include Medicare, Medicaid, and Tricare, if the patient is a former member of the military. These entities can end up paying large sums of money to big nursing home companies providing services to residents. With third party entities picking up the tab for their insured’s health and well being, those doing the billing can be tempted to abuse the process, especially if their goal is to place profits over the needs of patients.

Placing profits over patients is precisely what Life Care Centers of America, Inc. (“Life Care”) was recently accused of doing by the United States Department of Justice. Life Care eventually agreed to pay a fine of $145 million, a record for the Department of Justice. Life Care, based in Cleveland, Tennessee, operates over 220 skilled nursing home facilities across 28 states. It is owned by Forrest Preston, who has a net worth of over $1 billion. As part of the Department of Justice settlement, Life Care also agreed to participate in a “corporate integrity agreement” for five years. This program is designed to make sure Life Care’s procedures and actions comply with federal standards.

The Department of Justice accused Life Care of violating the False Claims Act over a seven year period by intentionally submitting false claims to Medicare and Tricare for millions of dollars for patient rehabilitation services that were not reasonable, necessary, or skilled. The company was accused of giving unnecessary treatments that brought in the most money to the company, regardless of whether the patient actually needed the service provided. Patients were also allegedly kept in therapy regimens for long after they needed to be. Instead of releasing patients once recovery goals were met, therapists continued to treat the patients for as long as reasonably possible. Life Care was accused of creating corporate policies designed to maximize profits accordingly. Per the investigation, Life Care set targets for how much to bill certain patients, provided bonuses for employees who met those goals, and discarded medical recommendations made by therapists regarding the necessity of care being given.

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Brookhaven Manor is the latest Tennessee nursing home to be investigated for abusing, neglecting and mistreating their patients. Brookhaven Manor, located in Kingsport, Tennessee, is the subject of two investigations, one by the Tennessee Department of Health and another by the Sullivan County (Tennessee) District Attorney’s Office. In November 2016, the Tennessee Department of Health began investigating the nursing home after receiving many troubling complaints. The investigation explored the facility’s administration, doctors, infection control, nursing services, and resident rights. The investigation culminated in a detailed 77 page written report that specifically described the widespread abuse and neglect that took place at the facility.

For example, the department found many instances of doctors providing inadequate treatment plans for the patients’ needs, such as bedsores and other wounds. Failing to timely identify and treat a bedsore could allow that sore to progress into a more significant wound that requires more extensive and invasive treatment. Nurses also did not do a good job of identifying and cleaning wounds, causing residents to contract infections. Investigators even found that nurses would not wear appropriate clothing in rooms where patients had been isolated.

Certain patients were found sitting in their urine and feces, as staff let them sit there unchanged for hours at a time. For patients who required dialysis, the nursing home did not properly classify those patients as needing such services. According to the allegations, certain nurses were not monitoring patients’ weight, which prevented patients from receiving proper diets. One patient in particular gained over 75 pounds in just one month. A significant spike in weight could trigger issues with other conditions a patient has, such as high blood pressure or diabetes. On the other end of the spectrum, a sharp decline in a patient’s weight could cause problems with malnutrition.