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Articles Posted in Nursing Home Investigation

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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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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, 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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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.

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