Articles Posted in Nursing Home Negligence

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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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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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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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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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The transition to living in a nursing home can be overwhelming and stressful. A change from independent life to assisted living often makes our elderly loved ones angry, frustrated, and anxious. It is no surprise that before nursing homes were so heavily regulated, the use of sedatives as a means to calm rowdy patients was a widespread practice. Using sedatives to calm an elderly nursing home resident is referred to as “chemical restraint,” and it involves the use of potent antipsychotic and other psychoactive drugs to involuntarily sedate unruly patients.

Common types of sedatives are benzodiazepines and antipsychotics, which tend to produce a calming effect. Around 300,000 nursing home patients are receiving some kind of antipsychotic drug to combat the anxiety and aggression frequently found with dementia as a byproduct of Alzheimer’s disease. Drugs like Seroquel and Risperdal are effective in the fight against dementia and other psychotic disorders, but should only be used as a last resort. Additionally, Federal and state laws prohibit the use of chemical restraint for the convenience of nursing home staff. Chemical restraint may only be used if patients pose a threat to themselves or others. Federal and state regulations have done wonders to prevent doping of healthy patients, but cases of unwarranted chemical restraint are all too common.

For example, a lawsuit was recently filed in Chesapeake, Virginia, accusing nursing home staff members of practicing chemical restraint. 84-year-old nursing home patient Alice Mackey claims that she was tied down by two nurses and injected with a heavy sedative. Mackey claims that the restraint was purely to “silence” her. After she was sedated, Mackey was left bound to a wheelchair for the remainder of the night, where she ended up urinating on herself and was left to sit in her own filth.

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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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The Tennessee legislature enacted a statute that transforms a lawsuit alleging that a “health care provider or providers have caused an injury related to the provision of, or failure to provide, health care services to a person, regardless of the theory of liability on which the action is based” is to be considered a healthcare liability action only.  No longer can these cases be referred to as medical malpractice cases under Tennessee law. The statute directs us to call these a “healthcare liability action,” no matter what is the actual theory of the case.

Forcing all causes of action that occur in a healthcare setting into “healthcare liability actions” matters quite a bit because it can transform the conduct of businessmen into “healthcare professionals.”   Thus, the standard of proof for a Plaintiff to prove that a “healthcare professional” acted with neglect requires expert proof.  Thus, a businessman making a decision to maximize profits by understaffing a nursing home must be called a “healthcare professional” because of this Tennessee law.

An example of how Tennessee law would work can be found in a New Mexico lawsuit where allegations of systemic understaffing in nursing homes by Preferred Care Partners Management Group have been alleged.  Understaffing is a serious problem in nursing home and long term care settings because any individual caregiver can only care for a certain amount of people before their work product declines and starts to suffer.  Thus, it is extremely important that nursing homes employ an adequate number of caregivers so a certain minimum amount of care is received by each patient.

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