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Articles Posted in Nursing Home Negligence

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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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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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The issue of sexual assault of elders in nursing homes is a serious one. The phrase promulgated on many college campuses to bring awareness to rape and other unwanted sexual encounters, “No Means No,” also applies in nursing homes. That is, elderly patients who do not maintain good cognitive condition may become victims of unwanted sexual advances and assaults. For example, elders who are Alzheimer’s patients or have dementia cannot effectively consent to sex because of their cognitive impairments resulting from those conditions. Moreover, sexual offenders and predators are usually attracted to individuals who are vulnerable. Certainly, elderly residents of nursing homes are vulnerable to sexual manipulation, coercion and assault.  When considering a nursing home or observing one in which a loved one is staying, consideration should be given to the security procedures of the facility. Are outsiders allowed to come and go, or must they check in? How often do aides and others check on individual residents, in order to assure that unwanted individual are not in their rooms? A check of local crime reports may also reveal sexual assaults or rapes near or in the facility.

Unfortunately, many nursing home sexual assaults are committed by third party criminals with no ties to the nursing home itself. For example, a man was arrested in September for walking into a Kentucky nursing home near Knoxville, Tennessee, and sexually assaulting a resident who had dementia. According to the police, he walked into the nursing home, entered the patient’s room, exposed his genitals, and let the patient hold them. A nurse entered the room, caught him in the act, and called the police. Officers charged the man with intoxication of alcohol, indecent exposure and sexual abuse.

Further, some nursing home residents are victims of sexual abuse by nursing home employees. A nursing home may negligently fail to conduct criminal history background checks on employees, or it may recklessly ignore an applicant’s prior history of sexual offenses. In such situations, the nursing home itself places vulnerable elderly residents in direct danger of sexual abuse. When considering a nursing home, ask administrators about their application hiring processes. Ask if they conduct criminal background checks on potential employees. Ask point-blank about whether any of their staff have prior charges or convictions for sexual offenses. Learn about the people who will be taking care of your loved one.

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A common warning sign of nursing home abuse in Tennessee and elsewhere is bedsores, which are also known as pressure ulcers. They arise because somebody stays in the same position in a bed or chair for far too long. The accumulated pressure on one spot of the body causes a sore to develop.

Elderly nursing home residents often can’t move as much as they would like or at all, and pressure sores can be a sign that they have been left too long in the same position without being moved. Bedsores are worsened by malnutrition or dehydration. The lack of nutrients causes the immune system to get overtaxed, resulting sometimes in an infection.

There are numerous Tennessee laws designed to make sure that nursing homes provide a uniform minimum standard of care. The laws are supposed to make sure that residents’ needs met and are kept in good health. These laws require, among other things, that facilities provide food and water to residents and provide at least two showers every week and more upon request.

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Dementia includes several brain diseases that change personality and social behavior, and they can cause the afflicted person to become confused and forgetful. Often, the changes caused by dementia affect a person’s ability to take care of him or herself, necessitating the participation of caregivers. Some people in Tennessee choose to put their loved ones in a nursing home precisely because caring for someone with dementia and properly supervising them over the course of the day and night can become overwhelming.

Nursing homes in Tennessee owe a duty to residents to properly supervise them so that they can stay healthy and safe. This duty arises out of the extensive regulations that cover nursing homes in Tennessee, but it may also have some basis in individual written contracts that are signed when a patient is admitted to the nursing home.

A failure to supervise residents is one type of negligence that is somewhat common in nursing homes. When a nursing home fails to provide supervision to residents with dementia, the resident is likely to get hurt. The resident may “elope” or wander away from the nursing home. The resident may become dehydrated or malnourished because he or she forgets to drink. The resident may be abused or abuse others.

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Bedsores, also known as pressure sores or pressure ulcers, are injuries to the skin and the tissue beneath the skin caused by prolonged pressure. People who are confined to a wheelchair or bed are most susceptible to developing bedsores. Those affected can include hospital patients or nursing home residents. The most common locations that bedsores occur are on a person’s heels, ankles, hips, tailbone, shoulders, back of arms or legs, rim of ears, and the back of the head. In short, the sores generally develop in any area of the body that receives prolonged pressure.

The progression of a bedsore is categorized in four stages, ranging from Stage 1 to Stage 4.

Stage 1:

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When we entrust our parents, grandparents, or others into the care of nursing and rehabilitation facilities, we expect that they will receive the care and attention they have been promised. When that care is not provided but is still being billed, the losers are numerous – the patients, the insurance companies, and taxpayers who support the government agencies paying the facility. The Tennessean recently reported that the Vanguard Healthcare, LLC, out of Brentwood, Tennessee, is being sued by the federal government for doing exactly this: submitting bills and accepting payment for care and supplies that were never provided to Vanguard’s patients and residents.

As a result of an investigation into the billing and claims submitted to TennCare and Medicare by Vanguard Healthcare, LLC, the US Attorney’s Office for the Middle District of Tennessee has filed suit against Vanguard in federal court, alleging Medicare and Medicaid fraud.  According to the Tennessean, rehabilitation facilities and nursing homes in Middle Tennessee, owned by Vanguard, were found to have submitted bills and claims for care that it never provided to its residents and patients. Investigators found that not only were wound and pain care not being provided to residents as billed, in many cases the basic needs of patients – such as administration of medication and control of infection – were not being provided.

The government’s investigation found that skilled care and adequate staff were not being provided to residents, although claims and billing for such were submitted by Vanguard to TennCare (Tennessee’s implementation of Medicaid) and Medicare.  Some of the nursing home residents suffered pressure sores, dehydration, malnutrition, and falls due to the inadequate staffing, lack of care, and shortage of medical supplies. A dying patient was discovered in obvious pain, having been denied the very pain medication that his family had previously deposited for him at the facility.

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One thing that most of us have in common is that at some point in our lives, we may have a loved one that needs continual care that we are no longer able to personally provide for them.  In these situations, we will look to a nursing home to provide the care that our loved one needs.  You trust that the nursing home will provide your family member with the very best care that they need and deserve.

You would never dream that you would have to consider that your loved one may be the victim of abuse or neglect at the hands of their caregivers.  However, as the elder population continues to increase, so does the number of incidents of nursing home abuse and neglect.

Since nursing home abuse and neglect is more common than you might think, you should be aware of the signs or clues that could mean your loved one is not being cared for properly.  Many times our loved ones, because of medical conditions, may not be able to communicate what is happening to them in the nursing home.  It is very important to be observant when you visit your family member, to see if there is a breakdown in the care your loved one is receiving.

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