Elders Abusing Elders in Nursing Homes

When we think about nursing home abuse and neglect, most of us imagine a scenario in which a healthcare professional or nursing home employee mistreats an elderly resident. However, a recent study conducted by Cornell University Weill Medical College found that many facilities actually see “a high level of resident-to-resident elder mistreatment.”

Nursing home abuse can take many different forms, and it can result in serious and life-threatening injuries to your elderly loved one. If you believe that your parent has been the victim of nursing home abuse or neglect, do not hesitate to contact an experienced San Diego elder abuse lawyer.

file0001780974018Aggressive Encounters with Fellow Residents

According to the study out of Cornell, about 20 percent of all residents were “involved in at least one aggressive encounter with fellow residents” during a one-month period. The study involved more than 2,000 nursing home residents, and it also included data from interviews with staff members, internal nursing home reports, direct observation, and responses to a questionnaire given to both residents and staff members. The researchers presented their findings at the Gerontological Society of America Annual Scientific Meeting earlier this month.

Karl Pillemer, a lead researcher on the study and a member of the faculty at Weill Cornell Medical College, indicated that “these altercations are widespread and common in everyday nursing home life.” And many people are not aware of this form of elder abuse. Indeed, Pillemer explained, “despite the acute urgency of the problem, resident-to-resident mistreatment is underreported.” What can we do to stop it? Pillemer suggests “increased awareness and the adoption of effective interventions.” Pillemer conducted the study with Mark S. Lachs, a professor of clinical medicine as well as the medical director of the New York City Elder Abuse Center.

Pillemer and Lachs’ study is the first of its kind in many ways. While other researchers have explored the issue of elder-to-elder abuse in nursing homes and assisted-living facilities, the recent study newly included direct observations of the residents and interviews with those residents in order to “determine the prevalence and predictors of elder mistreatment between residents in nursing homes.”

Determining Which Elderly Residents Are at Greatest Risk of Abuse

Who is at greatest risk of elder-to-elder abuse at nursing homes? The study came to the following conclusions about the types of residents who may be more likely than others to be involved in this form of abuse:

  • Younger residents;
  • Residents who show some signs of cognitive disability, but who are “less cognitively and physically impaired” than other residents;
  • Residents who are “prone to disruptive behavior;” and
  • Residents with the ability to physically move around the facility

Interestingly, the study found no clear distinction between male and female residents. It did, however, discover that white and Latino residents were more likely to be involved in elder-to-elder abuse than were African American residents. It is important to note, however, that the study did not differentiate between victims and perpetrators.

Has your elderly parent shown signs of nursing home abuse or neglect? You should contact an experienced California nursing home abuse lawyer as soon as possible to discuss your case.

Image Credit: cgiraldez via morgueFile

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Part 2 – Protests Continue in the Fight to Shut Down Alden Village North

Over the past 14 years, Alden Village North has repeatedly been in the news in regards to continued allegations of abuse and neglect to the children and young adults that reside at their facility.

Once the abuse and neglect of the residents of Alden Village North was brought to the attention of the state, Illinois lawmakers stepped in to try and rectify this problem, not only in Alden Village, but in facilities across the state. Several safeguards, including stiffer fines for poor care and fewer roadblocks to close non-compliant facilities have been enacted. To address Alden Village specifically, Governor Pat Quinn placed a state monitor in Alden Village and the federally backed company Equip for Equality began an investigation into the suspicious deaths of the residents.

In the Chicago Tribune’s recent follow-up article, it was discovered that regardless of any changes that were made, the facility has been cited for five more deaths that occurred between 2009 and 2013, all being subsequently reduced or the penalties dropped. There have also been at least 11 additional residents that have died since 2008; however no citations were given as a result of those deaths.

Part 1 – Protests Continue in the Fight to Shut Down Alden Village North

Over the past 14 years, Alden Village North has repeatedly been in the news in regards to continued allegations of abuse and neglect to the children and young adults that reside at their facility. After a 2010 investigation, a Chicago Tribune article first brought the severe dismay of the facility to the attention of the public and the state vowed to have the facility shut down, but failed to do so due to a legal technicality. Since then, improvements have been made, but many argue that it is simply not enough. Twenty disability advocate groups joined together this past Monday to continue their fight to have the facility shut down for good.

Facility History

Alden Village North is a facility located in Rogers Park that cares for children and young adults with severe physical and mental disabilities. The facility houses about 90 children and adults at a time with a wide range of medical problems. Over the years, Alden Village has had several owners and several name changes, but was recently acquired in 2008 by the Alden Nursing Home chain.

Elder Abuse is an Underreported Crime

Statistics in Southern California suggest that elder abuse is an extremely underreported crime, which means that many older adults suffer injuries while their abuses go unpunished. A recent article in the Los Angeles Daily News reported that Los Angeles officials recently indicated that the city will take greater efforts to protect the elderly from nursing home abuse. How will these new measures work? In short, millions of dollars in funding are going to flow in from the Department of Justice and the Verizon Corporation.

DSC_5767Elder Abuse Prevention Grants to the City of Los Angeles

Will San Diego be able to get the kind of funding that Los Angeles recently received? Grants totaling $1.6 million were provided in Los Angeles primarily to train police officers to recognize signs and symptoms of elder abuse—a skill that officials hope will lead to more abuse and neglect reporting. Last year, the Los Angeles Police Department saw a shockingly low number of elder abuse reports—only 100. To place that number in perspective, the LAPD received more than 11,000 claims of domestic violence reports in 2013.

Why do police officers need to receive such special training? First, elder abuse often is committed at the hands of the elderly person’s family members and caregivers. Without outside assistance, those older adults may continue to suffer injuries from elder abuse. And in cases where family members call the police to investigate claims of abuse and neglect at nursing homes, it is extremely important that those officers know what to look for. City Attorney Mike Feuer explained that there are “gaps” in the elder abuse focus on Los Angeles, and the funds are intended to help close those gaps.

Identifying Signs and Symptoms of Elder Abuse

What will these new programs that are supposed to help law enforcement officers identify signs of elder abuse and nursing home neglect look like? Both private sector and nonprofit organizations are partnering up to “help law enforcement attune to impalpable signals that could indicate mistreatment of this vulnerable population.”

What are some signs and symptoms of elder abuse that might not be obvious? According to the Administration on Aging (AoA), bruising or other signs of physical injury such as pressure marks, abrasions, and burns can all create cause for concern. In addition, it is important to keep an eye out for a change in an elderly person’s behavior. If your parent suddenly seems withdrawn from normal activities, seems less alert, or appears depressed, you may be dealing with an emotional abuse situation. In addition to abuse, you should learn to identify symptoms of neglect, which can range widely from severe bedsores to poor hygiene.

Elder abuse is much too common, and many cases go unreported because loved ones are not able to recognize the signs and symptoms of nursing home neglect or abuse. If you have reason to believe that your parent suffered an injury because of elder abuse, contact an experienced San Diego nursing home abuse attorney today to learn more about how we can help.

Image Credit: kconnors via morgueFile

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Medical Review Panels Could Help Businesses But Harm Residents

Nursing homes and long-term care facilities are often on the receiving end of allegations and accusations of abuse and neglect. These are often brought not just through complaints to state agencies and state investigations, but through civil lawsuits by victims and/or their loved ones. So naturally, nursing homes and other medical providers will do whatever it takes to avoid these lawsuits and the possibility of owing lots of money through settlements or judgments.

One such ‘out’ for homes could be through the use of medical review panels, which in the past have been used in certain states to ferret out tort claims against doctors and hospitals for negligence or malpractice. Such a panel would be comprised of certain individuals, at least some of which have experience in the relevant field, who will hold a hearing and decide whether or not a claim is meritorious enough to proceed to court, although in most states this is not binding but nevertheless could convince plaintiffs to change their minds, or at least just delay the process of going to court. The negative, however, is the chance that such panels will be more than likely to frown on a case and increase the chances of it not being brought to court. Typically such panel opinions will be admissible as evidence, and thus could be used as expert evidence by one side against another.

Recent Proposals

In the Commonwealth of Kentucky, there has been a proposal to create medical review panels that would review claims against medical providers including nursing homes, to determine whether they carry merit. Republicans within the state as well as various medical providers and the Kentucky Chamber of Commerce all support this law. One reason, in addition to a process to keep frivolous cases out of the courts, is that of the 284 nursing homes across Kentucky, far too many have below-par ratings, which would lead one to believe they are ripe for lawsuits given their poor performances in caring for residents. In the most recent of such medical review panel proposals in Kentucky, malpractice claims would go before a panel comprising three different health care providers that specialize in the relevant medical field and professions involved. This panel would hear a case and decide if the case has merit. This panel opinion would be admissible in court.

Of course parties can contract for arbitration, as typically has happened (although not as easily in at least one jurisdiction lately), or agree to bypass the panel and go to court. But with medical providers serving on these panels, one would assume that the defendants – doctors, hospitals, nursing homes and others – would jump at the chance to present their defense in the hopes their fellow medical providers will see things their way. Such bias could very well tilt things in favor of these defendants, and would have an adverse effect on plaintiffs one way or another.

With the victory of Democrats to keep the Kentucky House of Representatives in the recent election, the effort by Republicans to make these review panels a matter of law will likely be avoided. Yet there will be more elections, and the initiative to create such panels in Kentucky and in other states, it will be interesting to see if this idea retains and even gains traction as more laws are passed to protect the elderly and nursing residents, and more lawsuits are expected to be filed.

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CPI Report – Minorities Underserved in Nursing Homes

In an accompanying post, we covered a recent Center for Public Integrity investigation that revealed how a federal website administered by the Centers for Medicare and Medicaid, called Nursing Home Compare, has not been accurately reporting staffing levels at nursing homes across the country. This was due to a reliance on information self-reported by facilities rather than Medicare reports that reflect more accurate staffing levels. In some cases homes were self-reporting more than double their actual staff level, and the problem is particularly pronounced in many southern states.

Such discrepancies thus led to inaccurate reporting on the Nursing Home Compare website, which is meant to provide information on nursing homes such as ratings, investigation-related information, and staffing levels for consumers to use in searching for the right facility. The Center for Public Integrity investigation also revealed that staffing levels were particularly lower in nursing homes that served minority communities of residents.

The CPI Report

The Public Integrity report revealed how majority-white nursing homes have about 34% higher staffing levels than facilities with mainly black residents, and how those same homes had an even more astounding and disturbing 60% higher staffing level than nursing homes mainly comprised of Latino residents. According to the statistics, “[h]undreds of majority-black homes” nationwide reported through Nursing Home Compare that their registered nurses provided on average just over 30 minutes of care time to each resident every day. However, according to the Medicare reports, this figure was really only about 20 minutes per day. In Latino homes in Texas cities, the average time spent on care per day was only a dismal 10 minutes.

As was reported with regard to the general discrepancies in reporting accuracy being most pronounced in southern states, the racial discrepancies in the data for the black nursing home resident community were particularly notable in the Midwestern states. Illinois, Michigan and Wisconsin nursing homes had major differences in care time for white residents versus black residents. As far as cities are concerned, Chicago and Houston are among the major metropolitan areas with such differentials (in areas where at least five nursing homes had majorities of black residents). As evidence of a control for the empirical research into the differing care levels, the differentials occurred even in situations where residents between the white, black and Latino homes were “equally sick and poor” and thus all in theory would require the same amount of attention, yet the white residents received far, far more. Even more interesting, the facilities with majority black and Latino populations were almost all for-profit homes, and had higher resident populations than the white homes that still had more staffing and care time.

As the article mentions, cites a history of relevant study and literature, nursing home staffing levels have a correlation with the “quality of care and health outcomes,” and that a lack of care and attention can end up resulting in harsher consequences for residents’ health. It is so far unclear where the law comes into play here. For one, Title VI of the Civil Rights Act bars racial and other discrimination by nursing homes and other providers that accept Medicare and Medicaid funds. As with anything, accepting federal dollars means obeying federal laws and regulations. Yet so far it is unclear, according to CMS, whether this data indicated such unlawful racial discrimination. Furthermore, there is a lack of federal regulations requiring a minimum staffing level at homes receiving federal money, so there is no regulatory structure to lean on. It is no shock that facilities in general reduce staff to reduce overhead and make more money at the expense of its residents’ care, but it is even more egregious where different racial communities receive differing levels of care.

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Lack of Oversight from the California Department of Public Health?

Earlier this month, the Sacramento Bee ran a story that exposed the lack of oversight from the California Department of Public Health (CDPH) when it comes to nursing home abuse allegations. What is going on? According to the article, the CDPH is “weighed down by a backlog of more than 11,000 open complaints” with “no clear path to dig its way out.”

Evidence of this serious problem became cID-10045437lear after an audit report was released toward the end of October 2014. In short, the CDPH appears to have failed elderly adults in nursing homes and assisted-living facilities by failing to manage its investigations of elder abuse complaints received.

Numerous Problems “Up and Down the State”

While the Sacramento Bee was among the first newspapers to run the story about the recent CDPH audit, the report makes clear that the investigation problems exist far beyond northern California. Indeed, from San Diego up through Mendocino County, it looks as if the CDPH has not taken proper care with the elder abuse complaints it has received. To be sure, the audit showed that, “up and down the state,” a number of different district offices “were found to be inconsistent and haphazard in their handling of complaints, investigations, and corrective action plans.”

The report showed that department officials readily acknowledged the problems the CDPH has had with regard to investigating complaints, and many of those officially actually agreed with recommendations that came out of the audit. However, the CDPH has shown tremendous resistance when it comes to establishing a time frame for completing the investigation of a complaint. The CDPH indicated that it “recognizes the importance of timeliness,” but it rejected the notion of setting a specific time limit for investigation on each complaint.

Serious Problems that Were Not Investigated

The backlog of complaints—those cases that are still open—involve allegations of elder abuse that could have very serious repercussions. As the article emphasizes, many of these complaints are “not trivial.” Indeed, the auditor discovered that “40 percent of the unresolved concerns and allegations had been given high priority by the department,” which means that “the reported problem had caused or was likely to cause harm to a resident.”

For example, the Sacramento Bee described one case of elder abuse that was reported in April 2012. According to the auditor’s report, the state of California failed to even assign anyone to investigate the complaint until August 13, which was nearly a year and a half after the incident. By that time, the injured resident had left the nursing home, and the certified nurse assistant who had been implicated in the abuse got away with a mere warning. And this case represented a “high-priority” case for the CDPH.

Lower priority cases went unresolved for particularly long periods. The audit suggests that, for those cases not marked as high priority, the average time between complaint and investigation was about 3,500 days on average—or, in other words, ten years.

If you suspect that your elderly parent has been the victim of elder abuse at a long-term care facility in California, it is extremely important that you contact an experienced San Diego nursing home abuse lawyer.

Image Credit: taoty via freedigitalphotos.net

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Possible Medicaid Eligibility Rules on the Way?

As many know and as we have covered here, nursing homes and long-term care facilities can choose to accept certain insurance from private companies. They can also accept insurance from government programs. Medicare and Medicaid are two such programs, which are administered by the Centers for Medicare and Medicaid Services under the authority of the United States Department of Health and Human Services.

This federal agency can promulgate rules that nursing homes and other medical providers follow if they accept reimbursements from these government programs to cover medical care costs for patients and residents. Medicare and Medicaid have state components as well, though, in that states have offices that largely administer these programs, as the funds are actually provided to the states to then disburse, along with the state’s own funds depending on how much is allocated, to the qualifying and eligible providers and programs. Each state uses a specific formula, including based on federal requirements, to determine who may qualify for Medicaid reimbursement. This takes into account of course income and assets which signify one’s ability to pay.

Notifying Residents of Sex Offender Staffers

Nursing homes and long-term care facilities, like all employers, are responsible for the prudent and responsible hiring of doctors, nurses, aides and any other staff members. This includes extensive background checks on prospective employees’ prior experience, education, and of course a criminal record that can encompass anything. Many are also familiar with laws in general as pertains to convicted sex offenders who must register with their states and be on a public list, as well as have their living and working situations restricted geographically, as well as who they are allowed to interact with or be near. Now in the state of Ohio, under a new law, nursing homes will be required to notify its residents if it admits a sex offender to join the community as a resident patient.

As reported, the law until recently, as applied to sex offender situations in general, mandated that anyone who lived in a 1,000 foot radius of a state registered sex offender be notified that a sex offender lived nearby. However for whatever reason, nursing homes were not mentioned in the law, thus seemingly omitting that requirement. Now this loophole has been corrected. Section 3721.22 of the Health and Safety statutes in the state of Ohio now require that “the [nursing] home’s administrator shall search for the individual’s name in the internet-based sex offender and child-victim offender database . . . . If the search results identify the individual as a sex offender and the individual is admitted as a resident to the home, the administrator” must notify all other residents of that nursing home. In addition, the administrator must also “develop a plan of care to protect the other residents” and ensure that the new resident’s address at the nursing home is updated in the public records under sex abuse laws.

Report Shows “Nursing Home Compare” Website Not As Reliable As Thought

Nursing Home Compare is a website run by Medicare.gov under the umbrella of the United States Department of Health and Human Services. It is a website intended to make it easier for prospective nursing home residents and their loved ones to research the performance histories of facilities in their area, including investigation information, previous sanctions, and other ratings that can help inform these prospective consumers. (State health and aging agencies also responsible for gathering this type of information.)

Center for Public Integrity Report

The Center for Public Integrity, however, has recently called into question the reliability of information provided by Medicare through the Nursing Home Compare website. It conducted an investigation that has revealed that the Nursing Home Compare information from Medicare does not seem to accurately reflect nursing home staffing levels. One particular problem was that 2005 Medicare cost reports from nursing facilities indicate lower staffing levels than what Nursing Home Compare reported. The inaccuracies were particularly pronounced as to registered nurses among the various other staff titles. Approximately over 80% of facilities reported higher registered nurse staffing levels than was reported directly to Medicare.