New Jersey and Pennsylvania Nursing Homes Have Plenty of Room for Improvement

The second edition of the State Long-Term services and Supports (LTSS) Scorecard (2014), sponsored, in part, by the AARP, assigned New Jersey a 26th, and Pennsylvania a 42nd, overall ranking based on performance across twenty-six indicators, grouped into five dimensions, which include (1) affordability and access, (2) choice of setting and provider, (3) quality of life and quality of care, (4) support for family caregivers, and (5) effective transitions.

LTSS help persons-in-need perform activities of daily living that would be difficult or impossible for them to perform on their own. Services and supports are delivered in a variety of settings, but nearly everyone prefers to remain at home. When families must rely on nursing homes to provide those services and supports, family caregivers often attempt to provide oversight to ensure that care rendered by the nursing home or assisted-living facility is appropriate.

A Closer Look at the Effective Transitions Dimension

The Scorecard ranked New Jersey at 36 and Pennsylvania at 28 in the effective-transitions dimension, which shows that states that rely heavily on nursing homes for LTSS also demonstrate less effective transitions across care settings. That means that individuals with complex needs are more likely to experience inappropriate and costly hospitalizations and inadequate support in moving from a nursing home back into the community. This dimension aligns well with the quality of life and quality of care dimension.

The Scorecard explains that “unnecessary transitions among settings are disruptive, especially to people with dementia, and can increase the risk of medical errors. Moreover, when they occur at the end of life, they can indicate poor management of care or overly aggressive treatment.”

Notably, high ranking states tend to minimize disruptive transitions and focus more on helping nursing-home residents return to their homes and communities. Accordingly, states must actively facilitate those transitions. That is: provide adequate support  for movement from nursing homes back to the home- and community-based settings that most people prefer.

If you or a loved one has any questions regarding nursing home neglect, contact Stark & Stark today. 


Boston Nursing Home Cuts Wages of Workers

Shortly after Lexington took over this nursing home, plans were made to cut wages of important healthcare providers by as much as 40%.  This represents a true danger to those residents.  For more information, read here.

Nursing Home Resident Presses On to Attend D-Day Ceremony in Normandy

As a veteran myself, I loved this amazing story from England.  Bernard Jordan is a 90 year-old WWII D-Day veteran.  Unfortunately, he was originally unable to go to the ceremony commemorating the 70th anniversary of the D-Day landing because his request to take the tour attending was made too late.   Undeterred, Mr. Jordan, who is cognitively intact and able to make daily trips into the town where he lives (and once was mayor), just got on a bus and went himself.  He wore his war medals under his jacket.

I love this story because I find at times people are tempted to see the elderly in nursing homes as just a sick person with dementia at the end of their life.  This story perfectly illustrates that nursing home residents are not the sum total of their medical records.  That in many cases they lived amazing lives and accomplished great things – including participating in the largest amphibious assault in world history. 

Cheers to Mr. Jordan.  You can read the Today News article by clicking here.


Residents Not "Improving" May Now Get Physical, Occupational Therapy if Helping

I have heard many stories over the years of families that fight to keep a nursing home resident getting physical, occupational, or speech therapy. It used to be that if there was a determination that a resident wasn’t progressing anymore, then Medicare or Medicaid did not pay, and the therapy was discontinued. 

Many families were unhappy. Even though their mom or dad was not improving, the therapy was still beneficial – getting their resident moving or out of bed was simply good for them. They had to go through a lengthy appeals process.

Now however, after an important lawsuit filed against CMS, they are changing their policy.  The New York Times reports that “[b]ecause of the settlement, the agency updated its policy manuals last year. The revisions make clear that if treatment is needed to prevent or slow further deterioration in a patient’s condition, ‘coverage cannot be denied based on the absence of potential for improvement or restoration.’ The update applies to therapy provided in nursing homes, in outpatient clinics and at home.”

This means that even if mom or dad is not improving but therapy is helping, they may be able to still get the therapy. This is good news for seniors and their families.

You can read the full article by clicking here.


Nursing Homes Struggle to Hide Behind Corporate Entities

When I first began doing long-term care litigation, I assumed one owner was responsible for the conduct of their nursing home and stood behind a facility.  I’ve since learned that this is not normally the case.

Typically, filing a lawsuit against a nursing home or assisted living facility requires significant corporate research.  The plaintiff may have to sue holding companies, limited liability corporations, real estate companies, corporate partnerships, limited liability partnerships, and other corporate entities just in order to hold the right person responsible.

We call this the corporate shell game.

Many nursing homes fragment their companies in order to avoid liability and hide assets.  These are the entities we trust to care for some of the most vulnerable people in our community.

Fortunately, this practice is getting more difficult to pull off.  Obamacare has made it mandatory to disclose all entities that have an interest in a facility.  They can no longer hide behind various fake companies.

An interesting article in McKnight’s highlights this issue and recent fixes at both the federal and state level.  You can read the article by clicking here.


New Blood Test Predicts Development of Alzheimer's

Alzheimer’s can be a devastating illness that we see in many of our cases.  Good news from the front against this disease is that a new blood test was developed that can accurately predict the development of the disease.  While not yet fully available to the public, when it is it could have wide ranging possibilities. 

Knowing in advance that the disease is a real possibility will give people the ability to plan for a time when they may not be able to care for themselves – to purchase long term care insurance, draft a proper will, and make sure a power-of-attorney is in place.  It will also give patients the ability to take medical steps immediately to prevent or treat the disease as early as possible.

You can read the full VOA article here.


New Study Illustrates Problems with Sedentary Lifestyle

If you’re over 60, the next time someone tells you to “take a hike” it might not be a bad idea.   

A new study shows how problematic a sedentary lifestyle can be.  The study found that adults over the age of 60 spend roughly 9 sedentary hours per day, and that “[e]very additional hour adults over age 60 spend sitting increases by 50% their risk of being disabled for activities of daily living such as bathing, dressing and walking”.

Exercise generally is linked to better health, both physically and mentally.  Turn off the TV and take a walk instead.  You’re far better off. 

To read the full article describing the study, please click here

Pressure Sores are Preventable

There is a great PBS interview of a former CEO who talks quite candidly about preventability of pressure ulcers (bedsores) and the misdirection of health care in America. Please click here to see that interview. 


Elderly Man Dies After Being Left in Burning Sun Due to Understaffing

Many times, when I tell people the facts of our cases they cannot believe them.  Sometimes, the care and neglect the elderly suffer is simply stunning. 

This story from Florida is both horrifying and yet not surprising.  In a ManorCare facility in Florida, an elderly man died with second and third degree burns after being left out in the sun for almost 4 hours.  It is another example of a stressed facility with too many residents to care for.  It’s all about profit.  In a drive for profits, staffing gets slashed because it’s the biggest expense.  While most aides and nurses care about their residents, there is just not enough of workers to get the work done.

This was born out by a former employee of that facility who stated “she watched as conditions got worse over the past six years as budgets were slashed.”

The same employee went on to say “’A nursing assistant who would normally give daily care to eight patients is now up to nine, 10 or 11 patients,’” she said.  The former employee added that if it’s the night shift, an aide could have as many as 20 patients to look after.”

To read the full article, please click here.


A Real Cause of Increased Costs in Health Care is Fraud, Not Lawsuits

Even though lawsuits and litigation comprise only a small portion of the cost of health care – less than 1 percent – attorneys constantly get blamed for the rise in medical expenses.

You can read the statistics, which come from a study done by John Hopkins University School of Medicine and reported in the UPI, here.

A real driver of health care costs is fraud.  A recent L.A. Times article chronicles that the Ensign Group Inc., which operates nursing homes along the West Coast, just settled with the government to reimburse $48 million due to fraudulently inflated Medicare bills.  The facilities were billing for unnecessary work, or work that was never done – mostly in the areas of physical, occupational, and speech therapy. The company would have gotten away with it of not for an employee that spoke up and brought the truth to light.

You can read the full article here.


Florida Attorney General Pursues Billing Fraud

In yet another chilling example of wasting taxpayer dollars and jeopardizing vulnerable nursing home residents, a Florida based owner has allegedly bilked public funds to line his own pockets.

For more information, please click here.


Sleep Shown to Help Prevent Alzheimer's and Dementia

In many ways, what we do when we’re younger affects our health in the future.  Women must get enough Calcium when young in order to prevent osteoporosis in the future.  For men, keeping a healthy weight as a younger man reduces cancer risk and other complications as an elderly person. 

A recent Forbes article recounts a new study, which shows that adequate sleep may assist in the prevention of Alzheimer’s and dementia.  The study explains that during sleep, the brain actually flushes toxins out of the brain – toxins that can contribute to Alzheimer’s and dementia.  You can read the article here.

So, if you’re considering watching your fourth episode in a row of Breaking Bad, at 2 AM on a work night, perhaps going to bed may be a better decision.

South Carolina Hospital Sued for Medicaid Fraud

There has been yet another of a stream of whistleblower cases involving Medicare and Medicaid fraud. A hospital in South Carolina operated by Tenant Healthcare Corp. and Health Management Associates is being sued by the government for having a clinic illegally steer Medicaid patients to their hospital.

The whistleblower, a former chief financial officer, found out about the alleged scheme quickly after he began working at the facility.  After voicing concerns he was abruptly fired without reason.

You can read the full article by clicking here.


The Real Cost of Budget Cuts

You often hear the mantra about cutting the budget when talking about government spending.  We recently had the sequester, which cut significant amounts of money to numerous government agencies.  However few people realize what these cuts truly mean, other than perhaps slightly lowering a person’s or business’s tax bill.

A truly disturbing story from the Sacramento Bee chronicles a lawsuit filed by California against Nevada for the “state-sanctioned practice of improperly transporting indigent psychiatric patients” from Nevada to California.  In effect poor psychiatric patients were given one-way bus tickets out-of-state with no escorts, medication, or food – many of them to California.  California is suing to recoup the cost to their social services programs.

The article points out that the “state’s aggressive busing practices coincide with funding cuts that slashed Nevada’s mental health budget by 28 percent between 2009 and 2012.”

It’s hard to imagine any organization that can operate effectively when their budget is cut by 28% in three years.

The article tells the unfortunate story of a man who turned up at a Sacramento homeless shelter confused and suicidal after a 15 hour bus ride from Las Vegas.  The man knew no one in Sacramento and was told by doctors at the time he was discharged from the Nevada psychiatric facility to dial 911 when he arrived in the city.  This story is almost too terrible to believe.  You can read the full article by clicking here.

As a person who advocates daily for the rights of vulnerable people, this story is particularly angering.  Gandhi once said that “a nation’s greatness is measured by how it treats its weakest members.”  Perhaps this is something to reflect upon in light of this article. 


Assisted Living Facility Operating Without a License Sparks Wrongful Death Lawsuits

A recent article states that an assisted living facility (ALF) in New York is now facing several wrongful death lawsuits after operating for several years without a license.  One of the plaintiffs is the estate of a judge. 

When choosing an ALF, asking specific questions about expected care is important.  Just trusting a facility to accept only those people they can care for is insufficient.  Although they are not regulated as closely as skilled nursing homes, ALFs can accept residents requiring nursing home level of care.  The level of care ALFs can deliver may vary widely within the same county and may be significantly lacking.

Just trusting a doctor is probably insufficient as well.  A doctor that signs off on an admission generally knows little to anything about a particular facility.  The doctor will not meet staff or participate in the plan of care.  Doctors typically trust the facility to accept only who they can care for – many times incorrectly.

In short, proper research is necessary.  Talk to the doctor about specific needs of the resident (like fall prevention measures, mobility, and physical therapy) and question the ALF to be sure they can deliver the care. 

To read the article, click here

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