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CMS Considers Banning Pre-Dispute Arbitration Due to Abuses by Nursing Homes

Posted in Elder Issues, Protecting Your Rights

CMS is currently considering whether or not to ban pre-dispute arbitration documents from nursing home admission contracts. The patient or their family members must sign home admission contracts before they can be admitted, and these contracts are often lengthy and complex. Unfortunately, sometimes these contracts contain a pre-dispute arbitration document, and if the patient signs off on that contract, they will be unable to take a case to court if something terrible happens.

Instead, this document means that they will have to go to private closed-door arbitrations, where families generally have to pay arbitrators large sums of money, and arbitrators are not obligated to follow any of the typical laws and rules of the court.

A recent McKnight’s Long-Term Care News article describes one case in which a nursing home resident died, and an autopsy revealed that she had over 20 times the proper amount of diabetes medication in her blood. After the family was forced into arbitration, the arbitrator ruled in favor of the facility.

A recent article by The New York Times also chronicles how arbitration has been used and abused by businesses and nursing homes to shirk any responsibility to their patients, employees or customers.

If you think inserting pre-dispute arbitration documents into admissions contracts are a bad idea, you’re not alone. 34 U.S. Senators and 15 attorney generals signed a letter banning the practice in nursing homes.

Write your congressperson and ask them to tell CMS to get rid of these unjust documents. Hopefully, the Centers for Medicare and Medicaid Services will end this abusive practice soon.

Lawmakers Are Rejecting Pre-Dispute Arbitration Agreements

Posted in News, Protecting Your Rights

Our practice group has often written about how corporations unfairly use predispute arbitration agreements to sidestep the civil-justice system and gain disproportionate advantage when addressing their negligent conduct in arbitration.

Often times, corporations slip arbitration clauses into the admission papers and process—at a time when the family is justifiably thinking about the loved one’s health, wellbeing, and quality of life. They are not thinking about their preferred method for resolving a hypothetical legal dispute that may or may not occur in the future.

Now, numerous lawmakers have echoed our sentiment by stating that corporations that use predispute arbitration clauses at nursing homes make it more difficult for negligence and abuse victims to seek redress. On September 23, 2015, U.S. Senator Al Franken led a 34-Senator coalition in calling on the Centers for Medicare and Medicaid Services (CMS) to outlaw predispute arbitration clauses in contracts with long-term care facilities like nursing homes. (Read the letter here)

The letter explains that the “decision to admit yourself or a loved one to a long-term care facility can be difficult. Unfortunately, families often have limited choices due to cost and location constraints. Yet, long-term care facilities sometimes force and often encourage potential residents and their families to waive their legal rights before any harm has occurred and to agree to a dispute resolution forum that may be biased in favor of the facility.”

And, because families are rightly focused on their loved one’s wellbeing during the admission process, the letter explains that “only an arbitration agreement that is entered into after an incident has occurred and after a resident has considered all their legal rights can ensure that resident and their families are not deprived of their rights.”

Michael A. Brusca, a shareholder in our Nursing Home Litigation Group explains: “When admitting a resident, if you see these documents slipped into the admission paperwork, don’t sign them! You don’t have to, and you’re only hurting yourself if you do. If you’ve already signed one, tell the administrator you want to cancel it.”

No family wants to believe that a nursing home or an assisted living facility would hurt their loved one, but it happens all too often. If you or someone you know has been involved in a nursing-home negligence or abuse incident, consult with an attorney immediately to discuss your rights.

Troubled Nursing Homes with History of Poor Care Make Special Government List

Posted in Levels of Care, Nursing Home Information

Recently, the August 2015 Special Focus Facility List was published by the Centers for Medicare and Medicaid Services (CMS). The CMS regularly visits nursing homes to assure that they are administering the quality of care that Medicare and Medicaid require. With these regular visits, the CMS will identify any deficiencies in the quality of care being provided, as well as if the facility is meeting safety requirements. The CMS will also examine any previous noted deficiencies and how promptly they were or were not handled. These criteria will determine the facility’s overall survey from the CMS.

Additionally, if serious problems are left unchecked in these facilities, the CMS can opt to terminate the special focus facility’s participation in Medicare and Medicaid.

Once the CMS’ “survey” teams gather their data from the facilities, this is submitted to a master list, The Special Focus Facility List. This list includes all facilities with a history of care problems and/or poor surveys, and is updated monthly by the CMS. Every special focus facility must be visited by a CMS survey team at least twice a year.

If you would like to see the whole list, please visit the CMS website.

It is also important to note that if you go to Medicare’s Nursing Home Compare website and look up any individual nursing home, you will immediately be able to tell if that facility is on the Special Focus Facility List. Any facility on the list will have a yellow triangle with an exclamation point next to its name. Additionally, you can use the website to see other ratings for the facility, including health inspections, staffing and quality measures. At the moment, there are several nursing homes in Pennsylvania and New Jersey on the CMS’s most current Special Focus Facility List.

If you have a loved one in a facility on the Special Focus Facility list, you can go to the administration and demand they tell you why the facility on the list and what they plan to do to improve the quality of care provided to be removed from the list. You do not get on this list when you are meeting even minimal standards.

Pennsylvania Gets Tough on Nursing Homes for Neglect, Lying and Unsanitary Conditions

Posted in Documentation & Reporting, Elder Issues, News

In recent news in Pennsylvania, the Office of the Attorney General is suing the nursing home chain, Golden Living Center, for allegations that they repeatedly refuse to meet its residents most basic needs. Further allegations reported by WPXI include falsifying records and lying to state inspectors.

It looks like Pennsylvania is beginning to catch on to what those of us that practice in this area have long known: some nursing home companies are willing to put residents in jeopardy in order to increase profits.

The vast majority of the claims we prosecute are not about individual care givers; they are about business wrongdoing. When we prosecute these claims, we prosecute companies, not people. Most of the problems are the result of board room decisions, not individual failings. Most aides and nurses are doing the best with what they have – unfortunately, what they have is oftentimes not enough.

You can read the full article here.

False Nursing Home Staffing Levels Cause Families to Unwittingly Subject Residents to Poor Care

Posted in Documentation & Reporting, Elder Issues, Injuries, Levels of Care, Nursing Home Information

When deciding whether to place a loved-one into a nursing home, families attempt to determine whether the nursing home is capable of providing the necessary quality care. Most families visit the nursing home, as well as check the U.S. government’s Nursing Home Compare tool at Medicare.gov.

Despite their efforts, some nursing homes have purposefully misrepresented their ability to care for its residents.

Overstating Staffing Levels

According to the latest updated report from the Center for Public Integrity, over 80% of nursing homes have consistently overstated their staffing levels to Nursing Home Compare in an apparent bid for higher rankings at the site. The report explained that staffing overstatements occurred for all types of nursing positions, but were particularly high for registered nurses—the most skilled and highest paid workers.

Our nursing home negligence and abuse attorneys have long since understood that the amount of care, especially by registered nurses, is strongly connected to the quality of care provided to nursing home residents. For example, my associate Eric D. Dakhari, Esq. explained in a recent blog article that for understaffed facilities, evidence shows increased incidents of—among other critical issues—pressure ulcers, catheterized patients, urinary tract infections; as well as an increased likelihood of death.

As a nursing home lawyer, I have too frequently litigated nursing home negligence and abuse cases where the low levels of care were associated with a resident’s severe injury or death.

Nursing Home Compare: The Goal

The government website’s goal is to assist families in evaluating a nursing home’s ability to provide adequate “skilled-nursing” care, which is care given when you need skilled nursing or rehabilitation staff to manage, observe, or evaluate your care.

A Flawed Self-Reporting Process

The Nursing Home Compare website explains that each nursing home must self-report its staffing hours to its state survey agency and that the reported staffing hours reflect the staffing of RNs, LPNs, CNAs, and PTs from a two-week period just before the state inspection.

The government website displays the self-reported nursing home staffing hours as the number of staff hours per resident per day, which is the total number of hours worked divided by the total number of residents.

It is important to note that the website does not necessarily show the number of nursing staff present at any given time, or reflect the amount of care given to any one resident.

Our nursing home attorneys know that many nursing homes commit additional human and financial resources to prepare for the state inspections, and as a result, the self-reported staffing levels do not accurately reflect the typical staffing levels in the nursing home. This is particularly important because some nursing homes must provide more nursing staff due to the conditions of their residents, and other factors.

Recommendation to Families

Our nursing home negligence and abuse lawyers understand the difficulty that families face in selecting a nursing home based on false data. My partner, Michael A. Brusca, Esq., has previously recommended that families ask the nursing home about its CNA-to-Residents ratio. He explained that determining that ratio—as opposed to the RN or LPN ratio—is important because the CNAs are the frontline workers that provide the majority of the hands-on-care to residents.

If you or someone you know has been involved in a nursing home negligence or abuse incident, I recommend that you consult with an attorney immediately to discuss your rights.

Dementia and Alzheimer’s Patients: The Standard of Care of Nursing Homes

Posted in Elder Issues, Injuries, Nursing Home Information

In nursing-home neglect and abuse cases, the victims of the nursing-home negligence or abuse often suffer from some form of dementia, including Alzheimer’s, which is a specific type of dementia that accounts for 60 to 80 percent of dementia cases.

Alzheimer’s is a progressing disease. That means that it worsens over time, causing cognitive and behavioral problems. For example, cognitively, a person may have difficulty thinking and trouble understanding. They may also experience forgetfulness, confusion, and disorientation. And behaviorally, a person may exhibit irritability, agitation, lack of restraint, and difficulty with self care.

Behavioral Changes

For many, the behavioral changes present the most challenging and distressing symptoms from Alzheimer’s. The symptoms stem from a progressive brain-cell deterioration. Importantly, they may become worse through medication, environmental influences, and some medical conditions.

Environmental Triggers for Behavior Changes

Beyond the physiological reason for the behavior symptoms, changes in a person’s surroundings also often play a role in triggering those symptoms.

When I interview family members and nursing-home nurses in preparation for litigating a nursing-home negligence or abuse case, they often describe events or changes in the person’s surroundings that have created additional stress that can be difficult for an Alzheimer’s patient to manage. Some of those events and changes include:

  • Moving to a new residence, nursing home or new room within a nursing home;
  • Changes in a familiar environment or caregiver arrangements;
  • Misperceived threats;
  • Admission to a hospital; or,
  • Being asked to bathe or change clothes.

So, while the patient is trying to make sense out of an increasingly confusing world, those environmental factors increase the patient’s fear and fatigue while exacerbating the patient’s exiting irritability, agitation, lack of restraint, and difficulty with self care.

Standard of Care for Nursing Homes

Nursing homes and the nursing-home corporations that operate them know, and have reason to know, that environmental changes place the Alzheimer’s or dementia patient at greater risk of experiencing a serious nursing-home injury.

When I depose a Director of Nursing in a nursing-home neglect and abuse case, the nursing director admits and acknowledges the serious risk of injury that Alzheimer’s patients face while in the nursing-home facility. Also, the nursing director admits that the nursing-home corporation and its nursing staff must provide those patients with treatment and services that meet a specific standard of care.

The standard of care requires that the nursing home develop an individualized care plan to promote the patient’s health, protect the patient’s safety, and secure the patient’s dignity. The nursing-home staff must implement the treatment and care, from the care plan, on a daily basis—without fail. And then, the nursing home must evaluate that treatment and care to ensure its effectiveness and make changes to the plan when appropriate.

Nursing Home Negligence and Abuse

When a nursing-home corporation and its nursing-home staff follow the required standard of care, the nursing home can prevent the patient from experiencing preventable catastrophic falls, avoidable pressure ulcers, and other serious injuries.

If the nursing-home corporation and the nursing-home staff fail to follow the required standard of care, then the patient may experience serious physical injury, and the nursing-home corporation is responsible for the harms and damages that follow. If you or someone you know has been involved in a nursing home negligence incident it is recommended that you consult with an attorney immediately to discuss your rights.

Moderate Drinking NOT for the Elderly

Posted in Elder Issues, News

While the risks of drinking moderately in adults is the subject of debate, a new study published by the American Heart Association and reported on by NDTV.com confirms that for the elderly, the debate is over – put the alcohol away.

The study showed that alcohol caused cardiomyopathy – a condition where the heart scars or grows thicker and more rigid – in the elderly population with moderate drinking. Moderate drinking is defined as one or two drinks a day. Women were more susceptible than men to this damage.

If you would like to read the full article, please click here.

Assisted Living Facilities Must Not Expose Residents to Unnecessary Risks of Harm

Posted in Elder Issues, Levels of Care, Nursing Home Information

In New Jersey, Assisted Living encompasses providing various coordinated supportive personal and health services, available 24 hours per day, to residents who need those services. Its purpose is to promote resident self-direction and participation in decisions, with an emphasis on independence, individuality, privacy, dignity, and homelike surroundings.

And thus, corporations that operate Assisted Living Facilities (ALF) must provide, at a minimum, services for:

  • Nursing
  • Recreation
  • Medical Transportation
  • Personal Care
  • Social Work
  • Activities
  • Housekeeping
  • Dining
  • Pharmacy

Indeed, ALFs and our nursing-home lawyers know that potential residents have the right to live in an ALF that does not admit more residents than it can safely accommodate while providing those services and other care. And for persons who currently live in an ALF, the corporations operating the ALFs know that those residents have the right to receive care and services at a level that addresses the residents’ changing physical and psychosocial status.

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New Jersey Nursing Homes Must Protect Resident Rights

Posted in Elder Issues, Protecting Your Rights

Our nursing-home lawyers frequently explain that in 1976, the New Jersey Legislature expressed a broad policy and goal for protecting nursing-home resident rights. And in doing so, it empowered the Commissioner of the New Jersey Department of Health with setting the path and rules that nursing home corporations must follow to ensure that they do not violate their residents’ rights.

Nursing Home Mandatory Resident Rights

In fact, New Jersey nursing-home law holds nursing home corporations responsible for developing and implementing policies to protect, preserve, and guarantee nursing-home resident rights. Our nursing-home lawyers understand that those rights, as provided by New Jersey nursing-home law, include the following Mandatory Resident Rights:

  • To live in a nursing home that does not admit more residents than it can safely accommodate while providing adequate nursing care, N.J.A.C. 8:39-4.1(a)(11);
  • To live in a nursing home that does not subject the resident to neglect, N.J.A.C. 8:39-4.1(a)(5);
  • To live in a nursing home that does not subject the resident to physical and mental abuse; N.J.A.C. 8:39-4.1(a)(5); and
  • To live in a nursing home where the nursing staff protects the resident’s dignity and individuality by treating the resident with courtesy, consideration, and respect, N.J.A.C. 8:39-4.1(a)(12).

Furthermore, New Jersey’s nursing-home law requires nursing homes to inform and explain the mandatory resident rights, and many other rights, to a nursing-home resident, the resident’s next of kin, and the resident’s guardian, N.J.A.C. 8:39-4.1(b).

Nursing Home Rights Include Following the Standard of Care

Empowered by the New Jersey Legislature, the Commissioner has created the Mandatory Resident Rights, above, as well as rules and standards intended to assure that nursing-home corporations deliver high quality care to the residents who live in their long-term care facilities. The rights, rules, and standards address access to care, continuity of care, comprehensiveness of care, coordination of services, humaneness of treatment, conservatism in intervention, safety of the environment, and professionalism of caregivers.

Voicing Complaints About Nursing Homes

Importantly, nursing-home residents also have the right to voice their complaints without being threatened or punished. A nursing-home corporation must provide residents and their families with the names, addresses, and telephone numbers for the government agencies that will accept and document any nursing-home complaints of abuse and neglect. Here are two nursing-home government agencies that families may contact

  • New Jersey Department of Health, Health Facilities Evaluation & Licensing, P.O. Box 358, Trenton, NJ 08625-0358; and
  • Office of the Ombudsman for the Institutionalized Elderly, P.O. Box 852, Trenton, NJ 08625-0852.

Residents and families may file a complaint by calling the hotline at 1 (800) 792-9770, Select #1; but anyone may use the hotline, even nursing-home corporation employees and other members of the public. Or they may file a complaint online here: online complaint. Finally, anyone can submit a complaint by downloading and completing form AAS-60, located here: [.pdf] or [.doc]; and then faxing the form to (609) 943-4977 or (609) 633-9060.

The State of New Jersey created the Mandatory Resident Rights, rules, and standards in order to protect nursing-home home residents from neglect and abuse. When nursing-home corporations refuse to follow the rules and the standards of care, which protect and preserve those rights, our nursing-home lawyers litigate cases against them on behalf of caring families whose loved ones have suffered catastrophic harm and loss.

Yes, Nursing Homes Can Prevent Pressure Ulcers (or so-called Bedsores)

Posted in Elder Issues, Practice Tips

Pressure ulcers, which people sometimes call bedsores, develop when a person spends too much time in the same position while lying in bed or sitting in a chair. During that prolonged time, the person’s body weight and bones create pressure by pressing the skin and soft tissue against the—harder—bed or chair surface. The pressure reduces blood supply to that area, and damages or destroys the skin tissue.

Without immediate intervention, pressure ulcers will develop, and then progress through the soft tissue located between the bone and the skin. In the most advanced stage, a pressure ulcer, which is an open wound, exposes muscle and bone, which can lead to osteomyelitis (a bone infection).

Nursing homes can prevent pressure ulcers and bedsores from developing.

In our Nursing Home Litigation Practice, our nursing home lawyers have long since understood that nursing home staff can detect the early changes occurring in a patient’s health status that indicate that the patient’s skin is about break down and develop a pressure ulcer—if they fail to immediately implement well-recognized and accepted interventions for avoiding pressure ulcers.

Tn order prevent a pressure ulcer from developing, the nursing home staff must routinely perform the process of inspecting the patient’s body from head to toe—every day. Nursing homes typically call that process the Daily Skin Assessment or, when pressure ulcers already exist, the Wound Care Assessment. This is the standard of care that nurses in the community, and nursing experts across the nation, recognize and accept when our nursing home lawyers litigate nursing home negligence cases involving pressure ulcers or bedsores. By merely inspecting the patient’s body, nursing home staff will detect the occurrence of the following early signs that indicate that a pressure ulcer will develop: skin redness (nonblancable), warm areas, spongy or hard skin, and breakdown in the skin’s top layers.

If the nursing home management adheres to the recognized and accepted standard of care for detecting those early signs, it can easily ensure that its nursing staff immediately implement the necessary interventions to prevent a pressure ulcer or bedsore from developing; and more importantly, spare the patient the unnecessary and avoidable pain, complications, and prolonged healing process that accompany a pressure ulcer or bedsore.

When the nursing home management fails to follow the recognized and accepted standard of care for detecting the early signs of a developing pressure ulcer or bedsore, it has committed nursing or nursing home negligence by failing to ensure that its staff is able to provide the necessary interventions.

That nursing home negligence will often cause the avoidable and unnecessary occurrence of a pressure ulcer or bedsore. And when left undetected and untreated, the pressure ulcer or bedsore progresses into a serious health problem for the patient. That is so, because when a patient has a break in the skin, the patient will have all of the issues associated with healing broken skin, plus the problems of caring for an open wound, including preventing life-threatening infections.

Our nursing home lawyers litigate nursing home negligence cases for caring families whose loved ones have developed pressure ulcers or bedsores, only against nursing homes that refuse to employ enough trained nursing staff on the recognized and accepted standard of care for preventing pressure ulcers or bedsores.