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Water’s Edge Nursing Home and Liberty Royal Rehabilitation and Health Care Center on the CMS Special Focus Facility List

Posted in Documentation & Reporting, Elder Issues, News, Nursing Home Information

A very convenient tool for concerned families to evaluate nursing homes is the “Medicare Compare” website.  Included within this is a section that designates what are known as “Special Focus Facilities.”  A Special Focus Facility represents the bottom 1% or 2% of all nursing homes in the country which have demonstrated not only under-performance, but whose corporate practices have demonstrated a significant danger to members of our community who entrust them to care for their loved ones. http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/SFFList.pdf

In order to become a Special Focus Facility, a nursing home must demonstrate a significant period of time of a failure to comply with all the safety rules and regulations promulgated by the Federal government to protect their elderly residents and a failure to address concerns expressed by State and Federal surveyors. Currently, New Jersey has two special Focus facilities.  These are Water’s Edge Rehabilitation in Trenton, New Jersey and Liberty Royal Rehabilitation and Health Care Center, in Tinton Falls, New Jersey.

Consumers should carefully think twice before entrusting a loved one with a facility with this dangerous designation, although many of the better nursing homes in New Jersey have been Special Focus Facilities and have ostensibly cleaned up their act. That is, the Special Focus Facility program is one which works.  Many well meaning organizations take this designation quite seriously and improve their conduct.  However, some facilities have been forced to close their doors because of this designation.  As bad as that seems to many of the residents, it is unquestionable that the Special Focus Facility designation and the hard work of surveyors protects residents whose lives are placed at risk because of dangerous corporate conduct.

Staffing Levels Lower than Reported

Posted in News, Nursing Home Information

A new study by Public Integrity finds widespread discrepancies in actual staffing levels and those reported to the state and federal government.  You can read the full article here.

I often find significant issues with the administration, management and operating of nursing homes in the cases we prosecute – things that families couldn’t possibly know when they select a facility.  The Public Integrity staffing study illustrates this problem because it points out that even though a facility may have a great rating on staffing from the government that you can see on-line, that rating may be based on bad data.

To avoid this problem, I always recommend asking the right questions when admitting a resident.  When it comes to staffing, I recommend specifically asking about ratios of CNAs to resident – not nurses, as these are not the workers that do the majority of the hands-on care.  The lower the ratio, the better.  A day shift ratio of 1:10 could be a real problem, and 1:6 or 1:7 is far better.  You can imagine what it’s like to care for 10 dependent elderly people, many with dementia and Alzheimer’s, at one time.

I also recommend asking if there is a policy of exceeding the state minimum requirements.  New Jersey has minimum nurse hour requirements.  Many administrators say in their depositions that “adequate staffing” means simply meeting the state minimum hour requirements.  Unfortunately, the state minimum hour requirements just track “bodies in the building.”  They don’t take into account how good the aides are, how morale is, how much the aides like the work, how hard they work, and how experienced they are.

I also recommend asking about weekend and holiday hours, which some families report are much lighter than they should be.

A family should ask how a facility handles a CNA shortage.  I would ask about how many agency or contract workers the facility uses.  These are people who come in from an agency when there are shortages.  Contract or agency personnel are generally considered sub-standard because they don’t know the residents or the facility and just come in and get periodic assignments.  Another way some facilities fill open positions is simply making aides work double shifts – a daunting task which invites disaster.

Making sure there are adequate staffing is paramount to good care.  Asking the right questions is key to making sure facilities have enough people to do the required work.

Challenges Faced Within a Growing Elderly Population

Posted in Elder Issues

I read with great interest the recent article in The New York Times about the particular challenges faced within a growing elderly population and an alarming statistic with regard to the number of deaths caused by falls in the elderly.

A 2012 study revealed that 24,000 elderly individuals died from falls – a number that was nearly doubled since the prior study.

The science behind finding a balance between independence and safety is nothing new, but is advancing.  Many of the researchers involved in protecting the most frail of citizens have engaged in a technique wherein the researcher will actually wear special glasses that decrease their visual acuity, helping them appreciate the challenges faced by the elderly in navigating things as simple as hallways, carpet, and even toilet seats.

Embedded within this article are some fantastic live action animations that I highly recommend our readers to view.  They demonstrate what happens to one’s ability to differentiate surfaces with degrading vision.  By pressing play, one can see how the elderly will fall, not appreciating obstructions that stand in their way.  Many of the fixes for this are quite simple.  Most seem to involve painting contrasting colors in areas such as step‑ups for showers or even toilet seat covers. Approximately $30,000,000.00 was spent on this recent study and I am sure it will pay off great dividends toward our elderly population.

All studies have confirmed that a fall suffered by an elderly person is quite dangerous and just as often, fatal.  It is of utmost importance for us not only to take good medical care of our senior citizens, but to ensure that their surroundings are populated by enough safety personal to protect them and that the facility itself is designed with the elderly in mind. To read more, click here.

Front-Line Healthcare Workers: The Most Important Resource in Delivering Quality Care

Posted in Elder Issues, Levels of Care

Nursing homes, in New Jersey and Pennsylvania, must maintain enough nursing staff to provide nursing care, and related services, to their residents to maintain the residents’ physical, mental, and social well-being.

In facilities across New Jersey and Pennsylvania, front-line workers make-up the primary healthcare personnel responsible for delivering that care and service to the resident. Those workers include, at a minimum, certified nursing assistants (CNA) and licensed practical nurses (LPN): They are, undoubtedly, the most important resource that a nursing-home facility can provide to ensure that elderly residents receive quality care.

But recently, more than fifty front-line workers picketed outside the Castle Hill nursing home in Union City and the Harborview nursing-home in Jersey City, because, among other things, they are upset that those facilities have failed to provide enough personnel to deliver quality care to the residents: In other words, the workers believe that those facilities—which are owned and operated by Alaris Health—have been operating in a way that endangers the residents’ well-being.

Facilities, in New Jersey and Pennsylvania, that fail to provide enough nursing personnel for delivering quality care, knowingly place residents at risk for neglect and abuse. For example, understaffing can impair a facility’s ability to deliver critical and labor intensive nursing care such as frequent and regular turning and repositioning residents to prevent debilitating pressure ulcers from developing.

And indeed, recently, a front-line worker of the Castle Hill nursing-home in Jersey City stated that “caring for 13 people at one time is just too much.” Furthermore, the Castle Hill and Union City nursing-homes front-line workers believe that Alaris Health is waging “an aggressive campaign against workers” during a time when “the current staffing levels are below state and national average.

No one ever expects a family member or friend to endure neglect or abuse in a nursing home. However, despite federal and state regulations, nursing-home residents often suffer the negative effects stemming from nursing-home facilities that violate those regulations.

When someone you care about has endured nursing-home negligence or abuse, the problems can seem overwhelming. Stark & Stark’s Nursing Home Litigation Group will advise you of your loved one’s legal rights, and will aggressively prosecute a claim whenever our investigation reveals any instances of negligence or abuse.

Welcome Reform Measures to Correct Questionable Self Reporting Staffing Levels in Nursing Homes

Posted in Elder Issues, Nursing Home Information

As an advocate for nursing home residents, one of my greatest frustrations has been the lack of oversight for self reported staffing levels.  This has lead to an extraordinarily low incidence of short staffing citations – and worse yet, has allowed some understaffed facilities to crow over their lack of such citations.

The reality on the ground is that an alarmingly high number of long term care facilities CHOOSE to short staff their facilities to increase profit levels.  By falsifying staffing numbers, they can often evade scrutiny on this extremely important issue.  That is, nursing homes rarely have their payroll records cross referenced against their reported staffing numbers – leaving them free to fudge the math.  In our cases, we have uncovered such records, but I am fearful that this is just the tip of the iceberg.  Indeed, this fear is supported by the confounded families who see barely a foot on the ground, a complete lack of care for their loved ones – yet no citations from the State for failing to meeting staffing requirements.

Recognizing this problem, the White House just announced additional funding to assist authorities in preventing this type of dangerous conduct.  In the end, residents will benefit – as will overworked staff who need a helping hand to protect these vulnerable folks. Click here to see more information.

Lack of Nurses in Nursing Homes Exposed

Posted in Elder Issues, Legislation, News, Nursing Home Information, Protecting Your Rights

When I began working in this field, I was astonished to realize that very few nursing homes and no assisted living facilities have a full-time doctor working there.  I found that facilities at times may be staffed almost entirely with nurse aides and Licensed Practical Nurses (LPN) as opposed to Registered Nurses (RN).  RNs received far more training and education than LPNs and are able to do far more.  LPNs are supposed to do most activities under the direction of a RN and their duties are limited to collecting data.  For example, LPNs cannot assess residents for injury after a fall.

This problem was recently highlighted in an article in the New York Times.  It reports a study that shows that 11.4 percent of nursing homes did not have an around the clock RN.  This is significant because, as the article states, “With higher registered-nurse staffing, patients have fewer pressure ulcers (aka bedsores) and urinary tract infections and catheterizations. They stay out of hospitals longer. Their homes get fewer serious deficiencies from state inspectors. Their care improves, but it costs less.”

As a result, legislation entitled Put A Registered Nurse in the Nursing Home Act, or House Vote 5373, was proposed by Jan Schakowsky (D-Illinois) and six other democrats.  You can read the full article here.

I’ve personally encountered facilities that staff with LPNs and then have them conduct activities they should not do, such as assessing injuries and pain.  In some cases they are not competent to do these activities and serious and sometimes mortal injuries go undiagnosed leading to amputation and death.

Why aren’t there more RNs?  In short, cost.  RNs cost more than LPNs, and if the nursing home company does not offer good enough pay, RNs choose higher paying jobs in hospitals.

Hopefully, the legislation will pass and resident will all see the benefits of properly staffed facilities.

Know Your Resident’s Medications

Posted in Documentation & Reporting, Medication, Nursing Home Information

Many times I meet with families who were not told about medication changes or what a resident was prescribed.  It is easy to know what a resident is prescribed.  There is a document called a Medication Administration Record.  Nursing home staff refer to this document as a MAR.  It lists what a person is prescribed, what dosage, and when and how gave the medication.

This information is important to know for many reasons, one of which was recently highlighted in an excellent article in the LA Times.  A new study reported on in the LA Times showed the use of certain medications for anxiety and sleep increase risk of Alzheimer’s.   Unfortunately, the medications – the class called benzodiazepines that includes Xanax, Ativan, Valium, and Klonopin – are common prescribed in nursing homes.

The study indicated that those who took high doses for short periods of time, or lower doses, did not show problems.  It seems as though the problems are for those who took long-acting or high doses over several months.  You can read the full article here.

The Real Costs of Medical Care

Posted in Protecting Your Rights

News source Health Law 360 today reported that nursing home owner Ralex Services agreed to pay $2.2 Million after a whistleblower came forward and revealed to the government that the company was overstating to Medicaid the level of care residents needed in order to boost profits.

This disturbing story is all too common.  HHS reports as of February 26, 2014, that the government had recovered $19.2 billion in fraud and abuse over the last five years. 


This is the real driver of health care cost.  Although lawyers and lawsuits get typically get blamed high health care costs, this is not true.  Johns Hopkins Medicine, one of the premier health care organizations in American conducted a study and found that medical malpractice claims over $1 million accounted for “far less than 1 percent of national medical expenditures in the United States.” 


Looking out for fraud and keeping nursing homes honest is essential. If you or a loved one has any questions, please contact Stark & Stark today.    

Extendicare Announces Significant 2014 Profits

Posted in Documentation & Reporting

It is surprising to hear long term care push the fiction that Medicare and Medicaid don’t pay enough with profits like this.  http://www.marketwatch.com/story/extendicare-announces-2014-second-quarter-results-2014-08-06-1717337?reflink=MW_news_stmp

In our practice, we frequently see stand-alone facilities create the façade of corporate impoverishment, when in reality taxpayer money goes straight to do-nothing shell corporations and owners.  One of the greatest problems in healthcare today is the pressure on for-profit facilities to satisfy shareholders/owners, rather than focus on patient care.

Stark & Stark Spotlight on Continuing Care Retirement Communities

Posted in Nursing Home Information

Acquiring continuing care—in a community setting—requires a major financial investment by both the consumer and the provider. For the consumer, doing so may involve spending most or all of a lifetime of savings; and for the provider, delivering promised services during the resident’s stay requires sound financial and actuarial management. The following will assist consumers or potential residents in considering Continuing Care Retirement Communities (CCRC).  

Continuing Care Retirement Communities Defined

Dedicated to adults who are usually, at least, 55-years old, CCRCs—sometimes referred to as a “lifecare” communities—combine living accommodations, and continuing care, including health-care provisions. As a resident’s age and needs increase, the CCRC must increase the service it provides to the resident.

Continuing Care

When a CCRC provides continuing care, the care will progress or increase as the resident’s needs increase. Continuing care may include one or more of the following components:

A.      Independent Living — A living unit chosen by the resident for his or her exclusive use, in which the resident can live and function independently.

B.      Assisted Living or Personal Care — Should a resident require assistance or supervision with one or more activities of daily living, then, depending on the facility and the degree of care needed, assistance to a resident may be given in a variety of settings. Possibilities include: (1) assistance in the resident’s living unit, (2) transfer to a residential health care unit which is located within the community, and (3) transfer to a designated supervised unit specifically reserved by the provider for assisted living within the community.

C.      Long Term Care or Nursing Home — When a resident can no longer function independently and requires constant supervision or care, that care will be provided in a long term care facility, commonly known as a nursing home.

Potential residents should find out which components a CCRC offers, as well as how the CCRC defines, manages, and charges for the components. The CCRC must disclose and detail that information in a Disclosure Statement, and in the Contract.

The Contract

Residents must enter into a contract with the CCRC, agreeing to purchase service and the right to live in a specific unit: Unlike Adult Retirement Communities, it is not an agreement to lease or purchase property. Thus, if the resident meets the CCRC’s health and financial requirements, it will provide continuing care for the resident’s lifetime, if the resident desires.

Continuing Care Offered Through Different Plans

A CCRC will offer continuing care through three basic contract plans, described as follows:

A.      The All-Inclusive Plan — The fees in this plan pay for shelter, residential services, and amenities; and long-term nursing care, as needed, at no additional cost, except for adjustments of operating costs due to inflation. There are some slight variations among facilities, but, generally, in an All-Inclusive plan the health care costs are paid through all of the fees paid to the facility by all of the residents, regardless of individual resident needs.

B.      The Modified Plan — This plan also includes shelter, residential services, and amenities. However, this plan covers only a portion of health care offered, usually for a specified time in the long-term facility (nursing home). After the specified time, the resident who needs the care pays for it at an additional charge, or the resident will pay for the health care at a fee which is less than the fee charged to non-residents.

C.      Fee-for-Service Plan — This plan usually includes shelter, residential services and amenities, and sometimes emergency health care. It usually guarantees access to long-term care, but the resident who receives care will pay for it as an additional cost. Monthly fees vary according to the type of plan, size of the living unit, number of occupants, and number of services included in the contract.

The fees a resident pays will vary according to the type of plan, size of the living unit, number of occupants, and number of services included in the contract.

The Fees

To access the CCRC’s living accommodations and other services, a resident must, typically, pay three separate fees: the application, entrance, and monthly service fee.

A.      An Application Fee — may be nonrefundable and as high as $500, but no greater;

B.      An Entrance Fee — is a one-time lump sum of money paid to the CCRC for the occupancy of an independent-living unit, and for the provision of health care.

C.      A Monthly Service Fee — is charge that residents pay the provider in return for the services identified in the contract. Because the monthly service fee is subject to inflation, increases in the monthly service fee should be expected.


The State of New Jersey has regulated CCRCs since 1987 through the Continuing Care Retirement Community Regulation and Financial Disclosure Act (N.J.S.A. 52:27D-330 et seq.) The protects consumers by strengthening the CCRC’s long-term financial stability, and by requiring CCRCs to disclose a important information to the consumer before the consumer spends money and signs a contact.  The Disclosure Statement describes services, financial stability, fees, and other contract terms. Anyone considering a CCRC may acquire that statement directly from the CCRC.

More Information

The New Jersey Department of Community Affairs provides more information about CCRCs in its publication titled: Continuing Care Retirement Communities: A Guide Book for the New Jersey Consumer