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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

A Call for Action to Address Abuse of Older Americans

Posted in Injuries

Last month, the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced a framework for tackling the challenges to elder-abuse prevention and prosecution. In doing so, the departments called on all Americans to take a stand against elder abuse, neglect, and financial exploitation.

The framework, known as the The Elder Justice Roadmap, directly addresses “a problem that has gone on too long . . . by offering comprehensive and concrete action items for all of the stakeholders dedicated to combating the multi-faceted dimensions of elder abuse and financial exploitation,” explained Associate Attorney General Tony West.

But as the Stark & Stark Nursing Home Litigation Group has continued emphasize: we must do more in New Jersey and Pennsylvania.

Accordingly, the DOJ has developed an interactive, online curriculum to teach legal aid and other civil attorneys to identify and respond to elder abuse. And HHS is developing a voluntary national-adult protective-services (APS) data system, which collects national data on adult mistreatment. The system will “help to identify and address many gaps about the number and characteristics of adults who are the victims of maltreatment and the nature of services that are provided by APS agencies to protect these vulnerable adults.”

Here—in New Jersey and Pennsylvania—local communities, families, and individuals can take the following important steps:

1.      Learn the signs of elder abuse. The National Center on Elder Abuse, a program of the Administration on Aging at ACL, has developed a helpful Red Flags of Abuse Factsheet that lists the signs of and risk factors for abuse and neglect; and

2.      Report suspected abuse when you see it. Contact your local adult protective services agency. Phone numbers for state or local offices can be found at the National Center for Elder Abuse website (New Jersey, Pennsylvania), or call 1-800-677-1116.

Associate Attorney General West said it best: “We must take a stand to ensure that older Americans are safe from harm and neglect. For their contributions to our nation, to our society, and to our lives, we owe them nothing less.”

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

Staffing Issues May Affect the Quality of Care Rendered in Nursing Homes

Posted in Protecting Your Rights

When families are considering whether to use nursing-home services to care for their loved ones, they must consider various issues in determining whether a nursing home is capable of providing adequate care. Among other issues, a family must determine how well a nursing home staffs its operations.

For example, roughly 450 nursing-home care workers recently announced their intentions to go on strike to address the unfair labor practices occurring across four different facilities owned by the same company. But even before the workers commence their strike, the elderly residents within those facilities, and their families, have already endured the catastrophic effects stemming from underpaid staff, and the accompanying understaffed environment.

Understaffing, often, prevents facilities from delivering appropriate care to residents, and thus leads to neglect and abuse. 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. At the same time, a facility must maintain adequate staffing to assist residents with eating, and to encourage their independence in feeding themselves. Without adequate staffing, facilities threaten residents with malnutrition and dehydration.

Furthermore, an underpaid staff may cause low morale, which will likely affect the quality care rendered to the residents, particularly for critical and labor intensive care such as frequent and regular turning and repositioning—often at least every two hours—of residents at risk of developing debilitating pressure ulcers. 

The dangers of understaffing in nursing homes is clear, and government regulators have attempted to reduce the negative effects by requiring all Medicare-participating nursing homes to meet the requirements specified in the Federal Nursing Home Reform Act. That legislation requires nursing homes to have enough staff to provide all necessary care to all patients on a 24-hour basis.

No one ever expects a family member or friend to be the victim of neglect or abuse in a nursing home. However, despite government regulations, residents of nursing homes often suffer the negative effects of underperforming facilities.

When someone you care about has been the victim of 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.

Stark & Stark Shareholder Speaks at 2014 AAJ Annual Convention

Posted in News

Stark & Stark Shareholder, David R. Cohen, Esq. spoke on the topic “Advocacy Track: Social Media and Technology” at the 2014 American Association for Justice Annual Convention in Baltimore, Maryland. Mr. Cohen is a member of Stark & Stark’s Accident & Personal Injury Group and Chair of the firm’s Nursing Home Litigation Group. Mr. Cohen concentrates his practice in nursing home negligence and abuse claims, elder abuse and assisted living facility litigation. If you would like to see a photo of this event, click here.


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

Posted in Nursing Home Information

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.