Nursing Home Law Blog : Nursing Home Lawyer & Attorney : Stark & Stark Law Firm : Elder Care, Senior Care

Carlyle Group, a District-based private equity firm, has reached an agreement to acquire nursing home operator Manor Care for $6.3 billion, the companies said in a statement on July 2.

Manor Care runs more than 500 nursing homes and assisted living centers across the United States and employs more than 60,000 people. The company, which was founded in 1959 by Stewart Bainum Sr., has deep roots in the Washington region and for years was based in Montgomery County.

In 1998, Manor Care merged with rival Health Care and Retirement Corp. in a $2.9 billion stock swap, and moved its headquarters to Toledo, Ohio.

Stewart Bainum Jr., the founder's son, stepped down as chairman in 2002. He is chairman of Choice Hotels International, a Silver Spring hospitality firm that was a unit of Manor Care before being spun off as a separate company in 1996.

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The NJ Department of Health and Senior Services offers a great deal of information about NJ nursing homes. You can log onto their website for more information.

The mission of the Division is to ensure that New Jersey citizens receive quality health care at appropriate levels of care in regulated facilities. To accomplish this, the division:

• Regulates a wide range of health care settings for quality of care, such as hospitals, nursing homes, assisted living residences, ambulatory care centers, home health care, medical day care and others (complete list).
• Investigates complaints received from consumers and other state and federal agencies.
• Licenses Nursing Home and certifies Assisted Living Administrators.
• Certifies Nurse Aides, including performing background checks.
• Provides consumer information in the form of report cards and other performance information

   

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The following is a list of the four stages of pressure ulcers, otherwise known as decubitus ulcers or bed sores, with a general description of each stage:

Stage I - Non-blanchable redness of intact skin, the heralding lesion of skin ulceration. Discoloration of skin, warmth, edema, indurations or hardness may also be indicators.

Stage II - Partial thickness skin loss involving epidermis, dermis or both. The ulcer is superficial and presents clinically as an abrasion, blister or shallow crater.

Stage III - Full thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissues.

Stage IV - Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures (e.g. tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage IV pressure ulcers.

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Before pursuing any claim for nursing negligence, inquiry must be made as to the payor source for all forms of medical treatment received by the plaintiff. As a general rule, all bills related to ac cause of action paid by Medicaid are subject to recovery prior to payment to the plaintiff.

Because of the length of time it takes to determine the amount and applicability of both Medicaid and Medicare liens, inquiries to these entities should be made as soon as a case is opened. It is not uncommon for Medicare to take an excess of two years to determine the amount and applicability of liens.

You can read more practice tips in my chapter Screening the Nursing Malpractice Case, in a text edited by Patricia Iyer, RN MSN LNCC. More information about Nursing Malpractice, Third Edition, 2007 may be found at here.

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Before even considering entering the realm of plaintiff’s malpractice litigation, it is imperative to become intimately familiar with your jurisdiction’s malpractice law, including certificates of merit, affidavits of merit and the like. In many jurisdictions, the failure to fully comply with theses statutes serves as a complete bar to recovery and forms the basis for a dismissal of plaintiff’s claims.

You can read more practice tips in my chapter Screening the Nursing Malpractice Case, in a text edited by Patricia Iyer, RN MSN LNCC. More information about Nursing Malpractice, Third Edition, 2007 may be found at here.

 

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Some jurisdictions, New Jersey being one example, include provisions of the affidavit of merit statute which addresses situations where a defendant fails to produce a medical record, despite a legitimate request which has been made by certified mail. Under certain circumstances, the statue will allow an affidavit to be presented to the court indicating that despite an appropriate and timely presented request for records with a HIPPA-complaint authorization, such records were never presented and otherwise would have been necessary to have the matter evaluated by an expert.

You can read more practice tips in my chapter Screening the Nursing Malpractice Case, in a text edited by Patricia Iyer, RN MSN LNCC. More information about Nursing Malpractice, Third Edition, 2007 may be found at here.

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I recently met with the daughter of an 80-year-old woman who was left alone in blistering heat without water and wearing a fleece coat. It is uncertain how long the woman had been left unattended but it was long enough to make her pass out and suffer from severe dehydration. The facility at which this took place is a well regarded, pleasant looking facility. It charges residents $6,000 a month. The daughter, who visited her mother regularly, was shocked. She thought that type of thing only happened at the less well-to-do facilities. Sadly, she was wrong.

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A nursing home facility must identify each resident at risk of accidents and provide supervision and assistance devices to prevent accident. These include a thorough intake review of the resident’s pre-existing admission records. Those records are to be examined for the following existing risk factors:

(1) Previous falls;

(2) Cardiac arrhythmias;

(3) Stroke;

(4) Central nervous system disorder such as Alzheimer’s disease, Parkinson’s disease, dementia and others;

(5) Problems with mobility and gait;

(6) Low blood pressure on standing up;

(7) Bowel or bladder incontinence;

(8) Dizziness;

(9) Dehydration;

(10) Visual impairment.

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Nursing home neglect and abuse is occurring at an alarming rate in the state of New Jersey. This neglect and abuse is to blame for most of the instances of bedsores, dehydration, malnutrition, fractures, infections, as well as physical, emotional, and psychological trauma. Although these injuries are largely preventable, they persist because nursing homes are often understaffed and care providers are inadequately trained. This reality makes finding a nursing home that provides quality care challenging work. However, having a basic understanding of the substandard care presently found in nursing homes and employing the tips provided below will make it significantly easier for you to find the quality care your loved one needs and deserves.

Many nursing homes routinely fail to provide enough staff to meet the needs of the residents. Often residents wait long periods of time for even the most basic necessities. These delays can have horrific consequences. For instance, a significant delay in providing residents with food and water can quickly lead to life-threatening malnutrition and dehydration complications. Also, delays in repositioning of immobile residents can result in very painful wounds, severe infections, and amputations.

In addition to under staffing, nursing home personnel, particularly certified nursing aides, are often inadequately trained. CNAs have the most contact and provide the most care to the residents. However, administering quality care to frail elderly individuals is complicated. It can only be done properly after considerable training. Unfortunately, CNAs are overworked and underpaid. As a result, their turnover rate is high causing nursing homes to regularly scramble to train new employees. The unfortunate consequence is that residents are continuously left at risk of neglect and abuse.

The good news is that there are nursing homes within the State of New Jersey that are providing quality care to their residents but they have to be sought out. If you are considering placing a loved one in a nursing home, visit the State of New Jersey Department of Health and Senior Services web site. There you will find the DHSS report cards for nursing homes. Each year, the department conducts on-site inspections called "surveys", of all New Jersey nursing homes. State surveyors evaluate the quality of care and services provided, as well as the appropriateness of the facilities, building, equipment, staffing, policies, procedures, and finances. The surveys are a "snap shot" of the facilities' performance at that point in time.

If you find a nursing home that you believe will provide quality care, don't stop there. Go to the nursing home web site and read up on facility. Then visit the nursing home and meet with its administrator. Inquire about the staffing levels and turnover rates. While you are there make some observations: Do the residents appear to be well taken care of? Is the building well maintained? Do the residents appear active? Is the staff respectful to the residents? What do staff members think of their work? Ask the residents if they like the nursing home. The more time you take and the more questions you ask the better your chance of developing an accurate assessment of the facility.

Nursing homes should be a place where you can trust your loved ones' needs will be met and quality care administered. This is not always the case and in order to insure that it is for your loved one, it will be up to you to do the research and make certain the nursing home you choose provides quality care.

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