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

Golden Living Designated as a Special Focus Facility

Lancaster ratings reveal that while some facilities have improved their standings, Golden Living is now one star and has been found to have a history of poor care.  To read more, click here

Assisted Living Facility Refuses Potentially Life-Saving Medical Care

Claiming that it was corporate policy, an assisted living facility refused to provide medical care that might have saved a woman’s life.  This is an example of corporate disinterest in the safety and welfare of the elderly.  To read more, click here

Residents Deserve Better Staffing

Though we’ve always known that poor staffing leads to falls and pressure ulcers, new research shows that Norovirus is also causally linked to poorly staffed nursing homes.  The Journal for the American Medical Association recently published these findings and they are summarized in an article by Dr. Jeffry Levine. 

Obama Administration Launches New Alzheimer's Plan

One of the most common mental conditions we see with nursing home residents is Alzheimer’s disease.  It can be very difficult for a family to watch a family member slowly slipping away mentally.  This condition can also increase someone’s risk for falls and other injuries.

The government today announced that a new plan is being launched with “the goal of finding effective ways to prevent and treat the devastating effects of dementia by 2025.”  New studies are being conducted to learn to treat and prevent the illness, as well as optimizing care quality and expand support to families.

You can read the entire article online here.

Major For-Profit Nursing Home Chains Remain "Highly Profitable" Despite Medicare Cuts

Families for Better Care – a citizen’s advocacy organization – showed in a recent study that the largest publicly traded nursing home chains remained very profitable despite Medicare payment cuts last year.  The director of Families for Better Care, Brian Lee, believes that the profits are driven by lower nursing hours and less care based on a study conducted last fall.

‘“The reason care declines in nursing homes is that executives unnecessarily target labor costs to offset any reimbursement adjustments,” Lee said. “While this obviously maintains a robust bottom line for investors and cushy CEO salaries, the decline in frontline staff puts residents in jeopardy for harm while simultaneously creating dangerous working conditions for employees.”’

For-Profit Chain Nursing Homes Consistently Perform Worse than Non-Profit Homes

A new study conducted by Center For Medicare Advocacy (CMA) concludes that while “some for-profit nursing facilities give excellent care and some not-for-profit nursing facilities give poor care – the general rule is documented in study after study: not-for-profit nursing facilities generally provide better care to their residents.”

While each nursing home is truly different, knowing the facts before choosing a facility is key.
You can read the full study results online here


Never Events, Pressure Ulcers and Hospital Safety

I just happened upon an excellent website (, promoting the value of 11 years of “Never Events” as establishing safer practices in our hospitals. This site is authored by a physician and notes that another physician, Ken Kizer, MD, former CEO of the non-profit, National Quality Forum (NQF), first introduced this term in 2001. 

Since then, insurance companies, health organizations and later, the U.S. government, came on board – to support the notion that failing to protect the consumer public from preventable errors has devastating consequences for this nation. Topping the list on this site are preventable pressure ulcers.

Long Term Care Insurance - Read the Fine Print

Recently, I had the opportunity to review a long term care insurance policy. The document was confusing and full of exceptions. It was difficult for me to believe that the people who bought the policy could understand what it said.

Even worse is when a person who has paid for a long term care insurance policy is having difficulty getting the benefits. That is what some plaintiffs in California are alleging – that the company’s claims process is "designed to frustrate and confuse policyholders with needless demands for irrelevant information.”

While long term care insurance can be terrific protection for a family’s assets if long term care or home care is needed, not all policies or insurance companies are the same.  It certainly can’t hurt to have someone familiar with insurance products review a policy before purchase.  Many certified financial planners can review policies, or can assist in purchasing a policy best for the individual.  Researching companies before buying the products is also a good idea.

Insurance is only good if it works when you most need it! 

New Study States That Antidepressants Increase the Risk of Falls in Nursing Home Patients with Dementia

A new study confirms that a large percentage of nursing home residents are prescribed anti-depressants, or selective serotonin reuptake inhibitors (SSRIs). While in most cases, anti-depressants are beneficial to the well being of the residents, in patients suffering from dementia, they can significantly increase the risk of falls - leading to serious injuries, and even death.

Researchers from the Netherlands recently reported that a study, which included 248 nursing homes, shows that anti-depressants were used on over 13,000 patients of which more than 650 sustained injuries. These falls occurred in 152 out of the 248 nursing homes included in the study. Additionally, 38 residents fell once during the time of the study, while 114 had multiple falls. Of those 650 falls, 220 resulted in serious injury, or even death.

It is imperative that these facilities conduct interdisciplinary care meetings to ensure that the proper protocols are followed, in order to reduce the risk of life-threatening accidents.

Simple Tools to Prevent Bed Sores Found to be Cost Effective

While nursing homes should always look to prevent bed sores – a painful and sometimes deadly condition – a recent study conducted revealed that the prevention of bed sores is also cost effective.

Foam mattresses which reduce pressure were found to be cost-effective 82% of the time as opposed to using standard mattresses. This simple change could save on average $115 per resident. Additionally, foam cleansers for incontinence were found to be cost-effective 94% of the time, as opposed to traditional soap and water, which results in an average savings of $179 per resident.

On average, roughly 10% of residents in long-term care facilities have a pressure ulcer. And for those residents, treatments are critical early on in order to prevent a serious, and even life-threatening condition. A better solution to this problem is prevention. Nursing homes and assisted living facilities can, and should, prevent these problems from happening rather than treating them after the fact. Most importantly, not only are these prevention techniques the right thing to do, but they also save money for the facility!

Corporate Interests Outweigh Patient Safety

A recent article in the Star Ledger, Stronger safeguards needed in N.J. hospitals, nursing homes, asks the questions, “Should corporate lobbyists decide whether safe equipment and procedures are needed if you or a loved one have to go to a hospital or nursing home? Or should health care professionals make those decisions?”

All too often high power corporate interests utilize lobbyists to cut corners, increase profits and put patients at tremendous risk. In this recent article, we see how this plays out in ways that not only harm nursing home residents and hospital patients, but also places healthcare workers at risk. 


Suspicious Elder Deaths Rarely Investigated

I have had cases where a person suffers from a bed sore that is so large the spinal column is visible, and yet the cause of death listed on the death certificate states, “natural causes”, or “dementia”, or “Alzheimer’s”.  While we may still pursue a claim to hold those responsible for the large and painful wound accountable, it is frustrating to the family that the bed sore is not listed on the death certificate. 

We are currently prosecuting cases where had a resident not been taken to the hospital and died in the nursing home, the true cause of death would have never been discovered. 

Unfortunately, this situation is far from unusual. As reported in ProPublica, suspicious elder deaths are rarely investigated.  According to the article, autopsies performed on seniors are increasingly rare even though the United States population aged 65 and older has grown. From 1972-2007, the number of autopsies performed on seniors dropped from 37% to just 17% percent. Additionally, of the 1.8 million seniors who died in 2008, autopsies were performed on only 2%, and only performed on 1% for those elderly who passed away in nursing homes or care facilities.

How The Affordable Care Act & The Accountable Care Organizations Will Increase Quality Care at Nursing Homes and Hospitals

With the passing of the Affordable Care Act (ACA), this nation has seen the beginning of a dramatic shift in both the delivery of healthcare and the means by which payment is made for medical services.  Under the ACA, a new type of medical agency was created, known as Accountable Care Organizations (ACO). These entities are required to coordinate all levels of care in a fashion that is both more efficient and better focused on the provision of quality care.

As we have written on our blog, hospitals will no longer be paid to rectify medical errors which have been deemed as “never events.” This is a class of medical error which non-profit research groups and the federal government alike have determined to be wholly unacceptable in the hospital context. ACO’s are being organized to help prevent the occurrence of never events.

At present, we may be at a crossroads in terms of whether ACO’s will be lead by physicians or hospitals.  Either scenario has its share of opportunities and pitfalls. The New England Journal of Medicine has been following ACO issues and includes some excellent commentary.

A New Way to Combat "Never Events": Obama Administration May Penalize Nursing Homes That Unnecessarily Admit Patients to Hospitals

The Centers for Medicare and Medicaid Services (CMS) have recently designated certain injuries in hospitals “never events” – or injuries that should not happen. These injuries include Stage III and IV bed sores and falls with fractures. The penalty to hospitals when these injuries happen is that CMS will not pay for treatment rendered for these injuries. The result is that many hospitals are reporting the incidence of these events has gone down, and in some places tremendously.

Now, the Obama administration is doing a similar thing to nursing homes according to an article in Forbes magazine.

According to the article, a recent study showed that 25% of nursing home hospital admissions may be preventable. A further congressional review panel estimates that 14% of hospital patients sent back to nursing homes return to a hospital for a preventable condition. The Obama administration wants to penalize nursing homes that have unnecessarily high hospital admissions for preventable conditions by reducing their Medicare payments.

So, why are these residents being sent to the hospital to be paid for with your tax money? The author of the article documents that, “I’ve seen hospital emergency rooms filled with very frail seniors on Friday afternoons. Why? Because nursing homes know they won’t have enough weekend staff to care for their sickest residents, so they simply send them back to the hospital. The new rules could stop those practices.”

Perhaps hitting substandard nursing homes in the pocketbook will force them to take better care of their residents. 

New Jersey Ranks Poorly On Long-term Nursing Care

A recent article in The Bergen Record, New Jersey ranks poorly on long-term nursing care, discusses the fact that New Jersey nursing-home care is less affordable and patients are more likely to suffer bedsores or need trips to the hospital than in many other states. New Jersey ranked in the second tier of states — 22nd — for choice, affordability, quality of care and support for family members who take care of the elderly and disabled at home.

I recently wrote a post on my firm’s Facebook page discussing the implications this article, and these new findings, could have on the health care industry in New Jersey.  

The Centers for Medicaid and Medicare Now Publically Reports Safety Issues in Hospitals Including Bed Sores and Falls and Trauma

Recently, the Centers for Medicare and Medicaid Services (CMS) made certain information regarding safety issues in hospitals public information. Data tracking “hospital acquired conditions” - injuries/conditions a patient suffers that they did not enter the hospital with - are now available to the public. They are serious conditions that if proper procedures are less likely to occur. They have been deemed “never events” and CMS does not pay for services related to these injuries. The injuries include:

  • Foreign object retained after surgery
  • Air embolism
  • Blood incompatibility
  • Pressure ulcer states III and IV
  • Falls and trauma
  • Vascular catheter-associated infection
  • Catheter-associated UTI
  • Manifestations of poor glycemic control

You can download the most recent results online here. Now, you can now know your area hospitals before you become a patient in regards to these serious conditions.

Bill That Protects the Worst Nursing Home Abusers by Severely Limiting Damages Is Sponsored by Lawmaker Who Sought the Same Type of Damages in His Own Lawsuit

Currently pending in congress is bill HR5 sponsored by Representative Phil Gingrey. If HR5 passes, it would protect some of the worst nursing homes from even the most egregious abuses by severely limiting damages. 

If this law passes, even a nursing home where a resident was admittedly beaten to death or raped by a known dangerous employee, damages are capped despite what a jury believes is the right thing to do. 

Interestingly, when it comes to his own lawsuits, Representative Gingrey seems to have a different point of view. 

A recent article by Public Citizen writes that after a 2004 rear-end car accident, Representative Gingrey sued the other driver and sought damages for “mental pain” and punitive damages to be determined by “the enlightened conscience of fair and impartial jurors.” He claimed he “was injured grievously, has experienced conscious physical and mental pain, suffering, fright and distress in the past, and will continue to suffer the same in the future, for which he is entitled to recover general damages … in amounts to be determined by a jury.”

A Gingrey constituent, who had both her arms amputated as a result of medical errors after her car accident, wrote him a letter asking him to reconsider his bill. 

It seems hypocritical that for his car accident, Mr. Gingrey should have the right to a full and fair jury award, but a person who is seriously injured or killed in a nursing home is restricted.

Elderly Abuse in Nursing Homes: Physical and Financial

By now, most of us have heard of the tearful testimony of the great Mickey Rooney in Congress, on abuse and victimization of the elderly.  Here is yet another story on how abuse of nursing home residents is not only physical, but often financial. In this case, Tanya Fredrick, the business office manager at Golden Living Center, was fired after police revealed that she had been stealing thousands of dollars from the center and residents.

Mickey Rooney's testimony before Congress on Elder Abuse and Medical Malpractice Bill HR 5

With painfully shocking testimony, American Icon, Mickey Rooney, told a gripping story about how even he was the victim of elder abuse. It has become quite clear that the degree of this form of elder abuse is much more widespread than previously thought. We all need to be on the lookout for this abuse in our loved ones.
We have blogged before on the dangers of proposed HR 5 legislation, which in large part is designed to eliminate elder abuse claims.  Should this bill pass, our ability to prosecute such cases, uncover these horrors and protect the elderly will be severely limited.
Here is a link to the video of Mr. Rooney's testimony.  It is worth watching.

Assault on Innocent Nursing Home Resident by Staff Member at Harborage Nursing Home in North Bergen, New Jersey

A disturbing recent story was released and ultimately televised involving an over-stressed nursing home employee who was caught on tape assaulting an innocent resident.  No matter how difficult the job, harming an innocent senior is vicious and wholly worthy of the prosecution that this employee faces.  It is imperative that nursing home owners carefully screen and supervise employees to prevent the needless harms that inevitably will ensue.

Nursing Home Risk Factors Identified - From Soap to Staffing

A recent study of nursing home risk factors conducted by the American College of Preventive Medicine shows that washing hands with soap and water is far more effective in preventing norovirus - a virus common in nursing homes characterized by vomiting and diarrhea - than using alcohol based solutions found in dispensers throughout most nursing homes and hospitals. 

However, what was also interesting in this study was the identification of another risk factor - low and part-time staffing.  The study found that other risk factors with high risk ratios were the use of part-time staff when the proportion of staff-to-patients was less than 1:2, and when the total staff-to-patient ratio was less than the industry median.

You can find how nursing homes are rated in regards to staffing on the Medicare’s Nursing Home Compare website. Nursing Home Compare rates staffing, like other measures, on a one to five star scale.

Protecting the Rights of Nursing Home Residents

Many of our cases involve terrible injuries and death as a result of neglect, negligence and abuse, such as bed sores, hip fractures and assaults. However, many of our clients and their families also complain about living in nursing homes that are just bad - a lousy building, freezing in the winter, hot in the summer, residents not being changed and bathed, broken plumbing, roaches and rodents, uncaring staff, or not enough nurses or CNAs. After receiving complaints, the nursing home promises to fix these problems and don’t. What can someone do in these circumstances? 

Know your rights.
New Jersey, like many other states, gives nursing home residents specific rights by law. If nursing homes infringe these rights they can be punished. Resident rights must be in writing, posted, and given to each nursing home resident when admitted. These are important rights, and include the right to:

  • a safe and decent living environment
  • privacy
  • considerate and respectful care
  • expect and receive appropriate assessment, management, and treatment of pain
  • unrestricted communication at any reasonable hour
  • unaccompanied right to a telephone 
  • obtain assistance in writing and reading letters
  • retain personal property
  • to wear your own clothes
  • present grievances on behalf of himself or others to the nursing home administrator

Make sure you have a copy of the law. You can view the full text online. If the nursing home is not meeting these rights, demand that they start doing what the law requires.

Hospitals Prove Deadly for Some Medicare Patients

A government study released today states that roughly 15,000 Medicare patients die each month due in part to the care they receive at hospitals. The study focuses on understanding adverse events in hospitals, or more specifically, any medical care that causes harm to a patient.

The study included 780 Medicare patients who were discharged from a hospital in October 2008. Those patients suffered from problems such as bed sores, infections and excessive bleeding from blood-thinning drugs.  Of the 780 patients in the study, 12 died as a result of hospital care, five of which were related to blood-thinning medication. Additionally, two other medication-related deaths involved inadequate insulin management resulting in hypoglycemic coma and respiratory failure resulting from over-sedation.

This is simply devastating and completely unacceptable for the roughly 47 million Americans enrolled in Medicare across the country.

Pressure Ulcer Stages

Bed sores (also called pressure ulcers and decubitus ulcers) can develop into severe wounds that can be fatal.  Wounds can at times be so large that bones become exposed inviting infection.  It is not uncommon for a family member not to see the bed sore until it is serious.

While most people have heard the term bed sore before, very few have actual experience with them.  They are fortunate.  One person recently told me they thought a bed sore was akin to a bad rash, until she first saw one on her mom and almost passed out. 

A bed sore forms when a person is not moved.  Areas with constant pressure on the underlying tissue such as the tail bone (also called the sacral area), elbows, heels and head, and areas where there is a brace, prevent blood flow that can kill tissue.  This causes a bed sore.

Bed sores are categorized by Stages.  Basically they are 5 stages of bed sores or pressure ulcers:

Stage I - No skin breakage.  May look like a red rash.  
Stage II  - Superficial skin breakage.
Stage III  - Open skin wound.  Can see blood but no muscle or bone.
Stage IV  - Open skin wound.  Can see muscle or bone.
Unstageable  - Because of dead tissue covering the wound, these wounds cannot be staged.  Generally presumed to be a stage IV.


For more detailed descriptions, you can go to the National Pressure Ulcer Advisory Panel's website.

The good news about bed sores is that they are both preventable and treatable.  With good prevention measures and early intervention bed sores can be avoided or can heal.  Even people who suffer from large bed sores may heal with the right care.  Treatments vary for the different stages, so its important to understand the different stages when taking part in a care conference or talking to a doctor.  Armed with the proper facts, a person can become a better advocate for a loved one.

Better Care Saves Taxpayers Money

Here's a great health care industry article that says the same thing that we've been saying on this blog for years: Spending more time and money on improving the care for our nation's most vulnerable citizens is not only the right thing to do, but will actually save taxpayers money.  This report from the Kaiser Family Foundation confirms that these type of improvements to long term care can save taxpayers BILLIONS of dollars each year.
I have noted on this blog, as of today, some large nursing home conglomerates increase their profits by under staffing and underfunding nursing homes.  Who pays the price?  Patients who suffer and the taxpayers.  The fallout of underfunded nursing homes is human suffering and taxpayers footing the bills for hospitalizations when unthinkable injuries occur.

Many Health Insurance Companies No Longer Willing to Pay for Treatment Related to Hospital Acquired Bedsores and other avoidable mistakes.

I recently wrote an article for the New Jersey Law Journal about the new Medicare Guidelines for Hospitals and Never Events.  After some additional research, I have learned that many insurance companies agree that it is unfair for negligent hospitals to pass costs related to their mistakes along to others.
We first learned that after extensive studies by non-profit health related organizations, one of the best ways to improve the quality of care for patients was to prevent hospitals from passing the costs of their mistakes on to taxpayers.  So, Medicare now will not pay for treatment related to what are now called Never Events (injuries and mistakes which are never acceptable).
It seems that insurance companies agree....and many are joining in to follow Medicare's lead.  As this article from a leading insurance website notes:

Standing in the middle of Never Event messes are health insurance companies.  Just like Medicare, they’re tired of paying for Never Events and they want hospitals and doctors to be more accountable for their mistakes.

Independent Living Resident Dies After Unanswered Call for Help

The Milwuakee Wisconsin Journal Sentinel reported this disturbing story.  A woman died after bleeding to death when her emergency pull cord located in her “independent living” apartment went unanswered for four hours.  Apparently the nurse aide who was working at the time shut off the sound alarm, disregarded a phone call from another resident who heard the alarm, and went back to watching television while the woman was bleeding to death.

What is also remarkable about this story is that the woman lived in what was deemed an “independent living” building.  The same facility also included assisted living units and a nursing home.  The state Department of Health Services was asked if they were getting involved in the case.  Unfortunately, that agency does not oversee “independent living” apartments.  Since the District Attorney did not find any crime they could prosecute, it appears that the only one who can punish this facility is the family suing.

California nursing home fined for alleged neglect in resident's fatal fall and brain bleed

Just because a doctor orders something for a resident in a nursing home, it does not mean it gets done - sometimes with lethal consequences.  A California state investigator found that Pilgrim Haven Health Facility in Los Altos failed to install an electronic fall monitor as ordered by the resident's doctor, and failed to make sure the resident’s walker was in reach.   As a result, the man fell twice, and died from head trauma.  The nursing home was fined $100,000 by the state.


You can read more on the story online here.

Six Employees Arrested for Elderly Abuse at California Nursing Home

While resident abuse is shocking and disgraceful, there are times where behavior is simply unbelievable. Six employees were recently arrested at a facility where residents with dementia were covered from head to toe in ointment cream to make them slippery for the next shift as a practical joke.

It should be noted that when the elderly are dropped they can suffer fractured hips.  A fractured hip leads to disability and severe pain, and has a high mortality rate. The mortality rate is especially high in the first months after a fractured hip, and remains high for the first year. 

You can read more on this story online here.

Decubitus Ulcers: An Update on Staging and The Impact of Never Events on Hospital Litigation

David R. Cohen, Chair of Stark & Stark's Nursing Home Litigation Group, authored the article, Decubitus Ulcers: An Update on Staging and The Impact of Never Events on Hospital Litigation, for the June 21, 2010 edition of the New Jersey Law Journal.


The article features an update on the process of diagnosising and staging decubitus ulcers, as well as guidelines for proper care and prevention. The article also includes a discussion on the applicability of so-called “never events” and what effect they can have in litigation matters.


You can read the full article online here. (PDF)

Twenty-two Nursing Home Employees Arrested for Resident Abuse and Neglect

A recent Attorney General’s investigation using hidden cameras lead to the arrest of 22 nursing home health care workers for resident abuse and neglect.  Examples included not turning and repositioning an immobile resident for an entire shift, not administering medications, not treating a bed sore, and not changing resident undergarments for long periods of time.  Prior investigations by the Attorney General have so far lead to 30 criminal convictions, including a corporate nursing home owner.

Nursing Homes vs. Assisted Living Facilities

In this video, David Cohen, Chair of Stark & Stark's Nursing Home Litigation Group, discusses the benefits of assisted living facilities. Mr. Cohen states that assisted living facilities are a great alternative to traditional nursing homes for people who need assistance, but do not require the level of care offered by a nursing home. Mr. Cohen does warn the families of assisted living facility residents to stay in constant contact with their family member or loved one in order to ensure that they are receiving the appropriate level of care.


Nursing Home Litigation - Part 1 from Stark & Stark on Vimeo.

Petition In Support of Workers' Demands Given to Avery Eisenreich and Mendel Gold, Executives at Omni Health System Nursing Homes

Leaders from Democracy for America, Blue Wave NJ and the Anakbayan Filipino Youth Group and other community groups collected over 3,600 signatures for a petition which was sent to the administrators of four area nursing homes in support of workers who have been in contract negotiations for nearly three years.

More than 300 workers at three Hudson County facilities - Harbor View Health Care Center in Jersey City, Castle Hill Health Care Center in Union City, and Palisade Nursing Home in Guttenberg - plus a fourth in Bergen County, have been without a contract since July 2007.

The workers went on strike in August for three days, held several days of protests in October, and have run an extensive campaign of television, radio and billboard ads against Avery Eisenreich and Mendel Gold, top executives at the Jersey City-based Omni Health System, which owns the facilities. You can read more on this story online here.

Texas Speeds Up Investigations of Nursing Home Complaints

Nursing home care is proving to be a growing priority.  After being faced with alarming delays in investigating nursing home complaints, the Texas Department of Aging and Disability Services avows to speed up scrutiny to ensure safety and avoid resident harm. Read more on this story online here.


Nursing Homes and Assisted Living Facilities: Understanding the Differences and Keeping Your Loved Ones Safe

Dave Cohen, Chair of Stark & Stark's Nursing Home Litigation Group, authored the article, Nursing Homes and Assisted Living Facilities: Understanding the Differences and Keeping Your Loved Ones Safe, for the January 20, 2010 edition of US 1 Newspaper. You can read the full article below:

As a trial attorney for over twenty years and a litigator who has devoted his entire career to protecting the rights and safety of the elderly, I have seen a disturbing trend in recent years in the interplay of nursing homes and assisted living facilities.  As many are aware, when our loved ones’ health declines, families are faced with critical and emotionally heart wrenching choices.

Traditionally, nursing homes have been the most common choice in working toward obtaining the highest quality of life and safety for seniors who can no longer care for themselves and for whom family members simply do not have the qualifications to fulfill these needs.  More recently, assisted living facilities (ALFs) have been gaining popularity. They fulfill a well needed void in the healthcare continuum and are certainly a welcomed addition to the options available to families. 

However,Assisted living facilities are regulated, but not nearly as much as nursing homes.  The facilities themselves are generally much more attractive and family members tend to feel better about placing parents or spouses in them. However, ALFs generally have fewer nurses and fewer nurses’ aides.  Additionally, they frequently do not have registered nurses on site for significant periods of time.  For seniors with lesser needs and who are otherwise much more independent, this is an excellent environment.  However, the danger is twofold:

In the first instance, while the majority of ALFs are owned and operated by caring, professional and qualified individuals, many are so focused on filling beds that they often will admit those who simply are an improper fit for that level of care.  In my practice, I have seen far too many residents suffer from malnutrition, dehydration, bedsores, fractures and ultimately death based upon a poor fit for a facility which never could or should have let this person through their doors.  The second danger faced by families involves situations where the fit was initially appropriate, but when the resident’s health declines, it becomes dangerous to allow that person not to receive a higher level of care.  Much like poor admission situations, in my practice I have seen many residents needlessly suffer and die because the tough decision to move them into a higher level of care was overlooked by the staff at the ALF.

In the end, the decision to accept or reject the resident should be based upon the individual’s needs and not by profit.  This is the formula by which the vast majority of assisted living facilities operate.  It is those who do not operate in this fashion who create the dangers we speak of.  Families can and should be vigilant about all of these issues.  They should also conduct a significant amount of research into what the particular assisted living facility they are looking into can and cannot do.

Unfortunately, there is not a bright-line rule as to the level of care that assisted living facilities provide.  I have seen an incredibly wide variance between the lower levels of care and the higher levels of care.  At the lower end, there is very little supervision and medical/nursing staff available, while the higher end of care at some of these facilities is nearly indistinguishable from that provided in nursing homes.  Without a clear knowledge as to what these facilities can provide, families are ill advised to take the leap into admitting a loved one.  Every bit as important is monitoring the health and cognitive status of your loved one while living in an assisted living facility to ensure that they remain an appropriate fit.

With vigilance, attention and research, families can and should look toward assisted living facilities to provide the best of care and quality of life for their loved ones - but must do so with caution and their eyes open.   

Understaffing Causes Death in Nursing Home

An article out of Minneapolis, Minnesota last week reports of an 89-year old nursing home resident who, even with all of the proper precautions, died after a fatal fall. Despite a bed alarm, a motion sensor, a sound monitor and a perimeter mattress the resident fell in the middle of the night. Due to a severely understaffed wing, the resident died due to complications from the fall.

What You Can Do When You Feel Your Loved One Is Not Being Properly Cared For

The decision to trust a nursing home to care for a loved one can be a difficult one, even when a family does not have the time or resources to properly care for a elderly family member at home.  Conflict between family members and nursing home staff is very common, especially when a family feels their loved one is not being taken care of properly.  In this article, there is some great advice on what you can do when you feel your loved one is not being properly cared for. 

Falls in nursing homes: A deadly killer of the elderly

Here is an interesting article which addresses the fact that more than 100 Minnesotans die each year after suffering falls in nursing homes. The article questions why so few of these deaths are fully investigated by the state, and how serious penalties for violations are rarely enforced.

The real face of Medical Malpractice - A grieving mother speaks

There is a human side to the nonsense spewed by the insurance industry about malpractice.  It's about needless suffering and tragedy.  It is the face of many tragic cases that a billion dollar industry and its well funded lobby does not want the public to see.

I found an aticle online which gives insight into the lives of those affected by the most severe cases of negligent care. You can read the article online here.

15,800 Nursing Homes in America Rated By Centers For Medicare & Medicaid Services

I found an article online last week  which reports that the Centers for Medicare & Medicaid Services has issued quality ratings for 15,800 nursing homes throughout the USA which participate in Medicare or Medicaid. Each nursing home was assigned a star rating, from one to five - with five being the best. The ratings are based on health inspection surveys, staffing information, and quality of care measures.

Alaska had the best record with 0.0% of all nursing homes have a 1-star ranking, and 26.7% of all nursing homes have a 5-star ranking. While Louisiana had the worst record with 39.3% of all nursing homes have a 1-star ranking, and 2.8% of all nursing homes have a 5-star ranking. New Jersey was in the middle of the pack with 22.2% of all nursing homes have a 1-star ranking, and 12.7% of all nursing homes have a 5-star ranking,

You can read the full article and the complete list of rankings by state online here.

New York City Hospitals Issued Citations for Falsified Medical Records

I found an interesting article on this week entitled, Hospital records were sometimes falsified to cover up medical mistakes. The article discusses the recent report that doctors, nurses and support staff at New York City-run hospitals have falsified documents in hospital records in order to cover up medical mistakes. The records were either deleted altogether or were doctored in order to omit specific details of certain cases in order to mislead investigators. The state issued 16 citations between 2004 and 2008.

You can read more on the story online here.

American's Best Nursing Homes

According to US News & World Report, In a typical year, about 3.2 million Americans will spend at least some time in a nursing home. To help find a good choice from among the nation's more than 15,500 homes, U.S. News created America's Best Nursing Homes - a list of the roughly 15,000 best nursing homes from throughout the country. You can search by name of the nursing home, by state, city or by zip code.

Once the search has been conducted, a report is generated with all of the homes which fit your search criteria. Each home is given an overall rating, a rating for health inspections, nursing staff and quality measures. The report also provides a link to a full, more detailed report of each home. You can access the search online here.

Poor Medical Records in Hospitals and Nursing Homes: Unnecessary injuries and deaths

I had a deposition earlier this week involving a horrible bedsore/starvation claim.  After being underfed in the hospital for two weeks because the physicians never saw the three recommended feeding plans from the registered dietician, our very sick client was sent for rehabilitation to a local nursing home.
Upon her transfer, the hospital staff then understated the never-implemented diet.  Our client was supposed to be a tube feeding product called Jevity-Plus - because it has more nutrients than regular Jevity.  The transfer documents just indicated Jevity.  So, the nursing home began under-feeding her right out of the gate.
Not to be outdone by the hospital, though, the nursing home also ignored the recommendations of it's own dietician for the next two weeks.  The document was completed and placed in the chart - without the doctor ever seeing it.  No physician's order was ever generated to implement the feeding plan.
For a solid month, our client starved.  In the last two weeks, she lost 6% of her body weight.  Not surprisingly, she was malnourished, dehydrated and suffered from horrific bedsores.  All of these problems together lead to her death.
In the end, she might have lived had there been better record keeping and more eyes on properly maintained records.
I was gratified to hear an excellent interview on NPR the very next day of bioethicist, Arthur Caplan.  He talked about all of these issues and how antiquated our healthcare record keeping system is.  He referred to our non-computerized records as something that Dickens would be comfortable with!
It is an excellent interview...and worth a listen.  Here is a link to the NPR site.

Assisted Living Facilities

I have given a number of talks over the years about assisted living facilities and the dangers they pose to an unsuspecting public.  My concern is based upon the fact that these organizations face much less regulatory control than long term care facilities and often are purely profit oriented.  I have taken a number of depositions in cases surrounding what I consider to be questionable bonus structures - which focus on what is known as census (i.e. filling the beds) more than providing quality care. 
This story involves allegations of evicting residents after bleeding their assets dry.  If the allegations are true, it is reprehensible.

You can read the full story here (PDF)

Government List Ranks Worst Nursing Homes

Seeking a nursing home for a loved one in the Boston area? You will want to check out this list first.
The center for Medicare and Medicaid services released the 54 worst nursing homes in November, but homes that were showing signs of improvement were left off the list. After bowing to pressure from Democratic lawmakers, the Feds have released the first full list.

"Safe Patient Handling Practices Act" Becomes Law in New Jersey

I found an article online recently that discusses a new law in New Jersey that will require hospitals and nursing homes to have appropriate lifts and patient handling equipment available for patients. The new legislation also requires a training program on all of the new equipment for all hospital and nursing home staff members.

The new law will go into effect immediately and will hopefully improve the level of care for all residents impacted by this new legislation. You can read the full article online here.

Americas Watchdog's Corporate Whistleblower Center Releases Annual Report

Americas Watchdog's Corporate Whistleblower Center is releasing its annual report on Medicare & Medicaid fraud, and according to the group things have never been worse.

The report focuses on nursing homes, drug/medical device companies, not for profit, and boutique hospitals. The group referred to its findings as grim with respect to Medicare and Medicaid over billing & fraud. You can read the full report online here.

Know Your Rights

Below is a general overview of nursing homes' responsibility to abide by federal and state law.  Nursing homes that receive medicaid and or medicare are required to comply with federal legislation. Federal legislation calls for a high quality of care. All states must comply with the federal regulations and some states have adopted even tougher laws.

In 1987, Congress enacted legislation requiring nursing homes participating in the Medicare and Medicaid programs to comply with certain requirements for quality of care. This law is included in the Omnibus Budget Reconciliation Act of 1987 (OBRA 1987), also known as the Nursing Home Reform Act. According to OBRA, a nursing home "must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care..."

To participate in the Medicare and Medicaid programs, nursing homes must also be in compliance with the federal requirements for long term care facilities as prescribed in the U.S. Code of Federal Regulations (42 CFR Part 483).

Below is a list of some regulations with which the nursing home must comply:
  • Sufficient nursing staff to meet the needs of the residents. (42 CFR §483.30)
  • Conduct comprehensive and accurate assessments of each resident's functional capacity. (42 CFR §483.20)
  • Develop a comprehensive care plan for each resident. (42 CFR §483.20)
  • Prevent the deterioration of a resident's activities of daily living (the ability to bathe, dress, groom, transfer and ambulate, toilet, eat) (42 CFR §483.25)
  • Provide activities of daily living such at toileting, grooming, feeding and person hygiene if a resident assessment determines . (42 CFR §483.25)
  • Ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities. (42 CFR §483.25)
  • Ensure that residents do not develop pressure sores and, if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing. (42 CFR §483.25)
  • Provide appropriate treatment and services to incontinent residents to restore as much normal bladder functioning as possible. (42 CFR §483.25)
  • Ensure that the resident receives adequate supervision and assistive devices to prevent accidents. (42 CFR §483.25)
  • Maintain acceptable parameters of nutritional status. (42 CFR §483.25)
  • Provide each resident with sufficient fluid intake to maintain proper hydration and health. (42 CFR §483.25)
  • Ensure that residents are free of any significant medication errors. (42 CFR §483.25)
  • Maintain dignity and respect of each resident. (42 CFR §483.15)
  • Ensure that the resident has the right to choose activities, schedules, and health care. (42 CFR §483.40)
  • Provide pharmaceutical services to meet the needs of each resident. (42 CFR §483.60)
  • Be administered in a manner that enables it [the nursing home] to use its resources effectively and efficiently. (42 CFR §483.75)
  • Maintain accurate, complete, and easily accessible clinical records on each resident . (42 CFR §483.75)

Call your state's Ombudsman's office if your loved one has been abused in a nursing home or assisted living facility

One of the greatest obstacles to helping victims of abuse and neglect is the failure of nursing homes to self police. More often than not, we see a complete lack of investigation - even in light of serious allegations against staff. One way for families to overcome this is to immediately call the Ombudsman's office for their state.

The work doesn't end there, though. Families should remain in constant communication with the investigator. DO NOT ALLOW THE INVESTIGATION TO BE LIMITED TO THE NURSING HOME OR ASSISTED LIVING'S SIDE OF THE STORY. MAKE SURE THAT THE INVESTIGATOR GETS BOTH SIDES.

Our office has had great success over the years in utilizing these investigations to both improve the quality of care and help our clients achieve justice.

Here is a link to a helpful site which provides phone numbers for the Ombudsman's office for each state. And here is a direct link to New Jersey's Ombudsman's home page.

Prevention of Inhumane Care

I took a deposition of a nurse yesterday who was charged with the care of my client toward the end of her life.  My client was fitted with a leg brace that was significantly too tight.  She complained of pain.  Her leg was bleeding.  No one responded.

To make matters worse, no pain medication was given.  This is not humane and it is not acceptable.
Thankfully,  many good people are working hard to make the final days of terminally ill patients more comfortable.

I recently found a website which offers tips on how to prevent this sort of inhumane treatment from occurring again.

Nursing Home Quality Twenty Years After the Nursing Home Reform Act

I found this article which I feel is a very informative article on the improvements and continuing problems of nursing home care 20 years after the Nursing Home Reform Act. Although some changes have come about, there is still much work to be done.

The Kaiser Family Foundation that examines the progress nursing homes have made over the past 20 years since the Omnibus Budget Reconciliation Act of 1987 (also known as the Nursing Home Reform Act) became law reports that though the new act has been in place for over 20 years, there has not been a significant enough change.

You can read more the Nursing Home Reform Act and the Kaiser Family Foundation's study here.

Home Health Care

As we've been saying for many years now, under the right circumstances home care provides a well needed alternative to nursing homes and assisted living facilities.  
This is not to say that it is a fit for everyone, but of the one-million plus nursing home residents in this country, many do not need that level of care - and many gave up their homes, all of their savings and their lifestyle for a higher level of care than they really needed. 
We have reported on this blog legislation which is aimed at making funds more available to seniors to help widen the array of options available to them.  Obviously, the business community sees this opportunity and is acting upon it.

You can read more on home health care here.

New Jersey Safe Patient Handling Act

New Jersey has recently passed the Safe Patient Handling Act, which will hopefully help reduce the number of fall down incidents which occur in long term care facilities.
Many residents who have been assessed to need what is known as a two person assist for all transfers are injured when employees of understaffed facilities make the tragic decision to attempt this alone.

An interesting article in the Philadelphia Inquirer recently discussed the Safe Patient Handling Act, and the requirements which will assist in the decrease of injuries at New Jersey nursing facilities. You can read more on this article here.

Choosing the Right Assisted Living Home

David Cohen, Shareholder and Chair of Stark & Stark’s Nursing Home Litigation Group, was quoted in the January 16, 2008 edition of US 1 Newspaper, in the article, Choosing the Right Assisted Living Home.

The article discusses the importance of research and careful planning when selecting a nursing home for you and your loved ones, in order to prevent further injuries. Cohen advises families to be aware of the specific statewide and national regulations in place in order to prevent nursing home abuse in under-funded facilities providing inadequate care.

You can read the full article here.

Nursing Home Employee Background Checks

One of the most prolific and dangerous trends in the nursing home industry is the failure to perform background checks on and properly supervise employees.  In this astounding case, a predator-nurse was reported to have abused multiple residents at a significant number of long term care facilities before detection. 
Since our office maintains claims at some of these facilities, we will be investigating to determine whether the families of potentially abused residents were ever notified of this nurse's history.

At Many Homes, More Profit and Less Nursing

After being bought out by private investors in 2002, along with 48 other nursing homes in Tampa, Florida, Habana Health Care Center began to suffer, and so did it's residents. Within the first few months the number of clinical nurses at the facility had been cut by half in an effort to cut costs by the facility's new management.  And, according to Florida’s Agency for Health Care Administration, budget cuts were made for nursing supplies, resident activities and other services.

Meanwhile, the investors and operators of the 49 homes throughout the state were making millions. As if that wasn't bad enough, over the three years of budget cuts, 15 Habana residents died from what their families feel was negligent care and since have filed suits in state court. In addition to a severely understaffed team of caregivers, reports found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.

Due to the ever-increasing number of Americans needing elder care, nursing home facilities across the country are being bought out by large investors, who can only see dollar signs as our baby-boomers enter through their doors. The more people admitted to each facility should mean increased support and resources for the home. However, more and more this is not the case.

The severely neglected residents of these homes need more attention and care than ever. Federal and state regulators also said in interviews that budget cuts help explain why serious quality-of-care deficiencies — like moldy food and the restraining of residents for long periods or the administration of wrong medications — rose at every large nursing home chain after it was acquired by a private investment group from 2000 to 2006, even as citations declined at many other homes and chains.

While the suit is still in the beginning stages for the 15 families at Habana Health Care Center, similar cases continue to arise across the country. You can read more on the Habana and other facilities' stories in the New York Times article, At Many Homes, More Profit and Less Nursing.

Understaffing in Nursing Facilities

A major concern with both nursing homes and assisted living facilities (ALF) is short staffing. In our practice, we routinely find the plaintiff’s injuries are directly related to inadequate staffing. If you have a loved one who is in a nursing home or ALF and are concerned about the staffing speak with the facilities administrator and/or a social worker. If you are unsuccessful contact the Ombudsman’s Office (this is an independent state-run office who advocate for the rights of elderly residents).

Fourth Annual Patient Safety In America Hospitals Study

The fourth annual Patient Safety in American Hospitals Study was released recently, and contains very insightful information for patients and their families when choosing a hospital. Safety in hospitals has recently become an overwhelming concern due to the rise of injuries suffered to patients during their hospital stays.

Often times this process can be quite daunting and somewhat confusing if you are not familiar with the all of the available resources provided to assist you. The study provides patient safety incident rates and associated mortality among Medicare beneficiaries, gives an overall patient safety indicator hospital performance assessment, and provides a list of the best-performing hospitals for overall patient safety across the country.

You can read the full April 2007 report here.

Ocean View Nursing Home Found Deficient

Ocean View Center of Rehabilitation located at 2721 Route 9 in Ocean View, New Jersey, has recently been named by Consumer Reports as one of the twelve most deficient nursing homes in the nation. Ocean View has appeared on all four of Consumer Reports Nursing Home Watch Lists published between 2000 and 2005. For those four lists, Consumer Reports examined state inspection surveys for deficiencies that, in their judgment, raised questions about the quality of care delivered to residents. Consumer Reports examined staffing levels and other quality indicators as well as fines received by Ocean View. If you have a relative who lives in this home, you need to be extra vigilant about the care that person receives. It is advised that you visit often and stay involved in the care planning. And finally, speak up if you notice poor care. Report any concerns to your local long-term-care ombudsman and state regulatory agency.

Major Losses Reported by New Jersey Hospitals

A study from the New Jersey Hospital Association released on December 4, 2006 reported that nearly 40% of New Jersey’s hospitals posted a financial loss in the year 2005. It was predicted that that number would grow unless major changes were made in charity care funding and payments from other important participants, and with the major increase in nursing home patients being sent to hospitals, this has become a major concern. Adding to this problem is the issue with health insurance companies not fully compensating hospitals. While these insurance carriers were making record profits, much of the cause for this lies at the expense of the hospitals and ultimately the patients. Ultimately, these changes will inevitably negatively impact upon the many nursing home residents who rely upon quality acute care centers on a regular basis.

Greater Chance for Hospital Stay by New Jersey Nursing Home Residents

A recent study reported in the Newark Star Ledger and a number of other papers has revealed that New Jersey nursing home residents are more likely to be sent to the hospital, rather than being treated in the nursing home in comparison to nursing home residents in other states. The research further concluded that moving nursing home residents to hospitals, unfortunately, increased their risk of infection, led to disorientation and increased the frailty of the elderly. This is a disturbing study which will require additional attention. The study concluded that based upon data from the year 2000, 23.3% of New Jersey’s nursing home residents were hospitalized during a five month period - making this the highest rate in the northeast. The national average is actually only 17.4%, with Utah having the lowest rate at 8.4%. It was additionally concluded that “many hospitalizations of long-term residents are attributable to problems that could have been prevented with adequate medical care or oversight.”

Nursing Home Budget Impacting Care Level?

Nursing homes are often owned by large corporations, who are often time forced to restrict the level of care given to patients due to budget concerns. The corporations control the nursing home's budget. What we often see in nursing home litigation is that the corporations are instructing these nursing homes to operate on very low budgets. This then effects the level of care the nursing home residents receive. For instance, the nursing homes are often understaffed and don’t have the proper medication and/or devices needed to address the ailments of its residents. Thus without proper funding many nursing homes are train wrecks waiting to happen.