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.
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:
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.
Here is an article I recently read, which outlines not only allegations of abuse, but also retaliation against a whistle blower who reported the abuse. The article contains helpful links for families looking to research nursing homes.
One of the most important responsibilities of nursing home owners is to treat their employees well. This leads to a positive environment, which fosters good care and enthusiasm among staff. As may be seen, the opposite is alleged here in an article stating that the Union City's Manhattan View Nursing Home is being sued by the United States Department of Labor. The suit is seeking unpaid overtime wages for employees of Manhattan View over the past several years.
After receiving tremendous pressure from advocacy groups, CMS has released its expanded list of the most troubled nursing homes in the country. These are known as "Special Focus Facilities."
Acting CMS Administrator Kerry Weems disclosed at a special media briefing Thursday that the “Special Focus Facilities” list had actually grown to 131 nursing homes with poor survey records. The list will continually be in flux, noting the next public update will be in April.
In response to a McKnight's reporter's question, Weems also clarified that from now on providers would be given brief advance notice of their inclusion on the dubious list but no others would learn of list contents until results are refreshed online. When CMS went public for the first time ever, but with just the partial list, in November, consumer advocates loudly complained that nursing home lobbyists and associations had been given the full list, while the general public had not.
In New Jersey, there are currently only three facilities on the list. Two of these are listed under the category, "Improving," while the other, sadly, is now a veteran of the listing, in the list of "Facilities That Have Not Improved."
It will interesting to see if inclusion on this list will provide extra incentive for these troubled homes to improve the quality of care - and thus reduce the unacceptable quantity of nursing home injuries and abuse.
I recently found a great website for families looking to investigate nursing homes. The website offers a list of nursing home throughout the country that are in danger of harming it's residents. The site breaks down the potentially harmful home into three categories:
- a red code equals actual harm and/or immediate jeopardy
- a yellow code equals the potential for more than minimal harm
- a blue code equals the potential for minimal harm
In this link, there exist some significant problems at a facility known as Plaza Regency at Park Ridge, in Park Ridge, New Jersey. I strongly urge our Blog readers to explore this helpful site.
You can access the website here.
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.
As recently reported in the Courier Post, New Jersey faces a critical nursing shortage. As is frequently revealed in investigations of nursing home negligence and abuse, there is much more that Nursing home owners and the industry should be doing to provide greater support for this very important profession.
You can read more on the nursing shortage in New Jersey here.
Serving as an example of how regulators can effectuate change, the Altoona, Pennsylvania nursing home, Laurel Crest, is not only undergoing tremendous scrutiny for surveyors to ensure quality, but outside consultants are being brought into the facility to make sure that the right changes are made.
These changes could have a huge effect on the level of care to be provided to its residents. You can read more about these changes here.
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.
I found an alarming report on a New Jersey nursing home in the Star Ledger recently. A surprise inspection by Senator Richard Cody (D-Essex) revealed an astounding level of neglect at the New Vista Nursing and Rehabilitation Center in Newark, NJ.
Patients had been left alone for days in stifling heat, with broken facilities and unsanitary bathrooms. Senator Cody was disgraced by the level of care at the nursing home. I think an increased number of surprise inspections will enable us to keep an eye on nursing home neglect and will shed light on the need for higher standards and care for our loved ones.
You can read the full story here.
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.
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.
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).
In evaluating a nursing home for a loved one, it is advised that you go and visit the nursing home and ask yourself some of the following questions:
(1) Do the residents appear to be well taken care of?
(2) Is the building clean?
(3) Is the building well maintained?
(4) Are there any foul odors in the building?
(5) Do residents seem active or are they sitting around and appear ignored and bored?
(6) Does the food look appetizing?
(7) Do the staff members interact with you and especially the residents in a pleasant manner?
(8) Does the facility seem to be adequately staffed?
(9) Do the linens look clean?
(10) Does the staff seem to interact in a respectful manner with the residents?
(11) What is the lighting like?
(12) Ask staff members what they think of their work.
(13) Ask staff members if they are ever short-staffed.
(14) Ask the residents if they like the nursing home.
(15) Ask the residents if the staff is helpful and caring.
(16) Ask the residents what they think of the food.
When deciding on a nursing home for a loved one, it is recommended that you do a pre-visit investigation. Consider doing some of the following suggestions:
(1) Make a list of nursing homes that are close enough for family and friends to conveniently visit the resident;
(2) If your loved one will need assistance from Medicaid and/or Medicare in paying for their stay, list only those nursing homes that participate in the Medicare and Medicaid programs;
(3) Learn as much as possible about nursing homes by talking with:
(a) Others with loved ones in nursing homes;
(b) Clergy;
(c) Doctors;
(d) Social workers;
(e) Nurses;
(f) Nursing home employees; and
(g) Long-term care ombudsmen;
(4) Review state survey inspection reports. These reports are conducted by the state on an annual basis and can give you a good sense of what, if anything, the nursing home is failing to do in terms of care and treatment of its residents. These surveys should be posted in each facility that you visit. This is required by Federal Law. This information is also available on the internet at the Medicare website.
Finding the right assisted living or residential care facility for you or a loved one is an important decision. After you have determined the kind of services you or your loved one need, you should obtain or develop a list of assisted living facilities in your area offering those services. Your hospital discharge planner, social worker, personal physician and clergy may be familiar with facilities in your area. Additionally, you may want to contact New Jersey’s Department of Health and Senior Services.
According to the 2006 MetLife market survey of assisted living costs, the rate of private pay averaged approximately $35,616.00 yearly. This represented a 2.2% increase from 2005 and more significantly, a 17.6% increase from 2004. As we have posted on this site in the past, assisted living is increasing in popularity as an alternative to other forms of long-term nursing care.
Assisted living facilities provide relatively independent seniors with assistance and limited healthcare services in a homelike atmosphere. Assisted living services include twenty-four hour protective oversight, food, shelter and a range of services that promote the quality of life of the individual. The philosophy of assisted living emphasizes the right of the individual to choose the setting for care and services. Assisted living customers share the risks and responsibilities for their activities and well-being with a staff geared toward helping them enjoy the freedom and independence of private living. Assisted living facilities are licensed by state governments and can be known by several different names including residential care, board and care, congregate care and personal care. Assisted living is not a substitute, but rather a compliment to nursing facility care.
Poor work conditions represents one of the most significant hurdles facing nursing home residents today. Workers who lack job satisfaction and who feel a sense that the management company is not providing them the support they need simply cannot deliver the level of care that our elderly deserve. When conditions reach a critical level, workers will literally leave the job. This happened as recently as August of this year at a Veterans home in Menlo Park, New Jersey. A union representative noted “people don’t want to come to work anymore, it’s so bad…we just want to be able to do our job in peace.” One worker claimed that she was on suspension for utilizing six work days, even though her contract authorized fifteen sick days. This represents a classic example of management failing to protect nursing home residents through fair and equitable treatment of its own employees.
Assisted living facilities offer a special combination of housing, personalized support services and healthcare design to accommodate those who need help with the activities of daily living, but may not require the type of care provided in a nursing home. In selecting an assisted living facility in New Jersey, consult the State of New Jersey Department of Health and Senior Services website. There you will find a checklist of issues to be concerned with, including contracts, cost and finances, medication and healthcare, services, recreational activities, food and dining, and atmosphere. Assisted living facilities in the State of New Jersey are regulated by the New Jersey Department of Health and Senior Services. They are licensed facilities and are, therefore, held to a higher standard. The New Jersey Department of Health and Senior Services regularly inspect assisted living facilities throughout the state.
For those considering moving a loved one to an assisted living facility in the State of New Jersey, Chelsea Senior Living in Summit, New Jersey, has been named one of the top forty assisted living chains in the country. This, according to a survey found on the website for the National Center for Assisted Living. This survey takes into consideration the following factors: occupancy rates; revenue sources; and services offered.
According to the September 2, 2006 Wall Street Journal, the average assisted living center cost rose approximately one-third from 2002 up to $35,000.00 a year in 2005. That same article noted that assisted living centers are reaching a near saturation point, with a 95% occupancy rate. Many of these facilities have extensive waiting lists. Despite its popularity, the allure of the assisted living option represents a number of dangers to the unwary consumer. As I have lectured across the country, many assisted living facilities accept patients that they are not capable of properly protecting, while others are simply too slow in discharging those who are more appropriate for nursing home residency. It is essential to assure that a qualified physician not only performs an assessment upon a potential admission into an assisted living facility (ALF), but also that reassessments occur on a regular basis to ensure that the combined deteriorating effects of age and disease processes do not make ALF residency problematic. We will have many more entries on this emerging issue in the weeks and months to come.
Assisted Living Facilities and Nursing Homes cannot offer the same level of care. Assisted Living Facilities do not offer specialty care. They have fewer nurses, fewer CNAs, and less overall oversight of the individual resident. Thus, Assisted Living Facilities generally have residents who are more independent. However, due to desire to fill beds and generate more revenue, Assisted Living administrators sometimes take residents they cannot necessarily care for. Such is the case with a matter our firm is currently handling. In this particular case, the resident was brought into an Assisted Living Facility even though there was documentation that showing the resident had fallen thirty seven times at a previous nursing home. This resident was clearly a high risk for falls. Assisted Living Facilities are simply not equipped to provide the kind of care that this individual needed. Consequently, within three days after being admitted to the Assisted Living Facility, this resident fell and severely fractured her wrist.
I recently returned from a speaking engagement at the Association of Trial Lawyers of America's Annual Nursing Home Litigation Conference (now known as the American Association for Justice). Although I have attended many of these conferences of the years, I am continually impressed by the continued devotion of all of the hardworking attorneys who have chosen this specialty to protect our most vulnerable of citizens. Throughout the two days of seminars and interactions, the group continually talked about the unwavering goal of protecting the elderly and improving the quality of care for nursing home residents across the country. The devotion of this group, of which I am proud to say I am a member, never fails to inspire on this mission. In broad posts to follow, we will talk about a number of organizations that concerned citizens can join to serve as advocates for the elderly in long term care.
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