Stark & Stark Spotlight on Continuing Care Retirement Communities

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

Continuing Care Retirement Communities Defined

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

Continuing Care

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

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

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

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

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

The Contract

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

Continuing Care Offered Through Different Plans

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

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

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

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

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

The Fees

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

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

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

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


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

More Information

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

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

The second edition of the State Long-Term services and Supports (LTSS) Scorecard (2014), sponsored, in part, by the AARP, assigned New Jersey a 26th, and Pennsylvania a 42nd, overall ranking based on performance across twenty-six indicators, grouped into five dimensions, which include (1) affordability and access, (2) choice of setting and provider, (3) quality of life and quality of care, (4) support for family caregivers, and (5) effective transitions.

LTSS help persons-in-need perform activities of daily living that would be difficult or impossible for them to perform on their own. Services and supports are delivered in a variety of settings, but nearly everyone prefers to remain at home. When families must rely on nursing homes to provide those services and supports, family caregivers often attempt to provide oversight to ensure that care rendered by the nursing home or assisted-living facility is appropriate.

A Closer Look at the Effective Transitions Dimension

The Scorecard ranked New Jersey at 36 and Pennsylvania at 28 in the effective-transitions dimension, which shows that states that rely heavily on nursing homes for LTSS also demonstrate less effective transitions across care settings. That means that individuals with complex needs are more likely to experience inappropriate and costly hospitalizations and inadequate support in moving from a nursing home back into the community. This dimension aligns well with the quality of life and quality of care dimension.

The Scorecard explains that “unnecessary transitions among settings are disruptive, especially to people with dementia, and can increase the risk of medical errors. Moreover, when they occur at the end of life, they can indicate poor management of care or overly aggressive treatment.”

Notably, high ranking states tend to minimize disruptive transitions and focus more on helping nursing-home residents return to their homes and communities. Accordingly, states must actively facilitate those transitions. That is: provide adequate support  for movement from nursing homes back to the home- and community-based settings that most people prefer.

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


Boston Nursing Home Cuts Wages of Workers

Shortly after Lexington took over this nursing home, plans were made to cut wages of important healthcare providers by as much as 40%.  This represents a true danger to those residents.  For more information, read here.

Overworked Aides Can Overlook Dental Care with Catastrophic Results

A recent blog article in the New York Times discussed the fact that in some nursing homes, due to short staffing, many residents are not receiving the proper oral care. 

This can have serious consequences – from the terrible pain of tooth decay and damage, to gum disease, to pneumonia.  Apparently poor oral care can lead to pneumonia, a leading killer of elderly in nursing homes. 

Proper staffing is always at the root of these problems.  Having enough caring and well trained aides is critical to making sure the proper care is given.

To read the article, click here.

Ugly Side of Assisted Living Exposed on Frontline Documentary

I recently wrote an article for the New Jersey Law Journal discussing the shortfalls of some Assisted Living Facilities.  These same problems were discussed in depth in a recent Frontline documentary “Life and Death in Assisted Living.” 

The movie focused on the largest Assisted Living Corporation Emeritus, a very profitable publicly traded corporation.   It chronicled how when one facility was bought by Emeritus, care dropped.  Another ex-employee stated how the company wants to keep residents as long as possible to keep the beds full – keeping residents that should go into a nursing home.

One serious problem with Assisted Living is that there are no overriding Federal Regulations as in nursing homes.  In New Jersey, an Assisted Living Facility by regulation can keep anyone, regardless of how sick or cognitively impaired they are, including residents that require “nursing home level of care.”

Companies take advantage of these regulatory loopholes.  Assisted Living facilities are not staffed like nursing homes, do not have fall and wound preventions like nursing homes, and the staff do not have the same training.  They are cheaper to run and the company can charge almost as much as they want.  In many cases that we handle, the catastrophic results are fatal. 

These problems are not going away.  Assisted Living is a very lucrative business, and the elderly population is growing.  Many corporations that own these facilities are not healthcare companies.  In fact, one facility we litigated with was owned by a real estate corporation with the entire board of directors for the facility being marketers, financiers and attorneys.  Not one of them had a healthcare background.

If you are considering Assisted Living, this video is very important for you to watch.  You can watch here.

Researching Nursing Home Ratings and State Inspections

If you are currently faced with placing a loved one in a nursing home or rehabilitation center, it is critical to obtain as much information as possible on the facility.  This can be challenging when the residency is sudden or not expected – for example if mom or dad has a fall at home and is injured. 

A good place to start your search is the U.S. News and World Report nursing home ratings for this year.  The ratings are based on a 5-star scale that reflects how the facility performed during its last state inspection.  The list begins with the 5-star facilities listed alphabetically, followed by the 4-star facilities listed alphabetically, and so on.  You can see the results here.

If you already have someone in a nursing home, you can see how your facility performed.  If the facility did not do well, you can ask the Administrator or Director of Nursing what the problems were and what the facility is doing about the deficiencies.  It is a great way to be an advocate.

Department of Justice Joins Lawsuit Against Nursing Home Operator

In a disturbing case, the government has joined a civil lawsuit against a nursing home operator that was run so poorly, that the allegation is that the money Medicare and Medicaid paid for services was "effectively worthless."
You can read the article here.
The lawsuit alleges that money was not going to serving the residents, and that money was squeezed out by things such as rationing towels, garbage bags, laundry bags, medical tubing and oxygen bottles.  The administrator of the facility is alleged to have bought snacks with her own money.
The cost to the residents in this facility came in the form of pressure ulcers, falls, dehydration and malnutrition.
Unfortunately, this is a pattern we have seen many times.  In order to maximize profit, nursing home and assisted living companies cut corners to generate profit.  Unfortunately, some of the corners they cut are not obvious to residents and their families until someone is admitted for a period of time.  For example, staffing levels are kept to the bare minimum levels to boost profit.  In turn, we see the same problems cited in the article.  

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. 

New Study Shows Many People Unknowingly Receiving Medications For "Off Label" Uses

Ask any family member caring for an elderly parent with dementia about the number of medications prescribed and it’s likely to be quite a few.  It is important to know what someone is prescribed and what for.  A new study shows that roughly 20% of medications are prescribed “off label”. You can read an article discussing the study here.

“Off label” refers to prescribing medications for uses other than what the FDA has approved a drug for.  Despite what the FDA approves a specific drug to treat, doctors may prescribe drugs for anything – approved or not.  This practice is obviously not a problem per se, however, it might be more difficult for a consumer to learn about a drug’s pros and cons if it is being prescribed “off label”. 

It is important to discuss medications with a doctor.  Learn what risks, if any, a drug’s use entails. 

U.S. News Posts Top Nursing Homes for 2012

U.S. News has posted a collection of the best performing nursing homes in the country.  The report lists 39 nursing homes from across the country that received four straight quarters of perfect 5-star ratings from the federal Centers for Medicare and Medicaid Services in three specific areas: health inspections, nurse staffing and quality of care. The Centers for Medicare and Medicaid Services evaluates all nursing homes and assisted living facilities on these three criteria four times a year.

Although this list will aid you in selecting a good home for you or your loved one, there is no guarantee that any home doesn’t have its share of shortcomings. In addition to the list of top homes is the advice on what to ask about and what to look for when choosing a facility.  In many cases, the decision to place a loved one in a nursing home is sudden.  In other cases, people simply do not know what questions to ask.  This article gives some great suggestions.

UPDATE: Manhattanview, Teaneck Nursing Center, and Amboy Care Employees Fight for Better Wages: What this means for patient care

Here is an interesting article as a follow up to yesterday’s post discussing why members of Union 1199 SEIU (who are employees of Manhattanview Health Care Center) picketed earlier this week in protest of their un-renewed contracts and the potential discontinuation of their health insurance. Yesterday, Union City, NJ Mayor and state Senator Brian Stack, supports the workers, many of whom have worked at the nursing home for over ten years, are in danger of losing their health insurance if they do not renew their union contract that has been under negotiation for over a year.

“I support them one hundred percent,” Stack said in a phone call. “They deserve decent wages. These are people who work extremely hard taking care of people at various stages of their lives when they most need it in the nursing home.”

Manhattanview’s 85 employees, including nurses, nurse’s aids, and housekeeping staff, provide long-term care to more than 140 residents. The employees have had six bargaining sessions with Broadway Healthcare Management who oversees the Union City location and two additional nursing homes in Perth Amboy and Teaneck since May of 2011.

Manhattanview, Teaneck Nursing Center, and Amboy Care Employees Fight for Better Wages: What this means for patient care

Members of United Healthcare Workers East picketed yesterday out front of three hursing home facilities in New Jersey: Manhattanview, Teaneck Nursing Center, and Amboy Care. The employees are fighting for a new contract from the facilities' owner, Hackensack-based Broadway Healthcare Management.

The union is seeking a modest pay increase for its workers and wants to preserve current health care benefits. However, every time the employment contracts are up, the facilities state they are too poor to increase their worker’s pay.

Increasing worker’s pay for qualified nursing staff is essential in order to preserve the highest level of patient care. Those entrusted with caring for our loved ones need to be compensated accordingly.


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.”’

Doctors Getting Inaccurate Rosy Picture Regarding Some Psychiatric Medications

While many people have no formal medical training, having a parent that suffers from Alzheimer’s or dementia can give people a crash course in anti-psychotic, anti-depressant, and anti-anxiety medications.  Often times, these family members tell me they did not like the fact that their parent or loved one was taking these medications because it turned their parent “into a zombie,” had potential serious side effects, or just didn’t work. 

It appears that, in two articles today (available here and here), these family members may be right about the drugs not working.  Both articles discuss findings that some medications may not be as effective as previously thought, and that doctors are not getting the full picture with some of these drugs.

The articles find that some medical journals “continue to paint an overly rosy picture of the effectiveness of new drugs” and “selectively left out unflattering results.”

It’s important to know the medications your loved one is prescribed.  A family member spends the most amount of time with a resident and is best positioned to know what effect a drug is having on someone.  It cannot hurt to ask question.

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!

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.

AseraCare, a Hospice Company, Owned by Golden Living is the Subject of a Whistleblower Suit

The Federal Government has joined in a Whistleblower suit, which alleges that AseraCare, a national hospice company owned by Golden Living, wrongly took advantage of Medicare’s hospice benefit by pressuring its employees to place people into hospice who weren’t dying. The suit states that AseraCare first recruited patients who are eligible for skilled nursing care for 20 days, for which Medicare pays the entire bill. After 20 days, when Medicare requires patients pick up a part of the tab, AseraCare had the nursing homes send the patients to hospice, according to the lawsuit. In hospice, AseraCare would collect a flat payment from Medicare for each day they are enrolled.

We will follow this story on our blog and the recurring problem that appears to be growing on a national basis throughout both nursing homes and assisted living facilities. Here is an article relating to the government’s press release on the suit.

Study Shows Low Staffing Equals Poor Quality of Care at Largest For-Profit Nursing Home Chains

When first selecting a nursing home, the majority of people I meet have very little knowledge of how nursing homes work, how they operate, and how they are regulated.  Making this situation worse is the fact that selecting a nursing home must often happen quickly.

With a lack of knowledge, many people choose a nursing home solely because it looks clean and may have some modern amenities.  While these are factors a person may consider, the most important thing regarding any nursing home is that there is adequate staffing – with enough good and caring people to do the work.  Some excellent facilities are simply plain buildings with cinderblock walls and outdated furniture. 

A new study that confirms lowered staffing equals poor quality of care at some of the country’s largest for-profit nursing homes was reported in a recent article

The results were certainly not surprising and already known by most people working in the industry.  So, why are nursing home companies not hiring enough staff?  Simply put, to increase profit.  Staffing costs are one of the top expenses in a nursing home, and in order to drive up profits some nursing home companies staff their facilities at the bare minimum necessary to keep a facility out of trouble with the government.  

When selecting a nursing home, questions about staffing should certainly be expected.  A response that a facility tries only to meet government staffing regulations may not be good enough.  Additionally, good facilities tend to keep employees for a longer time.  A high turnover rate for aides and nurses may indicate a troubled facility.

Asking the right questions can be the key to avoiding a poorly staffed and substandard facility.  

Royal Health Gate Employee Arrested for Sexually Assaulting Resident

Good employee hiring practices and proper resident supervision is an important part of running a successful nursing home. When these components are missing, seriously terrible things can happen. One piece of advice I give to those with family members in nursing homes is to get to know the staff and make sure there are enough people in the building – especially on nights and weekends.

A nursing home employee of Royal Health Gate in Trenton was arrested over the weekend after a witness reported seeing the worker sexually assaulting a 56 year-old resident. Police Sgt. Steve Varn stated, “Apparently he did this to the same victim a couple of times.” According to an article in The Times of Trenton, the employee “faces four counts of aggravated sex assault for the alleged string of rapes."


Be Careful of Arbitration Clauses When Selecting a Nursing Home in New Jersey

Here is a typical scenario:

An elderly woman falls at home and fractures her hip for which she has an entire hip replacement. The family is surprised when the day after the surgery, mom begins her rehab and there is a visit from the social worker asking about where mom will go for either rehab or to permanently reside in a nursing home. The family – who has no experience picking a nursing home – is handed a list of nearby places, visits a few of them, and picks the best they can in the span of a few days. 

Usually, there is a long contract the family is presented – sometimes over 20 pages – in addition to numerous other documents.  Somewhere, buried in the middle of all this, in complex legal terms, is the arbitration clause.  A paragraph that effectively waives a person’s rights to have their case judged by a jury if something terrible happens. 

In New Jersey, these clauses used to be illegal, presumably because a person putting a loved one in a nursing home will probably sign just about anything put in front of them to get a person the care they need.  Unfortunately, these clauses are now legal in some cases and may hamper the ability to hold a bad nursing home accountable when terrible things happen.

Be careful what you sign.  Nursing home admittance cannot be conditional on agreeing to these arbitration clauses.  If you find one, you are certainly entitled to ask about it and find out exactly what it means before you sign anything.  No one who has sat in my office ever imagined the poor care and horrific outcomes their moms and dads would suffer when they were put in the nursing home.  You always hope for the best but prepare for the worst. You have an absolute right to understand exactly what you are giving away before you sign an agreement.

If you, or someone you know, has questions regarding your rights when selecting a nursing home for a loved one, please contact me. I would be happy to meet with you, free of charge, here in my firm's Lawrenceville, New Jersey office to discuss your matter in more detail.

Recent Study Shows 92% of Nursing Homes Employ Ex-Convicts

The physical environment of many nursing homes may be very appealing – such as clean floors and newly painted walls.  However, this is the easiest thing to fix and also the least important. 

It’s the care that a resident will get that is by far the most important.  High quality care comes from a good and caring staff.  The problem is that a nursing home worker’s resume and employment application are not readily available to the public. 

That is what makes this recent article from AARP,, all the more disturbing

According to the article, 92% of nursing homes employed at least one individual with a criminal conviction.  Additionally, the type of background check done is dependent on the state.  The article reports that in “2006, Centers for Medicare& Medicaid Services began an 18-month (April 06 – Sep 07) pilot program of comprehensive criminal background checks of prospective nursing home employees in seven states. The pilot program resulted in the disqualification of 7,463 applicants.”

Knowing the right questions to ask at admission is important.  While it’s nice to have a newly renovated or newly constructed nursing home, it’s the quality of the staff that’s most important. 

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.

Owner Of Six Connecticut Nursing Homes operated by two affiliated New Jersey companies charged With Labor Violations

Six Connecticut nursing homes, which are owned by two New Jersey companies, were sued in Federal Court with allegations relating to improper treatment of employees and unions. The National Labor Relations Board announced last week that the New England Health Care Employees Union filed a complaint on March 21st citing that the Jersey-based companies, HealthBridge Management and CareOne LLC, compelled a subcontractor to fire unionized laundry and housekeeping workers at three of the nursing homes, and forced them to reapply for their jobs at lower pay, with no seniority rights.

You can read more on this story online here.

Convicts Working at Nursing Homes: More Common Than You Think

Earlier this month, Daniel R. Levinson, inspector general of the Department of Health and Human Services, reported that more than 90% of nursing homes employ one or more people who have been convicted of a crime. In addition, the report states that 5% of all nursing home employees have at least one criminal conviction.


Levinson cross referenced the names of more than 35,000 nursing home employees with the Federal Bureau of Investigation to see if they had criminal records. Mr. Levinson states, “Nearly half of nursing facilities employed five or more individuals with at least one conviction. For example, a nursing facility with a total of 164 employees had 34 employees with at least one conviction each.”


Currently, there is no federal law or regulation specifically requiring nursing homes to check federal or state criminal history records for prospective employees. Ten states require a check of F.B.I. and state records, while 33 require a check of only state records, and the remainder do not have a standard set of requirements.

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.

Is Your Nursing Home a Troubled Special Focus Facility?

The Centers for Medicaid and Medicare (CMS) promulgate guidelines for nursing homes that must be met in order to receive federal money.  An annual inspection is done at every nursing home receiving federal money to be sure the facility is in compliance with these regulations. 

State workers, whom typically carry out these surveys, also enforce state laws and regulations during these inspections.  Troubled facilities that are not in substantial compliance with regulations are re-visited - sometimes numerous times in a year. 

To handle the worst offenders, CMS has developed the Special Focus Facilities program.  Nursing homes that have more problems than other nursing homes, more serious problems than other nursing homes, or a pattern of serious problems that persists over a long period of time, now appear on a nationwide list of Special Focus Facilities.  These facilities get more government attention, enforcement actions and penalties.

You can get the list of Special Focus Facilities online here.

Needless death at Newport Nursing Home and Rehabilitation Center

One of the most critical responsibilities for nursing homes that choose to accept cognitively impaired patients is to pro-actively do everything and anything it takes to protect them.
Many studies show that approximately 80% of nursing home residents suffer from at least some degree of cognitive impairment.  Many suffer in more profound ways.  Quality nursing homes engage in regular assessments and supervision to protect all residents.  When residents either display violent tendencies or the potential for violence, they must be supervised, treated and have constant attention made to their care plans.  Many times, there are solutions to such behavior and staff must always be on the lookout for new or changing issues.

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.

Sterling Manor Staff Member Accused of Selling Drugs

Theresa Walters, of Pennsauken, New Jersey, has been charged with conspiracy, distribution and possession of drugs and distribution in a school zone after police learned that she had been selling prescription drugs to residents at Sterling Manor Nursing Home in Maple Shade, New Jersey. Walters worked at Sterling Manor where she sold and offered to sell drugs to several people at the facility. It is not clear how many residents were offered the drugs or how many bought them. This is just another example of why it is imperative that administration of nursing homes carefully monitor their stock of drugs in order to prevent incidents like this from happening. 

Mandatory Nursing Home Responsibilities

Many of our clients describe poor nursing home conditions that a loved one was forced to endure until they could be moved or before they died.  All too often, a nursing home will promise to fix problems complained about and don’t.  Most people are not aware that there are laws that dictate mandatory nursing home responsibilities.  Nursing homes that do not meet their obligations can be punished.

Along with specific resident rights, state law also sets forth specific responsibilities that a nursing home must fulfill.  These are important to know as well as resident rights because when a nursing home is not meeting its responsibilities it can deliver poor care.  Some of these responsibilities include:

  • admitting only that number of residents for which it reasonably believes it can safely and adequately provide nursing care (not enough CNAs or nurses)
  • ensuring that drugs and medications are not used for convenience of the staff, or for punishment, or in such quantities that interfere with a resident’s normal living activities
  • complying with all state and federal regulations
  • providing for the spiritual needs and wants of residents by notifying, at a resident's request, a clergyman of the resident's choice
  • ensuring that no resident shall be subjected to physical restraints except upon written orders of an attending physician for a specific period of time when necessary to protect such resident from injury to himself or others
  • any applicant for admission to a nursing home who is denied such admission shall be given the reason for such denial in writing

It’s important to know what a nursing home must do by law so they can be held accountable for poor care.  Make sure you have a copy of the law.

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.

Nursing Home Database

Courtesy of the good folks at National Public Radio, here's a link to an excellent compendium of information on the nearly 16,000 nursing homes in the country - specifically focused on the level of independence of the residents at each home. This can serve as an invaluable tool when you have to start investigating the right nursing home for our loved ones.

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.

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.

The Nursing Home Shell Game: Holding Wrongdoers Accountable

David R. Cohen, Chair of Stark & Stark’s Nursing Home Litigation Group, authored an article for the September 13, 2010 edition of the New Jersey Law Journal entitled, The Nursing Home Shell Game: Holding Wrongdoers Accountable.

The article discusses how long term care facilities avoid liability through the use of a dizzying array of shell corporations and deplete Medicaid dollars from resident care. Mr. Cohen provides an overview of this complex structure with an analysis and offers insight as to what are the proper and improper structures of health care corporations.

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

Omnicare Faces With Additional Litigation

John Stone, Covington-based Omnicare's former internal auditor, has filed a whistleblower action accusing Omnicare of Medicare and Medicaid violations. Federal and state investigations and whistleblower claims have plagued Omnicare for years.


Stone alleges that Omnicare filed reimbursement claims for ancillary services that didn't conform with the Centers for Medicare and Medicaid Services (CMS) regulations. Stone also states that reimbursement claims from newly acquired pharmacies violated CMS regulations and that storage and handling of "a particular drug" violated U.S. Food and Drug Administration regulations.


Additionally, he claims that Omnicare "violated certain Medicaid billing regulations relating to usual and customary charges." Stone served as Vice President of Internal Audit from 2004 until early 2010, filed his lawsuit last year in federal court in Chicago. He's also asserting a "retaliatory discharge" claim related to his leaving the company.

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.

Judge rebukes nursing homes for misleading mentally ill patients

In Illinois, a recent court settlement allows certain mentally ill patients who pass a screening to live in supportive community based housing.  Many of these residents are currently resigned to living solely in nursing home facilities.  After the settlement, some for-profit nursing homes were distributing “information sheets.”  Language in the “information sheets” included implications that those who choose to leave the nursing facilities for a community setting would be left without housing, food, or medical care.  A Federal judge, in a stinging rebuke of the nursing homes, found the flyers to be inaccurate and incendiary, appealing to residents' and family members' fears.  The judge shut down the nursing homes using these “scare tactics.”

You can read the full story online here.

Assisted-living Centers Evict Residents

After spending their entire savings to stay at Mey House in Egg Harbor Township and Goldfinch House in Bridgeton, seniors are being evicted once they go on Medicaid.  Kicking the seniors out and uprooting them when they went on Medicaid conflicts with promises made to the seniors, sometimes in writing. 


The company that owns the facilities was court ordered not to throw the seniors out.  To make what the NJ State Ombudsman for the Institutionalized Elderly called, “an end-run around the court’s directive,” the facilities are just giving up their licenses and turning into “a senior housing community for older adults.”  This way, they believe the court ruling will not apply and they can avoid their promises.


You can read the full article 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)

State Inspectors Continually Fail to Recognize Deficiencies in Nursing Homes Throughout the Country

According to a recent report from the Government Accountability Office, the state agencies responsible for assessing whether or not nursing homes are compliant with quality standards continue to miss serious deficiencies in homes throughout the country. The report released by Senators Chuck Grassley (R, Iowa) and Herb Kohl (D-Wisconsin) brings to light a major disparity between the reports conducted by federal investigators and state examiners.

The federal surveys, which are used to monitor state reports, noted that the failure of state inspectors to notice deficiencies in homes is a serious problem that needs to be addressed and fixed immediately. Though the gap between federal and state inspections is closing (from 14.7% in 2007 to 12.3% in 2008), the Senators believe the rate at which the gap is closing is not quick enough in order to prevent serious harm to residents.
Additionally, the number of federal surveys that caught a lower-level care deficiency, which was initially missed by a state inspection, grew dramatically from 55% in 2001 to 75% in 2008. Once again, the reports show that federal inspectors are detecting problems which state inspectors have missed. The Senators hope that this report will urge Congress to do more in order to improve the survey system, increase funding and standardize the survey process.

New York City Nursing Home Catches Abuse on Tape

Jessie Joiner a nurse at William Benenson Rehabilitation Pavilion in Queens, New York faces criminal charges after a video found Joiner dumping an elderly woman in a wheelchair onto the floor.

On March 20, 2010 Joiner was caught on video jerking a wheelchair which causes the 85 year-old woman in the chair to fly to the ground. The woman fell from the chair and broke her hip. Joiner quickly left the scene. In the video, the woman is seen lying alone on the floor for more than two minutes before another employee arrives on the scene. It appears he will help her, but with the patient still writhing on the floor, for over a minute he does nothing.

You can watch the full video online here.

Blank Checks Stolen From Nursing Home Residents

Residents at ManorCare Health Services in Voorheees, New Jersey have fallen victim to someone stealing blank checks from the elderly residents. So far, at least five residents have been targeted, one of which is 97 years old and other wheelchair bound. So far, the thief has stolen more than $7,000 from his victims’ bank accounts.

And not too far away, in Stratford, New Jersey, there are police reports that Nathaniel Brooks was caught trying to cash one of the forged checks at a TD Bank. Luckily, the teller caught him, however, Brooks ran off before police could arrive. Police have said that none of the victims or administrators of the two facilities have seen the man before.

You can view a video of the man here, and police are asking anyone who recognizes the man to please contact their local law enforcement.

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.

New Plan for Illinois' Mentally Ill Nursing Home Residents

I found an interesting article online recently which discusses the fact that thousands of psychiatric patients are going to be moved out of nursing homes and into community based facilities during the next few years in an effort to reshape Illinois’ failing long-term care system.

The agreement details a schedule for when state officials will offer roughly 4,500 mentally ill nursing home residents the choice to move out of their current facility into smaller facilities which experts claim are more appropriate and less expensive.

You can read more on this article online here.

Omnicare and SavaSeniorCare settle kickback case

According to the Justice Department, two East Coast nursing home chains agreed to settle a whistle-blower lawsuit law week which alleged that they committed Medicare and Medicaid fraud.This high profile kickback case recently settled for $14 million and resolved the many allegations of medicare and medicaid fraud.

This settlement comes just a few months after Omnicare Inc. paid $19.8 million to settle several additional suits. Friday's settlement arises from government allegations that the Atlanta-based Mariner Health Care Inc. and SavaSeniorCare Administrative Services LLC nursing home chains solicited kickback payments from Omnicare in exchange for agreements by Mariner and Sava to continue using Omnicare's pharmacy services for 15 years.

You can read the full article online here.

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.

Workers' Suit Against Omni Nursing Home Chain Still Not in Front of Judge

The lawsuit filed by workers against this chain has still not found it's way to an assigned judge.  In the interim, these workers do not know where their fate lies. As we've noted before in this blog, proper treatment of employees by management is critical in assuring a well run, healthy nursing facility.
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.


Florida Nursing Home Resident Dies Due to Maggots, Infected Breathing Tube, and Bed Sores

A Delton, Florida man died last month due to horrendous care provided by the University Center West nursing home. Anthony Digiannurio, 82, was transported in November from University Center West to Florida Hospital DeLand where staff members found maggots in one of his eyes, an infected breathing tube, a partially inserted catheter and bed sores. You can 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.   

Another Charitable Hospital settles Whistleblower Suit for Medicare Fraud

Articles such as these have led many commentators to question whether so-called charitable health care institutions are truly charitable. A recent report online states that Our Lady of Lourdes Medical Center in Camden and Lourdes Medical Center of Burlington County in Willingboro will pay the government $7.95 million in response to allegations that the hospitals defrauded Medicare. This is not the first time Our Lady of Lourdes Health Care Services Inc. has been involved in litigation due to questionable billing practices. In 2005, Lourdes Medical Center was a defendant in a civil suit which stated that the hospital fraudulently inflated its charges to Medicare patients in order to collect enhanced reimbursements.

The Mercer County Geriatric Center To Be Sold

The Board of Chosen Freeholders resolved earlier this week to transfer ownership of The Mercer County Geriatric Center to the Mercer County Improvement Authority. The 240-bed nursing facility is being sold to a private entity in hopes of having the home run more efficiently, after years of monetary losses and poor quality ratings.

In 2008 the facility lost $7.4 million, and over $6.7 million in 2007.  Additionally, the losses were expected to continue to rise over the next several years, which would only increase the burden for taxpayers. The facility is staffed by 150 county employees and serves primarily residents on Medicare or Medicaid. Officials said they would try to persuade the new owner not to cut staff, and said that the county hopes to have the sale completed by June 2010, but added that no negotiations have yet been initiated.

Picking a nursing home but don't know where to begin?

Picking a nursing home to care for a loved one can be difficult and overwhelming.  You want the best care, but where to start?  What nursing homes are in the area?  Have they had any problems?  What services do they provide?  What are the right questions to ask?  Here is a great place to start.

Medicare keeps detailed records of all nursing homes, and rates them on a one-star to five-star scale. Its free, easy to access, objective, simple to read, and you can compare multiple nursing homes at the same time.  If your family member or loved one is currently in a nursing home, this website is also a great tool to see how your current nursing home compares to others.


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.

Omni Assets Management Employees Hold March in Hopes of New Contracts

I read an article online last week about nursing home employees in Hudson County who held a “Family Day” march in Jersey City after working the last two years without contracts. The walk was held in hopes of putting pressure on their employers, Omni Assets Management, in hopes of negotiating a fair contract for all Omni employees.

You can read more about the march online here.

Picket Lines at nursing homes owned by Omni and Avery Eisenreich

Families of residents in New Jersey nursing homes have joined the picket lines in support of the health care workers at their family members’ facilities. The strike began last Friday, August 7, 2009, against the Omni Corporation, owned and operated by Avery Eisenreich, and include Castle Hill, Harbor View, Palisade and Bristol Manor. Family members are supporting the caregivers who have dedicated years to their family members. Reports state that Eisenreich and his management have intimidated and harassed many caregivers—creating a difficult environment for both workers and residents.  He even tried to get an injunction to close down one of the four picket lines, but the judge ruled against him and in the workers’ favor.

You can read more on this story 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.

Assisted Living Concepts - A cautionary tale in assisted livi

I read an article online recently which reports on the plan initiated by the Dubuque Retirement Community to give up its state license in order to avoid state regulation. Dubuque is treating the initiative as a pilot program which may be expanded to other Iowa care facilities. Dubuque, Iowa's largest assisted living center, will give up its license September 14, 2009 and become an unregulated retirement home. The residents' medical services will be provided by home health agencies, one of which is unregulated and owned by the facility's parent company.

The move concerns industry officials and senior citizen advocates because the move allows the company to deliver the same care to the same residents but without annual inspections, state oversight or sanctions for inadequate care.

You can read the full story 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.

Freehold Nursing Home Owner Steals Pension Funds From Resident

I read an article online last week which reported of a recent case in which a nursing home owner and operator stole pension funds from a resident. On June 30, 2009 Michael D. Berg, 72, the owner of an Ocean Township nursing home, plead guilty to stealing approximately $39,000 from one of his home's residents. Berg plead guilty to one count of third-degree theft by deception.


The Prosecutor's Office had been investigating the allegations that Berg was stealing from his residents, and found that from January 1, 2005 through March 31, 2008, Berg began stealing pension funds which belonged to a resident of the home. Berg will face sentencing by Superior Court Judge Edward M. Neafsey in Freehold on July 31, 2009.


You can read more on this 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.

Understaffing of Nurses Leading to 1000s of Patient Deaths

The nation's crisis in patient care stems from routine understaffing of registered nurses in hospitals--and that understaffing, say nurses unions, leads to thousands of unnecessary patient deaths a year.

To read the full article Click Here. (PDF)


Toms River Nursing Home Sued by Township

Toms River Township sued Dover Woods Health Care Center because of abnormal conduct at the facility. There are over 20 calls a month to the police according to township officials. On Wednesday June 17, 2009 Township Officials asked a judge to force the adult home's owners to improve security at the facility.

To read the full story Click Here. (PDF)

National Nurses Movement

National Nurses Movement Launches Ad Campaign for Nurse TV Shows

By: PR Newswire
Jun. 16, 2009 02:17 PM

RN SuperUnion Uses "Pop Culture Moment" to Advocate for Safe RN Staffing Levels Bill and Nurse Rights

OAKLAND, Calif., June 16 /PRNewswire/ -- The three nursing organizations at the heart of the newly announced national RN Super Union today announce a new television and internet advertising campaign in conjunction with the debut of HawthoRNe, one of the new TV shows debuting this season that features nurse characters. The ad can be viewed or at (Click Here to read the full article) PDF

Trenton Providence Nursing Home Patient Left Behind

Saturday June 13, 2009 Providence Nursing & Rehab Center located on Bellevue Avenue in Trenton, NJ sent a group of its residents on an outing to the Casinos in Atlantic City. The residents were monitored by two activity aides. One male resident described as a Hispanic male in his 50s to 60s, did not return with the group later on that day. Providence Nursing & Rehab Center did not confirm or deny the allegations.

Click Here to read the full artice. (PDF)

Kindred Settlement $1.3 Million

Kindred, PharMerica to pay $1.3 million settlement
By Gregg Blesch
Posted: June 12, 2009

Kindred Healthcare and PharMerica, a company formed in part from Kindred’s spun-off institutional pharmacy division, have entered a $1.3 million settlement to resolve allegations that Kindred’s Knoxville, Tenn., nursing home billed Medicaid for more pharmaceuticals than were actually used or delivered to the facility from 2003 to 2006.

The settlement does not constitute an admission of liability by either company, both based in Louisville, Ky. The allegations originated in a whistle-blower lawsuit filed in 2005 by former billing clerk Jeanne Mayes and subsequently investigated by the U.S. attorney’s office in Knoxville and the Tennessee attorney general’s office. “Kindred Healthcare is pleased with the settlement announced today which puts an old pharmacy dispute to rest,” the company said in a written statement. “The parties settled to avoid the distraction, time and expense of further litigation.”

Mayes, the whistle-blower, is set to receive about $220,000 from the settlement payments PharMerica will make to the U.S. and Tennessee governments.

Whistleblower Sues Oklahoma Nursing Home for Wrongful Termination

A former female employee is suing Cimarron Pointe Care Center and one of its contractors for wrongful termination after she reported abuse and neglect of the nursing facility's residents.

To read the full article click here. (PDF)


Golden Living Attending Physician Provided Misleading Responses on Medical License Applications

Dr. Lewis A. Rogatnick is a attending physician at Golden Living Center- Rose Hill in Berryville. Dr. Rogatnick is also the medical director at Heritage Hill Nursing Home. Doris Critzer, whose mother, Lorena Virginia Tumblin, former resident at Heritage Hill Nursing Home has serious issues with the facility's medical director, Dr. Lewis A. Rogatnick because of his failure to disclose his background.

To read the full article click here. (PDF)

Lawsuit Against Assisted Living Concepts, Inc.

The family of an elderly Bridgeton woman claims a Millville nursing home intentionally misled them by promising she could remain in the facility after she depleted her personal savings, and then threatening her with eviction when she did, according to a lawsuit.

To read the full article click here. (PDF)

Omnicare Inc. paid settlement for Medicaid Fraud Charges

Omnicare, Inc., paid $283,000 to settle Medicaid fraud charges by the State of Delaware. Delaware alleged that the pharmacy had committed Medicaid fraud by illegally switching the drugs of senior citizens in nursing homes and other facilities.

To read the full article click here. (PDF)

States Diverting Medicaid Funds to Fill Budget Holes

A recent report from the House Committee on Oversight cites 8 states--New York, Michigan, Virginia, West Virginia, Kansas, Indiana, Florida, and Nevada--that are likely to use medicaid stimulus funding to fill budget gaps rather than to care for seniors.  See the full report  CLICK HERE

N.J. Public Advocate Says Assisted-Living Company Wrongly Evicted Elderly Residents

New Jersey's Public Advocate today accused a national assisted living company of "breaking its trust" with customers by trying to evict dozens of frail and elderly South Jersey residents who sought Medicaid assistance when they ran out of money.

To read the full article click here. (PDF)

State closes admissions to Golden Living Facility

Golden Living Center Mountain View, a 120-bed licensed nursing home in Winchester, was ordered Tuesday not to admit new residents.

To read the full article click here. (PDF)

Transparency is the New Black

Government public records are becoming more available or "Transparent" to citizens. This article talks about public records  including  nursing home inspection documents and many others.

To Read More click here. (PDF)

Monmouth County based Nursing Home

Here is an editorial about Monmouth County based Nursing Home :

Think for a moment about 85-year-old Mary and 90-year-old John, who live at the J.L. Montgomery and Geraldine L. Thompson nursing facilities. They've lived all their lives in Monmouth County, and were productive and law-abiding citizens. Now they face a difficult future, suffering from any number of serious medical conditions that require 24-hour nursing care.

At this point in their lives, Mary and John cannot eat, bathe or go to the bathroom without assistance. Fortunately, the nurses and aides at J.L. Montgomery and Geraldine L. Thompson are there when they need them.

Mary and John see less and less of their relatives and friends, and have come to view their caregivers as family. They are there for them each morning with a smile of reassurance. They bake cakes on their birthdays; they make sure they have a gift at the holidays. These caretakers, all public employees, do this even though they have more and more Marys and Johns to care for each day, and less and less time to spend with these vulnerable patients.

These caregivers are the same Monmouth County employees the Asbury Park Press criticized for being "intransigent" and trying to "extort wage hikes from fellow citizens" ("Unions remain intransigent," editorial, Jan. 31). Many have worked at J.L. Montgomery and Geraldine Thompson for 25 years or more, and yet earn barely enough to make ends meet. Their annual salaries are less than $29,000 per year.

Like the rest of us, these employees are struggling to pay rent, make car payments, support their families and stay out of bankruptcy. Their reward is the smile they get back from Mary or John once in a while, and the "thank you, dear," when they tuck them in at night.

But Monmouth County's administrators and freeholders, as well as the Asbury Park Press, have a different reward in mind for nursing home employees and other county workers. Their "thank you" is to blame the employees and their unions for the county's fiscal woes, as if the real causes of the present predicament weren't decades of patronage, corruption and overspending, most of which has been well-chronicled during the past few years in the Press.

Make no mistake about it: The measures being proposed by the administrators and freeholders are designed to get headlines (which the Press gladly will provide) and get them re-elected (we'll see). The county has taken a divide-and-conquer approach to these labor matters. Our members are being asked to give up their negotiated raises in order for the county not to consider laying off their fellow workers.

However, there is nothing preventing Monmouth County from accepting the wage concessions from workers and then turning around and laying off employees for financial reasons.

Our union also represents library workers in Monmouth County, who earn on average $31,000 per year and have advanced degrees. Our members' work in the libraries has been lauded by the public and their good deeds have been well-documented in the Press.

AFSCME Council 73 represents the lowest-paid groups of workers in Monmouth County. We are committed to speaking up not only for our members but also for Mary, John and the other citizens of Monmouth County who rely on county services.

Quick fixes got us into the current mess. Thoughtful solutions and responsible decision-making are what we need from our elected officials. But all we are getting are sound bites, sloganeering and politics as usual.

No one likes to be barked at and told that we are the cause of all the county's ills. We still are waiting for true discussions to take place in Monmouth County.

By Gerard J. Meara, APP.COM


Zyprexa and Nursing Home Residents

Here's a website link critical of the use of the drug, Zyprexa, for nursing home residents

Please click here to view website.

Problems at Innova Health and Rehab

Please see attached article on the strikes at two Innova Facilities in South Jersey

To read the full article click here. (PDF)

Capitol Call-In TODAY

The Senate Special Committee on Aging convenes tomorrow to discuss inclusion of improvements in long term care as a part of national heath care reform.  In advance of the hearing, the American Assn. of Homes and Services for the Aging has organized a call-in day today.  Healthcare workers and members of the public are being urged to call their representatives and tell them of the importance of reform in the long term care system as part of a broader reform platform.  If you wish to participate, call 800-958-5374 between 8:00 a.m. and 5:00 p.m. Eastern Time.

New Jersey Bill Would Require Pressure Redistribution Mattresses in all Nursing Homes

New Jersey Bill Would Require Pressure Redistribution Mattresses in all Nursing Homes

Legislation that would require all New Jersey nursing homes to use pressure redistribution mattresses to reduce the incidence of pressure ulcers is headed to the Governor’s desk for signature. Th e bill, S-1517, would require nursing homes, beginning one year after the enactment of the legislation, to purchase pressure redistribution mattresses when replacing the mattresses used by nursing home residents. The bill would also require that all mattresses within a nursing home be switched to pressure redistribution mattresses within three years aft er the enactment of the bill.

Source:, February 5, 2009

Access to Nursing Home Inspections

In one of  his last acts in public office, President Bush changed a significant number of federal regulations designed to help the consumer public. One of those was the set of regulations which allowed consumers access to the results of nursing home inspections. Undoing the damage caused by the former President is no small task, but it is an essential one.

Don't limit access to nursing home inspections

Monday, February 02, 2009

A new rule limiting public access to nursing home inspection reports is a prime example of bureaucracy run amok. Because administrators say requests for information have become too burdensome, the Department of Health and Human Services now says you can't have copies of inspection reports that might explain how your loved one came to have a broken bone, or bruises.

The requests "divert employees from their federal survey, certification and enforcement responsibilities," said Michael Leavitt, HHS secretary. Under the rule change, state employees who inspect nursing homes for the federal government are reclassified as federal employees who aren't allowed to provide "privileged" information or documents to the public without approval from the head of the Centers for Medicare and Medicaid Services. We rely on the government to provide services we cannot provide for ourselves, and policing an industry that has had more than its share of shady operators is one of those jobs. But HHS seems to have the idea that the inspections themselves are the end result, and that the public is willing to trust it to do the right thing by our loved ones.

- The News-Enterprise, Elizabethtown, Ky.

Nursing home abuse investigation in New York leads to arrests

Last month, it was reported that four nursing home employees were arrested for abusing of them actually tying a resident to a chair for two straight nights.

Golden Living Nurse Caught Stealing Drugs

In yet another case of a bad employee putting residents' lives in peril, this recent article conveys the dangers of allowing poor employees to have access to the medications that residents need.

Nursing Home Workers Have Rights and Should Exercise Them

Here is a story about a nursing home social worker who claims to have been fired for telling the truth about problems with a nursing home and for cooperating with investigators.  If this is true, it's illegal - AND ACTIONABLE.

To read the full article click here. (PDF)

Nursing Home "5-Star" Ranking System

Today, Medicare officially released its nursing home ”5-star” ranking system. Take a look to see how the nursing home(s) you are interested in hold up.

Click Here for Medicare's Official Website.

Selecting The Right Nursing Home

Here is a recent informative article in USA Today. It rates nursing homes across the nation and offers some tips in how the select the right one for your loved one. 

Click Here to read the full article.(PDF)



Last Acts of the Bush Administration: Closing off the Public's Access to Vital Nursing Home Information

Here is an article about the recent Bush administration's change in federal rules on nursing home inspection records.


To read the full article click here. (PDF)

Nursing Home Industry Worries About New Ratings

Here is a recent article about the Nursing Home Industry and the new federal government rating system.

To read the full article click here.(PDF)

Seminar : Dealing with The Surge in Nursing Home Litigation

David R. Cohen, Shareholder of Stark & Stark’s Nursing Home Litigation group, will be a speaker at the New Jersey Institute for Continuing Legal Education Seminar Dealing with The Surge in Nursing Home Litigation with A Special Presentation on Pressure Ulcers.

This seminar deals with learning how to deal with the recent surge in Nursing Home litigation, including: medication errors, medical directors, pressure ulcers, physical abuse, failure to address fall downs/broken bones, financial abuse , a discussion on the distinction between attending physicians and medical directors , elderly abuse, Assisted Living Evictions,and a review of the Fairness in Nursing Home Arbitration Act of 2008.

Date: Thursday, December 4, 2008

Time: 5:00 pm to 8:30 pm

Location: Law Center in New Brunswick, NJ

Click here for more info.

Publicly Owned Nursing Homes Typically Provide a Higher Quality of Care

As reported in this blog, most studies confirm that publicly owned nursing homes typically provide a higher quality of care than those driven by profit.  Here is a story about a quality facility in Warren County, NJ, which resisted the temptation to privatize.

You can read the full story here (PDF)

National Citizens' Coalition for Nursing Home Reform

The National Citizens' Coalition for Nursing Home Reform is a prominent national organization effectively utilizing consumer voices to fight for quality long term care. It is pro-actively defining and achieving a new standard of quality for long term care residents. If you feel you want to do more to help reduce neglect and abuse in long term care facilities, this is a great place to start!

Click here for more information.


Corporate Ownership of Nursing Home Facilities

I am slated to soon speak before the Tennessee Trial Lawyers Association on the topic of corporate ownership of nursing home facilities and the means by which many, though certainly not all, corporations will underfund the facilities and undertrain their employees. Sadly, we are seeing more and more of this practice these days where the front line healthcare workers simply are not provided with the tools that they need to provide the care that they desperately want to provide for nursing home residents. I am thrilled to enjoy the panel with a number of very distinguished speakers from whom I am confident I will learn a great deal.

"Corporate Walls" in the Nursing Home Industry

We have written in this blog before about the major problems caused by the Byzantine and mind-dizzying fashion by which corporate ownership has been altered in recent years in the nursing home industry. All of this started as a result of a number of articles printed in healthcare law journals which literally provided a step-by-step recipe through which unscrupulous nursing home owners could hide behind multiple corporations to avoid accountability for injuries and even deaths which occur in their nursing homes. As I negotiate a number of very significant cases, many owners seem to feel a false sense of security that their conduct is immune from consequence because of the so called “corporate walls” placed between them and the very people harmed by underfunded, poorly staffed and systemically failing homes. The reality is that we cannot and will not allow this lack of accountability to occur. More and more we are uncovering evidence to demonstrate that the so called “investors” of these homes also operate them and cause them to be dramatically underfunded. The Supreme Court of Illinois provided an excellent ruling in allowing for direct liability of owners of an enterprise which underfunded its franchisees and thus allowed two people to be killed as a result of worker safety violations. Although the Illinois Supreme Court case did not involve a nursing home, the concepts are no different. Owners who intentionally allow profits to be placed over the welfare of people cannot and will not escape responsibility for their conduct.

Nursing Home Suits Face New Litigation Hurdles

David R. Cohen, Shareholder of Stark & Stark’s Nursing Home Litigation, was quoted in the article Nursing home suits face new litigation hurdles published by LawyersUSA on October 9, 2008.

Mr. Cohen comments on the number of obstacles for Plaintiffs lawyers seeking negligence claims against nursing homes. Mr. Cohen discusses how nursing home owners often elect not to insure the nursing home. Many states do not require nursing homes to carry insurance, which can affect how plaintiffs’ attorneys bring suits.

You can read the full article 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.

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.

Nursing Home abuse and whistle blowers in New York state

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.

Nursing Home Sued by U.S. Department of Labor for unpaid Wages

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.

Special Focus Facilities

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.

Forced Overtime Shifts for Nurses Facing Ban in PA

I read an interesting article this week in the Philadelphia Inquirer that truly encapsulates much of what we've been trying to say on this blog since its inception.  The management and owners of nursing homes, must treat their front-line worker with dignity, respect and compassion.  Otherwise, patients in nursing home get injured and sometimes die.
New Jersey has passed good legislation to protect nurses...and in turn, patients.  Pennsylvania should follow this lead.

Resource for Families Investigating Nursing Homes

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.

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.

New Jersey Faces Nursing Shortage

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.

Laurel Crest to go under microscope

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.

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.

Turning Up Heat On Nursing Homes

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 to Buy Nursing Home Operator Manor 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.

Choosing A Quality Nursing Home

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.

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).

Nursing Home Evaluation Checklist

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.

Considerations in Choosing a Nursing Home

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 an Assisted Living Facility

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.

Assisted Living Facilities Gain Popularity

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.

What is Assisted Living?

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 Working Conditions for Nursing Home Employees

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.

What is an Assisted Living Facility?

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.

Chelsea Senior Living One of Top 40 in NJ

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.

Assisted Living More Popular But Be Cautious

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 vs. Nursing Homes

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.

ATLA's Annual Nursing Home Litigation Conference

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.