Special kudos to the Reading Eagle on its recent series on nursing homes – in particular the editorial We Must Demand Better from Nursing Homes, Regulators, published on December 11, 2016. For those of us who work hard to hold nursing home corporations accountable when seniors are neglected, abused, seriously injured, or die, this series of articles is a vindication.

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During much of the 20th century, hospitals did not have a duty to treat patients who entered emergency departments. Without any given reason, they could refuse to treat certain patients. The practice of “patient dumping” arose from that lack of duty.

Patient dumping refers to situations when hospitals deny emergency medical screening and stabilization services. It also refers to instances when a hospital transfers an individual to another hospital after discovering that the individual does not have insurance or a means to pay for treatment.

To correct that wrong and in an effort to ensure that individuals received needed emergency care, in 1986 Congress enacted EMTALA, which was designed to protect all individuals seeking evaluation or treatment at hospital emergency departments that participate in Medicare.
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I was recently speaking with someone about a woman who worked for a non-profit nursing home for many years. She liked it there and the facility provided good care. Then the facility was sold to a for-profit corporation. Overnight, staff hours were cut, pay was cut, and care declined. The person I was speaking with could not believe this could happen–I was not surprised as sadly I’ve seen this occur many times.

If an administrator at a non-profit tells her board of directors she made a little money that year and gave great care, she’s applauded. However, if that same administrator tells the same thing to a for-profit board, she’s getting fired. The replacement knows that staffing is the biggest expense and that’s where you will see the cuts.


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Often, many of the problems that occur in nursing homes are a direct result of terribly insufficient staffing. This knowledge is born out in studies that show a direct correlation between staffing ratios and quality of care.

Despite all of this clear evidence, many facilities only meet the bare minimum hours required under state regulation. Some aides have told me the ratio on their day shift at a nursing home was as high as 1 aide to 14 residents. For those unaware, aides are the people who feed, bathe, and transfer residents, and they are also responsible turning and repositioning any residents who are at risk for developing bed sores. Having only 1 person in charge of caring for 14 patients at the same time is a catastrophe waiting to happen.


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Recently, the August 2015 Special Focus Facility List was published by the Centers for Medicare and Medicaid Services (CMS). The CMS regularly visits nursing homes to assure that they are administering the quality of care that Medicare and Medicaid require. With these regular visits, the CMS will identify any deficiencies in the quality of care

When deciding whether to place a loved-one into a nursing home, families attempt to determine whether the nursing home is capable of providing the necessary quality care. Most families visit the nursing home, as well as check the U.S. government’s Nursing Home Compare tool at Medicare.gov.

Despite their efforts, some nursing homes have purposefully misrepresented

In New Jersey, Assisted Living encompasses providing various coordinated supportive personal and health services, available 24 hours per day, to residents who need those services. Its purpose is to promote resident self-direction and participation in decisions, with an emphasis on independence, individuality, privacy, dignity, and homelike surroundings.

And thus, corporations that operate Assisted Living Facilities (ALF) must provide, at a minimum, services for:

  • Nursing
  • Recreation
  • Medical Transportation
  • Personal Care
  • Social Work
  • Activities
  • Housekeeping
  • Dining
  • Pharmacy

Indeed, ALFs and our nursing-home lawyers know that potential residents have the right to live in an ALF that does not admit more residents than it can safely accommodate while providing those services and other care. And for persons who currently live in an ALF, the corporations operating the ALFs know that those residents have the right to receive care and services at a level that addresses the residents’ changing physical and psychosocial status.


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Harborview, a defendant in a case we took to trial last year, is back in the news.  During the trial, the ownership and management spoke of the facility in glowing terms – terms that were contradicted by state inspections and other testimony.  The article recounts rodent problems – and even chronicles a resident that bought

As an advocate in New Jersey  for nursing home residents, one of my greatest frustrations has been the lack of oversight for self reported staffing levels.  This has lead to an extraordinarily low incidence of short staffing citations – and worse yet, has allowed some understaffed facilities to crow over their lack of such citations.