Nursing Home Information

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 being provided, as well as if the facility is meeting safety requirements. The CMS will also examine any previous noted deficiencies and how promptly they were or were not handled. These criteria will determine the facility’s overall survey from the CMS.

Additionally, if serious problems are left unchecked in these facilities, the CMS can opt to terminate the special focus facility’s participation in Medicare and Medicaid.

Once the CMS’ “survey” teams gather their data from the facilities, this is submitted to a master list, The Special Focus Facility List. This list includes all facilities with a history of care problems and/or poor surveys, and is updated monthly by the CMS. Every special focus facility must be visited by a CMS survey team at least twice a year.

If you would like to see the whole list, please visit the CMS website.

It is also important to note that if you go to Medicare’s Nursing Home Compare website and look up any individual nursing home, you will immediately be able to tell if that facility is on the Special Focus Facility List. Any facility on the list will have a yellow triangle with an exclamation point next to its name. Additionally, you can use the website to see other ratings for the facility, including health inspections, staffing and quality measures. At the moment, there are several nursing homes in Pennsylvania and New Jersey on the CMS’s most current Special Focus Facility List.

If you have a loved one in a facility on the Special Focus Facility list, you can go to the administration and demand they tell you why the facility on the list and what they plan to do to improve the quality of care provided to be removed from the list. You do not get on this list when you are meeting even minimal standards.

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 their ability to care for its residents.

Overstating Staffing Levels

According to the latest updated report from the Center for Public Integrity, over 80% of nursing homes have consistently overstated their staffing levels to Nursing Home Compare in an apparent bid for higher rankings at the site. The report explained that staffing overstatements occurred for all types of nursing positions, but were particularly high for registered nurses—the most skilled and highest paid workers.

Our nursing home negligence and abuse attorneys have long since understood that the amount of care, especially by registered nurses, is strongly connected to the quality of care provided to nursing home residents. For example, my associate Eric D. Dakhari, Esq. explained in a recent blog article that for understaffed facilities, evidence shows increased incidents of—among other critical issues—pressure ulcers, catheterized patients, urinary tract infections; as well as an increased likelihood of death.

As a nursing home lawyer, I have too frequently litigated nursing home negligence and abuse cases where the low levels of care were associated with a resident’s severe injury or death.

Nursing Home Compare: The Goal

The government website’s goal is to assist families in evaluating a nursing home’s ability to provide adequate “skilled-nursing” care, which is care given when you need skilled nursing or rehabilitation staff to manage, observe, or evaluate your care.

A Flawed Self-Reporting Process

The Nursing Home Compare website explains that each nursing home must self-report its staffing hours to its state survey agency and that the reported staffing hours reflect the staffing of RNs, LPNs, CNAs, and PTs from a two-week period just before the state inspection.

The government website displays the self-reported nursing home staffing hours as the number of staff hours per resident per day, which is the total number of hours worked divided by the total number of residents.

It is important to note that the website does not necessarily show the number of nursing staff present at any given time, or reflect the amount of care given to any one resident.

Our nursing home attorneys know that many nursing homes commit additional human and financial resources to prepare for the state inspections, and as a result, the self-reported staffing levels do not accurately reflect the typical staffing levels in the nursing home. This is particularly important because some nursing homes must provide more nursing staff due to the conditions of their residents, and other factors.

Recommendation to Families

Our nursing home negligence and abuse lawyers understand the difficulty that families face in selecting a nursing home based on false data. My partner, has previously recommended that families ask the nursing home about its CNA-to-Residents ratio. He explained that determining that ratio—as opposed to the RN or LPN ratio—is important because the CNAs are the frontline workers that provide the majority of the hands-on-care to residents.

If you or someone you know has been involved in a nursing home negligence or abuse incident, I recommend that you consult with an attorney immediately to discuss your rights.

In nursing-home neglect and abuse cases, the victims of the nursing-home negligence or abuse often suffer from some form of dementia, including Alzheimer’s, which is a specific type of dementia that accounts for 60 to 80 percent of dementia cases.

Alzheimer’s is a progressing disease. That means that it worsens over time, causing cognitive and behavioral problems. For example, cognitively, a person may have difficulty thinking and trouble understanding. They may also experience forgetfulness, confusion, and disorientation. And behaviorally, a person may exhibit irritability, agitation, lack of restraint, and difficulty with self care.

Behavioral Changes

For many, the behavioral changes present the most challenging and distressing symptoms from Alzheimer’s. The symptoms stem from a progressive brain-cell deterioration. Importantly, they may become worse through medication, environmental influences, and some medical conditions.

Environmental Triggers for Behavior Changes

Beyond the physiological reason for the behavior symptoms, changes in a person’s surroundings also often play a role in triggering those symptoms.

When I interview family members and nursing-home nurses in preparation for litigating a nursing-home negligence or abuse case, they often describe events or changes in the person’s surroundings that have created additional stress that can be difficult for an Alzheimer’s patient to manage. Some of those events and changes include:

  • Moving to a new residence, nursing home or new room within a nursing home;
  • Changes in a familiar environment or caregiver arrangements;
  • Misperceived threats;
  • Admission to a hospital; or,
  • Being asked to bathe or change clothes.

So, while the patient is trying to make sense out of an increasingly confusing world, those environmental factors increase the patient’s fear and fatigue while exacerbating the patient’s exiting irritability, agitation, lack of restraint, and difficulty with self care.

Standard of Care for Nursing Homes

Nursing homes and the nursing-home corporations that operate them know, and have reason to know, that environmental changes place the Alzheimer’s or dementia patient at greater risk of experiencing a serious nursing-home injury.

When I depose a Director of Nursing in a nursing-home neglect and abuse case, the nursing director admits and acknowledges the serious risk of injury that Alzheimer’s patients face while in the nursing-home facility. Also, the nursing director admits that the nursing-home corporation and its nursing staff must provide those patients with treatment and services that meet a specific standard of care.

The standard of care requires that the nursing home develop an individualized care plan to promote the patient’s health, protect the patient’s safety, and secure the patient’s dignity. The nursing-home staff must implement the treatment and care, from the care plan, on a daily basis—without fail. And then, the nursing home must evaluate that treatment and care to ensure its effectiveness and make changes to the plan when appropriate.

Nursing Home Negligence and Abuse

When a nursing-home corporation and its nursing-home staff follow the required standard of care, the nursing home can prevent the patient from experiencing preventable catastrophic falls, avoidable pressure ulcers, and other serious injuries.

If the nursing-home corporation and the nursing-home staff fail to follow the required standard of care, then the patient may experience serious physical injury, and the nursing-home corporation is responsible for the harms and damages that follow. If you or someone you know has been involved in a nursing home negligence incident it is recommended that you consult with an attorney immediately to discuss your rights.

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.

Continue Reading Assisted Living Facilities Must Not Expose Residents to Unnecessary Risks of Harm

Eric Dakhari, Esq., member of the firm’s Nursing Home Litigation Group, was featured on WIMG and WPHY’s Trenton Talks – In the Public Interest, which was hosted by Shareholder David Cohen, Esq.

The program discussed at length the rights and role of healthcare whistleblowers, the role of the nursing home MDS Coordinator, and the role of the lawyers in whistleblower cases. Check out the clips below:

Eric Dakhari, Esq. explains the rights of healthcare whistleblowers and why they should be wary of non-disparagement clauses.

Eric Dakhari, Esq. explains the role of healthcare whistleblowers and the duty of care responsibility.

Eric Dakhari, Esq. talks Abraham Lincoln, the False Claims Act, and the role of lawyers in healthcare whistleblower cases.

Eric Dakhari, Esq. explains the role of the nursing home MDS Coordinator in financial fraud.

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 his own glue traps.

You can read the full article here.

 

 

One of the most common illnesses I see in nursing homes is C-Diff – a bacteria that can cause severe dehydration or death.  C-Diff is most common in nursing homes and hospitals, and 80% of fatalities from C-Diff are in people over 65.  A recent article in the LA Times reports a recent study and gives the important statistics.

Anytime a person receives antibiotics C-Diff can become a problem.  C-Diff is resistant to most antibiotics (C-Diff is short for the Latin name Clostridium difficile – a Latin word meaning difficult, stubborn, or unreasonable).  We all have lots of bacteria in our gut, but when a person is on antibiotics the rest of the bacteria in the gut are killed, leaving the C-Diff as the only bacteria.  There is nothing to compete with the C-Diff and it proliferates.  Unfortunately, one of the side effects of the C-Diff breaking down food in the gut is toxic, and the body tries to rid itself of the poison with diarrhea.

If you have a loved one who just got antibiotics, be on the lookout for diarrhea.  Many times a person suffering from C-Diff will have diarrhea that is green or black, and it most likely has a very strong distinctive odor.

The most important thing is to be sure your resident is properly hydrated.  By knowing the symptoms of C-Diff you may save your loved one’s life.  We’ve had cases where un-trained staff miss these obvious symptoms, and in some cases even give people suffering from C-Diff anti-diarrhea medication so the toxins stay in the body, further poisoning a person.  Any diarrhea after antibiotics should be of concern. Stark & Stark’s Nursing Home Litigation Group has handled many cases of neglect and issues that arrise such as this, contact us today for a free consultation.

 

Urinary Tract Infections, or UTIs, are a common complaint among families with a mom or dad in long-term care.  UTIs can be dangerous.  First, UTIs can become a serious infection if untreated.  However, UTIs also lead to falls, because UTIs cause people to feel as if they have to go to the bathroom constantly – a problem when someone with dementia forgets to ask for help to go to the bathroom.  This problem is made worse by the fact that UTIs can also cause people who have no cognitive problems to exhibit signs of dementia, like having hallucinations.

Aggravating the diagnoses of a UTI is the fact that a recent study has linked UTIs in New Jersey nursing homes to a failure to administer medications and poor supervision.  A recent study written about in McKnight’s, a long-term care publication, reported the findings published in Geriatrics. You can read the full article here.

The study, conducted by the University of Colorado College of Nursing, confirms what many of us practicing in this field know – that UTIs may be evidence of poor care and neglect.  UTIs are many times caused by improper cleaning after toileting and being left in a diaper for too long.

If a loved one is experiencing recurrent UTIs, demand a care planning meeting.  Find out why the UTIs are happening and what is being done to prevent them. If you or a loved one are dealing with issues due to poor care, contact Stark & Stark today for your free consultation.

In my practice, I am currently responding to a motion to dismiss a lawsuit because of a forced arbitration document that was slipped into admission paperwork.  “Arbitration” is basically something written in the fine print where a person “agrees” to waive their right to a jury trial and go to a secret forum for disputes.  These arbitration documents are so offensive they used to be illegal in New Jersey nursing homes.

The reasons companies do these are because they typically pick the rules and an arbitration company, and historically they get better results at arbitration then they do in court.  Also, a person generally has to pay very high costs at arbitration – costs they would never pay in court.  Most importantly, what happens in arbitration is secret – so even for the worst care or abuse no one will ever know what happened if there is an arbitration.  You never see these things explained in the fine print – it will just tell you how much cheaper and faster arbitration is, which is frequently a lie.

These pre-dispute “agreements” only help the company, and never the resident or the resident’s family.

To be clear, you do not need to sign these things.  They do not help you – they can only hurt you.  Because of the significant advantage arbitration gives to a company, they will agree to arbitration after something terrible happens if you want it after the fact.  There is no reason to sign them before a person is injured or killed.

A new video by a pro-consumer group documents how abusive arbitration can be.  In one case, a woman was fired because of her military service, something that is totally illegal.  The arbitrator disregarded the law and found for the company.  You can watch the brief video here:

When admitting a resident, if you see these documents slipped into the admission paperwork don’t sign them.  You don’t have to, and you’re only hurting yourself.  If you’ve already singed one, tell the administrator you want to cancel it.  No one wants to believe that a resident will hurt in a nursing home or assisted living facility but it happens.  If it happens, you want to be sure you have the full might of the law at your disposal.