Medicare Star Ratings May Do More Harm Than Good

August 26, 2014

2454143641_00d9fa44e5_o.jpgChoosing a nursing home for yourself or a loved one can be among the most decisions difficult of your life. In a culture increasingly dependent on the internet, Medicare's nursing home ranking website is exceedingly popular. There are more than 15,000 nursing homes in the United States; trying to find the right one is overwhelming, which is why systems that rank facilities are so widely used.

Nursing home lawyers at Pintas & Mullins and throughout the country are concerned that these online ranking systems are actually causing much more harm than good. Here, we delve into this matter and the reality of Medicare's five-star system.

The New York Times recently published an in-depth, wonderfully written yet harrowing account of how Medicare's ratings allow nursing homes to cheat the system - and ultimately elderly patients. Although the five-start Medicare program is relatively new (it was established in 2009), it has become exceedingly popular. Consider this scenario: your elderly mother lives with you, and one day she falls and breaks her leg, requiring emergency surgery and rehabilitation. After surgery, the hospital gives you just one day to choose a rehab center for recovery. Pressed for time and overwhelmed by the situation, you turn to Medicare.gov for help.

This is exactly what happened to the Chandler family, of Sacramento, California, in 2011. Wanting to keep her close to home, the Chandlers placed their 90-year-old mother in Rosewood Post-Acute Rehab, which had a five-star rating on Medicare.gov. Like so many others, they did not know how the rating system actually worked, and the hotel-like appearance of Rosewood comforted them. They placed Essie May Chandler in Rosewood for a six month stay.

In her six months at Rosewood, Essie lost 40 pounds, fell 11 times, had massive bruising across her body, and broke both her legs. Another six months after she returned home to her family, she passed away. The Chandlers now live with this guilt, clearly unable to forgive themselves.

What Went Wrong


Medicare's ranking system is based on three factors: inspection reports, staffing levels, and quality measures. These last two criteria rely only on data the nursing home self-reports to the government; and the feds never go in to check if the numbers are accurate. Therefore there is not much deterring nursing homes from over-reporting and sending false data to Medicare to boost their ratings.

To say the basis of this system is incomplete or lacking would be an understatement. It seriously misleads consumers because of its flaws and because it does not account for important factors, like complaints filed, or fines and enforcement actions. If that information was factored in, it is unlikely Rosewood would have five stars; from 2009 to 2013, officials received about 150 complaints and reports of problems at Rosewood, which is twice the state average.

To investigate further, Times reporters interviewed current and former residents at Rosewood, most of who said they did not think the facility deserved a five-star rating. Many residents live in a room with two other people, the facility is understaffed, and basic supplies are scarce. Rosewood has also recently been named in about a dozen lawsuits (including several resident deaths) from families who accuse staff of mistreatment and substandard care.

When injured residents or their families sue nursing homes for negligence or abuse, they quite often have to go up against the nursing home's parent companies. Rosewood, for instance, is actually operated by North American Health Care, which also owns more than 30 other nursing facilities. This offers a glimpse into why Rosewood appears so well-run on the outside, but fails its residents so egregiously.

North American Health Care is a for-profit corporation, focused on pleasing investors and increasing the bottom line. The nursing home industry is made up primarily of corporations like North American Health Care, who own dozens, if not hundreds of nursing homes. Understaffing, failing to keep up with supplies, and overcrowding rooms actually help boost profits, though cause grave harm to residents.

Many nursing homes have expertly learned how to play the rating game - one analysis shows that even facilities with illustrious histories of inadequate care have high ratings in the self-reported criteria. Case in point: of 50 nursing homes on federal watch for poor quality, two-thirds have four or five stars for quality data and staff levels, while the state-reported health inspections earned them one or two stars.

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Nursing Home Complaints Can Now be Submitted Online

August 20, 2014

7019381983_7be24d1bef_c.jpgIllinois Governor Quinn recently signed into law two pieces of legislation that will help nursing home residents voice concerns about their care. The first law, effective immediately, allows these complaints to be submitted electronically rather than only over the phone. Nursing home negligence lawyers at Pintas & Mullins explain these new laws and how nursing home residents can make the best of them.

The second law, which will take effect on January 1, 2015, will expand the rights and protections given to ombudsmen and those in community-based care. These measures are part of the Long-Term Care Ombudsman program, which is a federal initiative within the Administration on Aging.

Ombudsmen are advocates for residents of nursing homes and other similar facilities; they work to resolve problems that individual residents may have regarding their care, and to bring about positive change within the industry. They are critically important to improving the care and quality of life at nursing homes, and programs for them exist in all 50 states, the District of Columbia, Guam, and Puerto Rico. Each state has a full-time official ombudsman, and there are thousands of local advocates throughout American communities as well.

Allowing nursing home residents to file complaints online will greatly help those residents who are nervous about voicing their complaints aloud out of fear of retribution. Too often, elderly residents are afraid of reporting substandard care at their nursing homes. If this fear is due to outright threats by nursing home staff, it can be considered a form of nursing home abuse.

Some nursing homes are better than others at policing their staff. Generally, non-profit or private nursing homes are better run, because they do not have to please investors or cut corners to save costs. For-profit nursing home chains are, unfortunately, notorious for understaffing their facilities and budgeting supplies so low there is not enough to go around. Understaffed, overworked nursing home employees are typically the perpetrators of resident abuse or neglect.

Some nursing homes are members of a national accrediting organization called the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which inspects facilities and assesses staff performance. Nursing homes are also inspected by state officials about every six to 15 months; Illinois has about 200 inspectors of many different disciplines, including registered nurses, nutritionists, and environmental health practitioner.

For concerned families, information on these inspections are available. Complete survey reports can be found at the specific nursing home or through your state's Department of Public Health (typically within the Division of Communications).

What Happens After a Complaint is Made?


Complaints regarding care - which, as mentioned, can now be submitted online - are reviewed by ombudsmen in that state. These ombudsmen and their volunteers are trained and certified to investigate complaints and resolve them. If more than one complaint is issued against the same caregiver, an official case is opened, and visits are made to that particular nursing home. If necessary, the staff is given a training sessions on topics like residents' rights and safe practices. Private consultations are also available for managers or residents and their families.

According to the federal ombudsman website, the five most common nursing home complaints are:

1. Medications, such as wrongful administration and lack of organization
2. Improper eviction or inadequate discharges
3. Resident conflict
4. Lack of respect for residents
5. Poor attitude among staff

Medication errors are among the most dangerous forms of negligence at nursing homes. Antipsychotic drugs in particular have been used for many years as a type of "chemical restraint" for aggressive or unruly residents. Not only is this illegal, but it is incredibly abusive: there are specific labels on antipsychotic drugs stating that these drugs should not be used in the elderly or those with dementia, as it could cause premature death.

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Illinois Revokes License of Nursing Home Psychiatrist

August 13, 2014

78217195_07b2df9cdb_o.jpgA popular Chicago psychiatrist, Dr. Michael Reinstein, recently had his license suspended by the Illinois medical board due to his illegal prescribing of clozapine, an antipsychotic. He prescribed the dangerous drug to countless nursing home residents despite clear and irrefutable evidence that it could cause premature death in the elderly. Nursing home abuse lawyers at Pintas & Mullins highlight this case and how residents succumb to corrupt doctors.

According to investigative reports, Reinstein, who worked out of an office in the Uptown neighborhood of Chicago, gave clozapine to more than half of all his patients. Clozapine is a powerful antipsychotic drug, recommended for patients as a last resort. It can cause seizures, serious drops in white blood cells, heart wall inflammation, and death.

Reinstein received at least $350,000 in illegal payments from clozapine's manufacturer - a fact that came to light after a joint investigation by the Chicago Tribune and ProPublica, a non-profit advocacy group. After this investigation, the Illinois Department of Financial and Professional Regulation stepped in, beginning a two-year legal fight.

Reinstein has repeatedly denied any wrongdoing in his practice, and is seeking an to stop his license suspension in Cook County Circuit Court. He claims that every clozapine prescription was medically necessary, despite immense payments from the drugs' manufacturer, Teva Pharmaceuticals. Reinstein reportedly received $50,000 every year from Teva in a "consulting agreement."

In addition to this annual agreement, Reinstein also received numerous gifts from Teva, including free travel to and from Miami, fishing trips, lavish dinners, a boat cruise, and many tickets to sporting events. He enjoyed these gifts from 2003 to about 2009, when the investigation began, and Reinstein, undoubtedly feeling the heat, asked the drug maker to stop payments.

The legal battle is not looking promising for Reinstein. In March of this year, Teva agreed to pay a $27.6 million fine over claims that it paid Reinstein to prescribe the drugs. Another 2012 lawsuits against the disgraced doctor is currently pending in federal court regarding hundreds of thousands of false Medicare and Medicaid claims.

Nursing Home Deaths Tied to Clozapine


In addition to his Uptown clinic, Reinstein also served as a psychiatric medical director at over a dozen local nursing homes; one year he issued more prescriptions for clozapine than all doctors in Texas combined. It is impossible to understate how much damage he single-handed caused in the lives and wellbeing of his patients. At least three patients died of clozapine intoxication while under his care, and countless others lost their quality of life from this powerful antipsychotic drug.

One of his victims was a 50-year-old man named Alvin Essary, who was a resident at Somerset Place nursing home when he died in 1999. According to his medical records, he had over five times the toxic level of clozapine in his blood at the time of his death. Consequently, Essary's family sued Reinstein for his negligence, ultimately settling for about $85,000.

Another of Resinstein's patients was just 27 when she died of medication intoxication. According to investigations, Reinstein increased the dosage for Wendy Cureton at twice the recommended pace, and combined the drug with a sedative despite clear medical warnings not to do so. After yet another dosage increase, Cureton collapsed and died.

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Nursing Home Chain Caught in Criminal Scheme

August 5, 2014

4084144518_8db40df1cb_o.jpgA Tennessee nursing home chain, National HealthCare Corp. (NHC), was recently involved in a scandal involving risky campaign schemes and malicious contracts with the elderly. According to reports, NHC has been forcing its elderly residents to sign contracts agreeing not to sue the company if something happens to them. Nursing home abuse lawyers at Pintas & Mullins highlight the effort to expose this chain and their inside operations.

The contracts NHC residents are forced to sign makes suing the company nearly impossible if they are victims of abuse, neglect, or mistreatment in the home. Instead, residents would go through a process known as 'binding arbitration.' This keeps any grievances out of the courts, where NHC has been subject to massive lawsuits in the past.

Arbitration is a process of ending legal disputes without going to trial. It involves an impartial third party designated to listen to both sides, including any evidence and testimony. Both sides agree in advance to comply with the arbitrator's decision, which is typically final.

Not surprisingly, the Tennessee courts have frowned upon forcing elderly and sick residents to essentially sign away their legal rights so they can have a bed at a nursing home, calling the practice "unconscionable."

Nursing Homes, Judges, and Political Schemes


NHC has been slammed with many nursing home neglect and abuse cases in Tennessee and the courts have sided primarily with the injured plaintiffs. Politico recently published an exclusive article on the Republican State Leadership Committee (RSLC) and its involvement with a criminal campaign scheme. The RSLC is one of the most influential right wing players, spending tens of millions of dollars to sway elections in their favor.

The scheme is like something out of House of Cards, involving risky political schemes that prompted criminal penalties and "threatening the organization's continued existence," according to a 2011 internal report. The report was a result of an investigation into misconduct by RSLC officials during the 2010 elections, and published by the esteemed Washington law firm BakerHostetler.

Investigators accused Alabama RSLC members of laundering dirty money from the Native American gambling industry, by routing it into Tennessee and back in to Alabama. So, how does this connect to the NHC's binding arbitration clause? In April 2014, the Tennessee Lt. Governor Ramsey publically admitted that NHC officials were involved in plans to oust three Democratic Tennessee Supreme Court judges.

Ramsey's office confirmed that it believed Tennessee needed new judges on the state's Supreme Court, citing the NHC's arbitration clause as proof. When conservative judges launched their campaigns for Court positions, their campaigns were financed by the RSLC. To date, the organization has spent about $200,000 on this campaign, suggesting that officials find it completely acceptable to buy courts and judges. Ramsey was explicit in stating that he wanted the RLSC to be involved with the courts.

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Nursing Homes Linked to IL Governor Candidate Facing Lawsuits and Violations

July 16, 2014

7019381983_7be24d1bef_c.jpgFor those living in Illinois, Bruce Rauner is already a household name as the Republican nominee for governor of Illinois. Rauner is an incredibly successful businessman, and is running his campaign under the promise that he would run our (admittedly bankrupt) state more like a business. Nursing home negligence lawyers at Pintas & Mullins see one glaring problem with that promise: the serious violations coming out of a chain of nursing homes Rauner previously owned.

American Habilitation Services operates long-term care facilities for the elderly and disabled in Illinois and a handful of other states, including Texas, Arizona and Florida. Unfortunately, the chain has recently had to defend itself against several lawsuits and federal inspections after multiple residents passed away and hundreds of others were found living in deplorable conditions. American Habilitation Services (AHS) is one of Rauner's former companies, however, his spokespeople stated that he is not involved in the chain's day-to-day management.

Most of the nursing homes in the United States are run by for-profit corporations like AHS, which have only one goal in mind: to profit as much as possible. Too often, those profits come at the expense of patients, who are our nation's most vulnerable citizens. One would hope that a nursing home chain formerly owned by a political hopeful would demonstrate outstanding ethics or at least treat patients with respect; unfortunately, this is not the case.

It is no surprise that families of those elderly and disabled victims are taking legal action against AHS. Among their claims are several cases of wrongful death, one in an 11-year-old resident who was attacked and killed by an older resident. Other lawsuits allege instances of sexual assault, dangerous transfers, and severe negligence.

One lawsuit stemming from the 2001 death of a woman at and AHS facility in Arizona resulted in a $45.5 million verdict against the company. The case, which was one of the largest verdicts in Arizona within the past decade, arose when a disabled woman drowned in a bathtub after being left alone by AHS employees.

Around the same time, AHS was defending itself in a lawsuit filed by the Texas attorney general, after a woman at the Indian Wells House suffered numerous sexual assaults from an AHS worker. Two years later, the Texas attorney general again brought a suit against AHS, claiming the company improperly transferred a resident. The resident was found unconscious in the new home, without a heart rate. Employees of her new home were apparently unaware of her congestive heart failure diagnosis, and she later died in the ER.

In yet another example of gross negligence, in 2004 the Florida inspector general cited AHS for several violations, including overbilling the state for $7,000, several complaints regarding lack of food, and failing to report at least one sexual assault. Rauner left AHS's parent company in 2012, when he launched his campaign for Illinois governor.

Sadly, as the population ages, long-term care facilities like AHS will only become more crowded, making the residents more susceptible to harm and mistreatment. As stated, nursing home chains that run for-profit often leave their facilities without the resources necessary to properly care for and monitor all their patients. Similarly, to increase profits, many facilities are chronically understaffed, which leaves the employees who do work there incredibly overworked, stressed, and unable to fulfill their job duties.

Nursing home residents have considerable medical needs - some need constant supervision and care, which, if not received, can lead to significant physical deterioration and ultimately death. Many states have seen a trend in nursing home litigation and multi-million dollar verdicts. More often than not, these lawsuits are directly linked to issues of understaffing, lack of resources, and budget issues.

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After the Fall: Immobility in Nursing Homes

June 30, 2014

navigating-the-perils-of-broadway-and-79th-street-1.jpgOur nursing home negligence lawyers often see the dire and life-threatening consequences of frequent falls in nursing homes. Recent studies find that half of residents who suffer a hip fracture after falling either pass away or lose mobility completely. Families need to remember that there is help available, and many recovery options for elderly nursing home residents.

The above-mentioned study was conducted by the University of Pennsylvania's Perelman School of Medicine. Researchers at the University observed more than 60,000 nursing home residents who were hospitalized for hip fractures in a four-year period. Among their findings, researchers noted that residents above the age of 90 and those who did not undergo surgery for the fracture were most likely to pass away or become disabled.

Most of the nursing home residents observed for this study were able to move around on their own before they suffered a hip fracture, however, after the injury they suffered from many different types of disabilities. This reinforces the need to focus on preventing falls in the first place.

Six months after hospitalization, about one in three nursing home residents had passed away. Interestingly, males had a much higher mortality rate compared to female residents. By the one-year mark from injury date, about half of the patients had died.

Among the residents who survived, nearly 30% had to depend on others to help them get around, to get in and out of bed, and to perform personal hygiene. This significantly restricted their ability to participate in nursing home activities, so they spend much more time in bed, which in turn only amplifies their fragility.

How Families Can Help


Families with a loved one in a nursing home should be aware that, if a fall does occur and the patient suffers a hip fracture or break, they will likely never return to their pre-injury health state. It may also be helpful to encourage residents to undergo surgery for the fracture, even if they express hesitation. In these and other areas, families should begin planning for the future care of their loved one, who may become newly dependent on nursing home staff to get around.

About 12% of those involved in the study did not elect for surgery after their fracture, and that 12% were significantly more likely to die or need constant assistance than those who did undergo surgery. It is important for patients and their families to discuss the option of surgery with their doctors, even if it is not originally recommended. Surgery may still be possible even for those who have a host of other medical conditions.

Hip fractures left untreated can be extremely painful, with pieces of broken bone rubbing together with even minor movement. The benefits of reparative surgery can range from extending life to improving mobility, however, no one should be forced to undergo a procedure if they do not want it.

Many nursing home residents, because of cognitive conditions like dementia, are unable to make complex medical decisions for themselves. Compounding this, dementia residents are typically more vulnerable to falls and broken bones than other nursing home residents. In this type of case, is it important for family members to work together with the nursing home and medical care team to determine the best course of action for the resident.

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When and How to Choose Hospice Care

June 18, 2014

116482438_79d50d4e57_o.jpgAs Americans age, they are making greater use out of hospice care, which is offered to terminally ill patients at the end of their lives. Deciding to place yourself or a loved one into hospice care can be one of the most difficult of a person's life, and many are unaware that they have a choice of programs. Elder law attorneys at Pintas & Mullins offer some advice and a few tips on how to choose the right hospice.

Hospice programs involve comprehensive care for those near the end of their lives; the focus is on comfortable, at-home care, to relieve pain as much as possible. Although most hospice patients receive care in their homes, it is possible to receive hospice care while residing in a nursing home, even for those on Medicare.

Unfortunately, during the time most are considering a hospice program, they are in the midst of a health care crisis or have just received dire news. In other words, they are typically not in the best state of mind to research in-depth on the programs available to them. The good news is that hospice choices are growing, and now available in most communities throughout the country.

It is important to remember that, like nursing homes, hospices are sometimes run by large, for-profit corporations that may not always have the patients' best interests at heart. This is why doing research before choosing a facility is so important - not every hospice provides the same quality of care.

Advocacy groups like the American Hospice Foundation have been around for many years, collecting data on U.S. hospices during that time. Soon (within the next two to four years), it will release a tool to help consumers compare hospice programs using evaluations conducted by both primary caregivers and Medicare and Medicaid.

Knowing What to Ask


Before that becomes available, families need to do their own work, interviewing different hospice programs within their communities. During these interviews, caregivers often come to patient's homes and answer any questions they may have. How receptive they are to these questions and requests is the first indicator of how well a program is run.

Second, it is important to choose a program that has a solid foundation; avoid hospices that have only been around for a few months or even up to a year. The more established and stable a hospice is the better. You may be able to glean knowledge from friends, doctors or nurses who have heard about that program's reputation.

Third, ask about the staff's response times, whether they will be available in evenings and weekends, and how long the patient will need to wait in an urgent situation. Additionally, consumers should ask about the services the hospice provides. Although there is a set or standard services most are expected to give, the degrees and intensities of these vary.

For example, "continuous care," refers to the very last hours or days of someone's life, when 24/7 care is necessary. Ask the hospice if they will provide a caregiver at home during this time, if they will see the patient through to their death, and if the family will be supported. Another important service is inpatient facilities, in case complex health issues arise. Most hospices rent out units in hospitals or nursing homes to care for their patients who need additional services.

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Nursing Home Deaths Prompt Bed Handle Recall

May 21, 2014

386416510_aeb24a731d_o.jpgOver 110,000 portable adult bed handles were recently recalled after at least three elderly women died from suffocating between the bed handles and mattress. The bed handles are frequently used in assisted living facilities to help residents get in and out of bed. Nursing home negligence lawyers at Pintas & Mullins look into this issue more carefully and highlight a few ways to keep elderly loved ones safe.

Bed Handles Inc. is recalling all the adult portable rails that it sold from prior to 2007. Specifically, the company is recalling models BA10W, BA11W and AJ1. All three deaths caused by these handles occurred in assisted living or adult family homes, similar somewhat to nursing homes though with less supervision and nursing care. Two of the women were living in Washington State, and the third was residing in Minnesota.

The handles were sold by home health care stores, medical equipment stores and even drug stores throughout the U.S. from 1994 to 2007. They are L-shaped steel bed handles and can be up to 20 inches tall.

The handles are so dangerous because they can shift away from the mattress, creating a gap that disabled or elderly patients can fall in to and potentially strangle or become trapped. Any facility or private home with these bed handles are urged to stop using them immediately.

Bed handles should only be used when a safety retention strap is also in place, to hold the handle to the bed frame. These straps are about three-feet long and slip under the mattress. In a statement, Bed Handles Inc. said it will be sending customers these safety retention straps along with instructions on how to correctly install them.

Unsafe Nursing Home Beds Cause for Concern


Of all the dangerous aspects of a nursing home, beds and bed handles are likely low on the list of threats for families to consider. We have seen many cases of residents seriously injured by unsafe beds, however. In a recent lawsuit in Illinois, a man in his mid-50s was residing in a nursing home, where his bed was installed with side rails.

After an assessment, the nursing home staff decided to remove the side rails, however staff only removed the horizontal rails, leaving some posts in place. One night, the man tried to get out of his bed, lost his balance and fell backward. One of the posts negligently left in place pierced his rectum, tearing it, which required surgery.

His family filed a lawsuit against the nursing home for failing to properly remove the bed rails, and during interviews employees stated that the only reason they left the remaining posts on the bed was for convenience. Staff agreed that the posts posed an unnecessary hazard to the resident, and the man ultimately received about $125,000 for his injury.

It is now widely asserted that bed rails and handles can cause serious injury and even death in nursing homes, however the risk is still little-known among families. Patients who are particularly frail, or those with Alzheimer's or dementia, are particularly at risk. The good news, is that injuries from bed rails are largely preventable.

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Telephone Tax Scam Targeting Seniors

March 31, 2014

10293765284_87848338cd.jpgAs tax day approaches, criminals posing as IRS agents are taking to the phones to try to scam senior citizens out of their retirement money. Elder law attorneys at Pintas & Mullins detail how the telephone scam works and how to protect your loved ones.

The Fraud Watch Network recently issued a press released outlining this new and wide-spread scam, which has already taken over $1 million from tens of thousands of taxpayers. Scammers call citizens, targeting older individuals, pretending to be IRS agents and demanding tax payments using wire transfers or prepaid debit cards. The fake agents threaten legal action against the person on the phone if they refuse to pay.

The caller is typically listed as 'private' on caller IDs, and some may even know intensely personal information like the last four digits of the victim's social security number. Some even follow-up on the victim with an official-seeming email to convince them that they do indeed owe money to the IRS.

Some of the tax victims were recent immigrants, which scammers took advantage of, threatening to have them deported if they refused to pay. Similar tactics would be used against elderly victims, who may be unaware that the IRS typically communicates with taxpayers through the mail.

How to Protect your Loved One

Remind your aging loved ones that, if they are concerned about any owed back taxes, they should call the IRS themselves, at 1-800-829-1040. Also remind them that the IRS and other government agencies would never require a wire transfer or prepaid debit card payment, and would never threaten someone with deportation or drivers' license suspension like these scammers are currently doing. Government agencies would also never request PIN numbers or banking passwords over the phone.

Many people with elderly parents want to believe their mom or dad is still "all there," or at least competent enough to recognize scams like this. Unfortunately, even the most highly-educated and intelligent seniors are prone to lapses in judgment, especially when victimized by clever criminals.

In some cases, such as with those with advanced dementia, scammers may be able to get large sums of money out of seniors. If you recognize this happening to your elderly loved one, it is possible to obtain Power of Attorney over them to protect their funds and livelihood.

A Power of Attorney is a legal document giving the agent (typically a son or daughter of the elderly person) the right to act on behalf of that person. This can be limited to a specific event, like selling of a house, or during a specific time frame, such as while that person is receiving medical care. It can also be used specifically for medical decision (called a Health Care Power of Attorney) or, in this case, for financial concerns.

It is absolutely necessary, however, that the elderly person has full mental capacity when they sign the Power of Attorney in order for it to be valid. If this is impossible, other alternatives are available, such as going through court proceedings to be named a legal guardian or conservator. Therefore, it is often best to talk to your aging parents while they are still fully understanding about the possibility of becoming their Power of Attorney, should they ever develop a cognitive condition like dementia.

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The Six Worst Nursing Home Facilities in California

March 26, 2014

There are about 1,300 long-term care nursing facilities in California, where over 300,000 residents are cared for. Unfortunately, most nursing homes are run by for-profit corporations, such as HCR ManorCare, which aim to make money by caring for our nation's elderly. Nursing home negligence attorneys at Pintas & Mullins highlight the six worst offenders in the nursing home industry in California.

4083404157_4715434f19.jpg The six companies outlined in this article were featured in by an elder law advocacy group in California, Stop Elder Abuse (Stop EA). This coalition specializes in identifying and exposing the companies with extensive records or harming or neglecting patients. All six nursing home chains are private corporations that knowingly place profits over patients, leaving elderly residents at risk of systemic abuse and neglect.
The six worst nursing home offenders in California are:

1. North American Healthcare (NAHC)
2. Longwood Management
3. Golden LivingCenters (previously Beverly Enterprises)
4. Sava SeniorCare
5. Emeritus
6. Vitas Innovative Hospice Care

Many of these companies operate on a national level, with hundreds of facilities. It is not difficult to see how this type of business model, when applied to compassionate care, can lead to widespread abuse. We will explore each corporation in detail below.

North American HealthCare

This company operates 35 facilities in four states, however none of them use the NAHC name. The U.S. Department of Health and Human Services (HHS) investigated NAHC in 2010 for suspected fraudulent billing, among other allegations. The feds found that 64% of NAHC patients were billed to the highest category of Medicare and Medicaid, which is reserved for only the sickest, most specialized patients (the national average is 9%).

There has also been much contention within the company over employee organization. Arguably, nursing home employees are the most important, critical part of how well residents are cared for. If staff is underappreciated and overworked, they simply will not have the time or resources to properly care for residents. This leads to significant problems in nursing homes, such as sepsis from untreated bedsores, the spread of infections, and overmedicating residents. It is unsurprising to learn, then, that NAHC has been subject to several civil suits over elder abuse and neglect, one of which resulted in a $29 million award to the victim's family.

Longwood Management

Longwood operates over 30 facilities in California, extracting money from each arbitrarily, to pay shareholders. This leaves its facilities unable to address critical patient needs, placing residents in immediate harm.

Golden LivingCenters

This corporation owns over 300 facilities throughout the country, with 20 in California. The company has been federally investigated for making false claims to Medicare and Medicaid and subjecting residents to substandard services that caused great harm. Former employees have said the company is run on fear and intimation, and that they had to beg for new wheelchairs and mattresses.

Golden was recently hit with a class action lawsuit for its failure to disclose the true nature of its business. Plaintiffs claim that Golden did not provide sufficient nursing staff, deceived and misled vulnerable elderly residents into becoming residents.

Sava SeniorCare

Sava ranks among the nation's largest nursing home chains, with 26 facilities in California. It has also been subject to extensive litigation over negligent and abusive resident care. Sava is known for hiring staff that is untrained, unqualified, unlicensed, and ill-equipped to handle the careful care of senior citizens.

Emeritus

Emeritus is the country's largest for-profit assisted living operator, with more than 500 facilities. It is a publically traded company, so the bottom line drives everything. Staffing is always kept to a bare minimum, training is nearly nonexistent, and health and safety codes rarely followed. Unsurprisingly, Emeritus is constantly in the midst of lawsuits from victims of abuse and neglect, but since they rake in about $1 billion in revenue each year, they can afford the litigation. PBS Frontline recently aired a special on their poor practices and million-dollar lawsuit payouts.

Vitas Innovative

Vitas is an end-of-life hospice company, which enjoys about $1 billion in revenue every year. The company was sued by the federal government in 2013 for - what else - improperly billing Medicare and Medicaid. Providing hospice care is an immense and incredibly important responsibility. Knowing that hospice companies are motivated by finances rather than compassionate care is disheartening to say the least.

Vitas encourages staff to admit as many patients as possible, regardless of medical status. The consequences of this practice are far-reaching, but most acutely felt by the elderly residents themselves, who so rarely get the help they need.

Continue reading "The Six Worst Nursing Home Facilities in California" »

How to Treat and Prevent Sepsis in Nursing Home Residents

March 20, 2014

7404292006_dd8e5646d3.jpgSepsis, or serious infection of the blood, is one of the top reasons nursing home residents are sent to hospitals. Septic shock among the elderly results in death about 20% of the time, costing grave emotional and financial harm on families and the health care system overall. Nursing home negligence lawyers at Pintas & Mullins highlight new research that point to better ways to save elderly patients from sepsis.

One of the more prominent studies focuses on patients with septic shock who are treated using a catheter to monitor blood-oxygen levels. This practice is relatively new, and is now widely practiced at hospitals throughout the country. The study, published in the New England Journal of Medicine, examined over 1,300 septic shock patients at more than 30 different hospitals. Researchers found that the catheter treatment did not improve patient outcomes any more than older and simpler therapies.

The newer treatment, called early goal-directed therapy (EGDT), is more expensive and can cause more health problems than older treatments. These new findings suggest that elderly patients are being treated using a needlessly riskier therapy, which does not improve survival rates over other treatments. This is an immense problem, particularly when considering that this treatment is being used on one of our nation's most vulnerable population.

Sepsis in Nursing Homes

Among the elderly, sepsis is most often caused by untreated bedsores, or pressure ulcers. Bedsores occur from remaining in one position for long periods of time, such as in a bed-ridden or wheelchair-restrained resident. The prolonged pressure on that area, commonly the backside, results in injureis to the skin and underlying tissue.

Bedsores often develop quickly, particularly among the elderly whose skin is already fragile, and can be difficult to treat. If a nursing home resident suffers from any mobility issues, the risk of bedsores should be noted on their care plan. Furthermore, if staff fails to recognize, diagnose, treat and adequately monitor bedsores, it could lead to sepsis infection, and ultimately septic shock.

Hundreds of thousands of Americans die from septic shock in the U.S. every year. In addition to untreated bedsores, sepsis can also occur from post-surgery infections, pneumonia, and urinary-tract infections.

EGDT uses a catheter in the jugular (neck) vein to diagnose low blood oxygen. To raise oxygen levels, doctors then start a red blood cell transfusion and sometimes drugs are prescribed. The practice was created by an American doctor in 2001, and by 2008 experts started questioning how rigorously he analyzed the risks and benefits.

More traditional septic shock therapies involve less aggressive instructions than EGDT, but similar methods such as IV fluids and antibiotics. Catheters are not required, and red blood cell transfusions are only recommended if hemoglobin levels drop below a certain point.

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The Elderly in the ER

March 18, 2014

6336510146_e76da8e697.jpgOur team of nursing home negligence lawyers recently wrote on the alarmingly high rate of elder injury from medical care (one third of nursing home residents are injured by medical errors). Unfortunately, nursing home residents are often admitted to the emergency rooms, where the staff knows next-to-nothing about the person they are taking care of. Here we have outlined a few ways those in the industry are trying to fix this.

Dr. Pauline Chen recently wrote a blog for the New York Times on the subject, asking whether emergency rooms are at all safe for the elderly. In her piece, Dr. Chen recounts the story of an elderly man she once treated in the ER for a serious infection. The man lived alone, was overwhelmed by the information given to him in the ER, and none of the staff had been trained in coordinating the complex care elderly patients often require.

Finally, unsure how to proceed, an older nurse suggested they just admit the man to the hospital. It would cost more, and was likely unnecessary, but it was the only way they could ensure he received proper care. This case is far from uncommon, and the number of older Americans who need immediate or complex health care is expected to increase substantially over the next few decades.

Because our healthcare system is already short of primary care and geriatric caregivers, many elderly people will wind up in the ER for things like infections or falls. Emergency rooms themselves, however, are usually overwhelmed by patients and doctors and nurses are required to get through patients as quickly as possible.

With elderly patients, particularly those with dementia or other cognitive conditions, working quickly is not only dangerous but nearly impossible. Many nursing home residents suffer from numerous physical and cognitive ailments, take several different types of drugs (which are difficult to remember), and have trouble remembering other important details.

Medical experts recognize this danger and are taking measures to improve it. Among their calls for action, these specialists assert that medical centers need to update their facilities to meet the needs of elderly patients. More specifically, they recommend that hospitals:

• Hire or train staff on caring for older patients
• Screen for dementia
• Install non-slip flooring
• Train staff on social factors elderly patients may require, such as transportation
• Have walkers, canes and other medical equipment on-hand
• Assistance with prescriptions

Is Telemedicine the Answer?

Others suggest that nursing homes start using telemedicine systems, which would let residents see a doctor through video conference. If a resident gets sick or injured, outside physicians can use video chat to see and speak to them. In a recent study on these types of systems in nursing homes, facilities that regularly used the service sent fewer residents to the hospital. That study, published in Health Affairs, can be found here.

However, simply making this type of service available in nursing homes does not guarantee that staff will properly use it. There is widespread issues inherent in the American nursing home industry, most poignantly how overworked the understaffed these facilities truly are.

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One-in-Three Nursing Home Residents Injured During Treatment

March 4, 2014

senior-using-a-walker_l.jpgMedicare recently published a troubling study that found that one third of nursing home residents are injured during the course of their treatment through medical errors. Researchers also found that nearly 60% of these errors were preventable, and over half of injured residents had to be hospitalized. Nursing home abuse lawyers at Pintas & Mullins find these statistics disheartening, and offer analysis into the problem.

Among the medical errors described in the report include medication mistakes, new or spread infections, inadequate monitoring, and delay or failure to provide adequate care. Unfortunately, about 22% of patients suffered lasting harm from the errors, and 1.5% died even though they were expected to survive treatment.

The study centered on more than 650 patients who were treated in nursing homes about one month after being discharged from hospitals. About half of those patients had to be readmitted to the hospital after suffering substandard care in nursing homes, costing the healthcare system $208 million in just one month.

Most of the deaths resulted from excessive bleeding (from blood-thinning medications like Pradaxa, for which there is no mechanism to stop a bleed-out), kidney failure, fluid imbalances, and preventable blood clots. One patient specifically suffered a collapsed lung because nursing home staff failed to recognize the symptoms.

From their data researchers estimated that about 22,000 nursing home residents are injured each month from substandard nursing home care - and another 1,500 pass away. Federal researchers also noted that improvements are entirely possible, particularly calling on the Centers for Medicare and Medicaid Services (CMS) to aggressively promote patient safety in nursing homes.

What is Being Done to Fix It?

Similar strategies are already in place, however they focus almost exclusively on care in hospitals. CMS should also focus on instructing state inspectors to review and identify programs for reducing medical mistakes in nursing homes. State CMS agents inspect each nursing home that admits Medicare or Medicaid patients once a year (more so if the nursing home fails previous inspections).

Data from these inspections are made public, and ProPublica recently complied much of this information to create a Nursing Home Inspect database. All nursing homes in the U.S. are required to establish a Quality Assurance and Performance Improvement program.

It is important to note that the majority of medical errors in nursing homes are not caused by outright or malicious abuse or negligence. The majority of American nursing homes are run by for-profit companies, and, like any other private corporation, executives are primarily concerned with profits and pleasing investors. Unfortunately, this comes at a price, causing severely understaffed nursing homes.

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Improving Balance among Nursing Home Residents

February 25, 2014

2241137990_01ed72bed4.jpgResidents of nursing homes face an array of physical struggles, not least of which deteriorating balance, which can lead to serious and debilitating injuries if left unmanaged. With advancing age, it is imperative that senior citizens continue to care for themselves and their physical wellbeing with help from family, friends, and nursing home staff. Elder law attorneys at Pintas & Mullins highlight a few ways to help keep residents on their feet and out of harm's way.

Unfortunately, falls are frequent in nursing homes and thousands of senior citizens pass away prematurely every year due to fall-related injuries. Even when falls do not cause fatal injuries, they often result in broken bones, severe cuts, and other debilitating health problems. Balance is a tricky attribute - you never really notice it until it starts to wane. Some early warnings signs of decreasing stability include relying on handrails to use stairs or having to sit down to take shoes on and off.

According to the Center for Disease Control and Prevention (CDC), the most common causes of falls in nursing homes are:

• Muscle weakness or walking and gait problems
• Incorrect use of walking aides or poorly fitting shoes
• Wet floors, poor lighting, inadequate wheelchairs or incorrect bed height
• Medications that affect the central nervous system

If a fall is caused by incorrect or wrongful medication or environmental hazards, a nursing home negligence lawsuit may be filed against the facility. Too often, seniors suffer serious injuries from falls that could have been easily prevented if nursing home staff properly maintained common areas. Fall prevention is an extremely important part of staff's responsibilities.

When a resident is first admitted to a nursing home, a care plan should be immediately drafted that addresses the unique needs of each resident. The risk of falls should always be included in this care plan, along with specific preventative measures and individual risk factors. If a care plan like this is not drafted, and your loved one suffers a serious fall, legal action should be immediately taken to prevent future injury.

It may be necessary to make some minor changes in a nursing home if your loved one is particularly at risk for falls. Interventions can include lowering the height of a bed, installing grab bars or handrails, and putting gin raised toilet seats. Residents may also be equipped with hip pads or vitamin D supplements.

It is important to note that using physical or chemical (i.e. pharmaceutical) restraints to reduce falls is considered abuse. Limiting a person's physical and mental freedom is not only morally wrong, but illegal as well, as it constitutes elder abuse.

Tips for Stability

Experts suggest doing stability exercises in five- to ten-minute intervals every day. If possible, residents can try walking on several different types of surfaces (such as pavement and grass) to make muscles work more. Residents with good mobility can try standing on top of a few pillows and try balancing on one leg while swinging the other back and forth (if this is too challenging, try sitting on the pillows with legs outstretched and shift body weight side to side). Once you master this, try closing your eyes while repeating the exercises.

To strengthen the hips, physical therapists recommend holding onto a counter or similar surface while standing on one leg and lifting the other leg up to the front, side, back, and to the front again with your knee bent. This works all four hip muscles. Even exercises such as getting up from a chair a few times in a row can help, and be much less strenuous for the less agile.

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Nursing Home Residents At Higher Risk of Online Hackers

February 18, 2014

cyber-attack-economic-pearl-harbor-will-strike-wednesday-13-mar-2013-item-2-rules-of-cyberwar-set-out-for-first-time-in-nato-manual-95-black-letter-rules-8-52am-gmt-19-mar-2013_l.jpgBillions of dollars are stolen from the American elderly every year, and nursing home residents are at particularly high risk. In the wake of so many online data breaches, many are wondering who is most at risk of such attacks and how to be better protected. Nursing home negligence lawyers at Pintas & Mullins highlight just how vulnerable nursing home residents are for cyber hacks.

A recent article in the Wall Street Journal details a group of computer-security researchers who discovered sensitive nursing home documents that could be easily accessed by hackers. The cybersecurity researchers discovered this by mining a website commonly used by hackers.

The site, 4shared.com, includes a network of electronic medical records and healthcare payment data from. Several specific nursing homes were identified in the article, all of which are located in New York. 4shared.com is a file-sharing site facilities can use when acquiring new software or transferring records to a new system.

One of the nursing homes with data on the site told the WSJ that the documents were from 2007, when the facility installed new medical-records software. A spokesperson for the nursing home stated that it had no idea its information was online and it had not been contacted regarding any type of data breach.

Another nursing home with information on the site stated that it was contacted about a security breach in 2012, and quickly switched security providers. Among the data on the website included wireless access points inside residents' rooms, blueprints of facilities, and encryption keys, usernames and passwords for whole nursing home networks.

How At-Risk are American Nursing Homes?

It is getting increasingly difficult to keep healthcare records secure due to the prevalence of online medical records and billing systems. Many types of medical equipment use the internet to service and update software.

If a cyber-hacker is able to access an administrator's passwords, they can gain also access the network of healthcare records and install software to capture medical record passwords. Information from about 375 American healthcare facilities is currently on 2shared.com, including hospitals, pharmaceutical companies, doctors' offices, and health plan managers.

Experts assert that the security plans at many healthcare facilities are inadequate and largely unable to keep up with the number of attacks occurring throughout the country. Cybersecurity is a relatively new field that needs more attention and commitment to advancement.

Recent federal mandates require that medical data privacy be strictly controlled because they know healthcare records are extraordinarily sensitive. According to the WSJ article stolen medical records typically sell for about $60 apiece. Credit cards go for around $20. Healthcare records are more valuable because more fraud can be committed with that information, like messing with Medicare and prescription accounts.

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