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.

Continue reading "Telephone Tax Scam Targeting Seniors " »

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.

Continue reading "How to Treat and Prevent Sepsis in Nursing Home Residents " »

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.

Continue reading "The Elderly in the ER" »

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.

Continue reading "One-in-Three Nursing Home Residents Injured During Treatment" »

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.

Continue reading "Improving Balance among Nursing Home Residents " »

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.

Continue reading "Nursing Home Residents At Higher Risk of Online Hackers " »

Sex Offenders Living in Nursing Homes

February 10, 2014

6641384271_0fe701d48a.jpgIt's the last thing we want to think about when considering loved ones in nursing homes. The possibility that your elderly relative could be living among a convicted sex offender is disheartening and extremely frightening, but it does happen, all across the U.S. In order to prevent an attack or assault, the nursing home negligence attorneys at Pintas & Mullins highlight a few tips for families concerned about their loved ones safety.

Regulation of nursing homes in the U.S. varies from state to state. In Ohio, for example, there is a legislative loophole that does not require residents of nursing homes to be notified if or when a convicted sex offender gains admission as a resident. Current Ohio law requires only that sex offenders notify their neighbors when they move into a new neighborhood, however this does not apply if the offender is moving into the same address as other people.

Experts assert that 75% of sexual crimes against older adults (65+) occur in nursing homes. The news stories proliferate throughout the country - elderly women, more often than not ridden with dementia or Alzheimer's, being harassed or assaulted at the hands of other residents, and suffering dire consequences as a result. Due to their cognitive conditions, these victims may then be unable to sufficiently recount the incident to nursing home staff, police or family members, so the cycle of abuse continues.

Sexual offenders and criminals of all kind prey on people they believe to be most vulnerable, and the elderly living in nursing homes are among our nation's most vulnerable population.

How to Help

It is critical that nursing home staff be aware if or when a convicted sexual offender enters a nursing home, whether as a visitor, employee or resident. Nursing aides typically spend the most time with residents helping with everyday activities. If staff, and particularly nursing aides, were made aware of the presence of a sex offender, they could take the necessary steps to prevent and incidents from occurring. This does not have to be any type of major intervention, but could be very subtle, like merely keeping a closer eye on the dangerous resident.

Families of loved ones can help by contacting state and local governments to change or draft laws that would require such notification. In Ohio, Representative Tom Letson is now co-sponsoring a bill that would amend current laws and fix the above-mentioned loophole. The new bill would allow residents of long-term care facilities to be notified when sex offenders are admitted.

Despite the critical nature of their care, nursing homes are not always known to fully and willingly comply with the law. Recently in Calgary, Canada, for example, an investigation found that a nursing home failed to inform authorities after several residents were sexually assaulted, even though such notification is required by law.

In this case, one of the male residents repeatedly assaulted women residing in the McKenzie Towne Care Centre's dementia unit. Reports indicate that management had been aware of the ongoing abuse since June 2005 and allowed it to escalate over the proceeding six months. Eventually, only after the son of a victim saw the abuse first-hand, complaints were made to the Canadian government.

Continue reading "Sex Offenders Living in Nursing Homes " »

California Nursing Home Fined after Resident Suicide

December 5, 2013

2296138797_d77a1198c9.jpgInadequate care in American nursing homes is a widespread problem, with often dire consequences. One recent case in California highlights the issue of suicide in long term care settings, which fortunately is not a common problem, though the statistics are not decreasing. Nursing home negligence lawyers at Pintas & Mullins bring this case to light to discuss the taboo subject of suicide among the elderly.

According to Geriatric Medicine and Medical Direction, the prevalence of depression in nursing homes is between 12% and 50%, depending on varying definitions. Many who actually work in the industry, however, tend to estimate the rates much higher, due to the nature of long term care facilities themselves. Residents are generally inactive, suffer from wide ranges of cognitive and physical ailments, lack personal autonomy, and are constantly confronted with sickness and death.

The case we would like to discuss, Del Rosa Villa v. Kathleen Sebelius, centers on a suicide that occurred in 2009. In May of that year, the resident jumped in front of a car in a suicide attempt and broke his leg. He was brought to a local hospital, where he was voluntarily committed to a psychiatric ward. Hospital physicians noted that he had intermittent thoughts of suicide, that his actions were unpredictable, and he posed a risk to himself if discharged.

A few weeks later, he was discharged to the Del Rosa Villa nursing facility where a nurse recommended he be placed on 24-hour suicide watch. Physicians noted he was experiencing hallucinations and delusions, writing that he be on suicide watch at all times. In June 2009, the resident was prescribed Ativan, a sedative that can actually increase the risk of suicidal thoughts.

In fact, according to Ativan's labels, "older adults may be more sensitive to side effects, and the elderly may not experience relief of anxiety, it may have the opposite effect." Despite these clear warnings, his dosage was increased several times. Then, during a late night in mid-June, after another dosage increase, the resident walked outside through the laundry room, telling the nursing staff he was going to have a cigarette. Just before 1 a.m., he was found hanging on the parking lot fence by his belt, and died soon after.

Medicare and Medicaid investigated and fined Del Rosa $10,000 for failing to supervise the high-risk resident. Del Rosa appealed, however the appeals court confirmed that it was reasonably foreseeable that the resident would harm himself if he was allowed to leave the facility unattended.

Advice for Families

Unfortunately, suicide rates are high among the elderly. If any dangerous thoughts are expressed or suspected, it is critical that nursing home staff create an emergency care plan for that resident and strictly adhere to that plan. This can include anything from 15-minute checks to more frequent physician sessions (physicians must always be informed of resident's depression assessments). If a care plan is explicitly established, and the nursing home staff fails to adequately follow it, any harm inflicted upon the resident can be grounds for a lawsuit.

The following are items that are most cited as reason for liability in suicide lawsuits against nursing homes:

1. The facility failed to adequately asses resident's mental health upon admission
2. Staff failed to advise the resident's physician of any changes in their mental health
3. Staff failed to monitor a resident prescribed to anti-depressants or psychotropic medications

Continue reading "California Nursing Home Fined after Resident Suicide " »

Advice for Sharing Holidays with Aging Loved Ones and Challenging Families

December 2, 2013

Thumbnail image for 4083396423_684c9fa9b1.jpgThis holiday season, there is much to be grateful for, particularly for those with elderly loved ones. Every family has its own challenges, however, and the elder law attorneys at Pintas & Mullins want to highlight a few useful tips for those sharing the holidays with aging relatives and perhaps difficult family members.

This issue can be especially stressful if elderly relatives are diagnosed with Alzheimer's or any other cognitive condition. Trying to communicate and celebrate with someone living with dementia can be difficult and often frustrating, as the disease erodes communication skills, sometimes making them irritable or unpleasant. It helps to have a pre-conceived strategy when dealing with these types of events.

Tips for Effective Communication

The Mayo Clinic is one of the most trusted and esteemed medical centers in the country and is a great resource for Alzheimer's advice. According to its website, those with dementia often have difficulty deciphering words due to the destruction of brain pathways, resulting in frequent misunderstandings. Those diagnosed with Alzheimer's may also struggle to organize thoughts, curse or use offensive language, lose their train of thought, repeat words or phrases over and over, or need more time to process what is being said.

Although this may be challenging to deal with, your loved one does want to communicate with you. Families can help this process by following a few tips:

• Don't interrupt, criticize, hurry, or correct them
• Avoid distractions, such as televisions or other sounds
• Show respect, avoiding "baby talk" or other demeaning phrases, and talking as if they weren't there
• Stay calm, even when frustrated, and keep your tone of voice gentle
• Keep your sentences and words simple - yes/no questions may work best, and break down requests into easy steps
• Speak as clearly and straightforwardly as possible
• Don't argue - their reason and judgment will decline over time
• Stay present, maintaining eye contact
• Use visual cues, such as gestures to promote better understanding

Holiday-Specific Tips for Managing Family Time

Continue reading "Advice for Sharing Holidays with Aging Loved Ones and Challenging Families " »

The Choice Between Hiring a Home-Care Aide and Placing your Loved one in a Nursing Home

November 21, 2013

Thumbnail image for helping-grandmother-walk_l.jpgAs the baby boomers age, more and more families have to face the difficult but necessary decision of how to care for their elderly loved ones. Home health care aides are the fastest growing occupation in the country, estimated to increase by 70% by 2020, according to data by the U.S. Department of Labor. Elder abuse lawyers at Pintas & Mullins understand how trying this time can be for the whole family, and offer a brief outline of the benefits and disadvantages of each side.

Personal care aides, often referred to as PCAs, receive no benefits or regular hours, and often make less than $10 an hour. So why is it the nation's fastest-growing occupation? The younger generation can see that the population is aging, and many of them, lacking in education or socioeconomic ability, recognize this as an opportunity. Additionally, Medicaid and other governmental agencies are asserting efforts to keep senior citizens out of nursing homes as much as possible.

Caregivers provide an array of services to allow the disabled and elderly to remain in their homes. This can include anything from daily chores and feeding to companionship and emotional comfort. They can either be self-employed, as independent contractors, or employed through a home-care company, such as HCR ManorCare. An estimated 90% of PCAs are women, and many earn so little that they have to rely on some type of government assistance, such as food stamps or social services.

Citing an article by Bloomberg, about half of PCAs in Vermont are paid by Medicaid, the federal program for the disabled and poor. The other half are paid via Medicare, private funds, or other health insurance programs. PCAs, whether independently contracted or employed through a healthcare agency, do pose their own risks to the elderly and disabled. Like any other service dependent on the goodwill of others, there is potential for significant abuse of power. When that abuse is against an elderly person, the results can be devastating.

In-Home Care vs. Skilled Nursing Facility

Nursing homes, such as the previously-mentioned HCR ManorCare, provide in-home assistance as well as chains of skilled nursing facilities. When large, for-profit corporations are responsible for thousands of nursing home residents in hundreds of different nursing homes throughout the country, the potential for wide-spread patient neglect is ominous. At nursing homes run by large chains, corporate executives are making the decisions for on-the-ground needs, which they are not attuned to or even, in most cases aware of.

Continue reading "The Choice Between Hiring a Home-Care Aide and Placing your Loved one in a Nursing Home" »

$48 Million Settlement in Nursing Home Fraud Whistleblower Case

November 20, 2013

Thumbnail image for 4083390539_c89107bf37.jpgMost nursing homes throughout the U.S. accept residents who use Medicare and Medicaid as their health insurance provider. These programs enable nursing home administrators to bill the federal government for therapy sessions, medications and other required health care services so they can be reimbursed. Unfortunately, this system is often abused by nursing homes lacking in funding or merely seeking an increase in profits.

A nursing home in Mission Viejo was recently busted for fraudulently billing Medicare for therapy sessions at its facility that either never took place or were medically unnecessary. The federal government takes these cases very seriously, and prosecuted the nursing home for its fraud, resulting in a $48 million settlement. The operator, Ensign Group, owns nursing homes along the West Coast and as far East as Iowa, as well as providing in-home care to seniors.

Between 1999 and 2011, Ensign systematically inflated the prices of its services when billing Medicare, even submitting claims for therapy sessions that were never provided. This occurred at at least six facilities, which billed for unnecessary speech, occupational, and physical therapy services, and even incentivized employees to increase the amount of sessions regardless of patient need. The six facilities are: Victoria Care Center in Ventura, Southland in Norwalk, Sea Cliff Healthcare Center in Huntington Beach, Orchard Post Acture Care in Whittier, Panorama Gardens in Panorama City, and Atlantic Memorial Healthcare Center in Long Beach.

What to do if You Suspect Fraud

This lawsuit was triggered by two whistleblowers, former employees of Ensign, who filed a complaint with the U.S. attorney's office about the fraud. Medicare and Medicaid payments to nursing homes are meant to provide residents with a safe and sanitary living environment, medical care, daily assistance, and nutritious meals. If a nursing home bills for any of these services but does not adequately provide them, fraud is being committed.

Under qui tam law, employees who suspect fraud are able to file claims with the federal government, which will then launch a thorough investigation. If there is indeed fraud being committed, a lawsuit will ensue and the whistleblowers are entitled to receive a portion of the verdict or settlement (often between 15 and 30%). It is not yet clear how much the Ensign employees will receive, although it will be anywhere between $7.2 and $14.4 million.

Fraud can be committed in a variety of situations, such as billing Medicare for a brand-name drug when really a generic is administered, or using cheap medical equipment while billing for more expensive devices. Certain signs can indicate fraud is being committed in a nursing home even if you do not know for sure. These signs include residents that are dehydrated or malnourished, unsanitary living conditions, broken-down medical equipment, and insufficient heat or air conditioning. It is important for nursing home employees and families of residents to know and be able to recognize signs of fraud, as it often leads to dangerous neglect and abuse of residents.

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When Nursing Home Residents Attack other Residents

November 11, 2013

senior-citizens-find-that-new-ulm-minnesota-is-a-good-place-to-retire-10-1974_l.jpgNursing home negligence can take many forms, from blatant disregard for safety and health precautions to accidental consequences of understaffing. Regardless of corporate ownership or economic status, however, all nursing homes have the legal duty to protect their residents from harm.

Unfortunately, sometimes aggressive residents pose risks to other, more vulnerable residents. Elder abuse lawyers at Pintas & Mullins have seen first-hand how dire this risk can be, and would like to highlight ways to recognize when another resident poses a threat.

Know Your Rights

When a nursing home resident is harmed by a fellow resident, the facility, its employees or parent company can be held liable for their injuries. Nursing homes are obligated to protect their residents from all types of injury: from falls and wandering episodes to overmedication and physical threats by others.

Residents have an array of rights and protections under state and federal law, which they should receive in writing upon admission to the nursing home. Among these rights include the right to be free from physical, mental and emotional abuse. If another resident is known to be aggressive and act in violent manners, it is the facility's responsibility to keep that person away from other residents.

Conversely, aggressiveness and irritability are normal symptoms of dementia, Alzheimer's and other severe cognitive disorders, and oftentimes elderly residents do not realize they pose a safety threat to others. These residents have the same rights as everyone else in the facility, and must never be restrained with medications or physical straps. In cases where restraint is not necessary to treat medical symptoms, elderly residents may not be administered drugs to subdue them or "correct" unruly behavior. This is considered abuse.

A National Problem

Recently in Virginia, a female resident was attacked by another resident at Province Place of DePaul. According to the lawsuit filed against the facility, Province not only failed to protect the elderly resident from harm but attempted to cover up the incident as well. The victim, an 81-year-old woman with dementia, lived in the special care unit with the man who allegedly attacked her.

The man, who was known to be aggressive and who had attacked the woman once before, lived in a room near the woman's and she would routinely pass by his room on walks around the facility. The man believed the woman had entered his room without permission, and one day attacked her, leaving her face swollen, bruised and bleeding from various wounds.

The facility notified her family of the incident, and when they arrived 20 minutes later found their loved one alone, bleeding and without assistance. They immediately took her to the emergency room, and the man was later discharged from the facility. The victim's family claims that Province staff knew the woman routinely walked by the man's room, which presented a foreseeable risk to her safety.

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How Nursing Homes Should Manage Psychological Issues

November 8, 2013

4083396423_684c9fa9b1.jpgDeciding to enter a nursing home can be one of the most difficult of a person's life, and making this decision when the elderly person has psychological ailments renders that decision even more trying. Patients with histories of mental illness, even conditions as common as anxiety or depression, are more likely to be identified as a suicide risk. Our team of nursing home negligence lawyers wants to highlight the responsibilities nursing homes have to higher-risk patients, and how their psychological issues should be addressed.

Abuse and particularly neglect in nursing homes can be difficult to articulate and recognize for families. Oftentimes, neglect is the result of nothing more than understaffing and inadequate resources. For residents with psychological issues, however, employees may be tempted to medicate residents with drugs they are not prescribed to in order to subdue unruly behavior.

Depression is a Common, Chronic Problem among the Elderly

One recent study examined the prevalence, persistence and incidence of depression in nursing home residents and what risks the condition carries. Researchers took a sample of over 900 randomly-selected nursing home residents and assessed them for clinical depression, dementia, physical health and self-maintenance.

After one year of study, researchers noticed that rates of depression were tied with higher age, worsening physical conditions, not participating in daily activities, and severity of dementia. The prevalence of depression among the 900 residents was just over 21% during initial study, and after follow-up the persistence rate was nearly 45%.

Residents were more likely to be depressed if they were unmarried, had recently been admitted to the nursing home, or used antidepressants or anxiolytics (a drug to prevent anxiety, such as Xanax or Valium). The other factor most strongly associated with incidence and persistence of depression was severe dementia, as stated earlier.

How this can Affect Your Elderly Loved One

Some suggest that depression and other psychological symptoms can help predict falls among nursing home residents. One group of researches sought to test this theory and examined over 1,000 nursing home residents, tracking their use of medication, education, demographic data, dementia severity, and physical self-maintenance, among other factors.

About 40% of participants reported experiencing at least one fall over the 12-month study period, and analysis revealed that the factors most associated with fall rates were low level of education, severe dementia, severe psychological and behavioral symptoms, depression, and use of sedatives. Having psychological issues was one of the most significant indicators of fall risk.

Falls in nursing homes cause devastating, even fatal injuries, particularly when they occur frequently. Because of this, studies that identify the predictors and contributing factors of falls are extremely valuable both to the healthcare community and individuals with loved ones in nursing homes. If you know your elderly loved one is depressed, has dementia, or is taking any medications for psychological issues, you should notify the nursing home so they are aware of their heightened fall risk.

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Family of Nursing Home Resident Successfully Sue Corporate Company for Negligence

November 5, 2013

8101571228_651036a698.jpgThere are over 16,000 nursing homes in the United States, and like many other industries, the majority of these facilities are owned by large corporations. Nursing home negligence attorneys at Pintas & Mullins have been working with victims of elder mistreatment for two decades, and routinely face the sad reality of these corporations: in effort to increase profits, these companies systemically understaff nursing homes, placing patients at risk of abuse and neglect.

One recent case brought before the Pennsylvania Supreme Court, Scampone v. Highland Park Care Center, allowed plaintiffs to hold the corporate owner of Highland liable for injuries caused to a patient. This decision was highly anticipated, as it was the first regarding the cause of negligence in a nursing home case in 15 years.

The issue of corporate negligence was first taken up over two decades ago in the case Thompson v. Nason Hospital, which involved a woman who received care after a car accident and, as a result of malpractice, developed neurological problems. Plaintiffs successfully argued that the hospital should be held liable for the negligence of its staff as well as for its own negligent corporate actions.

Similarly, Pennsylvania justices unanimously ruled in Scampone that Highland Park and its corporate owner, Grane Healthcare, were liable for the patient's injuries. During trial, the patient's family presented substantial evidence that Highland was understaffed, failed to notify doctors and family members of her medical status, and failure to follow physician orders. As its management company, Grane was responsible for training staff, managed inventory supplies, and kept track of the books.

Understaffing Just the Tip of the Iceberg

The pursuit of profits by corporations like Grane Healthcare has resulted in an epidemic of understaffing in American nursing homes, and it is a problem that has far-reaching, catastrophic implications. The patient at Highland, Madeline Scampone, resided there six years before her death, during which time she suffered urinary tract infections, dehydration, pressure ulcers, a heart attack and malnutrition.

Former Highland employees testified that the facility was chronically understaffed and lacked the resources to properly care for residents. They stated that they repeatedly informed management at both Highland and Grane about the insufficient staffing and care, however, nothing was done.

Since the harm suffered by Scampone was the direct result of corporate choices - namely, failing to hire adequate staff and oversee medical care - Grane was susceptible to vicarious and direct negligence claims. This was an important ruling for several reasons; most importantly, the court clarified that Grane was responsible for providing Scampone with sufficient care separate from that of Highland. The focus on duty highlighted the responsibility healthcare corporations have to their patients - that anyone who provides services to another is liable for any harm suffered when reasonable care is not exercised.

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