Articles Posted in nursing home negligence

Last year, Florida reduced the budget for its Medicaid fraud-busting unit, meaning it also missed out on millions in matching federal funds for the program.

Our Wilton Manors nursing home abuse attorneys know that these kind of services are vitally important in helping to reduce harm to nursing home residents, who otherwise risk being subjected to treatments, therapies and medication that they don’t need.

We’ve reported extensively in our South Florida Nursing Home Abuse Lawyers’ Blog about the dangers of imposing such unnecessary treatment on elderly patients. Cases across the country have resulted in fatalities.

The state’s Medicaid Fraud Control Unit is the agency in charge of investigating claims in which health care providers charge for services that aren’t necessary, or in some cases, aren’t even rendered.

A report issued by the Agency for Health Care Administration and the Florida Attorney General’s Office indicated that more than $630,000 was trimmed from the unit’s budget. That meant that it lost matching federal funds totaling nearly $2 million over the last fiscal year, according to the Palm Beach Post. In fact, the federal government provides the majority of the unit’s $16 million funding.

Of course, the attorney general’s office contends that this has had little to no impact on the reduction of fraud. However, we question that assertion when considering the following:
–There has been a nearly 10 percent reduction in the number of new cases opened;
–A 15 percent decrease has been reported in prosecution referrals;
–The Medicaid Program Integrity audits recovered 22 percent less this past fiscal year than the year before;
–There was a nearly 25 percent drop in the number of arrest warrants relating to Medicaid fraud.

The agency has about 240 workers, with 15 of those in West Palm Beach. However, 23 positions have remained unfilled as the state grapples with its deficit.

Even in difficult economic times, though, anti-fraud unit cuts seem to make little sense. That’s because it’s one of the few state programs that actually generates more money than it costs to provide. Last year, the program generated $23 million in revenue, an increase from the $17 million it raked in the year before.

Nationwide, the federal government has been able to recover more than $4 billion as a result of its Medicaid fraud efforts – in large part due to the bolstering of the False Claims Act, which allows the government to collect triple the amount a company fraudulently obtained. (If a whistleblower is involved, he or she will likely get a portion of those revenues in a type of civil case called qui tam.)

So while Florida was reducing its Medicaid fraud-fighting resources, the federal government was actually increasing its own – and making money off of it.

One case that illustrates why these efforts are so important was one that the FBI investigated last spring in Georgia. The owner/operator of a nursing home facility just outside of Atlanta reportedly neglected patients for years. They weren’t given enough food. They were denied heat and air condition. Barrels and plastic sheets were spread out to catch the rain water from leaking roofs. Trash was overflowing. Nurses and other staff were scarce. Insects, rodents, mildew and mold had taken over. And yet, the owner was receiving Medicaid payments in exchange for providing those individuals with a safe, clean home with proper meals and adequate medical care.

A complaint ultimately sparked an investigation that led to his and his wife’s arrests and subsequent convictions on federal charges of Medicaid fraud.

We understand budgets need to be reduced, but these are not the kind of services we can afford to cut.
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A new investigative report by Bloomberg News lifted the veil on a startling pattern of nursing home abuse and fraud by for-profit care centers.

Our Davie nursing home abuse attorneys understand that of the $1.5 billion that the nursing home industry overcharges for Medicare, as reported by federal health care inspectors late last year, for-profit nursing homes are primarily to blame. Bloomberg reports that for-profit nursing homes were found on average to overcharge on 30 percent of their Medicare costs, versus the 12 percent found by non-profit nursing homes.

We’re talking about a nearly $3 trillion industry in the U.S., where nearly 80 percent of the revenues are being funneled to for-profit nursing homes, up from 72 percent a decade ago.

The journalists claim that for-profit nursing homes have perpetuated an enormous amount of waste and patient harm, backing their stance by citing at least six academic and government studies conducted over the last three years.

Researchers at the School of Law at the University of California say for-profit centers are far more likely to push the legal envelope in order to boost their bottom line.

In fact, with the rise in for-profit nursing homes over the last five years, we’ve also seen an enormous boost in civil and criminal cases against nursing homes and those employed by them. Between 2008 and 2012, federal prosecutors brought 120 criminal and civil cases relating to nursing home abuse, neglect and fraud. That’s more than double what it was in the five years prior.

Among the recent criminal cases cited by the reporters was that of an 80-year-old female patient of a South Carolina nursing home. She was unable to keep her eyes open or control her head. And yet, as part of “physical and occupational therapy,” she was put in a standing frame for nearly two hours. She died two days later. Federal prosecutors pressed charges against the facility for unnecessary care and overcharges.

Then there was the large nursing home system operating several sites in a single county in California, where at least six patients died over the course of seven years as a direct result of neglect. According to court records, the patients were reportedly left in soiled clothing for hours unattended, were refused baths and meals and suffered from widespread malnutrition and infection. Prosecutors say these actions were specifically taken to avoid spending money. A class action trial resulted in a lump sum settlement, though the terms of that agreement weren’t publicly released. The agency never admitted wrongdoing.

And these are not isolated incidents. Consider that the 10 biggest for-profit nursing home chains employed, on average, about 40 percent fewer registered nurses per patient between 2003 and 2008. It’s no surprise, then, that these facilities received an average of nearly 60 percent more deficiency notices from state and federal inspectors than non-profit facilities. (That’s according to a study published in 2011 by the Health Services Research journal.)
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The New York Times recently took aim at a problem our Hollywood nursing home abuse attorneys have been aware of for some time: the dangers of side railings on beds for the elderly.

Back in the fall of 2006, a woman in her 80s had just begun to suffer the effects of dementia. Her family moved her into an assisted living facility, one that could provide 24-7 care for the ailing wife and mother, who had wandered off several times. Five months later, she was dead. Her official cause of death was strangulation. Her neck had gotten caught in the side rails that were in place to prevent her from rolling out of bed.

Since then, the woman’s daughter has been on a campaign to raise awareness about the deadly nature of these rails. Astoundingly, both the Consumer Product Safety Commission and the U.S. Food and Drug Administration knew for more than 10 years about the high number of nursing home deaths due to bed rails – but they’ve done little to combat the problem.

Two years ago, she finally drafted a letter of her own to the safety commission, prompting a review of bed rail deaths. The results of that study have just been released.

The data, culled from death certificates and information from hospital emergency rooms from 2003 through May 2012, indicates that more than 150 elderly adults died after becoming trapped in bed rails. During that same time frame, 36,000 adults, mostly older, were treated in hospital emergency rooms for bed rail injuries. That breaks down to roughly 4,000 incidents a year.

It’s worth noting that these figures are most likely understated. Bed rails aren’t always listed as the cause of death by medical examiners and nursing home administrators (the latter of whom are obviously interested in insulating themselves from liability).

Those who have studied these incidents say these incidents, and the deaths in particular, are avoidable. The FDA issued safety warnings about adult bed railings way back in 1995, but it stopped short of requiring makers of these devices to put warning labels on them. Why? According to the Times, it had to do with “industry resistance,” and at the time, Congress was leaning toward less regulations. Voluntary guidelines were adopted in 2006.

More warnings are needed, but there is question about how the devices should be categorized: Are they consumer products or medical devices? That makes a difference in which agency has regulatory power.

Still, nursing homes and home health care agencies have been amply warned about the dangers, and yet continue to use them.

A former FDA official interviewed by the Times indicated that replacement of older models could cost nursing homes, on the whole, millions of dollars. On the other hand, we’re talking about thousands of injuries and numerous preventable deaths occurring each year. Last year alone, there were 27 deaths attributed to the devices. Is this not worth it to take action?

Patients at particular risk are those suffering from Alzheimer’s or dementia, who often get confused and can become trapped between the mattress and the rail.

The consumer safety agency issued a statement saying that as the elderly population increases with the number of aging baby boomers, we’re going to see an increase of these kinds of incidents, and it’s far past time to take action. These devices are widely used in these facilities, and to do nothing would be simply inviting further tragedy.

If your loved one has been injured or died as a result of bed rails in their nursing home, contact us today to find out more about the compensation to which you may be entitled.
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A nurse working at a nursing home in California was found dead on the job, after police say she suffered from a drug overdose.

Nearly 3,000 miles away, our Vero Beach nursing home negligence attorneys believe this story is relevant because it brings to light in a very dramatic way the larger issue of drug abuse by nurses.

The National Institute on Drug Abuse estimates that roughly 10 percent of all adults in the U.S. abuse drugs at some point during their life. Similarly, the American Nurses Association estimates that about 10 percent of nurses are dependent on drugs. So it’s not any higher than the average population, but the difference is nurses tend to have easier access to narcotics than those in other professions. Plus, nurses tend to work long hours with mandatory overtime in a job that is both physically, mentally and emotionally draining.

With 3 million nurses employed in the U.S., we’re talking about 300,000 registered nurses who are likely substance abusers. Another way to look at this is if there are 10 nurses working at your loved one’s nursing home facility, you can assume that one of those is battling some form of substance abuse or addiction.

The problem for your loved one is that a nurse who abuses drugs or, worse, is impaired on the job, is likely not able to provide safe and appropriate care. It can delay a nurse’s reaction time and affect her ability to make critical, split-second decisions. In a nursing home setting, that may have life-or-death consequences.

According to a recent article by American Nurse Today, nurses tend to abuse everyday medications that are available at work. If the nurse’s primary access to drugs is her patients’ medications, that means the patients may not be getting the drugs they need. This could mean not only might they be in unnecessary pain, but this too could result in fatal consequences.

We understand that most family members aren’t medical professionals who might be able to easily recognize the symptoms of an impaired nurse. Often, because these are individuals with higher-than-average drug knowledge, they are often very good at covering up their impairment. Generally, however, some things you may want to look out for include:

–Shakiness or tremors;
–Fatigue;
–Slurred speech;
–Frequent use of breath mints or mouthwash;
–Constricted or dilated pupils;
–Watery eyes;
–Walking unsteadily;
–Frequent runny nose.

Such suspicions should be reported immediately to the facility administration. If your concerns aren’t taken seriously and you believe that the nurse’s impairment may be having a negative effect on your loved one’s care, call us right away.

In the California case, the 28-year-old nurse was discovered in a bathroom, not breathing. Her elbow was bloody and there was a syringe in the sink. Police suspect the nurse was crushing patient pills and injecting them. She reportedly worked the overnight shift, and was responsible for dispensing prescription drugs to patients.
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Port St. Lucie nursing home negligence attorneys know that all too often in the elder care industry, facilities will put profits ahead of patients.

That is, they will reduce staff, scrimp on cleaning and hold off on critical services – all in the interest of saving a few bucks.

Of course, those who suffer are the vulnerable adults left in their care.

A case out of Mississippi illustrates this point all too well. There, federal authorities are joining in the whistleblower lawsuit, claiming that the facility operator withheld care in order to pad his own pockets.

The suit, filed by the facility itself against the former operator, says that money that was paid by Medicaid and Medicare to the facility was not spent on its intended purpose. If treatment or services were provided, the suit contends, it was so lacking as to be essentially worthless.

It’s also alleged that the operator, who ran the facility for seven years, ending in the spring of this year, held off on hiring necessary employees and withheld critical supplies. This allowed the home to run down, while providing just the bare minimum of cash necessary to keep the home running. Items that he reportedly rationed in order to hoard cash included:

–Towels;
–Laundry bags;
–Medical tubing;
–Garbage bags;
–Oxygen bottles.

In some cases, staff members were asked to put off cashing their checks until the operator could make sure he had enough in the bank.

It’s one thing to be a miser with your own money. But when your greed results in others suffering – which is exactly what happened here – it’s downright criminal.

According to media reports, residents of the facility suffered high levels of dehydration, malnutrition, falls, pressure sores and ulcers. In one case, a patient who was complaining of leg pain was found to have a snake in her bed. Patients frequently complained of hunger. On at least one occasion, and administrator used her own money to purchase snacks for the residents.

State officials say that in addition to clearly placing his own profits over the needs of the patients, the administrator may very well have committed Medicare fraud through false claims.

Interestingly, the operator owns some 35 nursing homes across the state – including one in Lake City, Florida. This lawsuit alleges that the operator’s actions are part of a larger scheme to bilk nursing home facilities for cash, while allowing residents to suffer and leaving creditors hanging.

If the lawsuit is successful, it’s possible the operator could face triple the damages for any money his companies raked in from federal programs. That’s in addition to civil penalties.

Often, families of Port St. Lucie nursing home residents won’t be able to tell right away whether this kind of negligence is occurring, because you’re not privy to the accounting books. However, you will be able to tell if your loved one is suffering from a substandard level of care. Some specific things to watch out for include:

–Complaints of painful abrasions or blisters;
–Poor hygiene;
–Constant thirst or very dry skin;
–Bedding that is soiled;
–Over-medication;
–Bedsores;
–Weakness or unexplained weight loss;
–Hazardous or unsafe living conditions;

Any of these should be a red flag that your loved one may be suffering from neglect. If this is the case, call us today.
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Some cases of nursing home negligence are so egregious, they churn your stomach.

Our Parkland nursing home abuse attorneys recently read about a case in Illinois that had this effect.

It involved a 92-year-old Alzheimer’s patient whose husband had spent his life savings – approximately $270,000 – to ensure his beloved wife was properly cared for around-the-clock. He even took the time to research the facility, which had earned four out of five overall stars according to state ratings. This was especially important, the husband knew, because his wife was unable to speak, and wouldn’t be able to communicate to him if something was not right.

As it turned out, after two years at the facility, something was very wrong.

She had been prescribed ear drops for a previous condition. One day, a nurse who had been caring for her noticed a maggot, moving around in her ear. A maggot, if you aren’t familiar, is fly larvae. At that point, the woman was rushed to the hospital.

Once in the emergency room, the woman’s daughter watched as doctors worked to extract nearly 60 of the live creatures from her mother’s ear. The bugs were shipped off to a laboratory, where it was determined that they had been alive for about three days at that point.

Her family wonders how staffers could have applied ear drops and bathed her without noticing the insect infestation in her ear.

Now, in addition to this, her family says she is now also fighting an antibiotic-resistant form of Staff infection known as MRSA (Methicillin-resistant Staphylococcus aureus). This is a contagious bacteria that can cause a range of infections, including sores or boils on the skin or infections of the blood, lungs or urinary tract if it follows surgery. It is particularly dangerous for someone who is elderly and has a weakened immune system.

The family now says that the MRSA infection is directly related to the maggot incident. They are holding on to hope that she is able to survive.

Nursing home facilities have a duty to ensure that their facilities are clean and patients are properly cared for. This is an example of what can happen when they don’t. Even if this woman is unable to comprehend or remember what happened to her, her daughter will have nightmares of this vision for years to come.

The family has recently filed a civil suit seeking $50,000 in damages, alleging negligence and emotional distress.

The state Department of Public Health launched an investigation into the incident in October, and found no violations of the state’s Nursing Home Care Act. However, that just means that the facility won’t face sanctions from the state. It has no bearing on the family’s ability to prove their case of negligence.

Our Parkland, Florida nursing home abuse lawyers know that thorough sanitation in nursing homes is key to providing proper care. When this doesn’t happen, patients are more vulnerable to infection and illness. Even if patients don’t get sick directly as a result, you have to wonder: If staffers are cutting corners on cleanliness – an aspect that is highly visible – what else are they neglecting, especially when you’re not looking?

While facilities are inspected every year or so for these issues, not all violations are caught because not all may occur on the same day the inspector arrives.

As a family member, you want to be on the lookout for cleanliness issues, and contact an attorney right away if you believe such problems contributed to the illness or loss of your loved one.
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We all know that the elderly in general are more vulnerable to severe injury when suffering a fall. Their bones are more brittle and break easier. Such an incident may result in permanent disability, functional decline and an overall reduced quality of life – not to mention death if the fall is serious enough.

What you may not realize is that new nursing home patients are at high risk for these type of injuries. Our Deerfield Beach nursing home neglect lawyers came across a recent study, published this year by the Journal of the American Geriatrics Society, that shows more than 20 percent of all newly-admitting nursing home patients suffers a fall within that first month.

The research was based on Medicare and Medicaid data collected from 2006, and included records on more than 230,000 patients at more than 10,000 nursing homes across the country.

The single biggest risk factor in these cases was a lack of proper staffing. Low staffing levels inevitably led to lowered patient safety, researchers found.

A very similar study found almost exactly the same thing back in 1995. That study, conducted by researchers at the Johns Hopkins University, found that patients who were moved to a new facility were at heightened risk of a fall. In fact, the fall rate doubled for non-bedridden patients after relocation to a new nursing home.

The Centers for Disease control report that every single year, a typical nursing home with 100 beds reports anywhere from 100 to 200 falls. That’s at least one per year per patient, but usually more. The average number of falls per patient is 2.6, the CDC indicates. Also, we need to point out that many falls go unreported.

We may not think of falling as being serious, but when you are elderly, it absolutely is life threatening. In fact, an estimated 1,800 nursing home residents are killed every year as a result of a fall.

Then you have another 10 to 20 percent that result in serious injuries, and then another 2 to 6 percent that result in broken bones.

The CDC indicates that of course there are a number of medical risk factors that can heighten the chances that a person may fall. Those include muscle weakness or certain chronic conditions.

However, other risk factors include environmental hazards. In fact, anywhere between 16 to 30 percent of all falls in nursing homes are caused by some environmental hazard, such as poor lighting, incorrect bed height, wet floors or wheelchairs that aren’t fitted or maintained correctly.

Additionally, certain medications are known to increase fall risks, particularly those that affect the central nervous system. These would include substances like anti-anxiety medications and sedatives. It’s well known that nursing home staffers tend to over-medicate patients and then not properly monitor them, so this is another factor in all this.

Some nursing homes have been known to try to reduce their fall rates by using restraints. But this isn’t actually effective in preventing falls, and actually, leads to an increased risk of painful pressure sores – not to mention a decrease in the quality of life.

It’s the nursing staff’s responsibility to be there 24-7, to provide appropriate care and prevent injury. When that doesn’t happen, serious or fatal fall accidents may result.
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As those along the northeastern United States struggle to recover from the devastation wrought by Hurricane Sandy, our Tamarac nursing home abuse lawyers know that we here in Florida are just as vulnerable to disaster.

For nursing home residents, the risk is even more grave.

According to a study by the Gerontological Society of America, nursing home residents who are evacuated in preparation for a disaster are at risk of serious injury or worse during the relocation process.

The three-year study analyzed 21,255 nursing home residents in facilities along the Gulf Coast of Florida within a month of an evacuation. What they found was shocking: A 220 percent increase in mortality during that time frame among residents with severe dementia. There was also a nearly 160 percent increase in deaths within three months of the disaster.

This follows a recent government study that cited certain flaws in evacuation plans that don’t properly take into account nursing home residents’ safety and health.

At the University of South Florida-Tampa, a professor of aging studies was quoted as saying that it’s not entirely clear why these deaths are occurring. This is the first time we’ve even had a study to quantify the fact that there is a spike before and after evacuation orders.

This study specifically focuses on dementia patients, as somewhere between 50 to 70 percent of all the 1.6 million adults who live in nursing homes suffer from some form of dementia, such as Alzheimer’s disease. It’s fair though to guess that other nursing home residents are similarly affected.

Relocating during an evacuation is a stressful event for anyone, regardless of your age or health. But older nursing home residents, particularly those who rely on 24-7 care, are at serious risk throughout every stage in the process.

In April, the Office of the Inspector General of Health and Human Services reported that there were a host of problems with preparation plans held by nursing homes. There were few guidelines for how facilities should “shelter in place,” let alone carry out a full-blown evacuation. Just as an example, there were two dozen facilities in Florida (just among those sampled) that did not specify how much water they would need in order to have at least a week-long, sufficient supply.

Emergency plans that were drawn up tended to be sorely incomplete. Of a checklist of 70 necessary considerations, many plans only had accounted for about half of those.

The state’s Agency for Health Care Administration does require nursing homes to have at least a week’s-worth of water and food, as well as prepared agreements with other facilities where residents could be taken, as well as companies that could be relied upon to transport them.

Those plans are supposed to be reviewed annually by the county’s emergency management office, as well as by state health care officials who conduct site visits.

Collaboration is key to making these plans effective. Hurricane Katrina showed us a dark picture of what can happen when we don’t.
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On the surface, it appears nursing home personnel were trying to ensure resident safety by conducting a fire drill.

However, our Weston nursing home negligence attorneys know that policies and procedures should be in place at these facilities to protect residents from harm.

That apparently did not happen at a facility in Alabama, where during the drill, a 94-year-old woman in a wheelchair rolled down hill, landing in a ditch filled with water. She suffered bruises and cuts to her arms and legs and she was covered with dirt on her face. In the days after, she developed severe pneumonia, and subsequently died.

Investigators are still trying to piece together how the fall occurred and whether her injuries were as a result were directly related to her death.

The local county coroner was quoted by a newspaper reporter as saying falls among elderly nursing home residents are fairly common, and even when they aren’t into a ditch of water, they can be fatal. That’s because once somebody is injured, their immune system is compromised. So any other ailment they may have been suffering becomes amplified as the body tries to fight off infection.

According to family members, the woman had already fallen and broken her hip once in recent memory while at the home. They debated moving her to another facility at that time, but decided ultimately to keep her there because she was closer to friends and family.

The family has also said they are waiting for the results of the investigation before taking any legal action against the facility. This is probably wise, but it’s also smart for survivors coping with such a loss to reach out to a skilled Weston nursing home lawyer who can help guide you through the process.

The Centers for Disease Control offers extensive information about how to prevent elder falls, and nursing homes should be following these guidelines and more, particularly with individuals who have increasingly limited mobility.

The CDC estimates that by 2020, the annual direct and indirect cots of nursing home falls for those over the age of 65 will reach $55 billion (it stood at $19 billion in 2000). The average cost for a fall involving a person 72 or older was nearly $20,000, and included hospital, nursing home, emergency room, and home health care. It did not include doctor services.

As you look around your loved one’s nursing home, make sure:

–Items such as papers, books, shoes, medical equipment, is removed from areas of high traffic, where someone may be likely to trip.

–If there are rugs in the facility, make sure they are somehow secured, such as with double-sided tape, to keep it from slipping. Also make sure the corners and edges lay flat, and don’t pose a risk to those in wheelchairs.

–If there are no grab bars on the sides of toilets or in showers, ask about having them installed for safety purposes.

–Make sure non-slip bathmats are located both in the bathtub, on shower floors and on the bathroom floor.

–Make sure that the lighting is sufficient enough for your elderly loved one to see where he or she is going.
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Cooper City nursing home abuse attorneys have been closely watching the developments out of Illinois, where thousands of nursing home staffers are protesting for better wages and working conditions throughout the state.

Local media is reporting that some 2,000 employees at more than 50 nursing home facilities throughout the state, following union contract negotiations. Among the complaints being lodged at the simultaneous pickets are:

–Inadequate supplies to provide care;
–High rates of employee turnover;
–Persistent problems with short-term staffing;
–Overtime demands at low rates of pay.

Of course, these issues are not unique to nursing home staffers in Illinois, and such conditions contribute to nursing home neglect and abuse every day across the country.

Protesters have said that inadequate staffing levels result in inadequate levels of care by employees who are exhausted.

There is not just anecdotal evidence of this – it’s scientifically proven as well. Recently in our Cooper City Nursing Home Lawyers’ Blog, we reported about a study released by the Medical Society of the State of New York, indicating high levels of doctor stress had a profoundly negative impact on patient care. Similarly, when nurses report high rates of burnout, there are increased rates of patient infections.

There is every reason to believe this same phenomenon carries over to nursing home staffers, such as aides and LPNs, who are responsible for the day-to-day care and needs of patients and residents.

Two years ago, legislators in Illinois passed a nursing home law that was groundbreaking, and mandated that all nursing homes equip their facilities with an adequate number of workers so that low-quality concerns could be addressed. The law was passed in response to a series of articles by The Chicago Tribune, chronicling nursing home neglect and abuse throughout the state. It requires a total of nearly 4 hours per patient of direct nursing and personal care for every nursing home patient by 2014. That’s a sharp increase of the 2.5 hours that had been previously required. However, many facilities have so far fallen short of that requirement. (Nursing home residents’ rights in Florida are spelled out in Florida Statute 400.022.)

Inadequate staffing has long been attributed to problems in nursing homes. A report released by the National Association of State Long Term Care Ombudsman Programs back in 1999 indicated that understaffing, insufficient training and supervision are primary contributors to the five most common complaints in nursing homes. These complaints are:
1. Accidents or improper handling;
2. Requests for assistance that go unmet;
3. Neglected personal hygiene;
4. Lack of respect for residents;
5. Lack of an adequate care plan.

That report goes on to indicate that neglect in nursing homes is essentially a form of fraud under The False Claims Act because services which are required to be provided and for which payment has been made is not being provided.

It is rare that we hear from nursing home aides and other workers on their perspective of this issue. It’s important, for the safety and security of nursing home residents, that administrators, owners and operators address these concerns.
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