November 21, 2014

Two Certified Nurse's Aides at the Terrace View Long Term Care Facility in Buffalo Charged with Abuse and Neglect

In September the NYS Attorney General's office announced that two certified nurse's aides at the Erie County Medical Center Skilled Nursing Facility in Buffalo, which has recently changed its name to the Terrace View Long Term Care Facility, have been charged with neglecting an elderly resident of the facility. Donna Laury and Nakeia Green were charged with a range of misdemeanor and felony counts in Buffalo County Court. The Attorney General Eric T. Schneiderman has said that because "nursing home residents are among our state's most vulnerable citizens, and the neglect that the victim in this case suffered is reprehensible... my office will not tolerate anyone being neglected by those responsible for their care, and we will use every tool in our arsenal, including hidden cameras, to ensure that those most in need of help are safely cared for and treated with respect and dignity." The Attorney General's office through the Medicaid Fraud Control Unit is tasked with looking into large scale Medicaid fraud including overbilling, kickbacks, substandard drugs and medical equipment. It also investigates and prosecutes abuse and neglect cases in nursing homes and other health care facilities.

The Terrace View Long Term Care Facility is a 390 bed facility that is part of the ECMC Health Campus on Grider Street in Buffalo. It totes itself as "designed to be patient-centered with a household or neighborhood design that focuses on the latest care delivery models", but the facilities record with the Department of Health points to more systemic problems within its system. The Department of Health, which keeps detailed records online about nursing home complains and conditions, has received 247 complaints about the Terrace View Long Term Care Facility in the reporting period lasting from October, 2010 until September of 2014. This is a rate of 125.3 complaints per occupied beds which compares to a statewide average of 35.7 complaints per 100 beds. In addition to the citations the facility has had 13 citations following onsite inspections during the reporting period, a number approximately three times the average in the state.

The facility has also been fined several times for quality of care complaints with fines ranging from two thousand to ten thousand dollars and its parent company Erie County Medical Center was involved in a large settlement for Medicaid overbilling. Further information about the facilities inspection record and complaint record may be found on the Department of Health's website where the department maintains information on all the nursing homes in New York State.

The employees were charged with falsifying business records in the first degree which is a class E felony, endangering the welfare of an incompetent or physically disabled person which is a class A misdemeanor, and willful violation of public health laws which is an unclassified misdemeanor. The most serious of these charges, falsifying business records in the first degree carries a penalty of up to four years in jail. It is alleged that the employees failed, in violation of the patient's personal care plan, to use two people while performing incontinence care and failing to use a mechanical lift to transfer the resident. It is also alleged that the employees falsified the patient's medical records in order to avoid detection.

The patient, who was not named in the Attorney General's press release and is referred to in court papers as M.H. to protect her privacy, is a 79 year old woman who suffers from Alzheimer's disease and dementia and is unable to walk. She is totally dependent on the care of the nursing home staff driving home the need for laws, regulation and oversight for these vulnerable members of the community who may not be able to advocate for themselves. Families and patients looking into nursing homes should be aware of the inspection and complaint record of the facility they are considering as neglect and abuse is a problem in many facilities in New York.

October 15, 2014

Rye Nursing Home Receives Deficiency for Pressure Sore Care

The Osborn, a Westchester nursing home located in Rye, received a citation by the Department of Health in February, 2014 for failure to provide proper treatment to a resident with a pressure ulcer. Per federal regulations, a facility must provide necessary treatment to a resident who enters with a pressure ulcer. In the case detailed in the Department of Health citation, the resident entered The Osborn with a Stage I pressure ulcer that deteriorated to a Stage II shortly after admission.

The resident was one hundred years old upon her admission to the facility. At her initial examination, it was noted that she already had a Stage I pressure ulcer located on the right heel. The existence of a pressure ulcer, obviously, puts a resident at risk for the development of new ulcers and the deterioration of existing ulcers. Beyond this, the resident displayed several risk factors for skin breakdown, including a recently fractured and surgically repaired hip (limiting her mobility), impaired cognition, and the need of assistance with mobility.

Despite the known presence of the heel ulcer, the records of the nursing home indicate that the heel was not monitored between the resident's admission and an ulcer flow sheet completed eleven days later. By the time the first post-admission flow sheet was recorded, the pressure sore on the heel had deteriorated from Stage I to Stage II.

The conduct of the nursing home in the case of this particular resident violated both federal and state regulations. 10 NYCRR 415.12.(c)(2) (The New York Administrative Code) states that a resident with pressure ulcers receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing. Clearly the plan of care administered by The Osborn did not promote the healing of this resident's bed sore. Fortunately, upon her discharge, the wound was in the process of healing. This does not excuse the fact that the facility allowed its condition to worsen. The full report, found here, does not mention whether the nursing home was issued a fine by the Department of Health.

The development and/or deterioration of a pressure ulcer or bed sore can lead to dire consequences for an elderly nursing home resident. Often a wound such as these is the precursor to infection, further cognitive impairment, or even death. If your loved one has suffered from a pressure ulcer or bed sore due to nursing home neglect, contact the attorneys at Gallivan and Gallivan today for a consultation.

September 23, 2014

Discussing the Legality of Nursing Home Surveillance

It is difficult to ignore the continuous flow of headlines regarding nursing home abuse. It has become a prevalent issue across the U.S. However, imagine the number of cases that go unreported. Many times incidents of abuse and neglect are brought to light because of video surveillance. We have seen an increase in the number of abusive acts caught on tape and shared through the help of media and news outlets. After all, video surveillance technology is readily available ranging from nanny cams, to spy cams, to traditional video cameras.

How has the use of video cameras impacted the cases of nursing abuse? How does it impact a person's right to privacy? The use of video surveillance has sparked some debate on whether it is legal to use them in nursing homes.

Real World, Real Results

surveillance.jpgIn February of this year, a surveillance video caught a nurse by the name of Rosemarie Brooks, attacking a 73-year-old resident at the Bronx Park Rehabilitation and Nursing Center. The resident sustained head injuries as a result of the incident.

This April, with the help of video surveillance footage, the New York State Attorney General was able to apprehend and charge eight nurses and nine nursing assistants with felony and misdemeanor counts.

A non-ambulatory and bedridden 56-year-old resident of HighPointe nursing home suffered continuous neglect at the hands of the 17 staff members. They failed to check on him, give him liquids, and perform incontinence care repeatedly and this was all caught on a hidden camera.

The nurses and nursing assistants were consequently charged with first degree falsifying business records, first degree endangering the welfare of an incompetent or physically disabled person, and willful violation of public health laws.

Most recently in August, a home health aide from Personal-Touch Home Care was caught on tape abusing a 78-year-old Queens, NY stroke victim. The aide continuously slapped the paralyzed man's arm, jerked his head, and force-fed him.

With the flood of nursing home abuse and neglect cases, Attorney General Eric Schneiderman states, ""My office will continue to hold nursing home employees to the highest responsibility to ensure that New York's most vulnerable receive the best and most compassionate care possible."

The Law on Surveillance

Some question whether it is legal for nursing homes or families to use video surveillance in the facility and patient rooms. As it stands, there are no federal laws either prohibiting or specifically authorizing the use of video monitoring in a nursing home. The Federal Wiretapping Law governs the use of surveillance devices that record audio communications but does not regulate silent video surveillance.

While some states may begin regulating the use of hidden cameras in nursing facilities, to date New York does not have a law in place to regulate the use of hidden cameras. The majority view holds that the benefit of keeping nursing home residents safe and free from neglect outweighs the need for privacy.

Invasion of Privacy

To balance safety needs and the right to privacy, some nursing homes require that families post a sign notifying room visitors and staff that there are cameras present. In the case of nursing homes, some post signs indicating that video surveillance is used in the facility. Although some nursing homes have enforced these measures in some states, this is not a requirement and the majority of facilities have yet to implement this type of notification.

Would You Like to File A Complain Against A Nursing Home?

The New York State Department of Health, Nursing Home and ICF/MR Surveillance is responsible for investigating complaints and incidents for nursing homes in New York State. You can submit a complaint online, via email or by mail. You can also call the Nursing Home Complaint hotline at 1-888-201-4563.

Contact Us

Nursing home and elder abuse is a serious matter. If you suspect that your loved one is the victim of abuse or neglect, you should file a complaint and contact an attorney immediately. If you require further assistance or legal help regarding nursing home abuse or neglect, contact our New York office today.

For more news and information on nursing home surveillance, check the following sites:

NY Times, Watchful Eye in Nursing Homes, Jan Hoffman, November 18, 2013

CBS NY, Bronx Nurse's Aide Accused Of Abusing Elderly Alzheimer's Patient, February 15, 2013

WIVB 4, Hidden camera leads to charges against 17 workers at nursing home,

September 22, 2014

Tips for Choosing the Right Nursing Home for Your Elderly Loved One

Selecting a nursing home for your loved one is a difficult decision. It is not easy to trust someone else or a stranger to meet the needs of your mother, father, spouse, or family member. Here is a list of factors you should consider when picking the right living arrangement and nursing home for your loved one.

1. Assess the Needs of Your Loved One

oldman.jpgBefore choosing a nursing home, it is best to understand the needs of the elderly person. Take into consideration your loved one's medical conditions and the level of care required. You don't want to assume that the nursing home or living facility has the right services, staff, medical equipment, or expertise to care for the individual. You'll want to make sure that the nursing home has the required necessities to meet the needs of the person.

2. Conduct Thorough Research

It's common practice to do research on the places you will stay, whether it's a hotel or neighborhood of a new home you're considering buying. The same holds true for selecting a location where your loved one will live. Before deciding on a nursing facility, you should take the time to conduct thorough research of your options. It is a good idea to see what others are saying about the nursing home through reviews and ratings. This is a decision that you should not take lightly, as the individual's health, safety, and quality of life depends on it. Take the time to investigate the nursing homes. Many states have assessments and ratings that are available to the public by request. This will give you the opportunity to see if there are any code violations as well.

Here are some questions to consider:
• What facility processes are in place for preventing the spread of illness and infection?
• What is the frequency of hospital-acquired infections?
• What fall prevention measures are in place?
• What is the falling rate of the facility?
• Has the nursing home been reported for violations? If so, how many and which ones?
• Does the facility have a poor reputation in the public and among residents?
Don't be afraid to ask questions about anything that is important to you. You want to be fully knowledgeable about the living facility, their reputation, quality of care, and competency level.

3. Get Recommendations

There are multiple ways to find ratings and reviews, but you can also get recommendations from family, friends, and co-workers. They are a great source for feedback, referrals, and insight. If they've had a positive and/or satisfactory experience, it's more likely that your loved one will experience the same. On the other hand, if they pinpoint areas of concern or share negative experiences, you'll want to investigate the nursing home more closely or remove the option from your list.

4. Schedule A Visit

Once you have a list of possible nursing homes, schedule a visit. Do not move the individual into a facility until you have seen it first-hand. A nursing home can look one way on a website, marketing material, or over the phone but be a completely different experience once you arrive at the door. Take the time to inspect the premises, speak to the staff, ask questions, talk to current residents, and get a real sense of the environment to make sure it is the best choice for the individual.

5. Do a Final Assessment of the Facility

While you are there at the nursing home, closely observe everything you see. Be careful not to overlook important factors that will play a role in your final decision.

Take a look at the following:
• Cleanliness of the indoor and outdoor spaces
• Activities program and/or schedule
• Staff friendliness
Meal options
• Safety measures

By performing detailed research and touring the nursing home community, you'll have a good sense of whether this is the right place for your elderly loved one. This will ultimately lead to an educated decision. Remember, the safety, medical needs, quality of care, and comfort of your loved one is the most important when choosing a living environment for them.

More information on choosing the right nursing home for your loved one can be found on the Medicare website, as well as A Place for Mom.

September 22, 2014

The Importance of Having a Board Certified Physician

Approximately 90% of practicing physicians in the U.S. are board-certified. While this is a fairly high percentage, it still shows that a number of doctors practicing in the U.S. without board certification. Receiving medical care from a qualified and competent physician is important when it comes to your healthcare. Take a look at the following information to understand what board certification means and why it is so important.

What is Medical Board Certification?

A doctor must demonstrate and meet a level of competency in the field of medicine. A medical board is an organization that has a set of minimum requirements that must be met to gain membership. By gaining membership, doctors achieve a level of competency that is respected among colleagues and patients. On the other hand, non-certified doctors are, more likely than not, deemed as less competent due to their inability or unwillingness to meet the minimum membership requirements.

When reviewing board certification standards and the status of your doctor, start your search with these medical boards:

• American Board of Medical Specialties (ABMS)
• American Board of Physician Specialties (ABPS)
• American Osteopathic Association(AOA)

If your doctor is not certified by one of these more prominent medical boards, then check the doctor's website to see if they mention their board certification. Another option is to look at the doctor's affiliated hospital or practice to search for a board certification statement.

Difference Between Licensed and Board-Certified

Licensed and board-certified are two terms that can cause great confusion if you are a patient. You'll want to understand the distinction between the two because licensed and board-certified are not equal. Doctors must be licensed to practice medicine in the state of New York. Licensing requires that doctors be of good moral character, at least 21 years of age, and meet certain educational, exam, and experience requirements. If you are a practicing doctor in New York, then you are licensed. Compared to the board certification process and requirements, the licensing requirements are not as stringent. Board certified doctors go through rigorous training and exams to gain expertise and certification in specialized fields such as oncology, pain management, anesthesiology, etc.

Here's a simplified breakdown:

• A medical license means the doctor is an MD or DO, passed the 3 USMLE examinations, underwent a 1-3 year residency, and was given a state medical license.

• Board Certification means completion of ABMS, ABPS, or AOA specialty training and examination in addition to the medical license requirements.

Why is Board Certification Important?

Once a doctor is board-certified, his or her skills, knowledge, and expertise in medicine meet the gold standard as it relates to quality of care. When a doctor completes the rigorous training and exams to become a specialist in a particular field of medicine, they have advanced knowledge to provide you a high level of medical care.

Be careful: just because you see certificates and awards on the wall does not mean a doctor is board-certified. If you want to find out if a physician is board-certified, find the website of that specific board and check the credentialing requirements yourself.

How to Verify Board Certification

So what should you look for to verify that a doctor possesses the appropriate certification? The following steps will help you verify a doctor's board-certification status.

• Use websites to check board association
• Go to one of the doctor's rating websites
• Check the medical licensing information in New York (it's public!)
• If you don't see a doctor's name listed for a particular medical board, remember there is a process of certification and then re-certification. The website may not be updated with the new status yet, so call the medical board instead.

To find out if your MD is board-certified, access the American Board of Medical Specialties Web site at www.abms.org or call 1-866-275-2267. Patients who would like to check the certification status of a DO can visit the American Osteopathic Association (AOA) Web site at www.osteopathic.org or call the Member Service Center at 1-800-621-1773, option 1 on the menu.

For more information on board certification, reference the following websites:

What is Medical Board Certification?

License Requirements

September 19, 2014

Rochester Certified Nursing Assistant Arrested for Hitting Elderly Dementia Patient

A Certified Nursing Assistant (CNA) at a Rochester, NY nursing home was arrested last month on charges that he slapped a ninety year old woman in the face. The woman, a resident of the facility at which the CNA works, also suffers from dementia. The CNA, Adrian King, is charged with Endangering the Welfare of a Vulnerable Elderly Person or an Incompetent or Physically Disabled Person in the Second Degree, Wilful Violation of Health Laws, and Harassment in the Second Degree.

There was a witness to the alleged attack. According to this bystander, King slapped the elderly resident hard enough that it both made a loud noise and left a mark on the woman's face. King pleaded guilty to the harassment charge in Rochester City Court. The plea to harassment satisfied all charges that had been pending against King. The Medicaid Fraud Control Unit was involved in the investigation as well.

As he often does in cases involving negligence or abuse of an elderly nursing home resident, Attorney General Eric T. Schneiderman held little back in his comments about the incident. "When a family entrusts a loved one to the care of a nursing home, they expect courtesy, kindness, and professionalism--none of which the resident received in this case, as we allege," said the Attorney General. "Today's charges reflect my office's dedication to protecting our most vulnerable, including the elderly and the disabled, by ensuring that those entrusted to provide care to them will be held accountable when they violate that trust."

Unfortunately, in many cases involving abuse at a nursing home, there is no uninterested witness present to present the facts to an administrator or investigators. Further complicating matters is the fact that often an individual suffering from dementia is unable to voice concerns for his or her own well-being. If you feel that a loved one may be the victim of nursing home abuse or neglect, contact the attorneys at Gallivan and Gallivan today to discuss your legal rights.

September 19, 2014

Attorney General Reaches $2.2M Settlement with New Rochelle Nursing Home after Fraudulent Billing

Eric T. Schneiderman, New York State Attorney General, reached a settlement in August with Glen Island Center for Nursing and Rehabilitation, a Westchester County nursing home, after allegations arose that the facility defrauded Medicaid. The fraudulent billing stemmed from services that in some cases were actually performed by the nursing home, but at inflated prices. State and federal investigators claimed that for a period ranging from 2002 through 2006, Glen Island submitted in excess of sixty thousand fraudulent claims to Medicaid. While occasionally the facility merely excessively billed for services rendered, in a great many others the reimbursements submitted to Medicaid were for services never performed for residents.

After the investigation began, administrators at the facility allegedly forged medical records in an attempt to hide their malfeasance from investigators. After the Medicaid Fraud Control Unit scrubbed these falsified records, two nurses at the facility were convicted for their fraudulent behavior.

This is not the first encounter with the law for Glen Island. In 2011, the administrator of the facility pleaded guilty to grand larceny after conceding that she had falsified records regarding patient care. The administrator received a prison sentence of one to three years in exchange for her plea. Two additional employees of the nursing home pleaded guilty in 2011/2012 to attempted tampering with physical evidence. All three individuals have been excluded from participation in New York's Medicaid program.

Because Medicaid is both a state and federally funded administration, federal prosecutors assisted the Attorney General's office with the investigation. As this blog has chronicled frequently in the past, AG Schneiderman has taken a strong stance when it comes to protecting our state's most vulnerable elderly citizens. The fervor with which his office conducted this investigation makes clear that his office will continue to prosecute to the fullest extent of the law those who attempt to take advantage of the elderly.

New York will receive approximately $1.3 Million of the funds recovered as part of the settlement.

The full press release from the Attorney General's office can be found here.

September 3, 2014

Queens Nursing Home Fails to Promote Healing of Pressure Sores

Silvercrest, a nursing home in Jamaica, Queens, NY received a deficient rating in a January, 2014 Department of Health Complaint Survey. The deficiency involved the facility's failure to provide proper and necessary treatment to a resident suffering from a pressure ulcer. The resident had had a previous pressure sore that had healed in December, 2012. Because of this prior wound, and because the resident still possessed several risk factors for the development of pressure sores, Silvercrest had several interventions in place to prevent the development of future ulcers.

old woman.jpgDespite these interventions, the female patient developed a new pressure ulcer in September of 2013 on the sacrum, the site of her previous wound. The woman's treating physician ordered application of bacitracin every twelve hours. When the wound appeared to worsen, the resident's Nurse Practitioner ordered additional treatments to be administered every shift. Although the new orders were seemingly in place because of the start of deterioration of the ulcer, documentation revealed that the treatment was not administered to the female resident of the course of two days immediately following the new order (a period of six nursing shifts).

Interviews conducted by the DOH with the nurses working these shifts revealed that the new medication was incorrectly ordered, and thus did not arrive in a timely fashion after the institution of the new order. In her interview, the Nurse Practitioner claimed to be unaware of the missing treatment. This contradicted the statements of one of the LPN's, who told the investigators that she had informed the NP.

As is often the case, it appears that lack of communication contributed to the worsening of this resident's pressure ulcer. A lack of oversight, or lack of a fail-safe to ensure that orders are followed, does not excuse negligent treatment on the part of the facility. In this case, lack of proper ordering and communication between the Nurse Practitioner and License Practical Nurses allowed the resident's already compromised physical and mental condition to worsen further. This confusion does not relieve the facility of its duty to provide proper care to its residents, and its duty to follow both state and federal statutes and regulations.

The DOH report did not provide an update on the resident's current condition.

August 31, 2014

Nassau County Nursing Home Cited for 19 Deficiencies

Parkview Care and Rehabilitation Center, a nursing home in Massapequa, Long Island, was cited in an April Department of Health certification survey for nineteen deficiencies. The most serious of these deficiencies resulted in "actual harm" to a resident. A finding of actual harm is the second most serious level of severity that the DOH assesses to a nursing home during a certification survey.

chest.jpgThis most serious incident involved a failure to promptly notify an attending physician of the radiology findings for a resident of Parkview. Because the resident was exhibiting symptoms of pneumonia, a chest x-ray was ordered. The physician was not notified of the results, or lack thereof, of the x-ray until four days after it was taken. Nursing notes for the time between the performance of the x-ray and the and the resident's transfer to the hospital indicate that the nurses did not check the resident's breathing, despite the symptoms of pneumonia that had prompted the physician order for the x-ray. When the physician finally received the x-ray four days after it was performed, he became aware that the patient was suffering from a collapsed left lung. The attending immediately ordered a transfer to the hospital, where the resident was treated for his condition.

In an interview with the DOH, the attending physician indicated that it is incumbent upon the radiology department to notify him immediately of any abnormalities or dangers indicated in the x-ray. Radiology did not adhere to this protocol in this instance.

Although this incident was the most severe of those documented in the certification survey, it was far from the only one in the report. Among the other deficiencies noted by the DOH were a failure to keep the nursing home free of accident hazards, failure to provide proper treatment to prevent and/or treat pressure ulcers, and failure to ensure that residents are free from significant medication errors. There is no word yet as to whether a fine will be assessed against Parkview for these numerous deficiencies.

August 31, 2014

Westchester County Nursing Home Cited for Failure to Prevent Pressure Sores

The Osborn, a Rye, New York nursing home, was cited in a December, 2013 Department of Health deficiency report for failing to properly treat and/or prevent pressure ulcers. According to the report, the facility did not accurately assess the resident's condition, and as such failed to institute a proper plan of care to address her propensity for pressure sores.

The resident was 100 years old upon her admission to the nursing home following a hip fracture. She had a pre-existing Stage I pressure ulcer of the right heel, as stated in the Ulcer Flow Sheet at her admission. Despite the presence of the ulcer, the resident's Minimum Data Set indicated that she had no identifiable pressure sores. The resident had several risk factors for the development of pressure sores, including impaired cognitive skills and requirements for assistance with all activities of daily living. Despite the presence of the sore and these risk factors, no further pressure ulcer assessment was performed.

Less than two weeks into her stay, the resident's right heel ulcer had deteriorated to a Stage II sore. When interviewed, the RN/MDS assessor stated that the inaccuracy of the initial assessment led to a substandard care plan. Because the patient was improperly assessed, the pressure ulcer was allowed to deteriorate rather than heal. It should be noted that when the resident was discharged, the heel ulcer was in the process of healing.

Accurate care planning is essential for elderly nursing home residents. Intake evaluations to determine a patient's risk level for the development of pressure ulcers must be performed diligently and accurately to ensure that residents without pressure sores do not develop them, and residents admitted with pressure sores are properly treated. If untreated, a pressure sore, such as the one exhibited by the Osborn resident, can deteriorate, become infected, and potentially lead to death. Fortunately for this resident the sore was eventually treated and seemed to be healing upon her departure from the facility; had the Osborn conducted a proper intake assessment, the sore may not have ever gotten to Stage II.

August 31, 2014

NYS Health Inspectors: Resident's Blood Clot Caused by Medication Error

After receiving a complaint in October 2013 against the Edna Tina Wilson Living Center, a 120-bed facility located in Rochester, the New York State Department of Health (DOH) fined the facility $4,450 for a medication error that caused a resident to develop a blood clot in her leg. The affected resident was admitted into the nursing home in September 2013. The resident's medical chart indicated that she had received a heart valve replacement, had a pacemaker and was taking Heparin and Coumadin, both of which are blood-thinning medications. A physician ordered that a routine blood test be done on October 14, 2013 to ensure that the blood-thinning medication was working properly. Administration of the Coumadin was to be suspended temporarily under the lab test results came back. However, the blood test was never conducted, and for a period of nine days the resident never received Coumadin.

On October 21, 2013, the resident began complaining about pain in her lower left leg. After conducting an imaging test, a doctor determined that the patient had developed a blood clot in her lower left calf. The physician immediately ordered that the resident be placed back on Coumadin and receive Lovenox, a blood thinner that is injected in the affected area. Moreover, the physician ordered a blood test, which revealed that the patient was at risk of developing more blood clots. Staff members were also instruct to perform tests to ensure that clots did not form on the resident's lungs.

Over the course of the investigation into the matter, DOH officials also discovered that lab tests for five other residents, including those on anticoagulants, were never conducted during the same time period. After working closely with staff members and administrators, DOH surveyors were able to trace the cause of the error to the implementation of a new computer system at the facility. Under the old paper system, nurses were required to manually fill out a lab request form and submit it to the secretary. Under the new computerized system, the nurses were not required to submit a paper lab request. The secretary stated that she was never trained or informed of this new change in policy and procedure. As a result, several lab requests were missed, resulting in actual harm to the resident.

In order to ensure that such an error doesn't occur again in the future, administrators created a written policy pertaining to lab requests. They also provided training to all staff members about the facility's new policy. The DOH report concluded that the appropriate changes were implemented in a timely fashion.

According to the "Nursing Home Compare" website, the facility received an overall rating that was below average.

August 31, 2014

Office Worker Stole Over $45K from Nursing Home Residents

Johnna Scanlon-Howland, a former office worker at the Sunrise Nursing Home, a facility located in Oswego, New York, was convicted in July 2013 of stealing $45,363 from the resident trust account at the nursing home. Investigators from the state's Medicaid Fraud Control Unit (MFCU) stated that Scanlon-Howland falsified business records to make unauthorized withdrawals from residents' accounts. She then spent the stolen money on personal purchases. In a similar incident in June 2013, Jodi Montenaro, a business manager at the Dutch Manor Nursing and Rehabilitation Center, a facility based in Schenectady, was convicted of stealing $4,450 from the resident trust account. Montenaro used some of the stolen funds to pay her personal bills.

When a patient enters a nursing home, he or she can deposit money into a trust account. The patient can then withdraw the money to pay for basic living expenses such as a haircut or personal hygiene products. The accounts accrue interest and are managed by the nursing home, which should issue regular statements much like a bank would. The accounts are insured in the event the funds are stolen or mismanaged. However, a USA Today investigation conducted in 2013 discovered that thousands of residents had their funds stolen by nursing home employees who used the money to pay for personal shopping sprees and gambling outings. In addition, the investigation uncovered that most states do not require routine audits of resident trust accounts, which can allow fraud to occur over a long period of time.

While nursing homes conduct criminal background checks for health care workers, 20 states currently do not require such checks to be extended to office workers, who often handle resident trust accounts. In one case, a nursing home business manager in Alabama stole $115,000 while he was on probation for stealing. The USA Today report also pointed out that some nursing homes fail to carry insurance to cover a potential loss to resident accounts.

In an attempt to address these issues, U.S. Senator Bill Nelson asked the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees nursing homes, to require that nursing facility inspectors conduct annual audits of resident trust accounts, In a letter to the agency, Nelson wrote, "CMS does not require state agencies to train surveyors on how to identify improper or suspicious withdrawals from these accounts, nor is it clear that the surveyors are required to look for this type of problem. I ask that you require...that surveyors be provided with the training they need to detect improper expenditures from these trust funds, and that these withdrawals be routinely reviewed."

Greg Crist, senior vice president of the American Health Care Association, stated that most nursing homes already conduct routine audits of resident accounts as part of their own internal financial controls system.

August 31, 2014

Study: NY Nursing Homes Failed to Meet Federal Goal to Reduce Use of Antipsychotics

The Long Term Care Community Coalition (LTCCC), an advocacy group that promotes the improvement of nursing home care, released a report in April 2014 about the use of antipsychotic medications in New York nursing facilities. The study, titled "Antipsychotic Drug Use in NY State Nursing Homes: An Assessment of New York's Progress in the National Campaign to Reduce Drugs and Improve Dementia Care," revealed that NY nursing homes failed to meet a federal goal to reduce the use of antipsychotics. In March 2012, the Centers for Medicare and Medicaid Services (CMS) set a goal for all nursing homes to reduce antipsychotic medication use by 15 percent by the end of the year. Despite this goal, in December 2013 the CMS reported that NY nursing homes reduced antipsychotic use by only 14.6 percent, short of the target.

pills8.jpgAntipsychotic medications were developed to treat patients diagnosed with psychosis, such as schizophrenia. However, because such medications have a sedating effect, many nursing homes prescribe such antipsychotics to dementia patients with behavioral issues. In effect, the medication is being used as a chemical restraint to control agitated residents. Moreover, in 2005, the FDA issued a "black box" warning stating that antipsychotics can cause strokes, heart attacks and death in dementia patients.

Discussing the use of antipsychotics in nursing homes, U.S. Inspector General Daniel Levinson remarked, "Too may [nursing homes] fail to comply with federal regulations designed to prevent overmedication, giving nursing home patients antipsychotic drugs in ways that violate federal standards for unnecessary drug use. Government, taxpayers, nursing home residents, as well as their families and caregivers should be outraged--and seek solutions."

Even though only one percent of nursing home residents are diagnosed with psychosis, the LTCCC's report points out that nearly 20 percent of NY nursing home patients are taking an antipsychotic. In general, the study found that nursing homes in the NYC metropolitan area had the highest rate of antipsychotic use, while nursing facilities in the western region of the state had the lowest rate of antipsychotic use. The report concluded that the discrepancy was due to higher enforcement actions in western regions.

To address the problem of antipsychotic medications in nursing homes, the LTCCC has made several recommendations. First, the NYS Department of Health needs to address and enforce the issue when conducting nursing home inspections. The LTCCC study found that higher enforcement leads to more nursing homes complying with antipsychotic use. Second, NYS lawmakers need to pass a bill that will require nursing home residents to give their verbal and written consent before taking antipsychotics. The consent form would list potential side effects of such medications, including the FDA's "black box" warning for dementia patients.

August 31, 2014

Bronx Nursing Home Fails to Maintain Proper Standards for Accident Avoidance

A March 27, 2014 Department of Health certification survey found Bronx nursing home Concourse Rehabilitation and Nursing Center deficient in numerous areas. One such area was related to keeping the facility as free of accident hazards as possible. The incident documented by the DOH concerned improper supervision of a resident while out of the facility.

The resident involved in the nursing home's failure was a 79 year old woman with known risks for wandering and elopement, including dementia and severely impaired cognition. Concourse had a wandering care plan in place for the woman. During a routine trip to the hospital for an appointment, the resident wandered from the waiting room despite the fact that she was accompanied by an escort. The escort and the resident both went to use the bathroom. When the escort came out, the resident had left not only the bathroom but the hospital itself. Staff of the nursing home searched for the resident at both the home and hospital, but were unable to locate her. Not until later that night was the resident found by her granddaughter. The report does not state where she eventually found her grandmother. Additionally, although the report does not specify whether she was fired or left of her own volition, the CNA escort is no longer employed by Concourse.

old man walking.jpgMany elderly nursing home residents are admitted with cognitive impairments that make them risks for wandering and or elopement. Proper care plans can minimize the risk that these events occur, but only if the care plans are followed. When left to fend for themselves, elderly individuals with reduced mental capabilities are at greater risk for dangerous accidents, such as falls and fractures. An accident resulting in a fall can also lead to increased cognitive decline, in addition to the obvious physical injuries that can result.

Fortunately the resident appears to have been unharmed as a result of her wandering from the hospital. This incident is a reminder that while proper care planning is essential to the care of elderly nursing home patients, the execution of the care plan is equally, if not more, important.

August 22, 2014

Federal Report: Medicare Paid $5.1 Billion to Nursing Homes that Failed to Meet Quality-of-Care Standards

report.jpgThe United States Office of Inspector General (OIG) released a report in March 2014 summarizing 25 key findings and recommendations pertaining to health care facilities throughout the nation. The report, titled "Compendium of Priority Recommendations," includes several findings related to long-term nursing home care facilities. For instance, the study pointed out that Medicare paid approximately $5.1 billion to nursing homes that failed to meet minimum quality-of-care standards, which regulate such items such as how nursing homes should provide basic wound care and manage patients' medications and therapies. To address this issue, the OIG recommends that nursing homes improve care planning for residents. Care plans are developed by a team of physicians, nurses, social workers and therapists for each resident to ensure a patient's needs are adequately addressed. Failure to develop such plans, or failure to follow care plans can actually harm residents. The OIG study found that 37 percent of nursing home residents either didn't have a care plan, or had a care plan that was not effectively implemented.

In addition, the OIG determined that many nursing homes failed to provide adequate discharge plans for residents. Approximately one in three residents who left a facility didn't have an appropriate discharge plan in place. Discharge plans often contain detailed and specific instructions for caregivers on how to treat the patient once he or she has left a nursing facility. When caregivers don't have such instructions, they make errors in care, such as improperly administering medication. Such mistakes can lead to costly, yet preventable, hospitalizations.

Another key finding pointed out that one in three residents experienced some type of harm while staying at a nursing home. The finding also determined that 59 percent of harmful or adverse events were caused by poor care and could have been prevented. Such adverse events sometimes lead to hospitalizations. To address this issue, the OIG recommends that health inspectors identify causes of such harmful events and come up with ways to prevent them in the future.

The OIG report also uncovered large scale Medicaid fraud by nursing homes. In 2009, Medicaid made $1 billion in inappropriate payments to nursing facilities. In most cases, Medicaid made payments for services that were never provided. In other instances, Medicaid paid for services that were not medically necessary. In addition, Medicaid overpayments were sometimes the result of "upcoding", a fraudulent billing practice in which a nursing home bills for a higher level of service than what was actually provided. To address this fraud and abuse, the OIG recommends that governmental agencies conduct more extensive audits and reviews of claims submitted by nursing homes to Medicaid.