New York Nursing Home Abuse Lawyer Blog

Three employees at a Havertown, PA senior living facility were arrested recently and charged with assault and harassment stemming from their treatment of a 79 year old resident of the home. Evidence of the alleged abuse came to light after the resident's daughter placed a "nanny cam" in her room. The resident had previously complained to her daughter that staff at the facility were abusing her.

In addition to the criminal charges faced by the three workers, the family has sued the facility for negligence. In the suit, the family alleges that the facility was understaffed, the existing staff was improperly trained, and that the facility violated regulations for the proper maintenance of a senior living facility.

Website Resource: Delco couple sue senior living facility after alleged abuse caught on tape

Philadelphia Inquirer, John P. Martin, October 13, 2011

We have discussed the Orange County, NY nursing home Elant at Newburg several times on this blog. The Fall 2011 Long Term Community Care Coalition Newsletter documents a $72,000 fine levied against the facility resulting from a September 2, 2009 Department of Health survey.

Many of the deficiencies chronicled in the report will not be unfamiliar to readers of this blog: 483.75(f)--Proficiency of Nurse Aides; 483.25(c)--Proper Treatment to Prevent/Heal Pressure Sores; 483.13(c)--Facility Prohibits Abuse, Neglect; and so on. The deficiency discussed below, however, illustrates problems that exist as high up as the management level.

Title 42 Section 483.75(i) of the Code of Federal Regulations states that "(1) The facility must designate a physician to serve as medical director. (2) The medical director is responsible for (a) [I]mplementation of resident care policies; and (b) [T]he coordination of medical care in the facility." The report, linked below, states that the Medical Director at Elant is the sole treating physician in the entire facility, thus the MD by default. The report also illustrates a lack of fundamental knowledge on the part of the MD with respect to diagnosis and treatment of pressure sores, as well as state and federal regulations regarding the same. There are 178 residents of Elant at Newburg; the MD is responsible for the medical treatment of each one.

Expecting a single physician to care for and treat close to two hundred residents is a lofty goal. Asking that physician to be knowledgeable about one of the most widespread health issues facing her residents is not, however. Perhaps the repeated individual deficiences documented by the DOH at Elant at Newburg are represenatative of deficiences at the top of the organizational structure. Regardless of the cause, it is evident that a shift in culture is necessary at Elant to stem what seems to be an incessant tide of deficiencies and failures.

Website Resource: Elant at Newburgh, Inc

A recent study conducted by the University of Iowa revealed that black nursing home residents are more likely than their white counterparts to develop bedsores (pressure ulcers, decubitis ulcers). In a five year study conducted at nursing homes throughout the country, researchers found that black residents were roughly five percent more likely to develop decubitus ulcers than white residents. Although the study does not promulgate definitive conclusions as to the cause of this discrepancy, several factors could be at play. Lack of funding, substandard training, and understaffing at predominantly black homes are potentially all contributing factors. Medical factors, such as diabetes, may also play a role. According to the American Diabetes Association, blacks are more likely than whites to be diagnosed with the disease.

Underqualified or insufficient staffing is a problem endemic to the nursing home industry. For reasons such as pay scale, stress, or insufficient screening during the hiring process, it seems that many of the problems that arise out of nursing homes are caused by poorly trained or over-worked staff. Regardless of the cause of these issues, however, it is a patient's right to be cared for by a competent, knowledgeable staff. As Title 42 (Public Health) of the Code of Federal Regulations states in Section 483.20(k)(3)(ii), "[T]he services provided or arranged by the facility must be provided by qualified persons in accordance with each resident's plan of care." This right provided by the Code is guaranteed to residents of any race or skin tone. And although, as evidenced in the study, the rate of pressure ulcer cases does seem to be in moderate decline nationwide, the discrepancy between black and white residents is one that should be addressed further to ensure that such cases continue to decline across all races.

Website Resource: Blacks in nursing homes have higher risk of sores

Reuters, Genevra Pittman, July 12, 2011

An investigation conducted over the past year by The New York Times highlights disturbing trends of abuse in group homes run for the mentally challenged and developmentally disabled. The emphasis of the survey, the lack of discipline imposed upon delinquent employees of such homes, underscores the importance of diligent oversight by not only authorities, but also families of the residents of these homes.

While this blog often focuses on neglect, the Times survey examines the aftermath of proactive abuse on residents of group homes. The report documents the cyclical nature of the abuse, with employees being transferred to other homes after violent, often criminal, incidents rather than facing actual sanction, dismissal, or criminal charges. This can be credited to lack of resources, diminished capacity and inability of residents to explain the circumstances of abuse or simply apathy from administration. Regardless of cause, however, the graphic depictions of physical, sexual, and emotional abuse cited in the Times investigation are less disturbing than the lack of repurcussions for those accused of these actions.

The report goes into case-specific information of several cases of abuse, transfer, further abuse, transfer, etc. The idea that employees at these homes are under-trained, under-paid under-motivated, and over-stressed does not excuse overt abuse. Inattention to this abuse makes administrators and supervisors complicit. While the report does not offer a comprehensive solution to the ongoing issue of group home abuse, making it known to the public is a good first step. Administrations of homes, law enforcement, and the judiciary must be more conscientious in enforcing the legislation put in place to protect group home residents, as they would protect any other vulnerable member of our society.

Website Resource: At State-Run Homes, Abuse and Impunity

New York Times, Danny Hakim, March 12, 2011

Gold Crest Nursing Home on Bruner Avenue, Bronx, NY has received a one out of five star rating (the lowest possible rating) from the Centers for Medicare and Medicaid Services (CMS). The rating is based on a combination of data compiled regarding each nursing home's performance during a health inspection, staffing, and quality measures. Analysis is conducted by CMS on these three data sources and each of these ratings were combined into one overall rating.

Gold Crest received one star for its poor performance on its health inspection and one star for staffing. The facility was given a three star rating based on data compiled regarding various quality measures. That said, CMS reports that 19% of resident's at "high risk" for developing pressure ulcers (bedsores, decubitus ulcers) actually developed such ulcers. This is in comparison to the state average of 13%.

The total number of licensed nurse staff hours per resident per day was 46 minutes in comparison with state and national averages of 1 hour and 24 minutes. The total number of CNA hours per resident per day was 1 hour and 47 minutes in comparison to state and national averages of approximately 2 hours and 20 minutes. This is particularly important because nursing aides reportedly provide between 80 - 90 % of care to residents, including such basic care as bathing, feeding, re-positioning, etc.

Understaffing is one of the leading causes of neglect or abuse in NY nursing homes. Oftentimes, nurses and nursing aides are genuinely good people trying to do the best job they can. Unfortunately, however, they face an impossible task - providing a daunting amount of care to too many residents due to short-staffing. In these instances, we believe the bulk of the responsibility for avoidable poor outcomes in nursing homes are the direct result of the administration's failure to hire and train an appropriate number of nurses and nursing aides.

Website Resource:

Medicare, Nursing Home Compare, Gold Crest Nursing Home

Northern Riverview Health Care, a nursing home in Haverstraw, NY, recently received the lowest rating possible (one star out of a possible five) from the Centers For Medicare Services (CMS). In evaluating the facility, CMS found poor results in annual health inspections and low levels of staffing. Summit Park Nursing Home in Pomona, NY received two out of five stars. Summit Park has done poorly on inspections over the last three years.

Each year, a team of trained health inspectors conduct onsite health inspections at each nursing home in New York. Inspectors look at the care of residents, the process of care, staff and resident interactions, and the nursing home environment. The data from the last three standard health inspections and all complaint inspections that have been conducted in the last three years were used to calculate the rating.

Many violations found at both facilities over the last three inspection cycles stem from failures in preventing falls or bedsores, as well as failing to implement appropriate care plans for residents.

The company that owns 22 for-profit nursing homes in California has been named in a class-action lawsuit accusing them of "skimping on staff" to raise profits at the expense of patient care. The lawsuit was filed in 2006, and the plaintiffs rested their case earlier this month.

In the lawsuit, plaintiffs accuse Skilled Healthcare Group Inc. of violating the California law that requires nursing homes provide at least 3.2 nursing hours per resident per day. The lack of adequate staff at the homes, the lawsuit contends, has a direct effect on the quality of care for the residents. The suit is seeking punitive and statutory damages for each day the nursing homes are found out of compliance.

Website Resource:

Valley nursing homes hit in staffing lawsuit, The Fresno Bee, Barbara Anderson, April 17, 2010.

More than 400 facilities called long-term acute care hospitals have opened across the national in the last 25 years. They specialize in providing care to seriously ill patients. Few of these institutions have doctors on staff, and most are owned by for-profit companies.

As As Alex Berenson of the New York Times reports, many of these for-profit hospitals have been scrutinized for their wide profit margins and lack of on-staff doctors during off-peak hours. Select Medical Corporation is a corporation that owns 89 long-term care hospitals nationwide. These facilities have been cited at a rate almost four times that of regular hospitals for serious violations of Medicare rules. Medicare inspection reports of many of these hospitals reveal preventable patient injuries, including bedsores (pressure sores decubitis ulcers) and deaths, as well as inadequate staffing numbers with high turnover.

Website Resources:

Long-Term Care Hospitals Face Little Scrutiny, New York Times, Alex Berenson, February 9, 2010.

The Centers for Medicare and Medicaid Services have given East Haven Nursing & Rehabilitation Center in the Bronx, NY its lowest rating (one out of five stars) due to below average findings in three categories: 1) health inspections, 2) nursing home staffing and 3) quality measures. Based on a June 15, 2009 survey, the Bronx facility was found to have failed to provide each resident with the highest quality of life possible, failed to provide professional services in accordance with each resident's written care plan, and failed to meet a professional standard of quality.

More specifically, the Bronx facility failed to monitor resident's bowel status to prevent fecal impaction, which resulted in actual harm to the resident.

Continue reading "East Haven Nursing Home In Bronx (NYC) Receives Lowest Rating From CMS" »

According to a 2008 poll conducted by the American Nurses Association, 73% of nurses polled do not believe the staffing on their unit or shift is sufficient. Over 10,000 nurses nationwide were surveyed. The survey also found the following:

• 59.8% of the nurses polled knew of someone who left direct care nursing due to concerns about safe staffing;
• Of the 51.9% of nurses polled who are considering leaving their current position, 46% cite inadequate staffing as the reason;
• 51.7% of the nurses polled opined that the quality of nursing care on their unit has declined in the last year; and
• 48.2% of the nurses polled would not feel confident having someone close to them receiving care in the facility where they work.

ANA President Rebecca M. Patton, MSN, RN, explained in a recent press release, "Safe nurse staffing has been linked to more positive patient outcomes, decreased length of
hospital stay, and decreased number of medical errors and patient falls. It has also been shown to improve nurse satisfaction and decrease burnout, both significant factors contributing to nurses leaving the profession."

The New York Elder Abuse Attorneys at Gallivan & Gallivan have successfully represented many victims of abuse and neglect whose main complaint about their nursing home or hospital was understaffing. We have seen first-hand, that short-staffing can result in falls/fractures, bedsores (pressure sores, pressure ulcers, decubitus ulcers), malnutrition and dehydration, and or abuse.

If you or a loved one is being neglected due to a facility's decision not to hire an appropriate number of nurses and/or nurse's aides, please contact us for a free consultation.