Articles Posted in Neglect

The Grove at Valhalla Rehabilitation and Nursing Center received 27 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on November 29, 2019. The Valhalla nursing home’s citations resulted from a total of four inspections by state surveyors. The deficiencies they describe include the following:

1. The nursing home did not adequately implement an infection prevent and control system. Under Section 483.80 of the Federal Code, nursing home facilities must create and maintain infection prevention and control protocols that are “designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.” An August 2018 citation found that the facility did not properly ensure its staff undertook adequate hand hygiene measures “to prevent cross contamination and the spread of infection” in connection to one resident. The citation states specifically that during a wound observation of the resident, who was at risk of developing a pressure ulcer, an inspector observed a Licensed Practical Nurse “his bare hands to reposition the resident in bed, in addition to pulling the bedside curtain to maintain privacy.” Then, without sanitizing his hands, the nurse in question put on a pair of of gloves with which he opened a saline solution bottle, poured the solution on gauze pads, and cleaned the resident’s wound. According to the citation, the nurse continued wearing “the soiled gloves” as he went on to perform several other activities that included touching the wound. The citation states that this conduct had the “potential to cause more than minimal harm.”

2. The nursing home did not properly implement its abuse and neglect investigation and reporting policies. Section 483.12 of the Federal Code requires nursing homes to develop and implement policies and procedures that prohibit and prevent abuse and neglect, and that provide for the investigation of abuse and neglect allegations. A November 2018 citation found that the nursing home failed to thoroughly investigate a resident’s unwitnessed fall, and to timely report the incident to state authorities in order to rule out the possibility of abuse, neglect, or mistreatment. The citation states further that the nursing home failed to report and investigate a second fall sustained by the resident. In response to the citation, the nursing home initiated an investigation into one of the incidents, and stated its intention to report the incident and the investigation’s results to state health authorities.

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New York nursing homes breathed a sigh of relief last week when a New York Supreme Court judge stopped the state from cutting Medicaid reimbursement funds to facilities across the state. Speaking on behalf of the nursing home industry, Ami Schnauber of LeadingAge New York told McKnight’s Long-Term Care News that the ruling is a “big relief” for its members across the state. The ruling comes after the New York Department of Health revamped its formula for determining Medicaid reimbursement rates. According to state officials, the new rates create a “more fair and accurate picture of [the needs of] nursing home patients.” 

The nursing home industry disagrees and says the state is trying to plug an unrelated budget shortfall by cutting necessary funding to the 80,000 New Yorkers who rely on Medicaid to pay for their nursing homes. While the health department says it does “not expect this change to result in any disruption to nursing home residents and the care they receive,” the nursing home industry disagreed and sued the state. In their arguments before Supreme Court Justice Kimberly O’Connor, the nursing homes said the $246 million cuts would cause “irreparable harm” to nursing home patients and force short-staffed nursing homes to lay off even more workers

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Manhattanville Health Care Center received 21 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on November 14, 2019. The Bronx nursing home also received Federal Civil Money Penalties of $19,505 and $12,678.25 for citations found on a May 9, 2018 survey and a May 14, 2018 survey, respectively, according to the Long Term Care Community Coalition. Federal Civil Money Penalties are one of several mechanisms state and federal authorities are empowered to enforce when nursing home facilities are found to fall short of minimum health and safety standards. Manhattanville Health Care Center’s 21 citations result from six inspections by state inspectors. The violations they describe include the following:

1. The nursing home failed to ensure it adequately administrated itself in a manner that provided for the highest possible resident well being. Section 483.70 of the Federal Code requires nursing home facilities to administer themselves in a fashion that enables the most effective and efficient use of their resources “to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.” A May 14, 2018 inspection found that Manhattanville Care Center failed to operate itself in a manner that timely provided basic life support to a resident who needed emergency care. An inspector observed a resident “unresponsive and not breathing.” A redacted number of minutes passed before staff administered CPR, and “approximately 5 minutes [passed] before 911 was activated.” The inspection found that this lapse “resulted in actual harm and the potential for serious harm to the health and safety of all residents in the facility.”

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Crown Park Rehabilitation and Nursing Center received 37 citations for violations of New York and federal public health law between 2015 and 2019, according to records provided by the New York Department of Health and accessed on November 2, 2019. Over the course of five inspections by health authorities, the Cortland, New York nursing home received five more citations than the statewide average of 32. It also received five enforcement actions resulting in fines between 2012 until 2018. According to the Long Term Care Community Coalition, Crown Park is a “one-star nursing home,” a term that indicates it “shows evidence of significantly poor levels of care.” The nursing home’s violations found by the Department of Health include the following:

1. The nursing home failed to ensure residents were free from abuse and neglect. Section 483.12 of the Federal Code provides nursing home residents with “the right to be free from abuse, neglect, misappropriation of resident property, and exploitation.” A January 17, 2018 citation found, however, that the nursing home did not ensure that ten of eleven sampled residents were provided with “adequate supervision to prevent abuse.” The citation states that these residents were involved in multiple altercations with each other, and that the facility’s failure to ensure each resident’s safety resulted in the continuation of these altercations. These altercations reportedly resulted in injuries: one resident received a bruise, while another sustained a laceration and bled visibly. Although the facility’s protocol provided for a system of safety rounds to ensure its residents’ safety, “there was no documented evidence” that such a program was operated as defined. A stipulation and order dated September 18, 2018, states that alleged violations uncovered during the January 17 inspection resulted in the Department of Health’s levying of a $2,000 fine against Crown Park Rehabilitation and Nursing Center. Continue reading

Between 2015 and 2019, Adira at Riverside Rehabilitation and Nursing received 37 citations for violations of public health laws, according to records accessed on November 2, 2019. The Department of Health is the public entity responsible for inspecting nursing homes every 9 to 15 months to ensure compliance with state and federal health and safety laws. Adira at Riverside’s 37 citations, which resulted from three inspections, were five more than the statewide average of 32. The Yonkers nursing home’s citations include the following:

1. The nursing home failed to provide proper provide treatment and services sufficient to prevent and heal pressure ulcers and bedsores. A citation issued on December 2017, found that Adira at Riverside failed to ensure that one of three residents inspected was provided with appropriate care of pressure ulcers. Section 483.25 of the Federal Code requires that nursing homes provide residents with care adequate to prevent pressure ulcers unless otherwise unavoidable given their condition, and further, that residents suffering from pressure ulcers receive necessary treatment and services to prevent infection or the development of new ulcers. The Department of Health states specifically that the facility did not properly inflate an air mattress to the manufacturer’s recommended amount so as to provide the patient with “optimum pressure relief” while they were in bed. A surveyor found that whereas the resident’s weight was recorded as 109.6 pounds, the control box regulating the air mattress was set at 200 pounds, and that facility staff were unaware who had set the air pressure at that level or who was responsible for ensuring proper mattress inflation.

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New York State agreed to pay more than $6 million to victims of abuse at a state-run nursing home in The Bronx. The settlement comes after a protracted legal battle that began more than five years ago after a series of news reports detailing physical abuse and widespread neglect at the nursing home. According to The New York Times, staff members would spit on the nursing home patient’s faces, force them to take cold showers, and physically attack the helpless patients. One family member of a nursing home resident, which is known as Union Avenue I.R.A., told the newspaper that the front desk answered the phone with, “Good morning, Bronx Zoo.”

As part of the legal settlement with New York, the nursing home abuse victims forced the state to surrender control of the facility to a private nonprofit agency. “We lost all faith that the agency can run this house effectively,” the victims said in a statement to The New York Times. Indeed, the misconduct of the nursing home was not the only problem at Union Avenue I.R.A. The lawsuit describes a dysfunctional culture where anyone who reported misconduct faced retaliation. After a state investigation found 13 instances of nursing home abuse at the Bronx facility, New York State did not fire anyone. A state-mandated arbitration process protected the confidentiality of the employees and the state merely transferred the abusers to a new facility.

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In a detailed piece on Health Affairs, David G. Stevenson dissects the current issues facing the nursing home industry and the government’s role in overseeing the unwieldy, complex industry. Beginning with the failed hope of the Nursing Home Reform Act, signed into law more than 30 years ago with the purpose of ensuring nursing homes provide a safe and healthy environment, Stevenson quickly delves into the absentee government oversight that has occurred since the landmark legislation.

After the high-profile rollback of several regulations enacted during the Obama administration deemed unnecessarily punitive or ineffective, the Centers for Medicaid and Medicare Services (CMS) appears to be refocusing its efforts on the well-being of nursing home residents.

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As part of a broader push to deregulate the nursing home industry, the Trump administration has proposed rolling back regulations on antipsychotic use in nursing homes. Under current nursing home regulations, doctors who prescribe antipsychotics to the elderly on an “as needed” basis may only write a prescription for 14 days. At the end of 14 days, the physician must reexamine the nursing home patient and write another prescription, if necessary. The Centers for Medicare and Medicaid Services (CMS) is proposing new regulations that would change the 14-day window to 70 days.

Antipsychotic use in the elderly has remained unnecessarily high and controversial, with public health experts and elder care advocates describing the practice as elder abuse. According to these experts, nursing homes who put their residents on antipsychotics lack a valid medical reason and are simply drugging these patients. Antipsychotics, such as Seroquel and Zyprexa, commonly sedate patients, especially at higher doses. In addition to doping up the residents, these mind-altering drugs also have serious side effects. The medications commonly interact with other drugs and increase the risk of everything from slip and fall accidents to death.

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The New York Health Department confirmed an antibiotic-resistant ‘superbug’ was found at Palm Gardens Center for Nursing and Rehabilitation in Brooklyn. State health officials say that Candida auris, a highly contagious, drug-resistant fungus infected 38 patients at the Brooklyn nursing home. Since arriving in the United States in 2015, 800 Americans have been diagnosed with C. auris. According to public health officials, the victims of this contagious disease are typically elderly and more than half die from the disease within 90 days.

Public health officials believe that Maria Davila may have brought the ‘super bug’ into the nursing home. After arriving at the nursing home several years ago, Davila suffered from recurrent bacterial infections – which were treated with heavy doses of powerful antibiotics. During those trips in-and-out of the hospital, bacteria that responded to the medication was eradicated. C. Auris, however, is resistant to antibiotics and therefore followed Davila back to the nursing home. The contagious disease then spread to 38 other residents.

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The Centers for Medicare and Medicaid Services (CMS) announced arbitration agreements would be allowed in nursing home agreements which receive federal funding. Under President Obama’s administration, CMS barred nursing homes from inserting mandatory arbitration clauses into their agreements. Mandatory arbitration agreements bar nursing home residents from bringing any legal grievance against their nursing home in a courtroom. Since nursing home residents are particularly vulnerable and nursing homes have a poor record of abuse and neglect, President Obama’s administration reasoned that mandatory arbitration clauses should be banned in all nursing home contracts.

Predictably, the nursing home chain did not support the federal government’s ban on arbitration clauses. The elder care industry said that arbitration provides a faster, more efficient resolution of claims for everyone involved. When President Trump came into office, his administration took a more industry-friendly approach to regulating nursing homes. In addition to sharp drops in fines on nursing homes, CMS also began deregulating the nursing home industry and appears to have reached a compromise on the mandatory arbitration agreement. Under the rule finalized this month, nursing homes will be allowed to include arbitration agreements in their default contracts with nursing home residents. However, nursing homes cannot deny admission to any resident because of their refusal to include a mandatory arbitration clause in their contract.

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