Articles Posted in Nursing Home Violations

After a spate of negative press coverage last year, Medicare has only issued limited guidance for the upcoming natural disaster season. After widespread lack of preparation in the wake of Hurricane Irma in Florida and Hurricane Harvey in Texas harmed America’s nursing homes, many patient advocates are worried about the nation’s nursing home residents. According to these advocates, the same systems and policies that led to widespread power outages and death last year have not been fixed yet.

Last September when Hurricane Irma struck Florida, residents of Rehabilitation Center at Hollywood Hills found themselves stuck at a nursing home without any air conditioning, power, or a backup generator – all violations of Medicare policies. Sadly, fourteen of the residents at this now-closed nursing home passed away during the 90-degree heat which overtook the nursing home for a week. In response to these flagrant violations, Medicare passed emergency planning regulations last November which required each facility to:

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In response to insufficient medical and nursing staff, Medicare has lowered ratings for 1 out of every 11 nursing homes across the country. The lowered ratings come after the government agency retooled the way it calculates the nursing staff at each nursing home. Under the new method, which requires nursing homes to submit payroll information every quarter, nursing staff numbers appeared grossly deficient at facilities across the country. After Medicare warned nursing homes in April about a possible reduction in their rating without an increase in nursing staff, the government agency followed through last week and reduced the star-rating for nearly 1,400 nursing homes across the country.

For the most part, the nursing homes with recently reduced ratings lacked a sufficient number of registered nurses, which are the “highest-trained caregivers” and responsible for managing other nurses. Under Medicare guidelines, a nursing home only needs to have a single registered nurse working eight hours per day. However, most nursing homes are not meeting these simple guidelines or could not provide payroll information proving the requirement was satisfied. According to Medicare officials, payroll information is not usually “taken seriously” by nursing homes and forcing the facilities to provide proof through their payroll system will hopefully force nursing homes to take their record keeping more seriously.

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The Attorney General for the State of New York charged 57-year-old Jerry Clarke, a Rochester Nurse, with abusing a nursing home resident. Clarke, who worked at Creekview Nursing and Rehabilitation Center, has been charged with a felony count of endangering the welfare of an incompetent or physically disabled person and a misdemeanor count of willful violation of health laws. Creekview says it released Clarke, whom it had employed for six years, upon learning of the pending investigation.

According to the indictment, Clarke wrestled and punched a 64-year-old patient at the nursing home multiple times. While violently assaulting the senior citizen, Clarke allegedly yelled, “I told you not to try me” along with several racial slurs. The attack occurred against a resident, whose name was withheld from all news accounts, was unable to take care of himself because of known mental and physical handicaps. According to the indictment, Clarke “smelled of alcohol and appeared to be high during the incident.”

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After increased regulation under the Obama administration, President Trump has whittled away at federal regulations targeting nursing homes and meant to prevent nursing home abuse across the country. At the same time, the country’s aging population is putting more senior citizens in nursing homes. According to research by Morningstar, by 2020, a full 40 percent of all deaths will occur in a nursing home. Elder care advocates worry about an increasing number of Americans being allowed into a decreasingly regulated nursing home system.

According to elder care advocates, their worry is not misplaced. Between 2013 and 2018, almost four out of every 10 nursing homes in the country received a citation for a “serious violation” that could endanger nursing home residents. Under previous administrations, these violations would typically come levied with a serious fine – hopefully high enough to deter future behavior. Under the Trump administration, however, the amount of these fines has been significantly reduced through new guidelines issued in December 2017. In an example cited by the Kaiser Foundation, a nursing home was fined $300,000 in 2013 after a nursing home resident died because the staff failed to effectively monitor and treat a wound. Under the new guidelines, the maximum fine the nursing home could receive is $21,000.

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The government recently adopted a more accurate measurement for determining when a nursing home has sufficient staffing levels and the results show a glaring problem across the nursing home industry. According to Kaiser Health News, the new method of recording hospital staffing shows a 12 percent decrease in hospital staffs. Further, there seems to be a severe fluctuation at many nursing homes which have sufficient nurses during the week but insufficient staff on the weekends. The new evidence shows that despite the minimal Medicaid requirements on the nursing staff levels at nursing homes, many nursing homes are still failing.

Under the previous method for calculating nursing staff, nursing homes would be required to provide all payroll information for the previous two weeks and government regulators would tally and report on the number of nurses employed during that time period. Because nursing homes sometimes knew when an inspection would occur ahead of time, this method was not generally considered accurate. Under the new method for calculating nursing staff, which Medicare began in April of this year, nursing homes must provide a report to Medicaid on staffing throughout the entire year.

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Over the past four years, the Franklin Center for Rehabilitation and Nursing received 26 citations from the New York State Department of Health. All of these citations related to violations concerning the treatment and health of the senior citizens at the Queens nursing home. Compared to the state average, this facility received approximately the average number of citations. However, residents of this facility were more likely to be physically restrained (4.6 percent of all residents) and more likely to have a catheter inserted (1.4 percent of all residents), according to the New York Department of Health. In addition to these issues, the government agency cited the elder care facility for the following violations:

1. The nursing home failed to adequately prevent pressure sores.

Franklin Center for Rehabilitation and Nursing did not adequately protect its residents from pressure sores, or bed sores in violation of Section 415.12(c)(2) of the New York Code. Under this New York regulation, each nursing home in New York must ensure that their residents do not develop pressure sores while at their facility, unless unavoidable.

For residents who enter the nursing home or elder care facility with pressure ulcers, or bed sores, the nursing home must provide “necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.”

Franklin Center violated this regulation when one of the residents, with a stage-four pressure ulcer, the most severe type, did not receive necessary treatment. Specifically, the health examiner noted that the nurse applied a “dressing appliance that was too small, and she dried the wound using improper technique.” When asked by the health examiner to explain her actions, the nurse admitted she should have “patted the wound dry instead of wiping in order to prevent tissue damage.”

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According to the Kaiser Health News, an average of 21 percent of nursing home residents are readmitted to the hospital within 100 days of returning to their nursing home. Now, Medicare plans to crack down on these nursing homes who either allow nursing home residents to return too quickly or fail to properly administer the resident’s post-hospitalization care. According to Medicare, most nursing home patients are readmitted for mostly preventable problems, such as dehydration, bedsores, infections, and medication errors. While patient advocates believe there can be significant room for improvement in these re-hospitalization rates, they also caution against punishing nursing homes who send their elderly residents to the hospital.

According to a government report, cited by NPR, a full 10.8 percent of re-hospitalizations are preventable. The causes for the high rate of unnecessary hospitalizations are numerous. First, the nursing home may not follow the hospital’s post-hospitalization care routine for their resident. In one example cited by the news organization, nurses at a nursing home in North Carolina injected a patient with a blood thinner twice a day – despite written instructions from a hospital doctor to cease all blood thinning medication. The second cause concerns overloaded hospitals, which would prefer to offload patients onto nursing homes in an effort to free-up space for more patients.

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State investigators in Raleigh, North Carolina have captured several nurses cruelly abuse an elderly man at a retirement home on a hidden camera. The hidden camera was set up after an elderly man told his daughter that the orderlies had been “tormenting and neglecting him,” according to WRAL. In response to the incident, state investigators are investigating the nursing home.

According to the news station, the video shows Richard Johnson, 68 years old and recovering from a stroke, fall out of his bed. After crying out for help, several orderlies pass by and ignore the elderly man for over an hour. When staff members finally arrive they immediately begin berating and cruelly taunting the senior citizen, asking “What are you doing there? Why are you on the floor?” Another nurse joined in on bashing the vulnerable man, stating “You had to do something very wrong with your life. What did you do? You’re suffering so bad, so you’ve done something wrong. Yes, you did.”

According to Richard Johnson’s daughter, Johnson even went to the bathroom while on the floor waiting for help. This unfortunate incident prompted a third member of the nursing staff to scold him, saying “How old are you? One? You’re supposed to be enjoying your retirement. Instead, look what you are doing, pooping on yourself. Shame on you.”

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Between 2014 and 2018 Beach Gardens Rehab and Nursing Center in Queens, New York received 92 complaints by its residents and 19 citations by the New York Department of Health. The Department of Health inspects all nursing homes throughout the state every 9 to 15 months to ensure their compliance with all laws regulating nursing homes and the treatment of their residents. These are several of the citations the Queens nursing home received over the last few years:

1. The nursing home failed to prevent pressure ulcers or bed sores.
Beach Gardens Rehab and Nursing Center received a citation in June 2017 for failing to prevent its residents from receiving pressure ulcers. Under Section 483.25(c) of the Federal Code, all nursing homes must “ensure that a resident who enters the facility without pressure sores does not develop pressure sores…” Further, if a resident does have pressure sores then the nursing home is obligated to provide “necessary treatment to promote healing, prevent infection and prevent new sores from developing.” In this instance, the New York Health inspector randomly sampled three residents at the facility that had not entered with pressure ulcers. According to the inspector, one of these residents later developed a pressure ulcer on their left heel after the nursing home failed to use preventative measures, despite documentation that the resident posed a moderate risk for pressure ulcers.

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Monitoring and reporting of elder abuse is one of the most important responsibilities delegated to New York regulators. However, recent news reports have cast a light on the accuracy and effectiveness of these reports. Advocates for elder care say the data collected by regulators does not effectively represent the harm caused to nursing home patients when the facilities violate state or federal regulations. Based on the evidence provided, it appears these advocates may be correct.

According to the Centers for Medicare and Medicaid Services (CMS), only 4 percent of all regulatory violations result in “actual harm” to a resident at its facility. While the data is collected at a federal level, state regulators are required to perform the inspections and relay the information to CMS. In New York, the legal entity responsible for inspecting nursing homes is the New York Department of Health.

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