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State authorities fined a Connecticut nursing home for allegedly allowing their staffers to steal money from the residents. According to The Connecticut Post, the nursing home did not even report the thefts when they became aware of their staffer’s criminal conduct. The thefts are part of a broader elder abuse problem in the nursing home industry. According to a USA Today report, nursing home facilities frequently lack safeguards and appropriate oversight that could prevent their resident’s money from being easily stolen by staffers.

In Connecticut, state authorities are trying to crack down on the problem. At Westport Rehabilitation Complex, the state agency responsible for nursing home oversight fined the facility $8,000 after an investigation revealed that 20 residents had money stolen from their resident trust funds. Commonly, nursing homes manage the finances of their residents through facility-controlled resident trust funds. Legally, the nursing home is responsible for managing and investing the savings of each resident’s trust account. Despite this legal responsibility, financial abuse of the elderly can run rampant in some facilities. At Westport Rehabilitation Complex, withdrawal documents from several of the stolen trust accounts are covered in white-out. A grand total of $3,161 was stolen from residents at the Connecticut nursing home. When reached for comment, Westport Rehabilitation Complex said the felonious staffer was fired.

Unfortunately, stealing from nursing home residents appears to be a nationwide problem. USA Today reports that more than 1,500 cases of theft have been reported in just the last year. The national newspaper says these cases varied wildly – from small, one-time thefts to embezzling hundreds of thousands from vulnerable senior citizens across the country’s nursing homes. A lack of sufficient oversight is generally to blame, according to Ken Moore of South Carolina’s Medicaid Fraud Unit. Moore told USA Today, “I do think there’s an oversight issue… There aren’t a lot of safeguards in the system.” Describing how thousands can be stolen, Moore says, “A lot of these cases involve an office manager or a business or finance manager, and they’re the only ones at the facility who really know how much money is coming in and going out of these accounts.”

Workers at twenty nursing homes across Connecticut are preparing to strike if their salary demands are not met. According to the Fox 61, caregivers represented by the New England Health Care Employees Union, District 1199 SEIU, plan to strike on June 3 if the state does not increase its wages. According to the local news report, nursing home staffers did not receive a raise in 2017 or 2018. Last year, the raise was only 2 percent – less than the annual rate of inflation and adding only 30 cents for “most workers.” Under the current budget, nursing home staff will not receive any raise in 2019 or 2012. The nursing union says it will not call off the strike unless all caregivers receive a 4 percent increase in wages. The estimated cost would be $40 million, according to labor officials.

According to the nurse’s union, stagnate wages for another two years would be unacceptable. “More than 2,500 nursing home caregivers will be forced to walk out of their jobs until proper funding is provided to raise their take-home pay,” Rob Baril, president of SEIU 1199 New England, told Fox 61. According to Baril, “some members” of the nurses union are currently making “as little as $10.93 an hour.” Baril did not mention how many caregivers in his union made such low salaries before noting that the hourly pay was less than one dollar higher than the state’s minimum wage. Baril says that the union will not call off its strike unless all caregivers receive a 4 percent raise.

The union and state have been operating without a contract since 2015. After failing to reach an agreement for the last four years, the negotiations this year have been unsurprisingly fraught. Just last week, SEIU 119 New England called off a nursing strike originally set to take place on May 1. According to the union, state officials agreed to continue negotiations with the union if it rescheduled the walk-out. Now, an estimated 7,000 nurses plan to walk off the job on June 3 if a new agreement between the union and the state is not signed. Given four years of fruitless negotiations and stagnant pay, it seems likely the nursing home caregivers in Connecticut will be striking next month.

Oklahoma’s new elder abuse law cracks down on the use by nursing homes of “chemical restraints” on their patients. According to America Nurse Today, chemical restraints are unnecessary medications used to “restrict a patient’s movement or behavior.” Importantly, these chemical restraints are not a part of a standard approved treatment. Most commonly, nursing homes use antipsychotic medications – powerful psychotropics with a variety of side effects, drug interactions, and risks.

While it is undoubtedly immoral and unethical to force someone without a proper diagnosis to take powerful mind-altering medications just to make them more compliant with nursing staff, the practice is sadly very common. According to Health Affairs, 14 percent of all nursing home patients are on an antipsychotic. The industry watchdog estimates that 83 percent of these prescriptions are for an unapproved or off-label use. A report by the Centers for Medicaid and Medicare Services found that 40 percent of nursing home residents on antipsychotics do not have a diagnosis of psychosis.

To counter the scourge of chemical restraints meant to make elderly residents docile, Oklahoma is cracking down on the nursing homes. Under Oklahoma’s new law, a doctor must conduct a medical exam, diagnose the patient, and obtain informed written consent from the nursing home resident or their caregiver before writing a prescription for antipsychotics. After passing the law, Oklahoma’s governor noted that the state with the most nursing home residents on antipsychotics (20 percent) will now have the toughest law against it.

The federal government is currently backing $20 billion in mortgages to the nursing home industry, including over $2 billion just in New York State. According to elder care advocates, the federal program originally meant to ensure a sufficient number of nursing homes is now widely abused and lacks sufficient oversight. According to The New York Times, the majority of these loans, which banks deem too risky without the federal government guarantee, are taken out by private, for-profit nursing homes. Unsurprisingly, this program has left the federal government on the hook for failing nursing homes and their missed mortgage payments. Last year, nursing home businesses defaulted on $146 million in government-backed mortgages.

Given the inadequate supervision of the nursing home industry, the problems will likely get worse before they get better. Problems with the federal loan program began in 1995 when the program only supported 800 nursing homes. At the time, a Government Accountability report found that nursing homes “generally do not focus attention on nursing home loans unless financial trouble appears imminent or a default occurs.” The report went on to excoriate the lack of adequate oversight and the potential for widespread abuse going forward. Since that time, the federal program has almost tripled in size – to 2,300 nursing homes comprising 15 percent of the country’s total.

With the increase in for-profit nursing homes, the problems with the program have become even worse. In some circumstances, nursing homes have continued to pay lavish salaries to executives while missing their mortgage payments at the same time. One nursing home quit paying its mortgage within several months of assuming ownership and then used federal money meant to prop up the nursing for other purposes. When the nursing home finally collapsed, the federal government took over and currently pumps almost $1 million each month into the grossly-mismanaged facilities.

The cost of nursing home care continues to increase sharply while the quality of nursing homes continues to decline. The cost of nursing home services even eclipses the broader medical field, according to a new study from Georgetown University Medical Center. According to researchers at the university, nursing home prices increased 30.18 percent between 2005 and 2010. Consumer goods increased by 11.7 percent and medical costs increased 20.2 percent during the same period. In New York, nursing home costs increased 21.8 percent during the six-year period – approximately the same level as the medical services industry, at large.

The study published in Medical Care Research and Review analyzed pricing trends for the nursing home industry. Besides the sharp increase in costs each year, the researchers also reported significant variation in nursing home costs across the United States. The cheapest nursing homes in the country are found in Texas where the average cost per resident is $47,800 each year. Nursing home residents in California pay the most for their nursing facilities. Costing almost three times as much as Texas, the average nursing home costs $121,910 a year in the Golden State. According to Fox Business, the gulf between average nursing home prices in California and Texas grows wider each year.

Besides geography, the study reported other factors which influence the cost of a nursing home. Following the basic rules of supply and demand, “nursing home concentration” or the number of nursing homes serving a geographical area played a large role in determining nursing home costs. The authors of the study posit that not only does competition for residents keep prices low but the larger nursing home industry attracts similar talents and the free exchange of information.

New York Senator Kirsten Gillibrand proposed a new federal law aimed at improving staff levels at nursing homes across the country. According to Sen. Gillibrand, the impetus for the new legislation on nursing homes comes from a bipartisan report released this summer, which detailed widespread problems at nursing homes across the state and country. Speaking to reporters, the New York Senator said, “Unfortunately, a report came out on nursing homes and long-term care facilities that have had problems, and 17 are located in New York State.” 

Sen. Gillibrand is referring to the 488 nursing home facilities across the country which the report found a “persistent record of poor care.” Currently, the federal government only applies extra scrutiny on 88 so-called “special focus facilities” across the country. This leaves 400 nursing homes with records of abuse and neglect without sufficient oversight.

According to Sen. Gillibrand, insufficient and incompetent staffing is one of the root causes of the poor performance and conditions at these nursing homes. The bill she proposed in the Senate last month aims to fix that problem. The bill, which has bipartisan backing and is sponsored by Colorado Republican Cory Gardner, would expand access to Medicare and Medicaid data to “nursing homes, home health agencies, and hospice programs,” reports The Buffalo News. The bill, called Promote Responsible Oversight and Targeted Employee Background Check Transparency for Seniors (PROTECTS) Act, would improve the standard of living at nursing homes by “bringing more transparency to workforce quality,” says Sen. Gillibrand. 

In 2018, one-third of all nursing homes in the country received a citation for violating federal standards on safely storing, preparing, and serving food to their residents. This makes food safety the third most common violation at nursing homes in the United States. The safety violations are not minor infractions, either. The Centers for Disease Control and Prevention (CDC) reported 230 foodborne illness outbreaks at nursing homes between 1998 and 2017. These outbreaks resulted in 532 hospitalizations and 52 deaths, reports NBC News. Further, the news agency says this number is almost certainly undercounted since the federal agency relies on voluntary reporting by nursing homes – facilities who do not have a track record of following even mandatory reporting requirements for heinous crimes such as sexual abuse or theft.

Similar to stories of nursing home abuse, horror stories about foodborne illnesses abound. In California, one woman described moving her 98-year-old mother out of a nursing home after finding cockroaches in the kitchen. In Arkansas, one facility was cited six times over the course of two years – including one health inspection detailing “grimy kitchen appliances” and “staff with unwashed hands,” according to NBC News. Such occurrences are not uncommon, according to the news report many nursing homes with the worst problems are usually repeating offenders. 

According to NBC News, food safety is especially imperiled for nursing homes owned by for-profit chains. For example, nursing homes owned by Genesis Healthcare, one of the largest nursing home corporations in the country, were 11 percent more likely to receive a citation for food safety violations in the last year. Speaking to NBC News, a representative for the nursing home chain said, “We are aware of some regulatory compliance issues and are working diligently to resolve any problems as quickly as possible.”

Pelham Parkway Nursing Care and Rehabilitation Facility received 28 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on December 7, 2019. The Bronx 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 take adequate steps to prevent medication errors. Under Section 483.45 of the Federal Code, nursing homes must ensure that residents are kept “free of any significant medication terrors.” A February 2017 citation found that the nursing home failed to ensure residents were free of significant medication errors in an instance in which a resident’s tablets were crushed and mixed into food even though, a pharmacist consultant said in an interview, the medication “is not crushable because when it is crushed, it becomes an immediate release and the total dose is delivered faster.” The citation notes that when the medication becomes an immediate release, it risks causing a drop in blood pressure.

2. The nursing home did not properly implement its policies and procedures related to flu and pneumonia vaccinations. Section 483.80 of the Federal Code stipulates that before nursing homes offer residents flu and pneumonia vaccines, they must provide the resident or the resident’s representative with “education regarding the benefits and potential side effects of the immunization.” A February 2017 citation found that the nursing home did not ensure a resident received education before receiving the pneumonia vaccine. The resident told an inspector that he received the flu vaccine but did not remember receiving the pneumonia vaccine, and that although a nurse provided him with a consent form for the flu vaccine, he did not remember receiving education concerning the pneumonia vaccine’s risks or benefits. The citation states that facility records reflected that the resident received the pneumonia vaccine, however, the inspector found no documented evidence reflecting that the resident was educated before receiving it. The citation described this deficiency as resulting in the “potential to cause more than minimal harm.”

Split Rock Rehabilitation and Health Care Center received 29 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on December 7, 2019. The Bronx nursing home’s citations resulted from a total of four inspections by state authorities. The violations they describe include the following:

1. The nursing home did take adequate measures to protect residents from abuse and neglect. Under Section 483.12 of the Federal Code, nursing homes are required to ensure residents’ right to be free “from abuse, neglect, misappropriation of resident property, and exploitation.” A February 2019 citation described Split Rock Rehabilitation and Nursing Center’s failure to ensure one resident’s freedom from physical abuse. The citation specifically describes a nurse’s statement that they witnessed a therapist slapping a resident on his right cheek. According to a note recorded by the nurse, the therapist used his left hand to slap the resident on his right cheek, which was noted to “have marks of fingerprints.” The resident was administered Tylenol and a cold compress. A plan of correction described in the citation states that the therapist was placed under arrest after the incident and terminated from the facility.

2. The nursing home did not properly implement its infection and control program. Under Section 483.80 of the Federal Code, nursing homes are required to “establish and maintain an infection prevention and control program” that helps to prevent the development and transmission of communicable diseases and infections. An August 2019 citation found that the facility did not ensure the proper maintenance of its infection control protocols. An inspector specifically found that a Respiratory Therapist did not conduct proper hand hygiene while caring for two residents, and that a Licensed Practical nurse did not conduct proper hand hygiene while changing a resident’s dressing. The citation found that these failures resulted in the “potential to cause more than minimal harm” to residents.

St. Patrick’s Home received 24 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on December 7, 2019. The facility was also the subject of a 2017 fine of $10,000 in connection to findings that it did not provide an environment free of accident hazards. The Bronx nursing home’s citations resulted from a total of four inspections by state authorities. The violations they describe include the following:

1. The nursing home did not ensure residents’ right to be free from physical restraints. Under Section 483.10 of the Federal Code, nursing home residents have a right to be treated with respect and dignity, which includes a right “to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.” A September 2019 citation found that the resident did not protect a resident’s right to freedom from physical restraints. An inspector specifically observed on multiple instances a resident sitting in her wheelchair “with a long table in front of her, close to a wall that prevented the resident from rising out of the chair.” A staffer said in an interview that the arrangement was intended to prevent the resident from sustaining falls; the facility’s Attending Physician said in an interview that he did not realize the table “could be considered a restraint.” A plan of correction undertaken by the facility included the use of a “least restrictive restraint device” as a last resort for the resident.

2. The facility did not provide an environment free of accident hazards. Under Section 483.25 of the Federal Code, nursing home residents are entitled to an environment free from accident hazards, and with adequate staff supervision (as well as assistive devices) to help prevent them from experiencing accidents. A November 2016 citation found that St. Patrick’s Home failed to ensure this right in an instance in which staff did not properly respond to a door alarm when a resident opened and moved through a staircase door equipped with an alarm. The resident subsequently fell down a flight of stairs, while in her wheelchair, and “sustained multiple fractures, laceration and a hematoma.” According to the citation, facility staff did not discover the resident until approximately an hour after the event. This incident resulted in a $10,000 fine against the facility.

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