February 2010 Archives

February 27, 2010

Beware of Binding Arbitration in Pennsylvania Nursing Home Contracts

When residents enter nursing homes, they are almost always asked to sign contracts. These contracts specify all of the obligations the home has to the resident and his or her family, as well as the family's obligation to the home. Our Philadelphia nursing home negligence attorneys recommend reading any contract carefully, of course. But in particular, we advise families to watch nursing home contracts carefully for a provision requiring something called binding arbitration. Binding arbitration removes families' ability to sue in the event of any abuse, neglect or other wrongdoing at the home.

Binding arbitration is essentially private judging. Rather than going to a courthouse and explaining your case to a jury and judge, you and the nursing home would hire a private arbitrator (sometimes a retired judge) to hear the case and make a decision. Companies say it's faster than going to court, and sometimes cheaper. However, binding arbitration has come under criticism in the past few years after statistics showed that arbitrators decide in favor of the companies in an unusually high proportion of cases. Overwhelmingly, the companies are also the ones that pay the arbitrators' bills. The resulting public outcry has led to two bills in Congress to ban the practice -- including one that applies specifically to nursing homes.

In nursing homes, there are two major problems with binding arbitration. At worst, families' cases are decided by someone who was bought and paid for by the nursing home company. Because their contracts specify that the arbitrator's decision is final, families can rarely appeal to a state court. This denies justice in that one case. However, there's also a larger problem of "moral hazard." Binding arbitration with a friendly arbitrator allows nursing home companies to escape accountability for their actions. In essence, that means nursing homes have no incentive to cover up unsafe and illegal conditions -- placing more residents at risk.

Consumers often don't realize binding arbitration is buried in contracts until after they sign. Some states have thrown these contracts out of court, but Pennsylvania is not currently one of them. That means Pennsylvania families should look for binding arbitration clauses anytime they're ready to place a loved one in a nursing home. If they find one and prefer not to agree to it, they can and should ask the nursing home to change or remove it. Families who have already signed a binding arbitration contract should not give up, however. You can and should have a Philadelphia nursing home abuse attorney represent you in arbitration hearings, as well as in any court case necessary to fight the arbitration clause.

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February 25, 2010

Long-Delayed Federal Database of Dangerous Pennsylvania Caregivers to Be Released

As Philadelphia nursing home neglect attorneys, we are extremely interested in a database of caregivers that will be released March 1. McKnight's Long-Term Care News reported Feb. 17 that the database of caregiving workers deemed "dangerous" in some way has been delayed for 22 years -- since 1988. The Department of Health and Human Services plans to finally make it available next month. But McKnight's reported that an investigative report has already criticized the database as incomplete.

The criticism comes from a joint investigation between ProPublica, a nonprofit investigative journalism organization, and the Los Angeles Times. That report found that states don't communicate well with one another. This allows caregivers with records of violence, theft or incompetence to move to a new state after the first state revokes their professional credentials. The investigation compared the federal database to state records and discovered that many states simply hadn't reported cases, or all of the details of those cases, to the federal government. Many of them are among the most recent complaints.

One licensed nurse in the article had been accused of mistreating nursing home residents at three previous facilities before he was charged in Minnesota with assaulting a resident. His licenses in three other states are on probation or restricted and he had surrendered a Texas license -- but his California license is clear.

McKnight's said DHHS Secretary Kathleen Sebelius responded to the report by asking state governors to fill in the missing information. As Pennsylvania nursing home abuse lawyers, we hope they respond quickly and decisively. Elderly, ill and disabled nursing home residents are among the most vulnerable people in our society. They deserve better.

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February 23, 2010

Nursing Home Residents Test Positive for Unexplained Opiates

An article about trouble at a nursing home in North Carolina caught the eye of our Pennsylvania nursing home negligence attorneys. The Times-News of Burlington, N.C. reported Feb. 18 that opiates were found in the blood of several residents of The Britthaven of Chapel Hill nursing home, even though none had been prescribed an opiate drug. State officials planned to investigate. The home's parent company is also running its own investigation, and Chapel Hill police have already investigated and determined that no crime was committed.

The case started when a blood test for one resident in the Alzheimer's unit found opiates, despite no prescription for such a drug. (Several kinds of prescription painkillers contain opiates.) The news concerned the nursing home's staff, some of whom thought other patients in the Alzheimer's unit seemed sluggish. Testing turned up opiates in at least two other patients, who were admitted to a hospital. The first resident died of a case of pneumonia that the home's spokesperson said was unrelated. The head of the state's Division of Health Service Regulation said the incident was confusing, especially because no drugs were missing or misplaced at the home. However, he said, some antibiotics can create a false positive for opiates.

The nursing home was already getting extra inspections because of its poor record of care. Inspections in 2008 and 2009 found that certified nursing assistants didn't have enough time per patient to meet state standards. In November, the home also paid a fine for a water-temperature violation that investigators said could have led to an accident for a resident.

As Philadelphia nursing home abuse lawyers, we are surprised the police finished their investigation before the state started its own. If antibiotics are the culprit, it should be fairly easy to determine whether any of the residents who tested positive were taking such a drug. If that's not the case, state investigators -- and residents' families -- should look carefully for evidence of wrongdoing at the home. Alzheimer's patients can be difficult, and at some homes, this has led to misuse of sedative and antipsychotic drugs to control behavior. Opiates can have sedative effects, but they can also cause patients' breathing to slow and stop, putting their lives in danger. It also causes withdrawal when patients quit abruptly. Any evidence that opiates were misused at the home should cause swift and permanent changes to protect residents.

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February 21, 2010

Pennsylvania Nursing Home Aide Charged With Stealing Patients Drugs

Nursing home employees have a lot of access to prescription drugs. As Philadelphia nursing home negligence attorneys, we know that this can lead to serious wrongdoing in some cases -- such as the case of 26-year-old Andrea Markland. The Allentown Morning Call reported Feb. 9 that Markland, a former aide at a Telford nursing home, will stand trial for stealing time-released painkiller patches from the bodies of residents. She is charged with neglect of a care-dependent person as well as theft and receiving stolen property.

Markland's victims were two women in their eighties who had been prescribed time-release patches containing fentanyl, a powerful synthetic opiate. One of the victims has died since the thefts. In written statements to police, Markland admitted that she stole the patches five to seven times, cut them open and ate the medicated gel inside to feed an addiction to painkillers. By stealing the patches, the home's nursing supervisor said, Markland left the women in "debilitating pain." She also stole from the people who were paying for the women's treatment, a police officer said. Markland was caught after another employee saw her leaving an area where she wasn't supposed to be working.

As Philadelphia nursing home abuse lawyers, we suspect that this problem happens more often in nursing homes than it's reported. Opiates and other painkillers are widely abused and are heavily restriction because of their high potential for abuse. It's easy to predicts that nursing home workers might be tempted to abuse their positions, or even intentionally take a job to get access to narcotics. Nursing homes have a legal and ethical obligation to protect their residents from employees and potential employees willing to feed their addictions at residents' expense.

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February 19, 2010

One Fifth of Nursing Homes in Pennsylvania and Nation Get Low Medicare Ratings

Our Philadelphia nursing home neglect lawyers believe independent rankings are one of the best ways for families to begin their searches for a safe and caring nursing home. So we were dismayed by a Jan. 27 USA Today article showing that about a fifth of nursing homes have consistently received poor ratings from the Centers for Medicare and Medicaid Services. The poorly rated homes are in every state and the District of Columbia, the newspaper said, and a quarter of a million people live in them. Perhaps most significantly, the report said almost all of the poorly rated homes were owned by for-profit companies.

The Medicare ratings began in 2008, so there are only two years of data to compare, the article said. But in those two years, about a fifth have consistently scored one or two stars on a five-star scale. The ratings are calculated from inspection reports, complaints from patients and families, health and safety violations and more. The lowest-rated homes had an average of 14 problems per home. Medicare spokespeople said the overall ratings have already improved in the past year and may continue to improve in future years, as homes continue trying to improve.

As Pennsylvania nursing home abuse attorneys, we agree that two years isn't much time to improve a rating. But this ignores the question of how those homes came to be poorly rated in the first place. No doubt many homes existed for years or decades before the Medicare ratings started in 2008 -- and so did their problems. Trying to improve now is still a good thing, but it also implies that long-term, difficult-to-solve problems may continue to plague them. We would advise clients to research this very carefully before placing a loved one in such a home.

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February 17, 2010

How to Spot Theft From Patients in Pennsylvania Nursing Homes

Nursing home abuse makes headlines, and it's a serious problem that homes and residents' families should be watching for. But as Philadelphia nursing home neglect attorneys, we find that theft and financial exploitation may be even more common in nursing homes. Theft in nursing homes can be straightforward -- an employee, another resident or a visitor may simply take money and valuables out of the patient's room, or sometimes even from his or her person. It can also be subtle and sneaky, with the thief using threats, intimidation, medication, medical conditions or deception to get valuables.

In some ways, nursing home residents make good targets for theft. Older people tend to have more savings and if they own a home, it's probably paid off. People in nursing homes are also there because they have problems living independently, making them dependent on others. Unscrupulous people can take advantage of incapacitating health conditions to steal things outright, and depend on the resident's inability to communicate clearly to keep them out of trouble. In other cases, thieves may coerce, threaten or deceive patients into giving things away or signing away rights to valuable property. Sometimes, the victim even knows about it, but believes the financial move benefited him or her, or that it's a reasonably sized gift.

To catch financial exploitation in nursing homes, residents' families should keep an eye on the resident's finances and valuables. Watch bank accounts for unexpected activity, and be sure you have the right to ask questions if necessary. During visits, make sure your loved one has all of the money and items he or she used to have, particularly items that wouldn't be casually lost or given away, like heirloom jewelry and wedding rings. And if you suspect particular people, watch those people to see they're spending more than you believe they could make at their jobs. If you catch a thief in time, you may be able to get the money back, through a criminal prosecution or a Pennsylvania nursing home negligence lawsuit.

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February 15, 2010

Life-Threatening Bedsores Can Be Caused by Nursing Home Neglect in Pennsylvania

Bedsores -- also known as pressure sores and decubitus ulcers, are one of the most common neglect-related health problems that arise in nursing homes. Our Philadelphia nursing home negligence attorneys frequently hear stories about them from victims of abuse and neglect at nursing homes, or victims' families. However, we find that many people who have never cared for someone with mobility problems don't realize bedsores exist and don't know how to detect them. This can be a problem, because it can delay the family's realization that their loved one is not being properly cared for, allowing the problem to worsen.

Bedsores develop when someone who is bed-bound or wheelchair-bound spends too long in the same position, especially on a bony part of the body. Fully mobile people don't develop them because they can simply shift position when they're uncomfortable. The pressure of the patient's own body weight, gravity and friction eventually cut off blood flow to the area, damaging and eventually killing the tissues. Excess moisture, lack of sanitation, poor nutrition and some underlying medical conditions can worsen the problem. At first, bedsores may look like a reddish (in light-skinned people) or darkened, blue or purple (in dark-skinned people) patch of skin. But as time goes on, they start to look like increasingly serious ulcers. If left untreated for too long, bedsores can create holes in the skin reaching down to muscle or bone. At their most serious, bedsores can cause potentially fatal infections, gangrene, anemia or kidney failure.

Despite the seriousness of the problem, preventing bedsores is simple. The accepted standard of care is to simply turn the patient every two hours (or sometimes more frequently). Some patients also use special pressure-relieving seating and mattresses. Nursing homes are easily able to do this -- but frequently, turning patients falls by the wayside due to poor training, lack of caring or understaffing and overwork. Patients who can't leave their rooms or tell someone about the problem may suffer for weeks without relief, until the problem is so serious that they need hospitalization. This is one reason pir Pennsylvania nursing home neglect lawyers believe it's essential for families, especially families of patients with communication problems, to understand how to spot and fix bedsores.

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February 13, 2010

Nursing Homes in and Outside Pennsylvania May Fail to Protect Residents From Sexual Violence

A recent Chicago Tribune article called attention to a little-recognized but important problem among nursing home patients: physical and sexual violence between patients. As our Pennsylvania nursing home abuse attorneys know, mentally ill or diminished patients in particular pose a risk to other patients if not properly medicated and supervised. The Chicago Tribune took a look at this problem and published some disturbing results Jan. 26. According to the article, authorities have investigated 86 cases of sexual violence in Chicago nursing homes since 2007, in a quarter of the city's homes. Despite all of those investigations, authorities made an arrest in only one case.

In the majority of the cases, elderly or disabled female residents were attacked by male residents. Only a few cases involved attacks by staff, although the one prosecution the newspaper found was of an orderly. The Tribune said attacks were more likely in homes that housed a high percentage of younger mentally ill people who had been convicted of crimes, some of them violent crimes. Of the 30 homes where sexual assaults happened, 21 were federally rated as below average or well below average on staffing levels. In one case, a 61-year-old woman yelled "No, no, please" as she was assaulted by a 47-year-old man with a history of "inappropriate sexual behavior," but said she was too scared to fight back. The home's police report, filed months later, said she described the sex as consensual.

These stories are deeply disturbing to Philadelphia nursing home negligence lawyers like us. Most stories of nursing home abuse focus on abuses of power by staff, but as this article shows, abuses by other residents can and do happen. Every nursing home resident has a basic right to be safe in his or her home. Homes that fail to provide adequate protection not only fail in their basic duties, but leave themselves vulnerable to administrative or criminal penalties and nursing home negligence lawsuits.

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February 10, 2010

Family Sues Philadelphia Nursing Home Over Father's Death from Exposure

Our Pennsylvania nursing home negligence attorneys wrote recently about a Pittsburgh Tribune-Review investigation of state-run veterans' nursing homes. As part of that investigation, the newspaper profiled a nursing home neglect lawsuit filed by a family here in the Philadelphia area. The daughters of Harold Chapman sued the Delaware Valley Nursing Home after the 75-year-old dementia patient died of exposure in December of 2007. Surveillance tapes showed that Chapman, a former Philadelphia police officers, simply rode an elevator downstairs with an off-duty staff member and walked out the door, two hours before any staff members noticed he was missing.

It was New Year's Eve when Chapman left the building; his widow, Barbara Chapman, said everyone in the building was busy getting ready for a party. Records show no one was monitoring Chapman at the time, nor did anyone stop him from leaving the building even though he was only wearing pajamas. Two hours later, a nurse noticed he was missing, but it took more than another hour to notify the home's commander and call the police. A search of the grounds on foot and by police helicopter turned up nothing, but the next day, Chapman was found dead of hypothermia, only a short distance from the building. A staff member who was with Chapman before he left quit his job when he discovered he would be questioned.

State officials would not comment on the incident. However, the Delaware Valley home was later cited for breaking several laws in the incident, and staff members were reprimanded or suspended for their roles. It was just one of several homes with serious problems found in the Tribune-Review's investigation. Unfortunately, as Philadelphia nursing home abuse lawyers, we know that patients like Chapman are particularly vulnerable to neglectful and poorly-run homes, because they don't have the ability to speak out or protect themselves. We represent clients who, like Chapman's daughters, are pursuing justice from homes whose negligence has harmed or even killed patients.

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February 8, 2010

The Importance of Staffing Levels at Pennsylvania Nursing Homes

As Philadelphia nursing home negligence lawyers, we cannot overestimate the importance of proper nursing home staffing levels as a way to prevent abuse and neglect. A 2004 study from the National Institutes of Health said the nursing homes with the lowest ratios of patients to staff performed significantly better on metrics measuring quality of care. Like all workers, nurses and aides work best when they aren't so overloaded that they neglect duties or lose their tempers. But unlike most workers, overworked nursing home staffers can have a dramatic negative effect on vulnerable people's quality of life.

Staffing levels determine how much time each patient gets with a nursing home staff member. When staff members don't have the time to give patients the attention they deserve, even the well-meaning ones may forget things. This can lead to serious health consequences right away, as with missed medication, or over time, as with bedsores or dehydration. The stress of overwork can also lead to overt abuse by staff members who feel resentful against the home or impatient with difficult residents. And nursing homes that chronically understaff may fill holes in their rosters with temporary workers, who aren't always subjected to the same rigorous background checks. A recent Los Angeles Times article found that temporary nurses were hired despite criminal backgrounds, having been fired or having had their licenses pulled in other states.

Federal law requires nursing homes to maintain adequate staff levels and ensure that an RN is on duty at least eight hours a day, although it does not specify a patient/staff ratio. Unfortunately, nursing home staffing levels are still a problem because it's expensive to hire and retain a high-quality workforce. Faced with these costs, some homes' owners choose to skimp -- putting their residents at serious risk. Our Pennsylvania nursing home abuse attorneys handle numerous cases that stem from a lack of adequate attention and care for residents' needs.

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February 6, 2010

Newspaper Exposes Serious Negligence at Pennsylvania Veterans' Nursing Homes

Our Pennsylvania nursing home neglect attorneys were shocked and disturbed to read a recent article exposing serious problems with two state-run nursing homes. The Pittsburgh Tribune-Review reported Jan. 25 that the state health department's inspectors found negligence and misuse of psychiatric drugs at the Hollidaysburg Veterans Home between Pittsburgh and Harrisburg. Another home, the Gino J. Merli Veterans' Home in Scranton, was cited for allowing two outbreaks of scabies, failure to prevent or treat bedsores and failing to maintain sanitary conditions. The state runs four other veterans' homes, but only these two garnered the lowest possible rating because of serious repeat violations.

In Hollidaysburg, health inspectors found that patients were improperly receiving psychiatric medicines to control their behavior. Attendants routinely physically restrained patients for bathing or medical treatment. Abuse concerns reported by a psychiatrist went uninvestigated by a director who said he didn't believe he had to investigate statements about staffers' personal feelings. In another case, home staff didn't contact police about suspected abuse, despite a state law compelling them to, so the victim's wife did it.

At the Scranton home, residents endured two rounds of scabies because home officials failed to ensure that an employee had recovered fully before coming back to work. It was also cited for failure to prevent bedsores. In one case, a doctor ordered treatment for bedsores, but the home failed to take action for nine days. At least two other patients were cited for dehydrated residents. And over three years, the state found 38 reports of possible patient abuse by staff or other patients.

As Philadelphia nursing home abuse lawyers, we hope this article leads to immediate corrective action by state regulators. Nursing home patients are in homes because they can no longer care for themselves, and that often means they're at the mercy of their caregivers. As the report shows, bad caregivers can have a profound effect on their health and their quality of life.

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February 4, 2010

Pennsylvania Nursing Homes Bracing for Medicaid and Medicare Funding Cuts

As Philadelphia nursing home negligence attorneys, we were disappointed to see that nursing homes across the state are experiencing and expecting financial trouble because of the recession. The Lebanon Daily News reported Jan. 22 that nursing homes in the region are laying off staff members, cutting patient services or even closing. The problem is driven by the bad economy, which has resulted in cuts to Medicare and cuts or lack of growth on the state level. The issue is particularly important because 90% of Pennsylvania's nursing home patients are part of the Medicaid system.

According to one advocate for the elderly and disabled, Medicaid and Medicare are chronically underfunded in Pennsylvania to begin with. The funding cuts will make this worse, he said, as would the Medicare cuts included in the federal health care bill, if they pass. Homes shouldn't have trouble providing basic services, but he said they might end up cutting recreation and other quality-of-life services. Local homes told the newspaper that they were renegotiating contracts and looking for ways to cut costs without letting go of staff.

Our Pennsylvania nursing home abuse lawyers hope that's true. Adequate staffing levels, and low staff turnover, are an essential part of making sure nursing homes are safe and healthy places. When staff members are overworked, skilled nurses are absent or employee churn is high, details and even basic care are more likely to be overlooked. This can lead to serious cases of neglect or abuse at nursing homes, sometimes with tragic results.

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February 1, 2010

Investigating Nursing Home Negligence in Philadelphia

As Pennsylvania nursing home abuse attorneys, we see many clients who discovered abuse and neglect of their loved ones after it led to severe health consequences. Unfortunately, this is probably the most common way families discover problems, because victims don't always have the ability to directly tell their loved ones something is wrong. And of course, corrupt nursing home staff take steps to hide abuse and neglect. But if your family suspects abuse or neglect, there are steps you can take to prevent serious physical and emotional harm to your loved one.

Experts say the best offense against nursing home abuse is to stay aware. Studies show patients receive better treatment when their families visit often, so if possible, make sure you visit regularly. To reduce the chance that nursing home staff will anticipate your visits, you should try to schedule the visits at different times of the day and week. During your visit, check the patient for physical and mental problems not related to any underlying health condition. Examples might include unexplained weight loss, signs of dehydration, confusion in a mentally competent person or medications a doctor didn't order. Also, examine the cleanliness of the facility itself and the way staff interacts with the patients. If patients seem dominated by staff, anxious or overly sedated, there may be a problem.

If you discover evidence of neglect or abuse at a nursing home, you can and should report the home to state health authorities. Families have also set up hidden cameras in homes to capture clear and convincing evidence of abuse. But even a swift investigation that shuts down a bad home for good can't help families deal with the physical and emotional damage abuse can cause. To penalize negligent nursing homes and recover the financial costs of dealing with the abuse, families should contact a Philadelphia nursing home neglect lawyer to discuss the possibility of a civil lawsuit.

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