May 2011 Archives

May 23, 2011

Some Nursing Homes Want an Exemption From Employer Mandate in Health Care Reform

As a Pennsylvania nursing home lawyer, I was interested to see a recent piece on how health care reform affects nursing homes -- as employers rather than care providers. As the New York Times reported May 15, many nursing homes are lobbying Congress for an exception to the employer mandate part of the Affordable Care Act because they're concerned about the cost of insuring their employees. The Act will require all employers with 50 employees or more to offer health insurance starting in 2014, with a financial penalty for failing to do so. The homes say they need an exemption because they depend heavily on Medicare and Medicaid, whose reimbursement rates are going down rather than up. As a result, they say, they can't simply raise the price of the service they provide.

According to the Times, one in four nursing home employees does not have health insurance. The president of a nursing home industry group told the newspaper that employees who do have insurance typically don't have very good benefits, which means they may also not meet the Act's standards. Employees also dropped coverage when they couldn't afford it. The nursing home industry is exploring several ways around the Act, including laws that would allow homes to deduct the cost of penalties for non-coverage from their taxes; a waiver or reduced fee for homes "placed in financial distress as a result of the new mandates and fines"; and an extension of the time until the law takes effect. A nursing school professor told the newspaper that health insurance would make nursing home employees less likely to pass on infections to their patients and more likely to be treated when they have an occupational injury.

As a Philadelphia injury lawyer, I know those are both frequent problems for nursing home employees. According to the article, nursing home workers are injured twice as often as average, with many back injuries among those who help bed-bound and wheelchair-bound patients into and out of bed. And I've written here several times about the probability of sick employees spreading disease through a nursing home's closed population of vulnerable people. Often, workers come to work sick because they can't afford not to -- because, as the Times notes, the front-line workers make $10 to $12 an hour and frequently don't have adequate health insurance. Sometimes, a sick day for one staff member understaffs the home for the whole day, resulting in thin-stretched workers who are too busy to meet every patient's needs. This keeps costs low for employers, but in the long run, it poses risks that could be far more expensive -- including the risk of communicable disease, neglect and Pennsylvania nursing home abuse. As a Philadelphia medical malpractice lawyer, I hope nursing homes realize that insuring their workers can save money and lives in the long run, as well as being required by law.

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May 16, 2011

Pittsburgh Nursing Home Study Finds 1 in 7 Homes Cited for Disease Practices

As a Philadelphia medical malpractice lawyer, I know that the spread of contagious disease is a major problem in nursing homes and hospitals. Contagious diseases are those that spread quickly from person to person, like the flu. Not surprisingly, they're a problem in every living situation where many people are clustered together -- but they're an especially big problem in nursing homes, where residents are more likely to be elderly and unwell. Now, a new study from the University of Pittsburgh has found that about 15% of nursing homes across the U.S. are cited for problems in their infection control practices each year. The study drew from records of citations used by evaluators considering homes for Medicare or Medicaid certification, which almost every home must have.

Pitt's Graduate School of Public Health looked through publicly available deficiency citation records from the years 2000 to 2007. The records included 16,000 nursing homes, about 96% of all homes. The results were not encouraging. One in seven homes had some kind of citation for problems in their strategies for controlling infectious disease. 48.6% of those citations were at a level indicating potential for more than minimal harm to the patient. The authors also noticed an upward trend, meaning the problem is getting worse over time. In 2000, 12.87% of homes had a deficiency citation for disease control; that number was 17.31% in 2007. And the authors said the deficiency citations were strongly correlated with a low quality of care overall and low staffing levels for nurses' aides, registered nurses or licensed practical nurses. They suggested that staffing problems may make it tempting for caregivers to skip important infection control measures like adequate hand-washing.

I couldn't agree more. As a Pennsylvania nursing home lawyer, I know that research shows low staffing levels at nursing homes is correlated with increased abuse and neglect. And while poor infection control is not usually Pennsylvania nursing home abuse, it is most certainly a form of neglect. For older people who are ill enough to go to full-time assisted care, infectious diseases can be deadly. Things like the flu or gastroenteritis might send a healthy adult to bed for a few days, but the associated dehydration and other stresses on the body can put a nursing home patient in the hospital. And preventing infectious diseases is relatively simple: caregivers, food handlers and others must be vigilant about washing their hands; not come to work ill; and separate patients who are known to be infected. As a Philadelphia injury lawyer, I believe nursing homes should give their staffs the time to take these steps, even if that means hiring more people, because lives can be on the line.

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May 9, 2011

Family Announces Pennsylvania Nursing Home Abuse Lawsuit Against Quadrangle

I've written here twice before about the abuse caught on camera at the Quadrangle nursing home in Haverford, outside Philadelphia. I've talked about the possibility of a lawsuit, from my perspective as a Philadelphia injury lawyer, as well as the possibility that the abuse may go beyond that suffered by patient Lois McCallister. So I was not surprised to see a May 4 report from the Delaware County Times saying that McCallister's daughter and son-in-law plan a lawsuit against the Quadrangle's parent company, Sunrise Senior Living. And I was interested to read about other allegations against the home, as well as some background information about the family's decisions and how they are dealing with the abuse, from the Philadelphia Inquirer on the same day.

Mary and Paul French, McCallister's daughter and son-in-law, moved McCallister from Pittsburgh to the Quadrangle after a lot of research. The Quadrangle was expensive -- $7,700 to $8,000 a month -- but offered the care they needed and was founded on Quaker principles. However, when McCallister was moved to the dementia ward, problems began right away. Her hearing aids went missing; insurance forms were never completed; and McCallister started to complain about people hitting her. When the home denied the allegations, the Frenches bought a "nanny cam" and hid it in the room. Only a few days later, they had a video of three employees hitting and tormenting McCallister, who was not permitted to put a shirt on.

The three employees are fired and criminally charged, and the home says their actions were an aberration. The state has moved to revoke the Quadrangle's license (pending an appeal), and the Inquirer said Haverford Township police have referred two other cases of possible abuse to state authorities. And last week, the family announced that it would sue Sunrise. The Times did not specify how much money the family will request, but their Pennsylvania nursing home lawyer said they hoped an expensive verdict or settlement would motivate the company to take abuse allegations seriously. For now, McCallister is living with the couple, who also have two teenaged daughters. They plan to add to their home to create extra space, and for now, Mary French is filling the role of caregiver.

This story is a good example of why families consider Pennsylvania nursing home abuse lawsuits even when there are also criminal and regulatory investigations. Prosecuting the three employees gets bad employees away from vulnerable patients, which is good, but it doesn't do much to the supervisors and parent company that allowed this behavior in the first place (and then failed to report it). Closing the Quadrangle may not hurt Sunrise much either, considering that it has 22 homes in Pennsylvania alone. But as a Philadelphia medical malpractice lawyer, I know a judgment of several million dollars, which is likely in this situation, would get any company's attention. It would also refund McCallister's family for more than two years of expensive care that is now suspect. For this family, which is now juggling full-time care of a dementia patient with raising children and working, it would provide some financial relief that can be used on an in-home caregiver or expand the size of the home. And it can provide some measure of compensation for McCallister's emotional trauma and the family's broken trust.

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May 3, 2011

Pennsylvania Nursing Home License Revoked After Employees Caught Abusing Woman

Last month, I wrote here as a Pennsylvania nursing home lawyer about the arrests of three former employees of a nursing home in Delaware County, near Philadelphia. The three women, ages 19 to 22, were caught on tape hitting and tormenting a 78-year-old patient with dementia. The tape came from a hidden camera placed in the room by the family of Lois McCallister, after nursing home officials dismissed the family's concerns about McCallister's bruises and complaints. Samirah Traynham, Tyrina Griffin and Ayesha Mohammed are all facing criminal charges and have been fired from the Quadrangle nursing home in Haverford. But more bad news for the Quadrangle came April 29, when the state Department of Public Welfare revoked the home's license for "gross incompetence, negligence and misconduct on the part of officials."

According to an April 30 article from the Philadelphia Inquirer, the state's problems with the Quadrangle go beyond McCallister's case. A report released by the DPW found that the Quadrangle failed to report abuse allegations and police investigations to the state; failed to conduct criminal background checks on employees in a timely manner; and made no effort to return lost valuables to patients, including eyeglasses. It also found medication problems: no doctor's orders were found for two patients' medicines, and another patient was not given prescribed medicine when needed. The Quadrangle last got in trouble two years ago, when a dementia patient drank antibacterial cleaner and another consumed paint, but it was given a full license last December. The current action means the Quadrangle may have to close if its appeal is not successful. The home's parent company, Sunrise Senior Living, voluntarily closed five other Pennsylvania nursing homes last year after regulatory compliance problems.

As a Philadelphia injury lawyer, I'm glad the state is taking action. Clearly, the behavior of the three fired employees is unacceptable Pennsylvania nursing home abuse, and was probably not sanctioned by the management. The question is whether their behavior grew out of negligent oversight by the Quadrangle's management, and the DPW's report suggests yes. Working with elderly dementia patients is an important responsibility, which is why Pennsylvania requires criminal background checks and regular inspections. Failure to conduct those background checks quickly enough -- to pick one example from the DPW's citation -- suggests that management does the bare minimum to comply with the law. Failing to administer needed medications or return lost eyeglasses may not even meet the bare minimum. None of this behavior suggests respect for these patients as people. As a Philadelphia medical malpractice lawyer, I hope the Quadrangle's appeal gives the state a chance to air these issues publicly, so regulators and families can decide for themselves whether this is a safe place for our community's most vulnerable adults.

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