The Nursing Home Compare tool on Medicare.gov allows families to find and compare information about every Medicare and Medicaid-certified nursing home in the country, using a rating system of one to five stars. One star means that the nursing home is far below average, and five stars indicates that it's far above average, on measures of health inspections, staffing, and quality. It also provides an overall rating based on annual inspections and data reported by nursing home administrators.

Experts advise families seeking nursing homes to use the rating system, in addition to visiting the nursing homes they're considering at varying times of the day and asking the nursing aides how long they've been in their jobs. They also suggest talking to nursing home administrators, other families and the local aging agency's ombudsman. By putting all these sources of information together, families may be able to avoid some of the worst problems that nursing home patients can experience, like bedsores and other injuries that result from understaffing, inexperienced or poorly screened staff, and financial abuse by poorly supervised staff members.

Marlene Owens, 76, of Easton, Mass., has been fighting for years to force Kindred Healthcare to own up to its culpability for harming Donahue, her stepfather. Kindred owned Embassy House at the time of the injury and operates nursing homes all over the United States, with several facilities in Pennsylvania. Donahue was 93 when nursing home staff failed to use a Hoyer lift properly when trying to move him, and his left eye was gouged by a metal hook. His eye had to be removed, and Donahue died of sepsis soon after. Donahue had signed an arbitration agreement that would have prevented him or his estate from suing the nursing home if he were killed or injured there, but at the time he signed it, he was 91 and suffering from delusions. A judge invalidated that agreement in 2009, allowing the lawsuit to go forward. The jury in Plymouth Superior Court agreed with Owens that negligence was a substantial contributing factor to Donahue's injury, although they did not find Kindred Healthcare responsible for his death.

Kindred Healthcare's lawyer said that the chain does still ask patients to sign arbitration agreements like the one Donahue signed, but noted that it is voluntary. Still, in my view as a Pennsylvania nursing home abuse lawyer, families should avoid signing these agreements whenever possible. They do not protect the patient's or family's interests; they protect the nursing home from being held responsible for its actions in an open court. Under an arbitration agreement, if a patient is injured or killed because of negligence or abuse by nursing home staff, families cannot turn to the legal system -- they have to go to an arbitrator, a private legal expert whom the company pays to settle the dispute. This is done outside the public eye and generally by someone who is being paid by the nursing home company, casting his or her neutrality into question. Because the court system is much less expensive, I do not believe nursing home companies would steer families into arbitration if they did not believe they would benefit. When a family member's life, health, and dignity are at stake, you should not limit your options by signing an arbitration agreement.

Because of the current recession, it's especially important for families to watch carefully to make sure that their loved ones are receiving proper care in nursing homes. State agencies are severely underfunded and have a limited ability to enforce their own rules. Pennsylvania's 2010-2011 budget will require layoffs from every state agency. More state employees will be laid off if the state does not receive $850 million for Medicaid, which helps to pay for many nursing home patients' care, from the federal government. Even though there are laws and regulations governing how nursing homes should treat their patients, state regulators will be trying to do their jobs with less money and fewer people. Inspections may not happen as often as they should, and follow-up after those inspections to make sure violations are corrected may take longer, or not happen at all. In addition, politicians, possibly looking for donations from nursing home companies, sometimes pressure state regulatory agencies to overlook nursing homes' negligence. Then, poorly run homes can get away with hurting people longer, sometimes until someone dies.

As Philadelphia nursing home abuse lawyers, we have seen many cases of neglectful and abusive treatment of nursing home patients, including theft and financial exploitation; life-threatening bedsores caused by staff members' poor training, lack of caring, or understaffing; and infections caused by poor hygiene. Unfortunately, government regulators are unlikely to catch and correct all of these violations given their own underfunded circumstances. Sadly, families simply can't afford to trust regulators to make sure that their loved ones are being treated properly in nursing homes.

Some nursing homes are notorious for low staffing levels, which is bad for patients because it means the staff can be slow to respond to their needs because they are stretched so thin. When employees are overburdened, they can get hurt, like Ruth Heastings, a nurse's aide at Consulate Healthcare of Cheswick. When lifting a patient, she hurt her shoulder and suffered pain so long-lasting that she had to have her whole shoulder surgically reconstructed. She missed five weeks of work and is still on light duty. Heastings said that her colleagues at Consulate and in other nursing homes have been hurt with back injuries, and that understaffing has something to do with it. When nursing home staffers have to miss work because of injuries, that means that their colleagues have to pick up the slack, or that substitutes have to be called in. Both choices raise the chance that patients will be neglected or abused by staff members who are too busy to thoroughly read the patients' care plans, follow procedures carefully, or respond to calls promptly, all of which can result in serious injury to patients. Staff members could also take out the frustration of their too-busy work situation on patients by treating them abusively. Consulate's injury rate was more than four times the national average, but two others--Arden Courts of Jefferson Hills and Latrobe Regional Health and Rehabilitation Center--had injury rates more than ten times the national average.

We have written about situations like this from our perspective as Philadelphia nursing home abuse lawyers many times over the past few months. Studies show that understaffing at nursing homes is a real problem, depriving staff members of the time they need to provide the best care. It can also shorten tempers and increase turnover, both of which can lead to neglect and abuse. As Philadelphia nursing home abuse lawyers, we hope that nursing homes that received warning letters will live up to their obligation to provide safe conditions for patients and workers alike.

The nursing home staff members are all employees of homes owned by Extendicare, including Spruce Manor Nursing and Rehab Center in West Reading, PA; Slate Belt Nursing and Rehab Center in Bangor, PA; Broad Mountain Nursing and Rehabilitation Center in Frackville, PA; and Beaver Valley Nursing and Rehab in Beaver Falls, PA. They complain that pay raises in their current contract don't keep up with the cost of living. This issue directly affects nursing home patients' lives, because underpaid and overworked nursing home staff members make serious mistakes in patient care. Studies consistently show that undertrained staff members are more likely to make mistakes or actively abandon good practices. Many of the abuses that nursing home patients experience can be traced to low staffing levels or insufficient attention to the quality of the staff, both of which can be caused by a nursing home company's desire to ramp up profits by cutting labor costs. For example, failure to read and follow a patient's treatment plan, or failure to respond to emergencies in time to help patients, can result from a small staff being stretched too thin. As I discussed recently, this can have tragic results.

Extendicare made over $17 million in profits last year in Pennsylvania, a profit that SEIU said rose by over 50% from the 2008 number. Christine Peters, part of the SEIU bargaining committee and a certified nursing assistant, said, "We want to make sure that some of these profits (go to) improving staffing for our residents and good job standards for caregivers." As a Philadelphia nursing home negligence attorney, I applaud this sentiment. Nursing home companies that privilege profits over patient care inevitably put patients' lives and well being in danger. The threat of a strike may ultimately help patients as well as the staff members live better lives.

Surprisingly, these are not the first allegations of sexual abuse concerning Gunderson. He is also facing a charge of third-degree sexual abuse for an alleged incident that took place during his employment at the Eddy Ford Nursing Home in Cohoes, NY. In August and September of 2008, Gunderson is alleged to have French kissed a patient with multiple sclerosis who was confined to a wheelchair. It is disturbing that Gunderson was able to behave this way toward patients in two different nursing homes over the course of a year. Nursing homes have a legal responsibility to ensure that they hire qualified staff with no history of abuse or other dangerous criminal violations. Nevertheless, some homes may cut corners to save money. For example, they may not conduct sufficient background checks. Or they may be so understaffed that personnel do not see patients frequently enough to notice signs of abuse from another staff member.

Nursing home patients' family members should be alert to signs of abuse when they visit. According to an article in Nursing Homes, signs that a patient may have been sexually abused include: "difficulty in walking or sitting, pain or itching in genital areas, the occurrence of sexually transmitted diseases, unexplained bruising, welts, lacerations, fractures, or other injuries, decreased socialization, self-injurious behavior and/or attempts to hurt others, fear of specific people or places, [and] habit disorders such as pulling hair or ears."

The owner of the Adelphia Personal Care Home, Anand Mittal, and his wife were charged by the Attorney General with criminal offenses such as reckless endangerment, insurance fraud, criminal conspiracy, and allowing an unlicensed person to operate the facility's pharmacy. Anand Mittal has already pleaded guilty to felony charges including making fraudulent claims. According to The Intelligencer News, Mittal and his wife, Kumkum Mittal, have faced such charges before in connection with the Willow Crest Manor assisted living facility they owned. A November 2009 report in The Intelligencer of Doylestown, Penn. details charges against Anand Mittal including Medicaid fraud, insurance fraud, theft by deception, recklessly endangering others, conspiracy and violations of the state's Pharmacy Act. Kumkum Mittal was charged with tampering with public records, theft by deception, recklessly endangering others and conspiracy. The facility's former nursing director, Cynthia L. Dreifert, pled guilty to tampering with placement records there and received a sentence of one year's probation.

Unfortunately, Mr. Mittal's history of problems does not end there. According to The Intelligencer, in October 2008, Mr. Mittal was charged with simple assault and disorderly conduct for allegedly yelling at a Willow Crest Manor patient, grabbing him around the neck, and shaking him. An employee who saw it happen was so upset that she quit immediately.

While I am glad that patients who were subjected to such treatment have finally been moved to safer environments, as a Pennsylvania nursing home abuse attorney I wonder how these patients are being provided for. They were unlikely to be in good health to begin with, and the abuse and neglect they experienced while in the Mittals' institutions may have worsened their health considerably. In addition, terrible experiences like being left helpless on the street to fend for themselves must have taken a serious emotional toll on these patients. While those responsible for abuse may be held criminally accountable by the state, an experienced nursing home abuse lawyer can help victims hold their abusers accountable in civil court as well. Abusers owe a debt to those whom they have harmed as well as to society as a whole.

Giron's schemes involved opening bank accounts at Citibank in the patients' names, according to the Department of Justice. Then she transferred their money into her own account, wrote herself checks from their accounts, and used their ATM cards. She also allegedly stole money from their trust accounts at the nursing home. Giron also told one patient's son that he had to pay an extra $600 per month for his mother's care, and then kept the money for herself, over the course of 18 months. And in August 2008, Giron claimed that one of the patients would be transferring to another facility, but in fact kidnapped the patient and moved her into Giron's own home. Then Giron cashed the patient's pension and Social Security checks.

In August 2009, the state attorney general's Bureau of Medi-Cal Fraud and Elder Abuse began investigating Giron in response to a complaint about her. That month, investigators found the kidnapping victim, 85-year-old Carnell Williams, in Giron's home, physically unharmed. Giron has been charged in Alameda County with kidnapping to commit another crime, false imprisonment, elder abuse and six counts of theft from elder or dependent adults by a caretaker. She is being held at the Santa Rita Jail in Dublin in lieu of $365,000 bail.

A dependent, elderly nursing home resident should not have to fear that his or her lifetime's worth of savings will be stolen by his or her caretakers, and thankfully many nursing home employees are honest. Nevertheless, financial exploitation of the elderly is all too common. Patients and their families should track their bank accounts and be alert to any unusual activity.