Pennsylvania Nursing Home Abuse Attorney Blog

As a Philadelphia nursing home negligence attorney, I was interested in a recent article in the New York Times that discussed a rating system now available to families seeking information about nursing homes. This is an important tool to help families assess these facilities as they make decisions about where they or their loved ones will be cared for. As a Pennsylvania nursing home abuse lawyer, I've seen many cases of abuse, neglect and other negligence in nursing homes where profits come before patients, and I know that families need all the help they can get to avoid substandard facilities.

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.

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As Pennsylvania nursing home neglect attorneys, we pay attention to news about investigations of nursing homes that neglect or abuse patients. In Kentucky, there has been an uproar over how long it takes for the state to investigate reports of abuse and neglect. Families of nursing home patients in Pennsylvania should take note of this conflict in Kentucky, because state budget cuts in Pennsylvania could lead to similar problems here. With state agencies increasingly trying to do more with less, nursing home patients' families should not depend entirely on the state to make sure nursing homes live up to their responsibilities to care for patients properly.

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.

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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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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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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.

Continue reading "One Fifth of Nursing Homes in Pennsylvania and Nation Get Low Medicare Ratings" »

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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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.

Continue reading "Life-Threatening Bedsores Can Be Caused by Nursing Home Neglect in Pennsylvania" »

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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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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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.

Continue reading "Investigating Nursing Home Negligence in Philadelphia" »

Families looking for a safe, loving and dignified home for their loved ones should turn to a recent issue of U.S. News & World Report magazine. As Philadelphia nursing home negligence attorneys, we're glad to say that the magazine has created a resource for families similar to its yearly college rankings. The magazine offers starred rankings of several aspects of each home, along with indicators of homes with problems and information on their ownership, size and whether they take Medicare or Medicaid. It has also published a four-step guide to choosing a nursing home.

The "how to choose" guide is actually four separate guides, each focusing on a separate part of the process. The first guide asks readers to decide whether a home is truly necessary, the second shows how to build a short list, and the third explains what to look for at the all-important on-site visit. The fourth and final article explains how to follow up to ensure that your choice is working out. The rankings themselves rely on a Medicare tool called Nursing Home Compare, but expand that tool's search capability to include multiple criteria, such as ranking, location and religious affiliation. Information is updated every quarter.

As Pennsylvania nursing home neglect lawyers, we think this is a great tool for families making this important choice. Nursing home choice matters greatly, because the nursing home is your loved one's permanent, long-term home. A bad nursing home can lead to unhappiness, but also serious health problems from neglect or abuse, or even death.

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