Articles Posted in nursing home resources

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The Daily Item of Sunbury, Pennsylvania recently reported that many Pennsylvania nursing homes have earned substandard scores on the federal government’s five-star quality rating system. The ratings are available on the Nursing Home Compare website at Medicare.gov. As a Pennsylvania nursing home negligence attorney, I think it’s unfortunate that so many nursing homes are not performing as well as they should be. However, it’s great that patients and their families have this information, so that they can make better-informed choices about which nursing homes will give them the care that they deserve.

The Centers for Medicare and Medicaid Services (CMS) began making the quality ratings available in December 2008. The ratings include nursing homes that participate in Medicare or Medicaid, and are based on three areas: staffing, quality-of-care measures and, most importantly, health inspections. Mary Kahn, senior public affairs specialist for Medicaid and the Children’s Health Insurance Program, said that the ratings offer “an incredibly detailed look at nursing homes’ health and safety: administration of medications, incidents of avoidable issues like bed sores, whether residents decline in an unexpected way.” Kahn added that families should also visit nursing homes to see for themselves what they’re like, and they should use the ratings to ask questions about areas in which the homes have scored poorly. For example, if the home has scored poorly in staff-to-patient ratios, a family might ask the nursing home administrator whether they plan to hire additional staff, and when.

Here in Pennsylvania, families will have to ask a lot of questions. In Montour, Northumberland, Snyder and Union Counties, there were six nursing homes that rated only one star out of five, far below average: Kramm Healthcare Center in Milton; Mount Carmel Nursing and Rehabilitation in Mount Carmel; and Mountain View, A Nursing and Rehabilitation Center in Coal Township. The other three are Grandview Health Homes Inc. in Danville; the Manor at Penn Village in Selinsgrove; and Buffalo Valley Lutheran Village in Lewisburg. Six other nursing homes rated only two out of five stars: Golden Living Center Mansion in Sunbury; Kramm Nursing Home in Watsontown; Manor Care Health Services in Sunbury; Nottingham Village in Northumberland; Sunbury Community Hospital’s Skilled Nursing Facility; and Rolling Hills Manor in Millmont. Only three nursing homes in these counties earned three or more stars. RiverWoods in Lewisburg managed to rise from a one-star rating in 2008 to a three-star rating; and Emmanuel Center for Nursing in Danville and Shamokin Area Community Hospital’s Skilled Nursing Facility both have four stars out of five.

A low rating doesn’t necessarily mean that patients are in danger, but in my experience as a Philadelphia medical malpractice lawyer, it’s a sign that patients and their families should pay attention to. A low rating can signal that a nursing home prioritizes profits over patients, or that it’s not training its staff or hiring them in sufficient numbers to ensure good patient care.
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As a Pennsylvania nursing home negligence attorney, I was dismayed to read an article from the Seattle Times detailing serious abuse suffered by many residents in adult family homes, residential settings for adults who need somewhat less assistance than is provided in nursing homes. The horrors described in the article underscore how important it is for Pennsylvania families of nursing home patients to trust their instincts about how their loved ones are treated in nursing homes.

According to the Times, Audree Hopkins, a 68-year-old partially blind stroke victim suffering from emphysema lived in the TLC Adult Family Home in Seattle. She was a smoker even though she was unable to light a cigarette herself and used an oxygen pump to help her breathe at night. A devastating explosion occurred in March 2007, six months after Hopkins moved in, searing off her earlobes and the end of her nose. Seattle police detective Suzanne Moore questioned the home’s caregivers about the incident, and they all claimed that Hopkins had caused the accident herself. They said none of them had given her a cigarette, and she was not using the oxygen pump.

But Moore found that Hopkins’s husband had preserved important evidence — her melted wheelchair, burned clothing, and damaged oxygen pump — and that the fire department responders had seen the oxygen pump at the scene. Tests by the Bureau of Alcohol, Tobacco, Firearms and Explosives confirmed that a cigarette had set off the explosion, which burned the same path along her skin as the oxygen tube. Hopkins’s caregivers had lied about their role in the explosion, and also failed to report the incident to the Department of Social and Health Services, as was legally required. In all, the Times found 357 cases over five years in which caregivers covered up abuse and neglect, often involving serious injury or death. Unfortunately, the state of Washington imposed few regulations on adult family homes, and the DSHS often failed to enforce the ones that did exist, or to report abuse to law enforcement.

Pennsylvania families can insist on better care than that, because Pennsylvania carefully regulates those who care for the elderly and others. As the Wilkes-Barre Times Leader points out, the Pennsylvania Department of Health now requires home care agencies and registries to be licensed, and by the end of 2011, all their direct care workers must meet state-mandated competency requirements. Family members can view online training videos for caregivers to learn more about the kinds of skills that competent caregivers are expected to have.

Even though these regulations and educational opportunities exist, some nursing homes continue to put profits ahead of their patients’ well-being, and they count on state agencies’ being overworked and underfunded to help them get away with it. That’s why families shouldn’t leave it up to state or federal regulators to make sure that their loved ones are being treated properly in nursing homes. Families who think that their loved ones are not receiving the kind of care that they expect should discuss their suspicions with a Philadelphia nursing home abuse lawyer.
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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.

Staffing issues are often the basis for claims brought by Philadelphia injury lawyers when a nursing home resident receives substandard care.

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. Philadelphia medical malpractice lawyers play an important role in continuing to fight for residents’ rights. 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.
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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.
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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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