California Nursing Home Abuse Lawyers Blog

Charlene Harrington, a professor emerita at the University of California at San Francisco, has studied the nursing home industry for 30 years. Last year, she examined the nation's 10 largest for-profit chains and found up to five layers of ownership.

"You can't tell who owns'' many nursing homes, Harrington says. "It's like tracking a problem mortgage when you don't know who owns the bank.''

Even the federal government can't figure it out. Medicare and Medicaid pay most of the nation's nursing home bills and require homes to disclose their ownership structures. But when the General Accounting Office looked at six big chains in 2010, the information those chains had provided Washington gave no indication of which affiliated companies controlled what.

People who put their mother in a nursing home have no idea that decisions on staff and supplies are not being made by the administrator or a local owner says California Nursing Home Abuse and Neglect Lawyer Steven Peck. Medical decisions are governed many times solely by monetary concerns by corporate entities and their individual ownership.

It's all about the amount of money the Nursing Home Operators can make versus the care the are supposed to give as is mandated by Federal Law and State Laws which regulate these facilities.

Continue reading "Nursing Home Abuse and Neglect Responsibility is a Sophisticated Network Of Behind the Scene Business Dealings" »

Two Orange County nursing homes, Newport Nursing and Rehabilitation Center in Newport Beach and Emeritus at Yorba Linda, both received Class "AA" citations, the most severe penalty under State law, from the State of California after investigations concluded that inadequate care at the nursing homes lead to a death at each facility, announced Dr. Ron Chapman, director of the California Department of Public Health (CDPH) and state public health officer.

Newport Nursing and Rehabilitation Center was fined $100,000 after a CDPH investigation found that the facility failed to provide adequate safety measures and supervision, leading to the patient's death. Emeritus at Yorba Linda received a $90,000 fine after a CDPH investigation found that the facility failed to serve a diet as prescribed resulting in a patient choking and subsequent death.

All nursing facilities in California are required to be in compliance with applicable state and federal laws and regulations governing health care facilities to ensure quality of care.

California has statutory authority to impose fines against nursing facilities it licenses as part of enforcement remedies to poor care. State citations that require a civil monetary penalty are categorized as Class B, A or AA. The associated fines range from $100 to $2,000 for Class B, $2,000 to $20,000 for Class A and $25,000 to $100,000 for Class AA. The citation class and amount of the fine depend upon the significance and severity of the substantiated violation, as prescribed and defined in California law.

By providing nursing facilities it licenses with consequences for substantiated violations, CDPH strives to protect the health and safety of vulnerable individuals. The citation process is part of CDPH's ongoing enforcement efforts in improving the quality of care provided to residents of the state's approximately 1,400 skilled nursing facilities

Continue reading "California Nursing Homes Receive The Most Severe Penalty Under State Law" »

•The United States Census Bureau projected in 2000 that California's elderly population will have doubled by 2025 to 6.4 million - a larger growth rate than any other state.
•The California State Department of Finance claims that the number of California residents age 85 and older - those who are most likely to need nursing homes --- will nearly double by the year 2030, when the bulk of baby boomers will come of age.
•In 2005, the Office of Statewide Health Planning and Development reported that one-fifth of California's nursing facilities did not meet state-mandated requirements for staffing levels.
•In 2006, Centers for Medicare and Medicaid Services reported that twice as many of California's 115,000 plus residents are placed in physical restraints as are nationally.
•From 2001 to 2005, the California Department of Health Care Services, found that two-thirds of all reported deficiencies caused or could have caused significant harm to one of more residents in nursing homes. More than half of all complaints in nursing homes are related to poor quality of care. Eighteen percent of substantiated complaints were related to mistreatment or abuse.
Together, these staggering statistics and projections illustrate the urgent need to address and remedy the poor quality of care in many of California's skilled nursing facilities

Continue reading "Elder Abuse Statistics Are Staggering says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

As the nation's elderly population balloons, nursing homes across the country have seen a demographic shift in their residents. More Hispanic, black and Asian elders are moving into nursing homes while white residents choose other options.

Between 1999 and 2008, the number of elderly Hispanics living in U.S. nursing homes climbed by 54.9 percent while the number of Asians increased by 54.1 percent. The number of black residents rose 10.8 percent. During the same 10-year period, the number of white nursing home residents in the U.S. dropped by 10.2 percent.

In the Los Angeles/Long Beach region, the residency increases were also significant with a 56 percent increase in the Asian population and 41 percent rise among Hispanics. The increase for blacks was slight, only 1 percent.

California currently has more than 7,600 residential care facilities, up from about 5,500 a decade ago, she said. The average rate for those facilities, which generally offer more freedom and personal attention to residents, can cost $5,000 a month.

These demographic shifts in the composition of nursing home populations are taking place within a rapidly shifting long-term care landscape. There are currently 76 million baby boomers in the nation; the oldest of them will turn 65 years old in 2011. The Census Bureau projects by 2030, 20 percent of the U.S. population will be sixty-five or older. Today that figure is 13 percent.

The population of older racial and ethnic minorities is slated to grow particularly swiftly. The number of older Hispanics, for instance, is projected to jump from under 1.8 million in 2000 to over 8.6 million by 2030. The number of elderly Asians is expected to balloon from 0.8 million to 3.8 million.

At the same time, elderly people don't have the support at home or the social structures of previous generations. People don't live as close to their relatives as they did in the past. Couples are having fewer children and often both have to work outside the home and are unable to provide full time care to their elderly or ill parents.

These dramatic societal changes have prompted the government to alter certain policies and priorities. There has been a shift in support from nursing home care to favoring home-and community-based services, the study said, which cost significantly less than institutional care. A significant change was the passage of the Medicaid "waivers" authorized in 1981 in the Social Security Act. It allows recipients to use their Medicaid dollars to pay for personal care and other supportive services, enabling more beneficiaries to live at home or in a residential setting.

Older adults and those with disabilities prefer living independently at home or in community-based alternatives, according to a related study published in Health Affairs that examined what people want from long-term care. Assisted living allows people to have more freedom; a skilled nursing facility is more confined and has more supervision.

Assisted living has become quite popular and it's also very expensive, When it comes to economics, white folks are able to afford a different level of care."

Pressure Ulcer, Bed Sore and Decubitus Ulcer litigation is a growing concern for nursing homes. The incidence of a pressure ulcer alone is many times used as evidence of neglect on the part of a nursing home.

Pressure ulcers, Bed Sores and Decubitus Ulcers are a phenomenon, not a disease or even a discrete medical condition. Pressure ulcers - skin breakdown that occurs entirely as a result of exposure to a toxic combination of physical forces, such as pressure and shear - are more accurately described as an injury as used by the Institute of Medicine (IOM). Experienced clinicians know that this type of pressure ulcer is the exception rather than the rule. Instead, the incidence of pressure ulcers in nursing homes is more accurately described as an event, often associated with medically complicated residents who usually are frail and immobilized. Clinicians must continue efforts to understand pressure ulcers, learn which can be avoided, and find better ways to treat them. .

Nursing Homes and Long Term Care Facilities though must watch and take every necessary precaution to prevent Pressure Sores, Bed Sores and Decubitus Ulcers from developing many causing e-coli infections, leading to Sepsis and many times death.

Continue reading "Pressure Ulcer, Bed Sore and Decubitus Ulcer Litigation Is A Major Concern For Nursing Homes and Long Term Care Facilities" »

Recent front-page Sacramento Bee headlines about tragedies in California nursing homes should be glaring reminders about the reasons California pioneered the Adult Day Health Care (ADHC) alternative to nursing home care 40 years ago.

If you are old, or are planning to be - pay attention - because this system is about to vanish.

Facing severe budget pressures, the Department of Health Care Services (DHCS) is currently dismantling the ADHC program in California.

This proven cost-effective program that has worked well to keep Californians out of nursing homes for the past four decades has fallen victim to an annual game of "budget chicken."

How did this happen?

In response to well-documented stories of institutional abuse in long-term care facilities in the 1980s, California pioneered Adult Day Health Care, a community-based, integrated health and social services program designed to keep frail and disabled persons out of nursing homes.

Since that time, the ADHC daytime congregate care program has saved the state hundreds of millions in nursing home and emergency services costs by providing frail seniors with multiple complex medical conditions a safe daily care setting.

Over the past several years, California's continuing fiscal woes have seen Republican and Democratic Governors alike cutting this MediCal "optional" program. Each time, advocates sued, with the courts blocking the cuts. In fact, a suit to block the elimination of ADHC is pending now.

Gov. Jerry Brown proposed the elimination of the ADHC program in his 2011-12 budget.

Without support for revenue extensions, all Assembly Democrats voted for the governor's proposal, with the understanding that AB 96, legislation that provided for a "step-down" alternative ADHC program would take its place.

This new program, "Keeping Adults Free of Institutions" - or KAFI - was budgeted at $85 million, half of the current cost of ADHC.

The governor vetoed AB 96 unexpectedly at the end of July, throwing the ADHC community into confusion and chaos.

With a looming deadline of Dec. 1, 2011 for program elimination, DHCS has started to shift ADHC recipients to Medi-Cal managed care and is contracting with out-of-state corporations to provide less reliable and more costly services.

Thirty-seven of my colleagues, including 35 Assembly members and two state senators,

There is no doubt that the destruction of the ADHC program will result in increased 911 calls, hospital emergency room visits, nursing home placements, and investigations for abuse and neglect.

Demands for mental health care, and in-home supportive services will also rise--at a time when budgets for all of these programs are being slashed.

Without safe adult daycare, working family members will either have to quit their jobs to care for their loved ones or place their family members in less appropriate settings - often, nursing homes.

Both Gov. Brown and I are senior citizens. My hope is that you will become one, too.

With an exploding population of baby boomers, persons with autism and Alzheimer's, returning veterans with disabling conditions and traumatic brain injuries, along with increasing numbers of impoverished adults with multiple chronic conditions in our communities, is this the time to take a wrecking-ball to a proven, cost-effective program serving our state's most vulnerable?

Will the courts again provide relief at the expected November 8 hearing, three weeks before the Dec. 1 elimination date?

History will be the judge of my vote and the governor's veto. But unless we raise our voices now, we will all surely suffer the consequences.

The most common types of health record falsification include:

1)Covering up poor outcomes, such as when a patient dies or sustains an injury;
2)Staff members filling out paperwork without knowing whether treatments took place or if the information recorded is accurate; and
3) Inaccurate recordings of dispensed medications.

So the question becomes, how do we properly track a patient's care without fear of caregivers falsifying information? The answer may be technology. As the Sacramento Bee found, "computerized record-keeping can prevent nursing home personnel from changing entries after the fact."

Continue reading "The Medical Records Can Be Easily Falsified in Long Term Health Facilities" »

Some nursing homes in California have altered patients' health records and provided false information in medical charts, the Sacramento Bee reports.

Elder abuse attorneys who sue nursing homes for civil damages have said they encounter some form of suspect record-keeping in nearly every case they investigate.

Background

From 1990 to 1999, California issued 180 citations for "willful material falsification" against long-term care facilities. That number dropped to 29 citations between 2000 and 2010.

Falsifying health records is a misdemeanor in California, but workers rarely are charged criminally for the offense.

Health record falsification is the least common citation the California Department of Public Health issues to nursing homes (Lundstrom, Sacramento Bee, 9/18).

Attorneys who sue nursing homes say patient record falsifications are common but infrequently pursued by authorities (Lundstrom, Sacramento Bee, 9/19).

Details of the Trend

According to an analysis of record falsification cases conducted by the Bee, some nursing home administrators have been driven to re-create medical records to hide negligence in care and to try to avoid costly lawsuits.

The most common types of health record falsification include:

Covering up poor outcomes, such as when a patient dies or sustains an injury;
Staff members filling out paperwork without knowing whether treatments took place or if the information recorded is accurate; and
Inaccurate recordings of dispensed medications.

Nursing Homes' Response

Nursing home industry representatives contend that falsification of health records is not widespread and is not a matter of great concern.

Deborah Pacyna -- a spokesperson for the California Association of Health Facilities, which represents more than 1,250 facilities -- said she has not heard of record falsification being an issue during her two years with the association.

Mark Reagan, an attorney for the association, said that the association does not condone fraudulent record-keeping but that "it's never been my experience that there's a pervasive problem with it" (Sacramento Bee, 9/18).

Industry representatives also have said fraud allegations are unjustified especially considering the amount of paperwork facilities have to produce to comply with Medicare and other regulatory requirements (Sacramento Bee, 9/19).

Read more: http://www.californiahealthline.org/articles/2011/9/19/california-faces-issue-of-record-falsification-at-some-nursing-homes.aspx#ixzz1YRELsxdd

Continue reading "California Faces Issue of Record Falsification In Nursing Homes" »

Pressure sores are areas of damaged skin caused by staying in one position for too long. They commonly form where your bones are close to your skin, such as your ankles, back, elbows, heels and hips. You are at risk if you are bedridden, use a wheelchair, or are unable to change your position. Pressure sores can cause serious infections, some of which are life-threatening. They can be a problem for people in nursing homes.

You can prevent the sores by

Keeping skin clean and dry
Changing position every two hours
Using pillows and products that relieve pressure

Pressure sores have a variety of treatments. Advanced sores are slow to heal, so early treatment is best.

Continue reading "Pressure Sores Also called: Bed Sores, Decubitus Ulcers, Pressure Ulcers " »

A Whittier nursing facility was fined $75,000 after a state investigation found that a wrongly inserted stomach tube led to a patient's death in 2008, it was announced today.

The Orchard -- Post Acute Care, previously known as Royal Court Health Care, failed to follow policies and procedures related to patient assessment, monitoring and care, according to Dr. Ron Chapman, director of the California Department of Public Health.

The facility has 10 days to appeal the fine.

The state probe found that nursing home staff mistakenly inserted a gastrostomy tube into a 78-year-old male patient by failing to place it all the way into the stomach, causing respiratory failure and septic shock.

The patient, who was suffering from Alzheimer's disease and other health issues, died six days later.

All nursing facilities in California are required to be in compliance with applicable state and federal laws and regulations governing health care facilities.

Along with the fine, the facility received a "AA" citation, the most severe category under state law, according to the DPH.

Continue reading "Whittier Skilled Nursing Facility Fined For Death of Elder" »

Among nursing home residents at high risk for bed sores, decubitus ulcers and / or pressure sores black patients are more likely than whites to develop the potentially serious condition.

Bed sores, also called pressure sores or pressure ulcers, greatly increase a patient's cost of care and the risk of illness and death. They can almost always be prevented through proper care, such as helping a patient change position every few hours says Nursing Home Abuse and Neglect Lawyer Steven Peck.

For this study, researchers analyzed 2003 to 2008 data on bed sore rates in 2.1 million white residents and 346,808 black residents of 12,473 certified nursing homes in the United States. The patients included in the study were at high risk for bed sores.
Overall rates of bed sores decreased over the years, but black patients had consistently higher rates than white patients. The rate among white residents decreased from 11.4 percent in 2003 to 9.6 percent in 2008, while the rate among black residents decreased from 16.8 percent to 14.6 percent.

The highest rate of bed sores in 2008 (15.5 percent) occurred among black residents in nursing homes with the highest concentrations of black residents. The lowest rate (8.8 percent) was among white residents in nursing homes with the lowest concentrations of black residents.

The researchers also found that residents of both races in nursing homes with the highest concentrations of black residents were at least 30 percent more likely to develop bed sores than residents in nursing homes with few or no black residents.

Nursing homes with higher concentrations of black residents tend to have lower staffing levels of registered nurses and certified nurse assistants and to be larger for-profit and urban facilities.

Continue reading "Black Patients More Likely to Develop Bed Sores, Pressure Sores and Decubitus Ulcers than White Residents" »

When bed sores are identified in their early stages a patients chances of a full recovery are quite good. Unfortunately, when facilities are slow to acknowledge the presence of a bed sore, decubitus ulcer, or pressure sore or the wound has advanced, there is a good chance of medical complications such as:

•Osteomyelitis
•Gangrene
•Sepsis
•Limb amputation
•Death

Continue reading "Medical Complications Associated With Bed Sores" »

Residents of a nursing home are usually admitted due to their need for care beyond that which can be provided at home. When a resident enters a nursing home they are promised proper care and treatment. Often times, this requires staff to clean, change and move the resident regularly. However, this does not always occur. When a person is not changed regularly both the moisture and the acid from their urine and feces can cause skin breakdown causing a condition commonly referred to as bedsores. Additionally, if a resident is not regularly repositioned, the areas of their bodies bearing their weight may also suffer from skin breakdown. These areas can include the elbows, heels, back and tailbone. You may also hear bedsores referred to as pressure ulcers, decubitus ulcers and pressure sores. If a resident has a bedsore, it may be the result of neglect.

Bedsores are preventable. In fact, it is easier to prevent a bedsore than it is to treat a bedsore. Nevertheless, bedsores are becoming commonplace in many nursing homes. Bedsores are extremely painful and should be addressed immediately. These sores can lead to sepsis and death if they are ignored or improperly treated. The first sign of skin breakdown is the appearance of reddened skin. This is easy to spot on areas such as the elbows and knees. However, families may not be present while a resident is being changed or bathed and may therefore be unaware of an area of reddened skin on their tailbone or hip. Often, family members are unaware that their loved one is suffering with a bedsore because he/she is unable to communicate either their pain or the location of the sore to their families. If your loved one is unable to communicate, you may need to be extra vigilant in checking their skin for any signs of breakdown.

If a resident does unfortunately have a bedsore, medical personnel may tell you the severity by stage. Bedsores range from Stage 1 to Stage 4, with Stage 4 being the worse. According to the National Pressure Ulcer Advisory Panel, bedsore stages are described as:

· Stage 1: Intact skin with non-blanchable (redness that does not subside when the pressure is relieved) of a localized area usually over a bony prominence.

· Stage 2: Partial thickness loss of dermis presenting a shallow open ulcer with a red pink wound bed, without slough.

· Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed.

· Stage 4: Full thickness tissue loss with exposed bone, tendon or muscle.

Regardless of the stage, bedsores require prompt and appropriate treatment. If you see an area of reddened skin, request that the nursing home provide the resident with preventative devices such as a special air filled mattress and/or cushions that can be placed to alleviate the pressure on that particular area. Also, make sure that resident is receiving medical care to ensure that the area does not continue to worsen. These measures may help but ultimately the nursing home must take appropriate steps to ensure that the cause of the reddened skin is remedied. Nursing homes owe it to their residents to provide the care necessary to prevent these sores.

Continue reading "Bed Sores Are Easier To Prevent Than to Treat Says Los Angeles Nursing Home Abuse And Neglect Lawyer Steven Peck" »

Almost half of all nursing homes in California don't meet federal standards for preventing surgical infections or bedsores, including MRSA, C. Dificile, and Sepsis says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck.

The federal government has set benchmarks for nursing homes in preventing bedsores, surgical infections, and using patient restraints. Medicare officials say homes that made the list aren't necessarily bad, they just do not adhere to the Federal Regulations. .

Elder Abuse Lawyer Peck says "If you're gonna be putting your father, your mother, or your spouse into a nursing home, you'd better get out there and take a look yourself, and get a feeling for the quality of care."

Peck says the overall level of care in California nursing homes is poor. He says "part of the problem is the state's inspection system is one of the weakest in the nation."

Continue reading "Almost Half of the Nursing Homes In California Do Not Meet Federal Guidelines indicates Los Angeles Nursing Home Abuse and Negelct Lawyer Steven Peck" »

One in 20 hospital patients get infections. In California, roughly 200,000 people get hospital infections annually, and 12,000 of them die, according to state Department of Public Health statistics. That makes such infections one of the state's leading causes of death, ahead of automobile accidents and Alzheimer's disease.

Yet these deaths have remained mostly in the shadows. They often are classified as "deaths from complications," an oblique term used in obituaries and often unquestioned by relatives and friends says California Nursing Home Abuse and Neglect lawyer Steven Peck.

Even the best doctors can be baffled whether an infection was acquired before or after a patient was admitted, and if it was the principal cause of death or no factor at all.

Many health care providers historically have viewed hospital infections - going by obscure names or acronyms such as C.diff, CLABSI, VRE and the more familiar MRSA - as a sometimes inevitable consequence of being hospitalized.

That has begun to change. Research has demonstrated that many hospital infections are preventable, and most hospitals, have launched campaigns to rid their facilities of infections.

The change has not come nearly fast enough for many of our loved ones who have died as a result of these facility acquired infections.

"Hospitals are in denial," Elder Abuse Attorney Peck says "Because the public does not have knowledge and understanding of C. difficile, a very potent infection. It is easy for the hospitals to sweep this serious situation under the carpet, and the relatives of the deceased are none the wiser."

Continue reading "Many To Many People Are Being Killed In Long Term Care Facility Acquired Infections Says Los Angeles Nursing Home Abuse and Neglect Lawyer Steven Peck" »