Articles Posted in Nursing Home Citation

It is an unfortunate fact that elder abuse is a common and growing problem in San Diego and throughout the United States. Abuse of the elderly can take many forms, ranging from neglect and abandonment to physical, verbal, financial, and even sexual abuse. Fortunately, professionals in health care are constantly working towards new breakthroughs in treatment and the prevention of abuse in the elderly population. It’s true that new research and techniques are changing the face of convalescent care every day.

As the population of elders in San Diego continues to grow, it’s also encouraging to see the elder abuse epidemic be drawn out of the shadows and into the light, so we can all learn to recognize symptoms of elder abuse, and report any suspicions. One such example of shining a light on elder abuse prevention will be coming to Southern California next month.

On September 15, 2016 the 2-day USC Judith D. Tamkin International Symposium on Elder Abuse will welcome “researchers, academics, physicians, nurses, and psychologists” to participate in a weekend committed to “Closing the Research Gaps and Moving the Field of Elder Abuse Forward.”

Perhaps in response to the revelation that the California Department of Public Health has been negligent in investigating claims of elder abuse occurring in nursing homes and assisted living facilities across the state, Governor Jerry Brown’s proposed fiscal budget includes the addition of roughly 260 positions in the Licensing & Certification Division of the California Department of Public Health.

A statement issued by the California Advocates for Nursing Home Reform (CANHR) in response to the proposed budget reads:

“According to the Department’s Budget
Change Proposals, the Department is requesting the new positions primarily because its prior methodology for assessing its staffing needs failed to consider that inspectors were needed to investigate its vast backlog of complaints or to finish complaint investigations and write reports after onsite visits were conducted.”

Unfortunately, even given the influx of a proposed $30 Million, and the addition of hundreds of jobs, CANHR also said that it is expected to take an additional four years for all pending investigations to be completed. Their statement further said:

“In other words, the Department allowed thousands of complaints involving nursing home abuse and neglect to languish for years because its leaders could not competently perform the most basic assessment of its staffing needs. Some of these failed leaders remain at the Department and should be replaced by qualified and competent managers before it is awarded any more money.

CANHR calls on Governor Brown to swiftly appoint a new leadership team at the Department of Public Health. The new leaders should have the qualifications, experience, and will to build the Licensing & Certification Division into a premier consumer protection agency that will protect the interests of nursing home residents and patients of other health facilities throughout California.”

If you suspect that an elder is being abused, it is vital to report your concerns immediately. Under California law elder abuse can be both a criminal and civil offense. The state of California has taken a firm stance and zero tolerance policy towards elder abuse in any capacity. As part of their mission to encourage all Californians to report suspected elder abuse, the state has created The Citizen’s Guide To Preventing and Reporting Elder Abuse, which can be viewed in its entirety here. You should report suspicions of elder abuse to:

• Local Law Enforcement, including the Police, Sheriff, and District Attorney’s office. The San Diego County Sheriff’s Department can be reached at (858) 565-5200. The San Diego County District Attorney may be reached at 619-531-4040.
• Long-Term Care Ombudsman Program provides a 24/7 Crisis Complaint Hotline at 800-231-4024.
• Adult Protective Services (APS). In San Diego County, you may contact: San Diego County Aging and Independent Services (858) 495-5660.
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Southern California elders – particularly those residing in nursing homes, or skilled nursing facilities – are unfortunately prone to developing life-threatening bedsores. Bedsores, which are also known as pressure ulcers, can lead to a host of health problems, particularly in elders whose health may already be compromised. Similarly, because many elders may be confined to a bed or wheelchair, their risk for developing these sores is increased.

According to the Mayo Clinic:
People are at risk of developing pressure sores if they have difficulty moving and are unable to easily change position while seated or in bed. Immobility may be due to:

•Generally poor health or weakness
•Injury or illness that requires bed rest or wheelchair use
•Recovery after surgery

However, more specific risk factors affecting elders which make them so susceptible to bedsores may include advanced age, which results in thinner, drier, less elastic skin, which is generally more fragile. Elders may also develop bedsores after significant weight loss, which can accompany a long-term illness. Poor nutrition and/or dehydration also make elders susceptible to developing dangerous bedsores. Illnesses such as diabetes, and vascular diseases may also lead to damaged skin tissue, making it easier for a bedsore to develop. Likewise, elders who suffer from bowel or bladder incontinence are also likely to develop bedsores if soiled clothing isn’t removed and replaced immediately.

Similarly, elders who are in a state of mental decline are typically more likely to develop dangerous bedsores. Those who have limited mental alertness may be unaware that sores are developing, leading them to progress into dangerous infections before being discovered. By the same token, any elder who has diminished sensory perception, such as those who are paralyzed, may also not discover bedsores until they have reached a dangerous stage.

The key to prevention (and treatment) of bedsores is to relieve pressure. This can be accomplished most effectively by repositioning an elder regularly, particularly once a bedsore has developed.

For elders residing in a Southern California nursing home, inspection of the skin should be a routine part of care. Unfortunately, all too often patients suffer from bedsores due to neglect or lack of an appropriate care plan implemented in the California nursing home. If you have found a bedsore on an elder you know, a doctor needs to be notified immediately. Bedsores can often be resolved with appropriate detection and treatment.

While many long-term care facilities in California provide excellent care, others subject their patients to many forms of neglect or elder abuse. The California Welfare & Institutions Code §15610.57, addresses “neglect” in part by stating it is “the negligent failure to exercise the degree of care a reasonable person would have exercised had they had the care and custody of an elderly person.” This would include the failure to protect that elder from dehydration, bedsores, falls, other injuries caused by safety or health hazards and any type of injury that does not fit the explanation provided by the staff.
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Governor Jerry Brown made it clear that assisted living facilities in California will be held accountable for violations of state regulations, to the tune of a 100% increase in fines.
Until recently, fines for violations at assisted living facilities maxed out at a measly $150.00. The top fine will now be $15,000.00. This is just the latest step in a statewide effort to increase oversight of assisted living facilities. The Governor also signed 9 additional assisted living reform bills, which marks the single greatest overhaul of the elder care facility industry in almost 30 years.

This bill was co-authored by San Diego’s own Assemblyman Brian Maienschein, and extends to cover all community care facilities, not just nursing homes. So far, Governor Brown has signed 13 new bills designed to protect our elderly into law this year. The San Diego Union Tribune has a great article which explains the details of the new law. It can be read in its entirety here.

At Walton Law, APC, we are very pleased to see our politicians working harder to protect our seniors. We certainly hope that the increase in fines will prompt elder care facilities throughout the state to begin to honor the rights of patients and elders living within assisted living facilities and nursing homes throughout the state as they have promised the families of these loved one they would.
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In one of the most recent and most alarming incidents of neglect and elder abuse, a Castro Valley assisted living facility was shut down a few weeks ago by Social Services after multiple complaints. But what happened after the closure may lead to not only civil, but criminal charges against the owners.

After the facility was officially closed down, it appears that the assisted living facility staff left as well, leaving more than one dozen elderly patients with just a cook, a janitor and a caretaker for an entire weekend. A medical call alerted authorities to the fact the residents had more or less been abandoned. Some of them were bedridden, and wheelchair bound. From here, the district attorney will decide what type of criminal charges the owners of the facility will face. All patients have since been moved to other hospitals and facilities.

It is horrifying to see such blatant abuse, and neglect of the elderly, but unfortunately it is not uncommon. Elder abuse, including neglect occurs in long term care facilities in California with alarming frequency.

Los Angeles ABC 7 News recently partnered with the Center for Investigating Reporting to shine a light on alleged abuse cases, which are being poorly investigated by the California Department of Public Health. The partnership has revealed that the agency is leaving allegations of elder abuse unexamined for years.

According to ABC-7’s website: “Investigators at California’s Department of Public Health are responsible for keeping dangerous people out of the health care business. But an investigation by our partners at the Center for Investigative Reporting says the agency is failing to protect some of the state’s most vulnerable: the elderly.

They’ve uncovered alleged abuse cases that the agency left unexamined for years — even some that ended with fatal results.

According to a report by Masters in Health Care, there are some very disturbing statistics about the long term care facilities that many of our friends, relatives, family members and loved ones call home.

Among the shocking facts revealed are the following:

• Over 30% of nursing homes have had some form of elder abuse either by the staff or other residents, including sexual abuse, physical abuse, psychological abuse, neglect and malnutrition.
• In 2005, nearly 92% of all nursing homes received at least one citation for a deficiency.
• Approximately 90% of the time when there is some form of abuse, it is done by the staff, other residents or non-strangers.
• In 1999 there were 5,000 death certificates for nursing home patients that listed the cause of death to be dehydration, bed sores and food deprivation.
• Most nursing home abuse cases never end up being because of the declining mental capacities of the patients and the failure to detect it by the staff members or the patient’s family.
• Over 50% of all nursing home patients have no close family to watch out for nursing home neglect or abuse.
• Many times a nurse’s aide or other staff member may be called upon to care for as many as 30 patients.
• Approximately 30% of all nursing home patients are overmedicated with tranquilizers.
• Approximately 92% of all nursing homes have at least one staff member who has a criminal background.
• With the aging of America, there are not enough nursing home beds to keep up with the growing need for long term care facilities.
• In 2007, there were nearly 258,000 complaints registered against nursing homes for an average of 20 for each.
• In 2001, one out of four nursing homes received a citation for serious injury or death of a patient.
• The cost of living in a nursing home continues to rise. In 2003, the average annual cost was $66,000 but by 2021 it is expected to be $175,000.
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The California Department of Public Health has fined three Los Angeles County nursing homes a total of $235,000 over the alleged poor quality of care the facilities provided to residents. The Downey Care Center, Fountain View Subacute and Nursing Center, and the Motion Picture and Television Hospital were issued Class “AA” citations, the most serious violations under California law, over patient deaths which occurred at each facility in 2010. According to Dr. Ron Chapman, Director of the California Department of Public Health, the fines were levied after an investigation revealed each patient death resulted from inadequate nursing home care.

The Downey Care Center must pay $80,000 for failing to properly monitor a resident’s blood sugar levels after she returned from the hospital. Because the center purportedly failed to provide appropriate care, the resident fell into a diabetic coma and died.

The Fountain View Subacute and Nursing Center located in the City of Los Angeles received a $75,000 fine for allegedly failing to properly supervise a patient with a record of falling. The nursing home resident died from a brain injury he incurred when he fell out of bed. Additionally, staff at the nursing home could not say how long the man laid helpless on the floor before his injury was discovered.

The Department of Public Health fined the Motion Picture and Television Hospital in Woodland Hills $80,000. The fine stems from an incident during which an Alzheimer’s patient reportedly fell down a flight of stairs while strapped into her wheelchair. The nursing home resident died from her injuries one week after her fall. Unfortunately, the resident also fell down the same flight of stairs in the past.

In California, there are approximately 1,300 licensed resident care facilities. When a licensed nursing home fails to comply with applicable state and federal laws designed to ensure residents are properly cared for, the State of California has the ability to impose monetary penalties. The amount of a fine depends on the severity of the resident care facility’s violation. A nursing home may be fined anywhere between $100 and $100,000 depending on the violation.

Nursing home abuse occurs when the elderly or infirm are injured or die as a result of mistreatment or negligence in a facility tasked with their care. Although most elder abuse cases result from negligence, they may also be the result of physical abuse, sexual abuse, a failure to provide adequate medical care, withholding food, incorrectly or over-medicating, and emotional distress. Unfortunately, nursing home abuse is frequently the result of improperly trained or unqualified staff.

Signs of elder abuse can be tough to detect. A nursing home resident may experience a loss of appetite, unexplained weight loss, dehydration or depression. Residents may also exhibit bruises, broken bones, scratches, bed sores, unexplained accidents, and complain of missing personal items. In order to safeguard the rights of the elderly, it is important to take all complaints of nursing home abuse and neglect seriously. If you suspect a nursing home resident is being neglected or abused, contact a qualified California elder abuse attorney to discuss your concerns.
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Following the death of Johnnie Esco at a Placerville facility, an investigation of similar complaints revealed nearly 150 cases of alleged chart falsification in California nursing homes. In Esco’s case, the Department of Justice reopened its criminal investigation of El Dorado Care Center (Center), the nursing home that allegedly altered Esco’s charts to reflect treatment she never received. After 13 days of neglect, Esco experienced massive bowel obstruction, ultimately leading to her death. Her family sued the Center, alleging fraud, elder abuse, and wrongful death. The family accused the Center of falsifying and altering Esco’s medical charts since her admission. The facility remains under civil and criminal investigation for fraud.

Johnnie Esco, 77, was supposed to be recuperating from a bout of pneumonia at a nearby nursing home when her condition suddenly declined. Like many elderly patients, Esco suffered from chronic constipation, which could result in fecal impaction if left unmanaged. Esco’s physician therefore ordered that nurses perform routine assessments, checking Esco on every shift for possible constipation. The physician also ordered that Esco receive a laxative or stool softener and milk of magnesia daily. Esco’s chart, however, showed no history of constipation or laxative use. The nurses never performed an assessment or asked for Esco’s history.

While Esco did not have a bowel movement for five consecutive days, her chart indicated a “zero” constipation. When the doctor ordered an evaluation of the patient’s abdominal distention, no one performed it. Esco lay critically ill, but her chart showed she had an “extra large” bowel movement and a temperature of 98.8. While she was bedridden and unresponsive, the Center billed Medicare for 170 minutes of physical therapy and 65 minutes of occupational therapy. It seems nobody looked in on Esco before she died. An autopsy revealed a severe bowel obstruction and fecal impaction, contradicting the notes in Esco’s chart.

Esco is not the only patient with a falsified medical chart. A supervisor at a Carmichael facility admitted altering the medical records of a 92-year-old with massive, rotting bedsores. A Santa Monica facility was fined $2,500 for claiming a patient received five days of physical therapy when the nurses responsible for performing the therapy were not at work on those days. Investigations into Medi-Cal Fraud and Elder Abuse reveal that falsification of records in nursing homes is an insidious practice, even when it leads to disastrous human consequences.

Falsifying medical records is a misdemeanor under California law. The California Code of Regulations and Business and Professions Code both require mandatory reporting of the offense. Nevertheless, this is what some providers do “to get the work done.” Nursing assistants admit to charting “in bulk,” documenting medication and treatment that were never given. Some administrators even re-create records to hide neglectful care. Others falsify forms to sedate patients or backdate forged documents to settle disputes. In a practice where providers rely upon the accuracy of medical charts, sloppy or fraudulent record-keeping takes a serious human toll.
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An Oroville, California nursing home, Olive Ridge Post Acute Care, was recently cited fifteen times by the Department of Public Health for failing to follow laws in place to protect residents from improper eviction. According to public documents, Olive Ridge attempted to move out many of its long-term residents to increase beds for short-term rehabilitation residents who are often times required to pay more for their care.

Long-term residents in nursing homes are often considered extremely vulnerable, which is why there are several laws in place intended to protect them from unplanned evictions. According to the citations, Olive Ridge failed to follow several State and Federal laws when it decided to suddenly close down an entire wing of the nursing home and relocate up to fourteen residents that were suffering from severe cognitive issues. To make matters worse, some of the residents were relocated more than 150 miles away from their family with virtually no notice. This understandably created a tremendous amount of anxiety and burden on these residents and their families.

The California Department of Public Health is responsible for overseeing the nursing homes operating within the state to ensure they comply with all state and federal regulations. If you have a complaint that cannot be resolved through direct discussion with the nursing home or an ombudsman, you should contact your local Department of Public Health Licensing and Certification office. A list of the district offices and phone numbers can be found at the CA Department of Public Health website.
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