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A new study in the Journal of the American Medical Directors Association, and later reported by the New York Times, indicates that some nursing homes may have found a lucrative new way to make money, through collecting extra funds from Medicare by providing excessive rehabilitation services to patients in their final weeks and days of life.

If this is the case, at least two major concerns are raised: Patients who need hospice and palliative care in their final days are not receiving it, but are rather receiving physical, occupational or speech therapy, and patients in need of rehabilitation services are potentially not receiving the appropriate level of care either, as the influx of rehabilitation patients crowds out therapists’ availability to help those in true need of their services.

The study, which was led by several professors at the University of Rochester Medical Center, found the trend to be more widespread in for-profit, rather than nonprofit, nursing homes.

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If you or someone you know is faced with the challenging task of finding a long-term care facility for a loved one, at times it can be difficult to know where to begin. Several websites have been designed so consumers can assess how individual facilities stack up.

Nursing Home Compare

Nursing Home Compare, run by the Centers for Medicare & Medicaid Services, is perhaps one of the most well-known resources that rates care facilities by providing a star-ranking system. Through the website, up to three nursing homes can be compared side-by-side regarding overall rating, general information, health inspections, fire safety inspections, staffing, quality of resident care and penalties.

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Under the Affordable Care Act of 2010, over 14,000 nursing homes were recently required to start providing payroll records to the government, which serve as indicators of staffing levels. Kaiser Health News analyzed the records and found that most nursing homes are operating at consistently understaffed levels, and some facilities even falsely reported having more staff on hand than they actually did.

Apart from across the board understaffing, the study discovered that on weekends, nursing homes see an even larger deficit in adequate staffing than during the week. At worst, a nurse or aide may be required to care for twice as many patients as he or she would on a day with more personnel.

Throughout the week, when staffing levels are typically at their highest, most aides were found to be responsible for anywhere from nine to 14 residents. On the weekend, that number goes up, as nursing staff drops roughly 11 percent on average, and aide staff drops roughly 8 percent.

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Anyone, including employees, residents or loved ones, has the right to file a complaint against a licensed long-term care facility in the state of Tennessee if any concerns in proper elder care arise. Unfortunately, many people do not know that this is an option, and the abuse or neglect suffered by a loved one goes unreported.

If you or someone you know has experienced substandard care in a nursing home, filing a complaint with the Tennessee Department of Health can be a proactive step that will prompt an investigation.

What Situations Can Be Reported?

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A 2016 Harvard University study found that nursing homes across America have been changing ownership at an alarming rate. On average, 1,500 nursing facilities were sold to a different corporation per year between 1993 and 2010. While change of ownership is not believed to directly cause turmoil and poor care, the study concluded that many nursing homes that already have a history of deficiencies and violations are more likely to be sold and rebranded.

David Grabowski, lead researcher and health care policy professor at Harvard Medical School, pointed out that nursing homes with a history of consistent, uniform ownership typically have fewer citations from inspectors, unlike their lower-quality counterparts, which more often have mergers, acquisitions or changes of ownership on their record.

More often than not, corporate chains are involved in the acquisition of failing health care facilities.

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Last year, Jehl Law Group represented the family of a nursing home resident, who was neglected so badly that she developed pressure sores on her foot that were bone-deep. The condition of her foot was ignored. Eventually, the wounds became infected with multiple bugs that are found in fecal matter, and her leg had to be amputated. She passed away two months later.

The nursing home, its owners, and their attorneys were responsible for multiple continuances of the trial, but after years, our clients finally got their day in court. Following a five-week trial where nursing home employees testified to chronic short-staffing and fraudulent record-keeping, a jury of twelve people from Shelby County awarded our clients approximately $2,000,000 for their mother’s injuries, pain, and suffering. The jury also determined that the nursing home and its owners had acted so badly that they needed to be punished to prevent them from behaving like this again. After seeing how much money the owners made each year from their terrible behavior, the jury awarded a $28,000,000 punitive damage award designed to deter the nursing home and its owners from ever doing this again.

Our clients’ mother suffered horrific injuries because of the behavior of the defendants.  A jury determined that she had suffered immense amounts of pain and that the nursing home and its owners deserved to be punished for their behavior. Even the judge, who heard all the proof, found that the jury’s decision to punish the nursing home and its owners should stand. However, if members of the House have their way, our clients would have only recovered approximately $300,000.

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This past March, Signature HealthCARE at St. Francis, located at 6007 Park Ave. in Memphis, TN, which is not affiliated with the hospital but is on the same campus, proved to be yet another disturbing example of a nursing home’s consistent failure to provide its patients with an acceptable level of care.  An “acceptable level of care” is the minimum amount of care all nursing homes are required to provide patients in exchange for receiving state and federal funds.

Signature HealthCARE at St. Francis has had a history of inspection failures and delivering substandard care to its residents. In order to continue receiving government funds, the nursing home not only paid out $1.2 million in fines in 2015 but also agreed to correct its numerous areas of non-compliance. The facility failed to live up to its end of the bargain. Consequently, the Centers for Medicare and Medicaid Services (CMS) terminated their contract with Signature HealthCARE at St Francis on March 8th, 2017. By April 25th only 9 of the 140 patients remained.

Signature HealthCARE at Saint Francis ratings from medicare.gov are below:

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When a 98 year-old woman entered a nursing home several years ago, her family dreamed that she might return to the assisted-living facility that she had called home for many years.  Unfortunately, unable to walk and suffering from dementia, she had reached a point where she needed around-the-clock care.   At the nursing home, her condition worsened, and she contracted an infection that caused diarrhea and required isolation from other residents.  After five weeks, she passed away at the nursing home.

Despite her condition, her records show that she was receiving more than 5 hours of therapy per day.  On the day that she passed away, the nursing home claims that she received more than 2 hours of therapy.  If you’re thinking that doesn’t make sense, you’re right. Here at the Jehl Law Group, we see nursing homes committing fraud like this all too often.  We have seen nursing homes bill for therapy and other services that they don’t actually provide.

Earlier this year, Kindred Healthcare Inc. and two of its subsidiaries agreed to pay the federal government $125 million to settle an ongoing fraud lawsuit. Kindred Healthcare Inc. is one of the larger nursing home chains in the country, and the government alleged that they were fraudulently billing for unnecessary therapy services. Life Care Centers of America, another large nursing home chain, is also being sued for these same practices.

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In July, the Centers for Medicare and Medicaid Services (CMS) proposed multiple rule changes applicable to nursing homes that accept funding from Medicare and Medicaid. Today we address the use of psychotropic drugs in nursing homes and the proposed rule changes to protect against their abuse. Psychotropic drugs include a broad range of drug categories, including anti-psychotic, anti-depressant, anti-anxiety, hypnotics, and opioid analgesic. These drugs have very important uses when prescribed correctly, but they also carry dangerous side effects, especially for people suffering from dementia.

Dementia patients frequently experience behavioral and psychological symptoms of dementia (BPSD) including agitation, aggression, cursing and swearing, anxiety, depression, psychosis, and wandering. As you can probably imagine or might have experienced personally, these symptoms make it more difficult to care for someone, but they can oftentimes be prevented or managed without the use of medication. However, these alternative approaches take time, effort, and patience. As a result, we often see these drugs overused in nursing home cases that we handle at Jehl Law Group.  Particularly, facilities that are under staffed or short staffed may use these drugs in excess as a way to chemically restrain residents.

These drugs carry serious side effects, especially for seniors. In particular, anti-psychotics can be dangerous if not FDA-approved “for the treatment of dementia-related psychosis.” It has been further warned by the FDA that these drugs can place dementia patients at “an increased risk of death.”[1] Not all the side effects are that serious, but most of the drugs carry risk of sedation (which is why they are used as chemical restraints), dizziness, and increased confusion. These side effects greatly increase the likelihood of falls, which oftentimes result in fractures and injuries that can be deadly to seniors. There are numerous other side effects associated with each specific psychotropic drug.