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10 Nov ' 10:08
How Much Money Does Manor Care Really Make?
on November 10, 2011
We’ve had a lot of discussion regarding the sizable nursing home negligence verdict in West Virginia against Heartland of Charleston and the parent company HCR Manor Care. If you haven’t heard about this landmark nursing home verdict, jurors awarded $91.5 million to the family of a patient at the facility who died shortly after her admission to the facility from complications related to dehydration and pressure sores.After unsuccessfully arguing that the verdict should be reduced based upon West Virginia’s caps on non-economic damages in medical malpractice cases, lawyers for the nursing home behemoth have now taken a position that a judge should substantially reduce the verdict or order a new trial based upon errors made during the course of the original trial.
In particular, lawyers for Manor Care claim that the company is a far less profitable organization than was alleged at trial by lawyers representing the patient’s family when seeking punitive damages.
Unlike compensatory damages that are intended to compensate an individual or grieving family for their loss, punitive damages are literally intended to punish the company for its conduct. In order assure that a reasonable punishment is imposed, most jurisdictions allow the jury to take into account the companies profitability—so theoretically, an commensurately appropriate punishment could be imposed against a mega corporation or small business.
In the Manor Care trial, lawyers claim that the $4 billion that the company was alleged to have pocketed in annual profits was merely its gross revenue and the real income was approximately $75 million.
While the actual amount of the Manor Care’s profits may appear to be an inconsequential mathematical exercise, the issue does highlight the complexity of many nursing home operations and the difficulty in understanding the financial structure behind many facilities.
Nursing home operators routinely have multiple derivative companies that may be responsible for the operation of the facility, the real estate that the facility sits on and staffing at the facility. While the entities may look to be independent, a closer examination can typically reveal that they are essentially the same with individuals holding positions at the allegedly separate companies.
Albeit on a massive level, the real profitability of Manor Care’s operations should be examined by a forensic accountant to determine the path of funds that the company pulls in and where the money goes. Given the large discrepancy between the alleged profits in this matter, I suspect that there is a lot more to this situation than is readily apparent.
Related:
Nursing home's earnings misrepresented during trial, lawyers argue, WVgazette.com November 6, 2011
$5 Million In Punitive Damages Awarded To Widow In Bed Sore Case Against Nursing Home & Hospital
New York Jury Punishes Nursing Home Where Man Develops More Than 20 Bed Sores
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09 Nov ' 08:55
Study Suggests That Surgery Has Limited Use On Nursing Home Patients
on November 09, 2011
Perhaps nursing home patients are more frail and vulnerable than we already thought? A recent study published in the Annals of Surgery essentially concluded that nursing home patients are significantly more vulnerable to complications following a surgery than their peers living in the community. The study looked at sample groups of both nursing home patients and elderly people living in the community and the differences between the two groups are striking. For example when researchers looked at surgical procedures, they discovered:
- Nursing home patients were six times more likely to die within a month following the removal of their appendix
- Surgery for bleeding ulcers claimed the lives of 42% of nursing home patients, while the same procedure only claimed 26% of the lives of patients living in the community
- Colon surgery death rates were more than 50% higher for nursing home patients compared with their peers, claiming 32% of nursing home patient lives vs. 13% of their community peers.
In addition to significantly higher mortality rates, researchers similarly found that nursing home patients had more post-operative complications and required more rehabilitative treatment than similarly situated people living outside of skilled nursing facilities. According to Dr. Emily Finlayson, the studies lead researcher, "[p]atients who survived had to undergo invasive procedures after surgery which means more time on the ventilators, more people getting feeding tubes and more time in the ICU."
Certainly, this study demonstrates both the extreme vulnerability of the nursing home population in general and how many seemingly common ailments may need to be addressed differently by the medical community when treating this group. Similarly, treating physicians need to be realistic about treatment option with the families of nursing home patients as their prognosis may be far more grim than that of other patients with similar procedures.
Related:
States Move To More Transparency Regarding Medical Malpractice & Hospital Errors
Nursing home residents face greater surgery risks, November 4, 2011 Reuters.com
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08 Nov ' 09:26
Staff Need To Protect Disabled Nursing Home Patients As They Transport Them In Wheelchairs
on November 08, 2011
No one seems to give much thought to transporting a nursing home patient in a wheelchair throughout the facility or outside on the facilities grounds. Just push the patient in the chair to where they need to go? Right?Well, like most tasks, there really is quite a bit more to it than is originally apparent. In order for patients to be safely transported in wheelchairs staff need to take precautions to make sure that the patient arrives where they need to be in a safe manner.
Though not a well-publicized topic, injuries resulting from faulty wheelchairs and staff negligence in pushing the wheelchairs, are responsible for a steady stream of needless injuries to especially vulnerable people. Just recently, I read about a patient at a Minnesota nursing home who broke three toes when a staff member sloppily pushed the wheelchair and knocked her foot into a wall.
While the incident itself may seem like not much of a deal, the fact that that patient was forced to live with a broken bone due to the inattention of a staff member pushing their wheelchair is inexcusable. At facilities where patients are regularly transported via wheelchairs, the facility needs to train staff on the basics of wheelchair use including:
- Securing immobile or spastic patients
- Transferring patients into and out of the wheelchair
- Use of wheel locks
- Wheelchair lifts between floors and on vans
- Loading patients into elevators
- Use of braces and other propping devices for patients who may already have an injury
- Parking patients in level areas and away from ramps and stairways
As an injury lawyer, who has represented people who have suffered a variety of wheelchair related injuries, I frequently find little attention paid by facilities or staff to this essential--- albeit somewhat mundane task. As more disabled patients begin to demand to live full and active lives--- not just in the confines of their room--- facilities need to make sure that their facilities and staff are equipped to safely care for patients in wheelchairs.
Related Nursing Homes Abuse Blog Entries:
Investigation Into Nursing Home Resident's Death In Van Accident Begins
Another Example Of Nursing Home Negligence: Disabled Patient Falls Down Unsecured Stairway
Nursing Home Aide Fired After She Forgets To Secure Paralyzed Patient In Wheelchair
Medical Facilities Must Use Wheel-Locks & Supervision To Protect Patients In Wheelchairs
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07 Nov ' 05:05
Financial Abuse Of The Elderly: Nursing Home Administrator Admits To Stealing From Patients
on November 07, 2011
A former administrator at a Kentucky nursing home has pleaded guilty to multiple charges including: theft, exploitation of a vulnerable adult and tax fraud. The nursing home administrator identified as James Tackett, confessed to stealing more than $300,000 from patients he was responsible for caring for at the Golden Years Rest Home (ironically a non-profit facility).
Authorities were tipped off to Mr. Tackett's activities after several patients at the facility complained about not receiving economic stimulus checks from the federal government. The complaint was then passed on to the Social Security Administration and Department of Revenue who quickly learned that Mr. Teckett took it upon himself to take his patient's funds.
This is not an isolated criminal venture for Mr. Tackett. In 2009, he pleaded guilty to physically abusing a patient at Golden Years Rest Home. A judge will determine the sentence for Mr. Tackett's crimes involving financial abuse of the elderly in February.
Commonly ignored and frequently perpetrated by close friends and family, financial abuse of the elderly can take many forms including:
- Taking money or property
- Forging an older person's signature
- Getting an older person to sign a deed, will, or power of attorney through deception, coercion, or undue influence
- Using the older person's property or possessions without permission
- Promising lifelong care in exchange for money or property and not following through on the promise
- Confidence crimes ("cons") are the use of deception to gain victims' confidence
- Scams are fraudulent or deceptive acts
- Fraud is the use of deception, trickery, false pretence, or dishonest acts or statements for financial gain
- Telemarketing scams. Perpetrators call victims and use deception, scare tactics, or exaggerated claims to get them to send money. They may also make charges against victims' credit cards without authorization
***above types of financial fraud highlights from the National Committee for the Prevention of Elder Abuse (NCPEA)
Medicaid Fraud Costs Nursing Home More Than $375k
Chicago CNA Charged With Stealing From Deceased Nursing Home Patient
Nursing Home Bookkeeper Admits To Stealing Money From Facility
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06 Nov ' 16:43
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06 Nov ' 04:35
Nursing Home Injury Laws: California
on November 06, 2011Number of nursing homes in California : 1,226
Patients living in California nursing homes: 100,578
Occupancy rates of California nursing homes: 84.8%
Average number of deficiencies at each California nursing home: 12.6
Percent of California nursing homes with serious deficiencies for actual harm to patient: 11.8%
Most common deficiencies at California nursing homes:Food Sanitation, Quality of Care, Comprehensive Care Plans
Distribution of ownership of California nursing homes: 80% for profit, 16% non profit, 4% government
Most populated cities in California: Los Angeles, San Diego, San Jose, San Fracisco, Fresno, Sacramento
Staffing levels at California nursing homes (daily hours): Above average, 4.0total staff, 1.4 licensed nurse
Visit Nursing Home Injury Laws to learn more about California nursing homes and your legal rights.**Data based upon 2009 CMS data, U.S. Department of Health and Human Service
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05 Nov ' 08:49
400 Patients Evacuated From Chicago Nursing Home After Fire
on November 05, 2011
A fire recently forced the evacuation of a large Chicago nursing home. According to news reports, the American Red Cross of Greater Chicago was called out to provide assistance to patients at Lydia Health Care Center in suburban Robbins in the early morning hours following the fire. Presently, an investigation is underway to determine the source of this nursing home fire. Lydia Health Care Center is a certificated long-term care facility that primarily cares for mentally ill patients.
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04 Nov ' 05:10
Under-Staffing At Nursing Homes: When There's Simply Not Enough Staff To Protect Patients From Harm
on November 04, 2011
Rightfully so, under-staffing in nursing homes remains a significant threat to the health and safety of the vulnerable people who rely on staff for their care. While many situations involving a patient injury may be suspected to be related to under-staffing, it frankly can be a difficult concept to establish specific staffing level requirements at nursing homes across the board because the needs may vary drastically from facility to facility.
One of the most identifiable problems I associate with under-staffing in nursing homes is when facilities simply do not supply enough to transfer immobile patients into or out of beds or wheelchairs. Working on a number of cases involving patients whom have been simply 'dropped' by staff, I find that many of these cases involve patients who were attempted to be transferred without sufficient manpower for a safe transfer.
By law, nursing home patients must be assessed (and re-assessed on a regular basis) to determine the level of assistance they require from staff. Particularly with physically disabled patients, an assessment and derived care plan will set forth the type of assistance as well as the number of staff who are to assist with transfers--- when a patient is moved from one modality to another. Completely immobile-- or larger patients-- may require the assistance of one, two, three or four staff members all working in concert with another to help move the patient.
Obviously, when facilities are not properly staffed, it can be difficult--- if not downright impossible for a patient to get transferred with the level of assistance necessary.
An example of the horrible problems that can ensue when an insufficient number of staff attempt to move a nursing home patient was recently reported by FOX40 News. According to reports, a patient at Crystal Ridge Care Center died following injuries he sustained when he fell from a mechanical chair lift used to move the man out of a bathtub. As a single CNA attempted to move the man out of the tub, he fell from the lift suffering an injury to his head and fractures in his neck.
While investigating the incident, the California Department of Public Health quickly learned that the facilities own policy required two staff members to assist in moving patients with the chair lift. Additionally, the investigation revealed that the California nursing home never provided any training or evaluation of staff on how to use the lift.
Training issues aside, I assume situations involving patient injury could be minimized if facilities would provide sufficient staffing levels necessary to implement the care that they assure families that they can provide.
Related Nursing Homes Abuse Blog Entries:
Nursing Home Aide Fired After She Forgets To Secure Paralyzed Patient In Wheelchair
Improper Maintenance Of Lift Device Costs Nursing Home Patient Their Life
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03 Nov ' 19:57
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03 Nov ' 10:51
Spurred by Herald Report, Florida Cracks Down on 17 Assisted Living Facilities
on November 03, 2011
[Photo Caption: In 2004, dementia sufferer Stowman Cox wandered from the Beckett Lake Lodge in Clearwater. His body was later found face-down in a lake, torn apart by alligators. (Photo Courtesy of the Miami Herald)]
An investigation by the Miami Herald into conditions at dozens of assisted living facilities has prompted a crackdown by Florida’s state regulatory agency, the Agency for Health Care Administration (AHCA).
“They’re finally doing what they should have been doing,” said Dan Reiter, a state ombudsman.
Over the course of a year, Herald reporters found deplorable instances of abuse and neglect at facilities across the state, including:- Scores of residents from Dunedin’s Rosalie Manor wandering the streets
- Staff at Miami’s Angelica Gardens locking a 72-year-old resident in a closet without air conditioning
- A 98-year-old Living Legends resident being sent to the hospital with two black eyes, a fractured neck
“It was almost subhuman,” said Albert “Doc” King, a former resident of Shalom Manor Retirement Home in Lauderhill. King claims that residents were often mistreated, and that medicine frequently disappeared.
In Florida, assisted living facilities (ALFs) commonly admit both the elderly and the mentally ill. The Herald attributes the AHCA’s widespread lack of oversight, in part, to growing numbers of both populations. It also attributes the failure in oversight to low standards required for potential ALF operators.
“To open a home for people with mental illness, administrators need only a high school diploma and four days of training - far less than other major states,” the Herald says.
A third reason could be the scores of new ALFs opening across the state. According to the Herald, more than 550 new homes opened in the past five years, bringing the total number of ALFs to 2,850 in Florida.
After reading the Herald investigation, I find it truly shocking that Florida hasn’t yet overhauled its requirements for ALF operators. Clearly, the lack of knowledge about elder care - combined with purely greedy intentions - has put thousands of residents in grave danger. Despite having some of the toughest elder abuse laws in the country, Florida still has a long way to go before all its residents are safely cared for.
Please Note:
Facilities mentioned in the Herald report include:
All America in Hialeah
Arlington House in Palatka
Angelica Gardens in Miami
Beckett Lake Lodge in Clearwater
Briarwood Manor in Lauderhill
Clare Bridge of West Melbourne
Emeritus at Crossing Pointe in Orlando
Edwinola Retirement Community in Dade City
Escondido Palms in Tampa
Hampton Court in Lauderhill
Hillandale in New Port Richey
Isabel Adult Care III in Miami
Living Legends Retirement Center in Deerfield Beach
Munne Center in Miami
Nueva Vida in Miami
Park of the Palms in Keystone Heights
Pleasant Manor in Plant City
Rosalie Manor in Dunedin
Shalom Manor in Lauderhill
Southern Oaks Retirement Center in Wauchula
Sunshine Acres Loving Care in Caryville
Related:
Neglected to Death: Part I Miami Herald, May 2011
Neglected to Death: Part II Miami Herald, May 2011
Neglected to Death: Part III Miami Herald, May 2011
How to Choose an ALF (Florida Department of Elder Affairs)
Task Force to Seek Reform of ALF Industry Miami Herald, August 2011
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