Friday, February 3, 2023

State investigation underway at southeast Iowa nursing home

by Nik Todorovich

Iowa state officials are looking into horrifying allegations about the treatment of two residents at a southeast Iowa nursing home.

In November 2022, a female resident was complaining of a headache. Her headache then turned into a migraine, which then turned into a stroke.

The resident complained about the pain to Aimee K. Crow, who is a nursing administrator at Windsor Place Nursing Home in Sigourney, Iowa.

The Iowa Department of Inspections and Appeals (DIA) is conducting investigations and officials have released 72 pages of legal paperwork detailing the allegations. The paperwork can be found HERE and HERE.

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State investigation underway at southeast Iowa nursing home

'Where will they live?': Humboldt nursing home residents displaced

Where will they live?

That's the question for 45 residents of a Humboldt nursing home that's closing its doors. It's one of six Iowa care facilities shutting down and displacing 260 residents by order of state regulators.

"I think it's awful that people are going to have to go so far away to see their family. My daughter works there, and she is losing her job, so that's a bummer," said Mandy Davis, who lives in Humboldt.

Davis says it’s the talk of the town. State regulators say the new owners, Blue Care Homes, must close the Humboldt facility along with five others across the state. And now, health care leaders in Humboldt County are scrambling to help.

"We are here to help any way we can," said Michelle Sleiter, CEO of Humboldt County Memorial Hospital.

Sleiter also oversees the Humboldt County Health Department. She is sending hospital workers to the Humboldt Care Facility to help as it closes. The hospital will now run the last 28-bed nursing home in Humboldt. But there’s a problem.

"Our nursing home at the hospital is the only option now after this closes, and again I only have 28 beds, and unfortunately, we're full," said Sleiter.

Sleiter says nursing homes are closing due to many factors. They include worker shortages, supply chain issues and revenue trouble. She is urging state lawmakers to investigate the problem

"This is going to be a long-term game that we are going to have to work through. Nothing is going to change overnight," said Sleiter.

The hope of Iowa leaders is that the residents will be placed within 20 miles. A new burden for the residents and their families who call Humboldt home.

"It's hard. These are people's lives, and most of them have lived in Humboldt their entire lives. So having to potentially find placement outside of our community hits close to home," Sleiter said.

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'Where will they live?': Humboldt nursing home residents displaced

Employee of Mount Lebanon nursing home charged with sexually assaulting resident

By Rich Pierce

MOUNT LEBANON, Pa. — A nursing home worker in Mount Lebanon is charged with sexual assault for what police say he did with a resident there.

Certified nurse assistant Solomon Rivers, 32, also known as Solomon Roberson, is charged with institutional sexual assault.

According to the criminal complaint, a resident at Mount Lebanon Rehabilitation and Wellness told police he performed a sex act on Rivers in the bathroom of his room.

Documents show the victim in this case has the mental capacity of a 7-year-old and is confined to a wheelchair.

According to the complaint, Rivers was interviewed multiple times and admitted to what happened saying “it went too far.”

People 11 News spoke to were disturbed by it.

“I find it weird that somebody thought that it was okay to do to another person when they know that they aren’t able to say anything back to them,” Jessica Berger said.

The report also says Rivers told police he would no longer “pursue a job in the healthcare field.”

It is unclear whether Rivers was fired from his position.

11 News reached out to management at the center over the phone and in-person. We were told no one there could speak with us and we’d have to try another day.

We also spoke with retired clinical social worker Vinceena Deiulus who says if you have a loved one in a nursing home and are worried about them being mistreated, there is something you can do.

“When you visit a person, when they know you’re there and around it changes the scenario of things. If they know you never show up? Not so much,” she said.

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Employee of Mount Lebanon nursing home charged with sexually assaulting resident

Thursday, February 2, 2023

NYSP: Schoharie woman steals from guardianship account

by: Harrison Gereau

COBLESKILL, N.Y. (NEWS10) — A Schoharie woman is doing time in Schenectady County Jail after she allegedly stole over $265,000 from a guardianship account. The funds were reported missing on Oct. 6, 2022, from an account owned by Daniel S. Ross of Ross Law Offices in Middleburgh.  

While investigating the alleged theft, officers learned that Amber M. Wood, 39, of Schoharie, had worked as a secretary for Ross. Between November 2013 and June 2021, police claim Wood took the cash out of her boss’ guardianship account and deposited it into her personal bank account.

During the same time frame, Wood allegedly altered business records related to the guardianship bank account. Those were later filed with Schoharie County Surrogate Court containing false information, police said. 

Wood was charged with second-degree grand larceny, eight counts of third-degree grand larceny, five counts of second-degree forgery, five counts of first-degree falsifying business records, and fourth-degree grand larceny.

On Friday, Wood turned herself over to state police. She was arraigned at the Cobleskill Town Court and sent to Schenectady County Jail. She will be arraigned in Schenectady County soon on charges stemming from the same incident.

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NYSP: Schoharie woman steals from guardianship account

Nursing home owners drained cash while residents deteriorated, state filings suggest

by Jordan Rau

New York state records show nearly half the state's 600-plus nursing homes hired real estate, management and staffing companies run or controlled by their owners, frequently paying them well above the cost of services. Meanwhile, in the pandemic's height, the federal government was giving the facilities hundreds of millions in fiscal relief. Maskot/Getty Images

After the nursing home where Leann Sample worked was bought by private investors, it started falling apart. Literally.

Part of a ceiling collapsed on a nurse, the air conditioning conked out regularly, and a toilet once burst on Sample while she was helping a resident in the bathroom, she recalled in a court deposition.

"It's a disgusting place," Sample, a nurse aide, testified in 2021.

The decrepit conditions Sample described weren't due to a lack of money. Over seven years, The Villages of Orleans Health & Rehabilitation Center, located in western New York near Lake Ontario, paid nearly $16 million in rent to its landlord — a company that was owned by the same investors who owned the nursing home, court records show. From those coffers, the owners paid themselves and family members nearly $10 million, while residents injured themselves falling, developed bedsores, missed medications, and stewed in their urine and feces because of a shortage of aides, New York authorities allege.

At the height of the pandemic, lavish payments flowed into real estate, management, and staffing companies financially linked to nursing home owners throughout New York, which requires facilities to file the nation's most detailed financial reports. Nearly half the state's 600-plus nursing homes hired companies run or controlled by their owners, frequently paying them well above the cost of services, a KHN analysis found, while the federal government was giving the facilities hundreds of millions in fiscal relief.

In 2020, these affiliated corporations collectively amassed profits of $269 million, yielding average margins of 27%, while the nursing homes that hired them were strained by staff shortages, harrowing injuries, and mounting deaths from COVID-19, state records reveal.

"Even during the worst year of New York's pandemic, when homes were desperately short of staffing and their residents were dying by the thousands, some owners managed to come out millions of dollars ahead," said Bill Hammond, a senior fellow at the Empire Center for Public Policy, a think tank in Albany, New York.

Some nursing home owners moved money from their facilities through corporate arrangements that are widespread, and legal, in every state. Nationally, nearly 9,000 for-profit nursing homes — the majority — outsource crucial services such as nursing staff, management, and medical supplies to affiliated corporations, known as "related parties," that their owners own, invest in or control, federal records show. Many nursing homes don't even own their buildings — they rent the space from a related company. Homes pay related parties more than $12 billion a year, but federal regulators do not make them reveal how much they charge above the cost of services, and how much money ends up in owners' bank accounts.

In some instances, draining nursing home coffers through related parties may amount to fraud. Along with The Villages' investors, a handful of other New York owners are facing lawsuits from Attorney General Letitia James that claim they pocketed millions from their enterprises that the authorities say should have been used for patient care.

Deciphering these financial practices is timely because the Centers for Medicare & Medicaid Services is weighing what kind of stringent staffing levels it may mandate — potentially the biggest change to the industry in decades. A proposal due this spring is sure to spark debate about what nursing homes can additionally afford to spend versus what changes would require greater government support.

Federal Medicaid experts warned in January that transactions with affiliated companies that share the same owner as the nursing home or are controlled by the same people "may artificially inflate" the true cost of nursing home care in reports that facilities file to the government. And the U.S. Department of Health and Human Services' inspector general is investigating whether homes properly report related-party costs.

'A dog would get better care'

Beth Martino, a spokesperson for the American Health Care Association, said there is no evidence that related companies charge more than independent contractors do for the same services. "The real story is that nursing homes are struggling right now — to recruit and retain caregivers and to keep their doors open," Martino said.

Lawyers for The Villages and its investors have asked the judge in the case for a delay until April to respond to the allegations of fraud and resident neglect in the lawsuit that the attorney general filed last November. One of the lawyers, Cornelius Murray, said in court papers that many allegations of short-staffing occurred during the pandemic when workers were out sick and the facility was required to accept any patient who had COVID-19. The attorneys for The Villages declined to discuss the case with KHN.

In a deposition for that case, Ephram "Mordy" Lahasky, one of Fulton's owners, disputed that he and fellow investors improperly depleted The Villages' resources to the detriment of residents.

"I can assure you there was a lot of money left in the facility to make sure that it was not running on a shoestring budget," he testified. The Villages, Lahasky said, was a "beautiful facility" with "beautiful gardens" where "residents look great" and employee morale was strong.

That wasn't the opinion of Margarette Volkmar, the wife of one of the facility's residents. She said in an affidavit filed with the state lawsuit that her husband was left in his bed with only a diaper on, was bruised by a fall, choked by another resident, given the wrong medication doses, dressed in other residents' clothes and covered in bruises that could not be explained. After she moved him to another home, she testified, he gained back the 60 pounds he had lost and never fell at the new facility.

"I wouldn't put a dog in Villages," she said. "A dog would get better care than he did."

The owners invested in hundreds of homes

Both The Villages and its related real estate corporation, Telegraph Realty, were controlled by the same trio of investors, although they arranged for the nursing home to be listed in regulatory filings as solely owned by a silent partner and did not disclose their co-ownership of The Villages, court records show. One co-owner, David Gast, disclosed his net worth was $22 million and revealed that he had shares in more than 100 nursing homes, according to a loan application included in court records. Lahasky, whose disclosed net worth was nearly $73 million, said in a deposition he was the biggest nursing home proprietor in Pennsylvania and owned one of New York's largest ambulance companies.

A third co-owner, Sam Halper, who reported a net worth of about $23 million, is under federal criminal indictment in Pennsylvania on charges of submitting false reports to the government about staffing and patient health at two nursing homes. He has pleaded not guilty. Added together, all the investors in corporations tied to The Villages have stakes or official roles in 275 other facilities across 28 states, federal records show.

The lease that The Villages had with Telegraph Realty required the home to pay up to $1 million in profits on top of the costs of debts and $50,000 a month for rent, according to a copy filed with the lawsuit. The attorney general alleged that, over seven years, the owners gave themselves and other investors more than $18 million from outsized rent profits, management fees, and proceeds from refinancing the property, an act that saddled The Villages with higher debt.

Lindsay Heckler, a supervising attorney at Center for Elder Law & Justice in Buffalo, which provides free legal help to older, disabled, and low-income adults, said she is concerned other nursing home owners in the state fail to provide quality care after purchasing facilities.

"When you see quality of care decline after an ownership change, the question needs to be asked: What's going on with the finances?" she said.

Inflated rents — paid to sister companies — aren't uncommon

Separating a nursing home operation and its building into two corporations is a common practice around the country. In New York, for-profit nursing homes with related-party realty companies spent 19% more of their operating revenue toward rent in 2020 than did for-profits that leased from unaffiliated firms, KHN found.

Fulton Commons Care Center, a nursing home on Long Island, spent nearly a third of its 2020 revenue on rent, a higher portion than all but three other facilities in New York, financial records show. In a lawsuit filed in December, the attorney general charged that the rent paid to Fulton Commons Realty, the company that owned its East Meadow, N.Y., building, was grossly inflated. Both the home and real estate company were owned by Moshe Kalter and his extended family, according to documents filed with the lawsuit.

In 2020, the nursing home paid nearly $10 million in rent to Fulton Realty, but an auditor for the attorney general calculated the property expenses that year were less than $6 million. The owners of Fulton and their families gave themselves nearly $16 million over four years from inflated rent, substantial management fees, and "no-show" jobs for Kalter's eight children, the attorney general alleged.

"Rather than honor their legal duty to ensure the highest possible quality of life for the residents in their care, the Fulton Commons owners allegedly maintained insufficient staffing so they could take more money for their own personal gain," James said in a statement.

Raul Tabora Jr. and David Yaffe, lawyers for Kalter, called the lawsuit's charges "one-sided" in a written statement to KHN. They said that the payments to the children were not for jobs but because they were shareholders, and that Fulton kept an average balance of $3 million on hand to cover any pressing needs. "The evidence will demonstrate that any time resources are needed, they are provided by Mr. Kalter," the lawyers wrote.

Residents' families told investigators that staff shortages existed well before the pandemic. In an affidavit filed with the lawsuit, Frank Hoerauf Jr. said workers left his father sitting in adult diapers without pants and let his hair grow so long it covered his eyes. Another time, they left his father screaming in pain from a urinary tract infection, he said.

"Fulton Commons seems like it was operated to be a cash machine for the owners," Hoerauf said. "The care and the quality of life for residents there was very poor."

Another resident, Elena Milack, who had lost one foot to diabetes, complained about poor care for years, including having to ring the call bell for an hour to get help to get to the bathroom, according to an affidavit filed by her daughter-in-law, who was also Milack's health proxy. "GET ME OUT OF HERE OR TELL ME WHAT I CAN TAKE TO KILL MYSELF," she texted her son in the summer of 2019. In 2020, she contracted an infection that turned her remaining foot black.

"Toes are all infected now," Milack, a retired law school secretary, texted. "[M]y upper foot is dying and will soon fall off. I am hoping the good Lord will take me before that happens." She died in November 2020.

Kalter said in a deposition he had never stepped inside his nursing home and did not supervise the quality of the care. He testified he granted full authority over the facility to its administrator and relied on his nephew, who was the controller of the nursing home, to interact with the home's leadership, according to court records.

In his deposition, Kalter said: "I have no personal knowledge of anything that's going on in the nursing home."

According to an affidavit from an auditor for the attorney general's office, over the course of four years, Kalter deposited nearly $12 million from Fulton into the personal bank account he holds jointly with his wife, Frady.

KHN data editor Holly K. Hacker contributed to this report. KHN (Kaiser Health News) is a national, editorially independent program of KFF (Kaiser Family Foundation).

Full Article & Source:
Nursing home owners drained cash while residents deteriorated, state filings suggest

Florence woman arrested for alleged abuse of an elderly person, authorities say

by: Caleb McCusker

FLORENCE, S.C. (WBTW) — The Florence Police Department made an arrest Tuesday afternoon after an elderly person was allegedly abused, according to a news release.

Police arrested Stephanie L. McCullough, 49, of Florence, for abuse of a vulnerable adult and kidnapping, after police responded to a welfare check on an elderly person in the 1300 block of Rebecca Street.

The victim told officers that McCullough had not allowed them to leave and was physically and emotionally abusive toward them, according to the release. 

Officers found that the residence had no running water or electricity, according to the release. The victim was taken into protective custody and transported to the hospital for an assessment.

As of Wednesday afternoon, McCullough remained in custody at the Florence County Detention Center on a $50,000 surety bond, according to the release.

No other information was immediately available.

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Florence woman arrested for alleged abuse of an elderly person, authorities say

Wednesday, February 1, 2023

Alzheimer's advocates rally at Iowa Capitol, ask lawmakers to improve dementia care

by Skylar Tallal

On Monday, Iowans from across the state went to the Iowa Capitol, advocating for improvement in dementia care.

Looking to help the 66,000 Iowans currently living with the disease, the Alzheimer's Association Iowa Chapter rallied at the statehouse, asking lawmakers to add a dementia service specialist to each of the six area agencies on aging.

Estimating it would cost $750,000, the association said it pays for itself if it can keep 13 Iowans with dementia out of long term care facilities each year.

It will provide much needed care for people that have been diagnosed with Alzheimer's and their families when they need to figure out what services are out there and what they need to do to prepare for the future," Alzheimer's Association Iowa Chapter public policy director, Robyn Mills said.

They're also hoping lawmakers will create a task force to review the Alzheimer's state plan every three to five years.

Full Article & Source:
Alzheimer's advocates rally at Iowa Capitol, ask lawmakers to improve dementia care

More Steps and Moderate Physical Activity Cuts Dementia and Cognitive Impairment Risk

Summary: Older women who walked or partook in moderate-to-vigorous exercise each day had a reduced risk of developing mild cognitive impairment and dementia.

Source: UCSD

Senior women were less likely to develop mild cognitive impairment or dementia if they did more daily walking and moderate-to-vigorous physical activity, according to a new study led by the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego.

In the Jan. 25, 2023 online edition of Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, the team reported that, among women aged 65 or older, each additional 31 minutes per day of moderate-to-vigorous physical activity was associated with a 21 percent lower risk of developing mild cognitive impairment or dementia. Risk was also 33 percent lower with each additional 1,865 daily steps.

“Given that the onset of dementia begins 20 years or more before symptoms show, the early intervention for delaying or preventing cognitive decline and dementia among older adults is essential,” said senior author Andrea LaCroix, Ph.D., M.P.H., Distinguished Professor at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego.

While there are several types, dementias are a debilitating neurological condition that can cause loss of memory, the ability to think, problem solve or reason. Mild cognitive impairment is an early stage of memory loss or thinking problems that is not as severe as dementias.

According to the United States Department of Health and Human Services, dementia affects more than 5 million people in this country. That number is expected to double by 2050. 

More women live with and are at higher risk of developing dementia than men.

“Physical activity has been identified as one of the three most promising ways to reduce risk of dementia and Alzheimer’s disease. Prevention is important because once dementia is diagnosed, it is very difficult to slow or reverse. There is no cure,” said LaCroix.

However, because few large studies have examined device measures of movement and sitting in relation to mild cognitive impairment and dementia, much of the published research on the associations of physical activity and sedentary behavior with cognitive decline and dementia is based on self-reported measures, said first author, Steven Nguyen, Ph.D., M.P.H., postdoctoral scholar at the Herbert Wertheim School of Public Health.

For this study, the researchers sampled data from 1,277 women as part of two Women’s Health Initiative (WHI) ancillary studies — the WHI Memory Study (WHIMS) and the Objective Physical Activity and Cardiovascular Health (OPACH) study. The women wore research-grade accelerometers and went about their daily activities for up to seven days to obtain accurate measures of physical activity and sitting.

The activity trackers showed the women averaged 3,216 steps, 276 minutes in light physical activities, 45.5 minutes of moderate-to-vigorous physical activity and 10.5 hours of sitting per day. Examples of light physical activity could include housework, gardening or walking. Moderate-to-vigorous physical activity could include brisk walking.

More women live with and are at higher risk of developing dementia than men. Image is in the public domain

The study findings also showed that higher amounts of sitting and prolonged sitting were not associated with higher risk of mild cognitive impairment or dementia.

Together, this information has clinical and public health importance as there is little published information on the amount and intensity of physical activity needed for a lower dementia risk, said Nguyen.

“Older adults can be encouraged to increase movement of at least moderate intensity and take more steps each day for a lower risk of mild cognitive impairment and dementia,” said Nguyen.

“The findings for steps per day are particularly noteworthy because steps are recorded by a variety of wearable devices increasingly worn by individuals and could be readily adopted.”

The authors said further research is needed among large diverse populations that include men.

Co-authors include: John Bellettiere, UC San Diego; Kathleen M. Hayden and Stephen R. Rapp, Wake Forest University School of Medicine; Chongzhi Di, Fred Hutchinson Cancer Center; Priya Palta, Columbia University Irving Medical Center; Marcia L. Stefanick, Stanford University School of Medicine; JoAnn E. Manson, Harvard Medical School; and Michael J. LaMonte, University at Buffalo – SUNY.

Funding: This research was funded, in part, by the National Institute on Aging (P01 AG052352, 5T32AG058529-03) and the National Heart, Lung, and Blood Institute (R01 HL105065). The Women’s Health Initiative was funded by the National Heart, Lung, and Blood Institute (75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, 75N92021D00005).

Full Article & Source:
More Steps and Moderate Physical Activity Cuts Dementia and Cognitive Impairment Risk

Tuesday, January 31, 2023

Supporting decision making as cognition declines

This post is a preview of a presentation for the Baruch A. Brody Lecture in Bioethics. Want to learn more about this topic? Tune into the lecture Feb. 7 at noon CT.  Register Today! Coupon code for Baylor physicians: BIOETHICS23

Dementia – the progressive loss of cognitive and behavioral abilities to an extent that interferes with daily life – is among the most feared conditions of old age. What ignites such fear? It’s not merely or even primarily the prospect of physical suffering. Rather, it’s that our society places significant emphasis on independence and on the ability to self-determine. Rational thinking and memory are needed to engage in daily tasks independently; dementia robs people of exactly these skills, threatening autonomy.

Numerous diseases cause dementia. The most common of these is late-onset Alzheimer’s disease (AD). Historically, AD has been a clinical diagnosis. This meant that it was diagnosed based on the detection of dementia with a characteristic onset and pattern of cognitive and functional impairments.

Now, however, research is pulling the threads of AD and dementia apart. Clinicians and researchers can use biomarkers to identify AD neuropathology in vivo, rather than post mortem. There is evidence that AD biomarkers begin accumulating years or even decades before the onset of cognitive impairment. This means that we can reconceptualize AD as a continuum disorder – one that begins in a preclinical stage (defined by the presence of pathology in the absence of cognitive impairment) and moves through a prodromal stage before the individual experiences Mild Cognitive Impairment or dementia.

In prior work, I have conducted interview studies with cognitively unimpaired older adults to understand how they react to learning that they are at increased risk for developing dementia caused by AD because they have AD biomarkers. I’ve found that many individuals note the information has unique implications for their identity, but they also find it empowering because it allows them to plan for the possibility of cognitive impairment. 

They choose to share this information with others, particularly family members, because it allows them to make plans for caregiving and surrogate decision-making. Similarly, when I have interviewed family members of older adults who’ve learned AD biomarker information, they also discuss the importance of planning. They envision themselves stepping into a caregiver role in the future.

Once we envision AD as a continuum disorder and we realize the importance patients and families place on planning ahead, we can see the urgent need to find new approaches to protect and promote autonomy and support patient wellbeing across the Alzheimer’s continuum. Unfortunately, the law and ethics are currently lagging behind scientific progress.

One promising means of helping patients is supported decision-making, in which an adult with cognitive impairment (called a beneficiary) identifies one or more trusted others (called supporters) to assist them in decision-making. The domains and types of decision-making assistance are specified by the beneficiary, and the resulting decisions are the beneficiary’s own. While Texas was the first state in the U.S. to recognize supported decision-making in law—and nearly half of states now recognize or are considering recognizing supported decision-making—there is an ongoing need to spread awareness and increase the uptake of this important tool.

In my 2023 Baruch A. Brody Award Lecture, I will:

  • Discuss AD as a disease of autonomy
  • Describe how our evolving scientific understanding of AD requires that we find new social approaches to AD
  • Present supported decision making as an ethically and legally appealing approach

By Dr. Emily A. Largent, the Emanuel & Robert Hart Assistant Professor of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine and a Greenwall Faculty Scholar in Bioethics. She is the recipient of the 2022-2023 Baruch A. Brody Award & Lecture in Bioethics sponsored by the Baylor College of Medicine Center for Medical Ethics and Health Policy, Houston Methodist and the Rice University Department of Philosophy.

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Supporting decision making as cognition declines