Wednesday, February 19, 2020

Crooked caretakers: ‘Easier than you think’ to steal from the vulnerable



GRAND RAPIDS, Mich. (WOOD) — A Grand Rapids woman is under investigation again for allegedly taking thousands of dollars from the bank account of a vulnerable adult for whom she served as guardian and conservator.

Margaret Freund is already on probation after a conviction in Muskegon last year for a similar embezzlement complaint. At last check, the Kent County prosecutor is reviewing the police report involving the new allegations to determine if a criminal case can be made.

A family member of the alleged victim, who said she’s an accountant, reported finding mysterious withdrawals in the thousands of dollars when reviewing financial statements.

“Where some expenses were legitimate and other expenses were not and it popped right out,” the family member said.

Freund was removed as the alleged victim’s guardian and conservator last spring after Adult Protective Services reported that there was “significant financial exploitation.”

Freund said she has done nothing wrong, that all the money has been accounted for and that she has cooperated with the Michigan State Police investigation.

SYSTEM IS REACTIVE, NOT PROACTIVE


In the recent case involving Freund, the alleged victim was able to spot that something was wrong and call Adult Protective Services.

“It’s a rare set of circumstances, honestly, where the ward would be in a position to identify possible financial exploitation,” Scott Teter, head of the Michigan Attorney General’s Financial Crimes Division, said.

That’s because in order for a court to appoint a guardian or conservator, it has to declare people are no longer able to take care of themselves and their property, making them wards of the court. The probate judge then appoints a guardian to take care of the ward’s general needs and a conservator to handle finances. Sometimes, one person takes both those roles, giving the guardian control over personal and financial decisions.

Teter said it’s “easier than you think” for rogue guardians and conservators to steal from wards.

He said spotting exploitation is often left up to family members, but noted that “most families don’t have the resources to do that.”

The system, he said, is set up to respond to complaints, not search for evidence of exploitation.

FLAWS IN THE LAW


The Michigan Legislature tried to create some safeguards, but there are holes in the law that can let abuse slip through.

For example, conservators have to file an annual financial report, but guardians don’t.

Additionally, the financial report itself doesn’t require any receipts or backup documentation to account for the money.

“It’s basically just a State Court Administrator document that says, ‘This is where it went,'” Teter said.

The system was set up expecting judges would check the financial reports, but it doesn’t look like that always happens.

“We’ve had complaints in cases where I’ve looked back and it was pretty clear the judge has not reviewed them in detail,” Teter said. “I’ve seen other times where judges have said, ‘I noticed an irregularity'” and took action.

Another problem: Right now, anybody can be a guardian or conservator.

“You could be stocking … at Walmart yesterday — no offense to those folks — but today you could be a guardian if the judge appoints you,” Teter said. “That’s it. There’s no training required. There’s no certification. There’s nothing.”

FIXES PROPOSED


Teter is part of Michigan Attorney General Dana Nessel’s Elder Abuse Task Force, which is writing changes it wants the Legislature to adopt to fill the holes in the system.

The task force wants guardians as well as conservators to file annual financial reports and include documentation of any expense over $1,000. It wants to require training, certification and background checks for guardians and conservators.

Bills are expected to be introduced soon in the Legislature and Teter said the recommendations have bipartisan support.

Teter said being a guardian and conservator is “very difficult” and that there are a lot of people who “do a really good job.” But he thinks the system needs repair to weed out crooks who could take advantage of the vulnerable people for whom they are responsible.

Full Article & Source:
Crooked caretakers: ‘Easier than you think’ to steal from the vulnerable

NY Lawyer Arrested in Atlantic City, NJ, After Buying Boat, Sailing for St. Croix to Escape Grand Larceny Charges

Tara Boyle Fallon was arraigned in a Manhattan courtroom Tuesday, six months after a warrant was issued for her arrest, according to criminal court filings.


By Jane Wester

Photo: Shutterstock
A New York lawyer tried to escape a grand larceny investigation related to one of her cases by buying a sailboat in cash and heading for St. Croix in the U.S. Virgin Islands, according to the Manhattan District Attorney’s Office.

Tara Boyle Fallon was arraigned in a Manhattan courtroom Tuesday, six months after a warrant was issued for her arrest, according to criminal court filings.

A client who hired her in 2016 to help settle his brother’s estate approached police because he suspected Fallon was not handling the matter properly, according to the filings. Investigators discovered she was taking the estate money—nearly $850,000 in two and a half years—for personal use, according to the filings.

After learning that the client had reported his concerns to police, Fallon turned over a misleading accounting of the estate, according to the filings. An arrest warrant was issued in August, but it would take investigators—including the U.S. Coast Guard—months to find her.

Fallon and her husband “sold their Brooklyn home, changed their phone numbers, and adopted aliases,” according to the filings.

She missed other clients’ court dates without explanation, according to the filings, because she and her husband had spent $12,500 on a boat and told the seller they were heading to St. Croix.

The couple were “not experienced sailors,” and their boat ran aground in New Jersey, according to the filings.

Fallon was arrested last week in the Atlantic City area while trying to repair their boat and continue to flee, according to the filings.

Fallon did not immediately respond to requests for comment Tuesday.

At Tuesday’s arraignment, assistant district attorney Kelly Thomas noted that grand larceny is not a bail-eligible offense under new laws in effect this year.

Fallon and her husband are believed to still “have access to a significant amount of cash,” Thomas said, so she asked for strict supervised release.

Fallon is expected to give up her passport Thursday and is not allowed to travel outside New York and Connecticut, according to the conditions of her release.

According to her LinkedIn page, Fallon graduated from Brooklyn Law School in 2003. She is managing partner at Tara Fallon & Associates, according to the page.

Full Article & Source:
NY Lawyer Arrested in Atlantic City, NJ, After Buying Boat, Sailing for St. Croix to Escape Grand Larceny Charges

Do Dementia Patients Die Faster in Nursing Homes or at Home?

Hinterhaus Productions / Getty Images
By Esther Heerema, MSW

Nursing homes are often thought of as a last resort, but sometimes a necessary one, for the care of people with dementia. The majority of people want to remain at home for as long as possible, and some may have even asked their family not to send them to a nursing home. One fear is they, (or a loved one) might decline, and eventually die, more quickly in a facility than he or she would at home. Is this accurate?

The short answer: It depends. The longer answer? There's limited research on this question, but there are certain factors that make decline and death in dementia more likely to occur.

Relevant Research


According to figures compiled in 2019, Alzheimer's disease and related dementias are the 6th leading cause of death in the United States.1 So, where do people with dementia die?

One study published in the Journal of the American Geriatrics Society involved more than 4,000 older adults who were studied for approximately five years.2 Researchers in this study tracked the deaths of the participants and found that almost half (46%) of those with dementia died at home, while 19% were at a nursing home and 35% were hospitalized when they died.

In contrast, a previous study published in 2005 found that 2/3 of deaths relating to dementia happened in a nursing home.

A third study from 2013 analyzed 378 nursing home residents and found that those with a diagnosis of Alzheimer's disease—as compared to those with other types of dementia and those with cardiovascular diagnoses—actually survived for a longer period of time.3 This finding seems counter-intuitive at first but could possibly be explained by understanding that nursing homes are caring for people who are more critically ill now than in the past, and thus perhaps those with conditions other than Alzheimer's may have a reduced life expectancy.

Decreased Risk

  • Being overweight and not losing weight
  • Reducing antipsychotic medications plus increased social interaction
  • Treating behavioral and psychological symptoms of dementia

Increased Risk

  • Delirium
  • Falls and hip fractures
  • Pressure sores
  • Unable to perform activities of daily living (ADLs)
  • Pneumonia
  • Age 85 or older

Factors Correlated With a Decreased Risk of Death in Dementia


While it's difficult to find research that addresses where people with dementia will die more quickly, there are a few factors that have been correlated with a longer lifespan in dementia. They include the following:

Being Overweight


Ironically, while extra pounds in our middle-age years increases our risk of developing dementia, extra pounds in older people with dementia is associated with a reduced risk of death in nursing homes.

Weight loss in dementia, even in people who are obese, should be viewed with concern because of this correlation with an increased risk of death.

Reducing Antipsychotic Medications Combined With Social Interaction Programs


There is a strong push to decrease the use of antipsychotic medications for people with dementia in nursing homes, and as a nation, we have made much progress in this area. However, some research says that's not enough.4 It found that reducing the usage coupled with the provision of increased social interaction improved survival rates in facilities. Simply decreasing antipsychotic medications without adding other interventions resulted in an increase in the challenging behaviors and emotions related to dementia and did not improve survival rates.

Effective Treatment of Behavioral and Psychological Symptoms of Dementia


Another study of people with dementia living in nursing homes compared the mortality rates of people who receiving anti-depressant medications to those who were receiving antipsychotic medications. They found that death rates were impacted not by whether or not someone was getting medicine or by which medicine they received, but by whether or not the medicine was effective in improving their BPSD. In other words, people in both groups (those on antidepressants and those on antipsychotics) lived longer if their behaviors and emotional symptoms of dementia improved with medicine.

Factors Associated With an Increased Risk of Death in Dementia


Conversely, research has associated these factors with a higher risk of dying for someone with dementia.
  • Delirium: The presence of delirium in people with dementia has been associated with an increased risk of death. One common cause of delirium is an infection.
  • Falls and Hip Fractures: People with dementia have an increased risk of falls and hip fractures, and that risk, in turn, is associated with an increased risk of dying.5
  • Pressure Sores: Decubitus ulcers (also called "bed sores" increase the risk of death in those living with dementia.
  • Inability to Perform ADLs: As dementia progresses, the ability to perform daily tasks such as dressing, bathing, eating or walking decrease. This decrease is associated with an increased risk of dying.
  • Pneumonia: Developing pneumonia poses an increased risk of death in people with dementia.6
  • Age: Being 85 years old or older is associated with a significantly higher risk of death from Alzheimer's disease.

A Word from Verywell


Placing a loved one in a nursing care facility can be a difficult decision. Understanding which factors are correlated with positive and negative outcomes can be helpful in evaluating your care options as well as in developing realistic expectations.

Full Article & Source:
Do Dementia Patients Die Faster in Nursing Homes or at Home?

Tuesday, February 18, 2020

Rebecca Fierle, guardian accused of causing death, arrested in Marion County


MARION COUNTY, Fla. -- A professional guardian who was under criminal investigation for the death of a man under her care has been arrested in Marion County Monday night.

Rebecca-Fierle.png
The guardian, Rebecca Fierle, is being charged with aggravated abuse of an elderly person and neglect of an elderly person.

Fierle captured headlines across the state after she was accused of issuing a do not resuscitate order for a person she cared for without the court's permission.

The Price of Protection


steven-stryker.png
Investigations showed Steven Stryker, a 74-year-old man who was under Fierle's care, did not want a do-not-resuscitate order (DNR) and stated several times that he wanted to live. Despite the elderly man's request, as well as wishes of the man's family, Fierle ordered his doctors to "not perform any life prolonging medical procedures," according to a release from the Florida Department of Law Enforcement.

FDLE issued a warrant for Fierle's arrest and on Monday, she was arrested by the Marion County Sheriff's Office.

Investigators said Fierle also demanded that the elderly man's feeding tube be capped, which happened on May 9, 2019. Days later, Stryker choked to death while at the hospital.

FDLE says investigation will continue and the case remains active.

Full Article & Source:
Rebecca Fierle, guardian accused of causing death, arrested in Marion County

See Also:
Marion deputies release video of arrest of former Florida guardian Rebecca Fierle

Attorney General Ashley Moody fires back at embattled former Florida guardian

Guardian at center of Florida scandal appeals judge’s ruling that she broke state rules by misusing DNRs

Ex-guardian Rebecca Fierle charged Altamonte Springs facility $100K, illegally pocketed refunds, investigation finds

Florida Elder Affairs chief announces ‘immediate’ changes as embattled Orlando guardian Rebecca Fierle resigns from all cases

Florida professional guardian Rebecca Fierle: Devoted or dangerous? | Exclusive

Cremated remains of 9 people found at Orlando office of disgraced former guardian Rebecca Fierle

Expert’s complaint against Florida guardian Rebecca Fierle was ignored for years before scandal erupted | Exclusive

Orlando guardian accused of filing unauthorized ‘do not resuscitate’ orders resigns from Seminole cases

Watchdog: In Short Hearing, Fierle Given Guardianship Over Patient

Judge releases confidential information to authorities investigating former Orlando guardian Rebecca Fierle

American Bar Assn. President Criticizes U.S. Legal System As Backward, Resistant to Change

by Patricia Barnes

Judy Perry Martinez, president of the American Bar Association (ABA), has issued an unusually frank plea calling upon the legal profession to support reform of America’s backward legal system to better serve the public.

“We need new ideas,” said Martinez. “We are one-fifth into the 21st century, yet we continue to rely on 20th-century processes, procedures and regulations. We need to retain 20th-century values but advance them using 21st-century approaches that can increase access to justice.”

Martinez’ comments are contained in a letter appearing in the February-March 2020 issue of the ABA’s monthly magazine, The ABA Journal.

Martinez expressed frustration with resistance in the legal profession to state-level efforts to innovate in the provision of legal services.

It may be no coincidence that the California Judicial Council last fall rejected proposals to permit “educated technicians” without law degrees to offer limited legal services and to allow non-attorneys to have an ownership stake in law firms.

Martinez said the aim of reform is not to eliminate lawyers but to “help lawyers lead changes that are sweeping all economic sectors of society.”  She said states should serve in the role the late U.S. Supreme Court Justice Louis Brandeis described as “laboratories of democracy.”

D-Minus


Martinez was particularly critical of the lack of access to civil justice in the United States.

She cited the World Justice Project’s ranking of the U.S. in the bottom tier with respect to access to and affordability of civil justice. She said the U.S. is tied for 99th place out of 126 countries.

Additionally, Martinez said research by the Legal Services Corp. found that low-income Americans received inadequate or no professional legal help for 86% of their civil legal problems, including child custody, debt collection, eviction and foreclosure.

She did not spare the criminal justice system. In many states, Martinez says, “overwhelming caseloads and inadequate resources for public defenders severely hamper the Sixth Amendment right to counsel for indigent criminal defendants.

Protectionism?


Martinez indirectly raised the issue of protectionism. She notes lawyers have the “privilege” of regulating their own profession. With privilege, she says, comes responsibility to ensure that the rules and regulations of the legal profession serve the public good.

“The ultimate purpose of regulation is not to protect the livelihoods of lawyers but to advance the administration of justice,” said Martinez. “Some would suggest that if we don’t have justice or public protection as our goal, we potentially put our self-regulation at risk.”
The ultimate purpose of regulation is not to protect the livelihoods of lawyers but to advance the administration of justice.”

American Bar Association President Judy Perry Martinez
Martinez acknowledged that “change is difficult …. But given the dire circumstances that the public faces when trying to protect their basic rights, doing nothing poses an even greater risk to our system of justice and the rule of law.”

Last fall, Forbes wrote about the ABA’s 11th annual “Celebrate Pro Bono” week, in which it urged lawyers to volunteer to represent victims of domestic violence, sexual assault and stalking. These victims, mostly women, regularly go to court without an attorney to seek civil restraining orders to protect themselves and their children, and to fight for child custody, child support and to stay in their homes.

In her letter, Martinez writes: “Though lawyers donate countless hours to help, pro bono cannot fully address the unmet legal needs in our country.”

Another area where poor people increasingly face injustice involves eviction due to rising rents and low wages, a problem that is particularly devastating to families with children. The National Coalition for a Civil Right to Counsel reports that five cities, most recently Philadelphia, have adopted measures to provide a right to counsel for tenants facing eviction.

Forbes also wrote about the plight of employment discrimination victims who cannot afford to hire an attorney and are required to follow obtuse rules that are unintelligible to the vast majority of non-lawyers and many lawyers.

Martinez’ letter ran under the headline: “We must not squander the future of legal services”

Full Article & Source:
American Bar Assn. President Criticizes U.S. Legal System As Backward, Resistant to Change

Woman arrested for stealing over $1000 elderly victim

Click to Watch Video
(WBNG) -- The Delaware County Sheriff's Office says a home health care aide was arrested following an investigation into theft Saturday morning.

The sheriff's office says 31-year-old Brandi A. Wyckoff of Delhi, N.Y. was charged with grand larceny in the 4th degree, a class E felony, and three counts of petit larceny, a misdemeanor.

Authorities say in September 2019, Wyckoff stole a credit card from an elderly, "ailing" victim and spent over $1000.

Wyckoff was employed for the elderly victim between August and October 2019.

The sheriff's office says Wyckoff was arraigned in the Town of Delhi Court and released on her own recognizance.

Full Article & Source:
Woman arrested for stealing over $1000 elderly victim

Monday, February 17, 2020

Marion deputies release video of arrest of former Florida guardian Rebecca Fierle

FDLE says Fierle faces 1 count of abuse of an elderly person, 1 count of neglect of an elderly person

Rebecca Fierle Arrest Video
MARION COUNTY, Fla. – The Marion County Sheriff’s Office released the video of the arrest of former Florida guardian Rebecca Fierle.

Fierle was arrested on Monday. 

She is facing charges of abuse and neglect of an elderly person. 

The video shows Fierle discuss bond options with the officer before she is handcuffed and placed in the patrol car.

Fierle posted bail on Tuesday morning.

The Florida Department of Law Enforcement said Fierle was arrested and is facing one count of abuse of an elderly person and one count of neglect of an elderly person in regards to the case of 74-year-old Steven Stryker.

The Office of Statewide Prosecution is prosecuting the case, according to FDLE.

She is accused of placing do not resuscitate orders on clients who did not want them.

She's admitted to doing so in court.

A state investigation reveals one of her clients may have died as a result. According to a statement from the FDLE, the investigation began after a complaint to the Office of Public and Professional Guardians about Stryker’s death, he was under the guardianship of Fierle.

FDLE said the investigation shows Stryker did not want a do not resuscitate order and stated several times he wanted to live.

The investigation shows the elderly man did not want a do not resuscitate order (DNR) and stated several times that he wanted to live.”

Medical professionals who examined him believed he was capable of making end-of-life medical decisions for himself and informed Fierle-Santoian that her client had a strong desire to live and that he understood his condition. Despite the wishes of the elderly man and those of his family and friends, Fierle-Santoian ordered his doctors not perform any life-prolonging medical procedures saying she preferred “quality of life versus quantity of life.”

In addition to the DNR, Fierle-Santoian insisted the victim’s feeding tube be capped ignoring doctors who told her this would likely cause his death. The man also requested that he continue receiving nutrition through the feeding tube. Contrary to the advice of medical professionals, Fierle-Santoian obtained an order to cap the feeding tube which was capped on May 9, 2019. The man died on May 13, 2019 at a Tampa hospital.

State investigators contend Fierle’s decision to place the order against Stryker’s wishes caused his death.

Full Article & Source:
Marion deputies release video of arrest of former Florida guardian Rebecca Fierle

See Also:
Attorney General Ashley Moody fires back at embattled former Florida guardian

Guardian at center of Florida scandal appeals judge’s ruling that she broke state rules by misusing DNRs

Ex-guardian Rebecca Fierle charged Altamonte Springs facility $100K, illegally pocketed refunds, investigation finds

Florida Elder Affairs chief announces ‘immediate’ changes as embattled Orlando guardian Rebecca Fierle resigns from all cases

Florida professional guardian Rebecca Fierle: Devoted or dangerous? | Exclusive

Cremated remains of 9 people found at Orlando office of disgraced former guardian Rebecca Fierle

Expert’s complaint against Florida guardian Rebecca Fierle was ignored for years before scandal erupted | Exclusive

Orlando guardian accused of filing unauthorized ‘do not resuscitate’ orders resigns from Seminole cases

Watchdog: In Short Hearing, Fierle Given Guardianship Over Patient

Judge releases confidential information to authorities investigating former Orlando guardian Rebecca Fierle

Some Assisted-Living Residents Don’t Get Promised Care, Suit Charges

Court decisions in California may shed light on how large chains make staffing decisions.

By Paula Span

The letter went out to about 1,900 Californians a few weeks ago from law firms bringing a class-action suit against one of the country’s largest assisted-living chains.

If the recipients, or their family members, had lived in a community operated by Sunrise Senior Living in recent years, “we would like to speak with you regarding your residency and experience,” the letter said.

It was the latest action in an ongoing campaign: Since 2013, a group of law firms has systematically sued several major chains operating in the state, employing an unusual strategy.

“It all boils down to the use of assessments, or lack thereof,” said Kathryn Stebner, the trial counsel in the case. “These are à la carte facilities — the more needs you have, the more you have to pay. So, they assess you.”

The plaintiffs’ complaint, filed in 2017 and now before the U.S. District Court for Central California, argues that when staff members conduct such periodic assessments — to determine whether a resident needs help bathing or dressing, for example, or suffers from dementia — the facilities don’t use the results to determine an adequate number of staff members.

Instead, the plaintiffs argue, administrators make staffing decisions financially, based on budgets and return on investment. When assessments show increasing needs, the suit alleges, fees rise but staffing ratios may not change.

“People pay more, but they’re not getting more care,” Ms. Stebner said.

The suit claims that Sunrise is misrepresenting its practices and deceiving customers, in violation of state business statutes, and lacks enough trained staff members to deliver the care specified in resident contracts and marketing materials.

“The business model is fraudulent, and it’s putting people at risk,” Ms. Stebner said.

Sunrise’s practices are unlawful in another way, as well, the suit charges. “If you take an elder’s property, knowing it could harm them, that’s financial elder abuse,” Ms. Stebner said. “In this case, they’re taking their money.”

In an emailed statement, Sunrise denounced “baseless lawsuits like these, in which the plaintiffs’ lawyers file copycat allegations,” a reference to the firms having brought four previous suits using essentially the same tactics. Sunrise called the claims “categorically false.”

The lawyers’ scorecard to date: two settlements reached in 2016, totaling $13 million from Emeritus Corporation (since merged with Brookdale Senior Living) and $6.4 million from Atria Senior Living.

Suits against two other chains, Aegis Living and Oakmont Senior Living, will proceed when and if courts certify them as class actions. The Sunrise case, with a “purported class” of 13,000 current and former residents in California, also awaits certification. (A smaller group received the letters asking for information.)

But in the meantime, the plaintiffs have compelled the chain, with 268 facilities across the country and 52 in California, to turn over a trove of documents showing how it determines staffing levels.

Sunrise argued that those were “protected trade secrets.” The judge disagreed. Given that this is an industry whose practices often remain opaque, that might constitute a victory in itself for the plaintiffs.

“It gets at internal systemic issues,” said Eric Carlson, a directing attorney at Justice in Aging, a legal advocacy group not involved in the lawsuits. When facilities disclose information like how much time staff members spend on tasks, “it gets at what’s happening behind closed doors.”

Are assisted-living facilities understaffed? It’s a common complaint from residents and families, but one difficult to document.

“We don’t have a very clear picture of what staff looks like in assisted living,” said Kali Thomas, a health services researcher at the Brown University School of Public Health.

“We don’t know what an individual assisted living’s staff ratios are. Many states don’t even require them to track or report them.”

Offering a less institutional environment for seniors who require help with the so-called activities of daily living — but don’t need round-the-clock care in a nursing home — the assisted-living industry can house close to a million people in almost 30,000 facilities nationwide.

It includes both small four-bed care homes and complexes with more than 100 residents, but chains dominate the field. And the industry has staved off the kind of regulations that make it much easier to see what’s going on — for better or worse — in nursing homes.

Though Medicaid pays for a small but growing proportion of residents, assisted living remains primarily a private-pay option. (The average cost last year, in one annual survey: $4,051 a month nationally, and $4,500 in California.)

The lack of federal dollars helps explain why assisted living is subject not to federal oversight, like nursing homes, but to state regulations, which vary wildly.

Colorado, for instance, requires that an assisted-living facility employs one aide per 10 residents during the day, and one to 16 at night. In Missouri, it’s one to 15, and one to 25. Only 19 states specify minimum staffing ratios at all.

Families can find it difficult to make informed decisions about assisted living; there’s no equivalent of the federal inspection findings and quality rankings at Nursing Home Compare. State websites are inadequate substitutes, a recent study found.

Yet the people moving into these complexes need more help than they did years ago.

“They’re older,” Ms. Thomas pointed out. “They’re entering with more chronic diseases.” More than 40 percent have moderate or severe dementia, a study in the journal Health Affairs reported.

The California lawsuits don’t seek individual damages, and because the classes involved contain thousands of individuals, their checks from settlements so far have been paltry — a few hundred dollars each.

But the suits also seek “injunctive relief,” a court-ordered requirement that the defendants change their practices.

“They’d be told to be transparent,” Ms. Stebner said. “We want them to use the assessments properly and to tell people what they’re doing. And to have sufficient staff.”

Veteran researchers sounded more skeptical about the lawsuits’ impact. Understaffing represents “a complaint about long-term care in general,” said Dr. Philip Sloane, a geriatrician at the University of North Carolina School of Medicine. “Of course it’s true. The question is, what is realistic?”

“These places do set very high expectations,” said Sheryl Zimmerman, a health services researcher at the University of North Carolina School of Social Work. “Everyone’s website sounds like Utopia.”

But she added, “These group settings cannot individualize everything for every person.” Being forced to add staff members could make assisted living even more expensive, unreachable for many older adults, she said.

Dr. Sloane said facilities might respond to the suits by adding disclaimers to their marketing: “They’ll probably address the promises, rather than the care.”

After Florida increased staffing requirements for nursing home aides in 2001, Ms. Thomas recalled, she led a study showing that the homes complied, then cut hours for their housekeeping and activities staffs.

Assisted-living providers targeted by lawsuits might respond similarly, she noted.

Mr. Carlson saw it differently. It’s tough to compel substantial changes in long-term care facilities, he acknowledged. But, he said, “You get pressure from residents, from surveyors, from plaintiffs’ counsel, and it all pushes providers to be more accountable to residents.”

If the court certifies Sunrise residents as a class, a resolution of the case probably lies two years away, Ms. Stebner estimated. And if the plaintiffs win further settlements, lawyers in other states may start taking notes.

Full Article & Source: 
Some Assisted-Living Residents Don’t Get Promised Care, Suit Charges

California Agencies Failing to Regulate Mental Health Care Funding and Promptly Investigate Abuse in Nursing Homes, Auditor Finds

By Claudia Boyd-Barrett

Photo credit: iStock.
The California State Auditor condemned three government agencies in a recent report for failing to fix problems with health care programs that serve some of the state’s most vulnerable residents.

In a 61-page report, State Auditor Elaine Howle singled out California’s Department of Health Care Services, the Department of Public Health, and the California Department of Corrections and Rehabilitation as having significant problems with health care provision and oversight. These departments are responsible for the health and wellbeing of low-income residents, seniors in nursing homes and incarcerated people, respectively.

Released in January, the report informs the governor and legislators about potential fraud, mismanagement and ineffectiveness in government agencies that, if left unresolved, pose a substantial risk to the state or its residents.

Health Care Services has been slow to improve oversight of how counties manage and spend money for mental health care, the auditor said. In 2018, the auditor found that counties were sitting on $2.5 billion in unspent mental health funds collected from a voter-approved state tax on millionaires. Health Care Services has yet to provide counties with proper guidance on how to spend those funds, and still hasn’t implemented recommended auditing and data collection requirements, the latest report concluded.

The agency also hasn’t done enough to correct problems with how it determines eligibility for Medi-Cal, California’s health insurance program for people with limited incomes, the auditor found. This may have resulted in as much as $1 billion in improper Medi-Cal payments and claims, including some for people who are deceased, the report said. This could put the state on the hook to repay millions of dollars to the federal government, the auditor warned.

“Health Care Services’ failure to provide sufficient Medi-Cal oversight may result in state liability for improperly disbursed funds,” Howle wrote.

In a letter to the auditor, Health Care Services’ acting director, Richard Figueroa, disagreed with the report’s findings. Problems with the Medi-Cal eligibility system stem largely from the chaotic months following implementation of the Affordable Care Act, and have since been remedied, he said, including the enrollment of deceased beneficiaries. The auditor’s interpretation of how much the state may be liable for is also incorrect, the letter said, and the department may in fact owe nothing to the federal government.

Additionally, Figueroa said his department plans to complete improvements to its oversight of mental health spending this year, and already has an auditing system in place.

Meanwhile, the auditor criticized the Department of Public Health for not doing enough to rectify problems with how it handles complaints of abuse in nursing homes. This endangers the lives of patients in these facilities, the auditor stated.

Public Health must set a time limit for investigating complaints, and ensure it has enough staffing to handle the volume of complaints received, the auditor wrote.

The department did not respond to a request for comment before the publication deadline. According to the auditor, the department has said it is taking steps to address the problems identified in the report.

However, Michael Connors, an advocate with California Advocates for Nursing Home Reform, a nonprofit that has sued the department over its handling of nursing home complaints, said he sees little evidence of improvement. If anything, Public Health’s failure to address complaints in a timely manner is worse than ever, Connors said.

Abuse and neglect in the state’s nursing homes has reached “epidemic proportions,” the advocate contended. Many residents die before their complaints are investigated, and even after investigations are completed the department often fails to take action to ensure abuse doesn’t reoccur, he said.

“The Department of Public Health needs to start acting like a consumer protection agency,” Connors said. “It needs to speak out about the terrible conditions in California nursing homes, prevent unscrupulous operators from acquiring nursing homes, hold operators accountable when they mistreat residents, and begin treating nursing home residents as if their lives matter.”

Lastly, the auditor condemned the California Department of Corrections and Rehabilitation for failing to adequately improve its ability to provide medical care to inmates in the state’s 35 prisons, according to the report. The federal government currently oversees inmate medical care at almost half of the state’s prisons, because the department has failed to show it can handle this responsibility itself. Quality of care has also declined at six prisons since 2017, according to a report by the Office of the Inspector General.

“CDCR has not made the significant improvements in the provision of inmate medical care necessary to remove it as a high‑risk agency,” the auditor concluded. “Inadequate health care heightens the likelihood of serious injury to patients and liability to the State.”

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California Agencies Failing to Regulate Mental Health Care Funding and Promptly Investigate Abuse in Nursing Homes, Auditor Finds