Saturday, January 6, 2018

Shenanigans in the Montgomery County, PA, Courthouse

This is Elko's story told through real court records from Montgomery County, PA. A comparison is made with his youth during Nazi Germany to his old age in the courthouse.

Shenanigans in the Montgomery County, PA, Courthouse

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Two caregivers sentenced for exploiting a vulnerable Willcox adult

Two caregivers were sentenced for exploiting a 74-year old vulnerable adult in Willcox.

Theresa Alice Titus was sentenced to seven years' probation, while Reynard Gordon was sentenced to five years' prison, said Mia Garcia, director of community relations for the Office of Arizona Attorney General Mark Brnovich.

“Restitution will be determined after an accounting by the trustee,” Garcia told the Range News.

The two were sentenced Monday, Dec. 18, in the Division Five Courtroom of Cochise County Superior Court Judge James L. Conlogue. Arizona Assistant Attorney General Douglas Clark prosecuted the case.

Titus and Gordon had been convicted of fraudulent schemes and artifices, theft from a vulnerable adult and two counts of forgery.

The 74-year-old victim, whom a psychologist had deemed vulnerable to exploitation, had deposited two $60,000 checks into her account at the Cochise Credit Union in Willcox. At the urging of Titus, the woman then attempted to immediately withdraw $30,000.

Titus also tried to deposit into her own account $15,000 and $9,900 in checks, written against the victim's account.

Gordon had also presented the Credit Union with an affidavit of donation, attesting that the victim wanted to give Gordon the entire $120,000, as well as giving Gordon financial and medical power of attorney over her.

When it appeared that the victim did not understand the document, the local Credit Union refused to notarize the power of attorney, instead contacting Adult Protective Services.

After a search of the victim's home — which had no running water — police found $14,800 in cash hidden in a “derelict truck,” where Gordon appeared to be living.

More than $10,000 of the victim's money remains missing, Brnovich said.

While her comments are not specific to the case, Cochise County Sheriff's Office spokeswoman Carol Capas talked about the potential for victimizing the elderly.

“The problem is when you have someone who does not have any support (by family or close friends) and they are vulnerable,” she told the Range News.
What makes these cases difficult is that they may not be reported, as the elderly person might not realize he or she is being victimized.

“Once they become aware of the fraud/theft, it may be too late because the suspect(s) could be already gone and/or the victim may pass and no one is aware of the situation,” Capas said. “We can tell people not to let anyone into their lives without knowing/trusting them, but those people can be the same ones that steal from them.”

The Sheriff's Office encourages family members to be aware of their elders and to “help keep track of their financial and medical needs as often as possible,” though doing so can be problematic, “due to the lack of family and friends, as well as “the isolation in more rural parts of the county for elderly people,” Capas said.

Full Article & Source:
Two caregivers sentenced for exploiting a vulnerable Willcox adult

New state programs will provide options for aging seniors

HARRISBURG — Gov. Tom Wolf on Tuesday announced the launch of a new website called PA Link to Community Care to help connect older Pennsylvanians with community services and support.

“Everyone deserves the right to age at home if they choose to,” said Wolf in a prepared statement.

“The initiatives my administration has been putting together to help seniors stay in their homes offer options to make a smart decision about services. No one wants a cookie-cutter offering of where they should live or what their health care should look like.”

The website,, connects users with more than 350 in-home service providers, which appear on a searchable directory offering personal care, assistance with activities of daily living, companionship services, respite care and rehabilitation services.

Also, residents of Beaver County and 13 other southwestern Pennsylvania counties may be eligible to enroll in a new managed-care program for seniors, those with long-term disabilities and others starting in January.

The state’s Community HealthChoices program will begin a three-phase roll out, being fully implemented by 2020. It will serve hundreds of thousands of Pennsylvania residents.

“Both PA Link to Community Care and the soon-to-be-launched Community HealthChoices present community options to help Pennsylvania’s seniors choose the best care for themselves or their loved ones,” Wolf said.

Full Article & Source:
New state programs will provide options for aging seniors

Friday, January 5, 2018

State paid $285K to settle suit by former elder care advocate

Sondra Everhart
Gov. Susana Martinez’s administration paid $285,000 to settle a lawsuit filed by the state’s former chief advocate for residents of nursing homes and assisted-living facilities.

Sondra Everhart, who served more than a decade as New Mexico’s long-term care ombudsman, had alleged she was illegally fired in June 2016 from her $81,000-a-year position with the Department of Aging and Long-Term Services.

The lawsuit said department managers terminated Everhart because of her advocacy on behalf of boarding home residents, her request that the agency do more to protect the elderly from financial exploitation, her attempts to combat Medicaid fraud by the department and her proposal that the ombudsman office be separated from the Department of Aging and Long-Term Services.

The department had denied the claims, saying Everhart was fired for unlawfully providing a newspaper with records of conditions in boarding homes in the Las Vegas, N.M., area. The homes serve people who have been released from the state psychiatric hospital in Las Vegas.

The settlement between Everhart and the administration brought to a close a short but very public dispute that proved costly for taxpayers.

Under the settlement, Everhart was allowed to retroactively resign, and the Department of Aging and Long-Term Services agreed to give her a neutral job reference. The two sides also agreed not to disparage each other.

The department didn’t admit wrongdoing as part of the settlement. Everhart can seek new employment with an executive agency after Martinez leaves office at year’s end.

A department spokesman didn’t respond to a request for comment. The settlement was signed by Myles Copeland, who has since resigned as head of the agency.

Everhart couldn’t be reached for comment.

The state Risk Management Division, which represented the administration in the litigation, released the settlement Wednesday in response to an open-records request.

The settlement was reached in June but was sealed for six months under New Mexico law.

Linda Hemphill, an attorney for Everhart, had said in June that she and co-counsel Diane Garrity were extremely pleased with the settlement.

Employees in the office that Everhart previously oversaw make regular visits to long-term care facilities to investigate complaints, help resolve resident concerns and ensure quality care. The jobs of long-term care ombudsmen are federally funded positions, and U.S. law prohibits state interference in the duties of the advocates.

In June 2015, Everhart complained to the federal government that the Department of Aging and Long-Term Services was interfering with her responsibilities, according to a document filed by Everhart’s attorneys in the lawsuit.

Shortly after she complained, the document says, the department sought outside legal advice on how to remove Everhart.

An attorney advised the department in September 2015 that the removal would likely run afoul of federal law and be retaliatory toward Everhart, the document says.

The Department of Aging and Long-Term Services has said the legal advice was sought because the agency was trying to determine whether it could make the ombudsman job exempt from the state’s merit-based civil service system. Everhart was a classified, or civil service, employee.

In agencies under the control of the governor, such as the Department of Aging and Long-Term Services, exempt employees serve at the will of the state’s chief executive.

After Everhart’s lawsuit was filed, the department said she was doing a great job until she broke the law by releasing the boarding home records to the Albuquerque Journal, which had filed an open-records request for the documents.

Everhart’s lawsuit said she was legally authorized to provide the records and that the allegation she did so unlawfully was a pretext for the Department of Aging and Long-Term Services to finally carry out its plan to get rid of her.

The Journal later published a series of stories on substandard conditions of boarding homes in Las Vegas. The homes are largely unregulated.

All ombudsman records pertaining to clients, patients and residents are confidential and don’t have to be disclosed under the state Inspection of Public Records Act. However, state regulations require that the ombudsman make a reasonable effort to grant a records request when it is possible to do so without revealing client identifying information.

Everhart redacted names of boarding home residents from the documents provided to the Journal, but the department has said the redactions were inadequate to protect all identifying information for complainants and residents.

The New Mexico Foundation for Open Government — a nonprofit supported by business, the news media and others — last year honored Everhart for releasing the boarding home records.

Full Article & Source:
State paid $285K to settle suit by former elder care advocate 

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Advocate for elderly fired

State, former elder care advocate reach settlement

County Attorney’s Office works to protect vulnerable adults

The Albany County Attorney’s office is trying to get ahead of the curve of a new state statute that was made effective Jan. 1, aimed to protect residents from elder abuse, or vulnerable adult abuse.

Albany County prosecuting attorney Peggy Trent said Gov. Matt Mead assembled a taskforce to look into preventing elder abuse in the state. The findings from the taskforce were used to revise the Uniform Power of Attorneys Act to protect residents against elder abuse, she said.

“Gov. Mead set up a taskforce some time in 2016, and it is my understanding that this taskforce was looking at how we can better address the issues our elderly are facing,” she said.

“As a result of that, the taskforce came together and proposed some revisions to our current Wyoming statutes that they felt would better guide and assist law enforcement and the public to assist elderly people in our community.”

Trent and Albany County Sheriff Dave O’Malley attended a training in 2017 to help identify and prosecute instances of elder abuse using information gathered by the taskforce, she said. After the training, Trent said she thought of ways the county could prepare for preventing of these types of abuses, and enforcing laws aimed at protecting vulnerable adults.

“I was watching what the state report was saying, and we want to be ahead of the curve,” Trent said. “After training on (elder abuse) and learning of the committee, it was my intent that maybe we need to look in Albany County if this is an issue and how we would go about addressing it.”

There were few cases of elder abuse in the past few years, but she predicted the problem is more common than reports suggest, she said. Because of the lack of elder abuse reports, the attorney’s office is putting together a vulnerable adult initiative to help individuals who might not be reporting abuse, Trent said.

“I have seen maybe two or three cases (of elder abuse), statistically we know there is more exploitation of vulnerable adults out there in our community but it is not getting reported,” she said. “I don’t know if people completely recognize it at times, so this is an initiative that I wanted to start addressing to see what needs to be addressed.”

Information provided by the National Council on Aging states about one in 10 Americans — over the age of 60 — have experienced some form of abuse, of those only one in 14 cases are reported to authorities. About 60 percent of elder abuse and neglect incidents are committed by a family member, the council information states.

Albany County’s initiative would encourage residents to make a report if they or someone they know is experiencing the abuse, while providing law enforcement with the tools to better identify different signs of abuse, Trent said.

“We discussed getting the same mechanisms in place that we have for child protection services,” she said. “All of the service providers come together (and discuss) how they can help vulnerable adults in our community and provide service to avoid them becoming part of our system.”

Full Article & Source:
County Attorney’s Office works to protect vulnerable adults

Charges: Caretaker took nearly $100K from St. Paul senior

Barbara Joan Siercks
ST. PAUL, Minn. - A Florida woman faces felony charges after investigators say she stole nearly $100,000 from an elderly St. Paul woman.

Barbara Joan Siercks, 68, of Paisley, Florida, is charged in Ramsey County with two counts of financial exploitation of a vulnerable adult.

The criminal complaint states that between Sept. 2014 and March 2015, Siercks, a caretaker, took $97,150 from a 96-year-old woman.

Investigators believe Siercks wrote dozens of checks to herself from the woman's account, having the senior sign them while knowing she lacked the capacity to consent. The charges state Siercks also withdrew cash from the woman's account via ATM.

In July 2015, the victim signed a Power of Attorney with a longtime friend. The friend discovered several of the transactions, including checks written out to Siercks or "cash." The woman then contacted police about her suspicion that her friend was being financially exploited by Siercks.

Siercks was charged by summons and is set to appear in court later this month. If convicted, she faces up to 30 years in prison.

Full Article & Source:
Charges: Caretaker took nearly $100K from St. Paul senior

Thursday, January 4, 2018

A New Show Premiers Tonight on T. S. Radio: Exposing Medical Predators with Carly Walden

5:00 pm PST … 6:00 pm MST … 7:00 pm CST … 8:00 EST

Join me this evening as Carly Walden of Hospice Patients Alliance launches her new program on TS Radio dealing with medical murder and the use of Hospice to end the lives of the elderly and the disabled.

What you don’t know about the creeping genocide of the elderly and disabled should scare you. Hospice is no longer the good Samaritan organization it used to be. Now it is used to override the patient, the family and even those few medical providers who might object to the coming premeditated death of the patient. Medical providers now more concerned with profits than patient care are too many times willing and active participants in what is nothing less than medical murder.

This is no country to grow old in, or to suffer a chronic illness or injury. W are in danger and the very people entrusted with caring for us could not care less. Join Us in welcoming Carly Walden to the TS Radio lineup. We have a lot to talk about!!

LISTEN to the show live or listen to the archive later

State employees say elder-abuse reports tossed in trash due to backlog of cases

Minnesota Health Commissioner Dr. Ed Ehlinger
The abrupt firing of a senior regulator at the Minnesota Department of Health is unleashing a torrent of complaints by employees who describe dysfunction and disarray at the state agency responsible for protecting vulnerable adults at senior care facilities.

In interviews with the Star Tribune, employees described an office so overwhelmed by backlogged cases that workers dumped dozens of maltreatment complaints into recycling bins without reading them. Others said unread complaint forms piled up into stacks 2 feet high and went unexamined for months.

At one point, employees said, they were ordered to stop making phone calls to elderly victims and other individuals who reported nursing home abuse because it was too time-consuming. But that only angered families, hindered investigations and subverted office morale, they said.

“Day after day, people here are put in an impossible situation,” said Jessie Saavedra, who has worked at the Health Department for 23 years, including the past three years at its Office of Health Facility Complaints (OHFC).

Workers contacted the Star Tribune after learning that Nancy A. Omondi was terminated last month as director of the agency’s health regulation division. Her firing came just weeks after the Star Tribune published a five-part series documenting that ­hundreds of residents at senior care centers across Minnesota are beaten, sexually assaulted or robbed each year.

The employees’ accounts help explain why the Health Department suffered chronic breakdowns in investigating maltreatment complaints, holding facilities accountable and addressing the alarm and anxiety of worried families.

In an interview, Health Commissioner Dr. Ed Ehlinger said he was “really disturbed” by reports that employees may have destroyed complaint records and said he has already launched an investigation into those claims. He and other agency officials also emphasized that OHFC staff are expected to call individuals who report complaints, and that such calls are vital to families and the investigative process. An agency spokesman said any contrary guidance by a supervisor “would be unacceptable.”

“I admit that we have some dysfunction in OHFC,” Ehlinger said. “We acknowledge that we are not doing as good a job as we should. If we are going to be a resource that people can trust and come to, then we need to do a better job.”

More investigators

Agency officials acknowledge they were caught off guard by a massive surge in abuse complaints in recent years, and they are now taking steps to reduce the backlog and streamline investigations. This includes a plan to double the OHFC’s investigative staff over the next four years by adding 27 investigators. The surge in complaints partly stemmed from the July 2015 launch and promotion of a new, centralized hot line for maltreatment reporting, which made it easier for seniors to report abuse.

The agency is also modernizing its computers so it can collect and share more information about abuse investigations electronically. Starting in January, agency staff will begin scanning maltreatment complaints into its computer system, an important step toward reducing the agency’s reliance on paper.

The number of maltreatment allegations received by the OHFC has swelled from about 4,000 in 2010 to more than 25,000 in 2016. Yet the unit has failed to keep pace with this surge, and last year it only investigated 3 percent of these cases on site, state records show.

“We were not ready for that kind of onslaught,” Ehlinger said.

However, former and current employees at OHFC say the problems in the unit are deep-rooted and unlikely to be solved through more funding or additional staff.

“The system is broken and it’s been broken so long that the people in charge can no longer see it,” Omondi said in an interview shortly after her termination.

OHFC employees said many of the unit’s problems stem from an archaic, paper-based reporting system. Even when complaints are sent electronically by other state and county agencies, staff must still create a special paper file. At times, the complaints are written out by hand and stuffed in the complaint files, workers said.

“You could fill up a whole baseball diamond with the tons of paper files waiting to be processed,” Saavedra said. “With that volume of paper, the chances of things getting lost and important things going missing is really, really high.”

Employees said files would sometimes go missing for months at a time or get permanently lost. The delays frustrated relatives who reported abuse because they couldn’t learn why their cases were not being investigated, workers said.

Enforcement breakdown

The result, as documented by the Star Tribune investigation, is that the vast majority of abuse allegations from senior care homes in Minnesota are never resolved and perpetrators are never punished.

Two former OHFC employees, who spoke on the condition of anonymity, said they recall written complaints being tossed in recycling bins, without being reviewed, because of pressure to reduce the backlog of unresolved cases. The practice, they said, contradicted the agency’s claim that it reviews every complaint.

Diane Konecny, a former complaint intake specialist, said she left the unit in 2013 after 16 years, partly because of guilt over not being able to respond to abuse complaints in a timely manner.

“People were in tears because we felt so bad for these families and these vulnerable adults,” said Konecny, who is retired. “We wanted to get these cases resolved. But obstacles were being thrown our way that made it impossible to do quality work.”

Mixed messages

One of these obstacles, say former and current employees, was conflicting messages on whether to communicate with abuse victims and others who report abuse.

These interviews were often vital to determining exactly what happened in an incident and whether the allegation warranted a deeper investigation. The regular calls also put victims and their relatives at ease, indicating that the state took their allegations seriously, employees said.

But OHFC staff said they were told by administrators — at various points since 2013 — to stop calling individuals reporting abuse, as a way of speeding up investigations and reducing the backlog of unresolved cases. At other times, employees said they were encouraged to make such calls.

“I remember thinking, ‘Why are they putting a roadblock in front of us?’ ” Saavedra said. “People file these complaints because they have a serious concern, and we should be responding to [them] in a timely fashion.”

Crying in their cubicles

Omondi said she became concerned about a “dysfunctional work environment” at the OHFC soon after joining the agency in September 2016. She said she was told that some staff were “crying in their cubicles” because of the backlog of unresolved cases. The unit also suffered from high turnover, with more than a third of the staff leaving each year, she said.

“I walked into a lot of chaos,” she said. “People desperately wanted to do a good job, but their plate was overflowing. So how could they catch up?”

A number of OHFC staff said they have shared their concerns with top department administrators and the Minnesota Office of the Legislative Auditor. The auditor’s office is conducting an evaluation, expected for release in February.

Responding to the Star Tribune series, Gov. Mark Dayton has appointed a special work group led by a handful of consumer groups, which will make recommendations to the 2018 Legislature.

State legislators also have expressed concern. Last week Sen. Karin Housley, chairwoman of the Senate Aging and Long-Term Care Policy Committee, and two other lawmakers called for an investigation into management practices at the Health Department after receiving reports of bullying at the agency. Housley, a Republican from St. Marys Point near Afton, is also working with advocacy groups to craft legislation that would improve the speed and transparency of senior home investigations.

“We need to remember that elder abuse is a life-or-death issue,” said Sen. Jim Abeler, R-Anoka, chairman of the Senate Human Services Finance and Reform Committee. “If I ran the [Health] Department, I would be working overtime … to solve this problem.”

Full Article & Source:
State employees say elder-abuse reports tossed in trash due to backlog of cases

Sliding towards euthanasia in Oregon

Many Americans oppose abortion because they reject injustice – particularly when it targets vulnerable, fellow human beings.

You and I would be hard-pressed to find anyone more vulnerable than an innocent preborn child.

However, there is another segment of society whose right to life is being increasingly jeopardized, and there are ways we can – and should – help protect them.

It seems with each passing week another patient who has suffered a serious brain injury is being threatened with or denied the basics of food and water – the result of a healthcare professional deeming his or her life hopeless.

This is a much more serious problem than most people realize.

If you read only one article on this topic, let it be Basic Care, Human Dignity, and Care for Medically Vulnerable Persons, by Bobby Schindler. Bobby is the president of the Terri Schiavo Life & Hope Network.

Bobby recently became an associate scholar with the Charlotte Lozier Institute (CLI), the research arm of Susan B. Anthony List. In his first article for CLI, he articulately summarizes key moments in history that brought America to the point of ending the lives of patients by denying them food and water. He exposes the alarming margin of error associated with diagnosing a patient of being beyond hope and he notes some subsequent ramifications.

Bobby also directs us to the flickering light at the end of the tunnel that may mean life or death, recovery or languishment, for many thousands of people.

Last year Oregon’s State Senate passed a bill redefining food and water when given by a cup or spoon, as “medical care.” Thankfully it was tabled in the House. Had it passed, patients who were alert and aware but unable to feed themselves may have been denied food and water.

This frightening legislation isn’t a giant leap in logic from the laws in all 50 states that allow patients’ lives to be ended by denying them food and water. Yes, every state.

The term Persistent Vegetative State (PVS) means a complete unawareness of self and environment. It was coined by just to physicians, and it degrades and dehumanizes unresponsive or minimally aware patients, relegating them to the category of grocery produce.

PVS is arbitrary and subjectively applied to patients. In addition, research shows it has been misdiagnosed as much as 48 percent of the time. If that were the case with heart disease there would be an immediate stampede to rectify the situation.

Once a patient is labeled with PVS it’s difficult to undo and they are often denied insurance benefits for rehabilitation when it’s needed the most, their first signs of recovery are often overlooked, or it can lead doctors to persuade families to “let them go” by withdrawing food and water.

The flickering light at the end of the tunnel is this: New medical advancements have allowed doctors to better diagnose brain-injured patients. And the European Task Force on Disorders of Consciousness recommends the medical community abandon PVS and replace it with “unresponsive wakefulness syndrome.” It jettisons the dehumanizing “vegetative” language and infers the possibility of some level of recovery.

Santiago Ramón y Cajal, one of the founders of modern neurology, believed that the human brain was “hardwired” and unable to fix itself in the wake of an injury. However, Dr. Joseph J. Fins’ research now suggests the brain has a capability of “rewiring” itself to some degree. Even more is being done to assist this process with adult stem cells.

To help protect you and your family from the potential withdrawal of food and water against your will, please check out our free resources.

No patient should ever be subjected to death by dehydration and starvation. We wouldn’t do that to an animal, so why are we doing it to our own human family?

Brad serves as chairman of the board for the Terri Schiavo Life & Hope Network.

Bradley Mattes
President, Life Issues Institute

Life Issues Institute is dedicated to changing hearts and minds of millions of people through education. For 25 years, organizations and individuals around the world have depended upon Life Issues Institute to provide the latest information and effective tools to protect innocent human life from womb to tomb.

Full Article & Source:
Sliding towards euthanasia in Oregon

Joliet woman charged with financially exploiting elderly

AURORA — A 41-year-old suburban Chicago woman has been charged with stealing money from a resident of a long-term care facility while working for a state contractor.

A Thursday statement from the Kane County State's Attorney's Office said Mary E. Pfingston of Joliet faces a multicount indictment that includes charges of financial exploitation of the elderly and public contractor misconduct.

Pfingston worked for Senior Services Associates. It was contracted with the state through the Illinois Department on Aging. The indictment alleges Pfingston stole thousands of dollars from the care-facility resident in 2015.

Pfingston was arrested Wednesday. An Illinois State Police statement said that she also had a warrant for failure to appear in a Will County case and remained in custody on Thursday. The official statements don't name an attorney for Pfingston.

Full Article & Source:
Joliet woman charged with financially exploiting elderly

Wednesday, January 3, 2018

Care Suffers as More Nursing Homes Feed Money Into Corporate Webs

Allenbrooke Nursing and Rehabilitation Center in Memphis is part of a chain of businesses that produced $145 million in revenue over eight years, from which the owners and their families’ trusts took 28 percent in distributions. Credit Houston Cofield for The New York Times

MEMPHIS — When one of Martha Jane Pierce’s sons peeled back the white sock that had been covering his 82-year-old mother’s right foot for a month, he discovered rotting flesh.

“It looked like a piece of black charcoal” and smelled “like death,” her daughter Cindy Hatfield later testified. After Mrs. Pierce, a patient at a nursing home in Memphis, was transferred to a hospital, a surgeon had to amputate much of her leg.

One explanation for Mrs. Pierce’s lackluster care in 2009, according to financial records and testimony in a lawsuit brought by the Pierce family, is that the nursing home, Allenbrooke Nursing and Rehabilitation Center, appeared to have been severely underfunded at the time, with a $2 million deficit on its books and a scarcity of nurses and aides. “Sometimes we’d be short of diapers, sheets, linens,” one nurse testified.

That same year, $2.8 million of the facility’s $12 million in operating expenses went to a constellation of corporations controlled by two Long Island accountants who, court records show, owned Allenbrooke and 32 other nursing homes. The homes paid the men’s other companies to provide physical therapy, management, drugs and other services, from which the owners reaped profits.

In what has become an increasingly common business arrangement, owners of nursing homes outsource a wide variety of goods and services to companies in which they have a financial interest or that they control. Nearly three-quarters of nursing homes in the United States — more than 11,000 — have such business dealings, known as related party transactions, according to an analysis of nursing home financial records by Kaiser Health News. Some homes even contract out basic functions like management or rent their own building from a sister corporation, saying it is an efficient way of running their businesses and can help minimize taxes.

But these arrangements offer another advantage: Owners can arrange highly favorable contracts in which their nursing homes pay more than they might in a competitive market. Owners then siphon off higher profits, which are not recorded on the nursing home’s accounts.

The two Long Island men, Donald Denz and Norbert Bennett, and their families’ trusts collected distributions totaling $40 million from their chain’s $145 million in revenue over eight years — a 28 percent margin, legal documents show. In 2014 alone, Mr. Denz earned $13 million and Mr. Bennett made $12 million, principally from their nursing home companies, according to personal income tax filings. Typical nursing home profits are “in the 3 to 4 percent range,” said Bill Ulrich, a nursing home financial consultant.

Contracts with related companies accounted for $11 billion of nursing home spending in 2015 — a tenth of their costs — according to financial disclosures the homes submitted to Medicare.

In California, the state auditor is examining related party transactions at another nursing home chain, Brius Healthcare Services, regarding reimbursements from the state’s Medicaid program. Rental prices to real estate companies related to the chain of homes were a third higher than rates paid by other for-profit nursing homes in the same counties, according to an analysis by the National Union of Healthcare Workers.

Such corporate webs bring owners a legal benefit, too: When a nursing home is sued, injured residents and their families have a much harder time collecting money from the related companies — the ones with the full coffers.

Martha Jane Pierce in photographs at the home of her daughter, Cindy Hatfield. After Ms. Pierce needed an amputation in 2009, her family sued over her care at Allenbrooke, which had a $2 million deficit on its books that year. Credit Houston Cofield for The New York Times

After the Pierce family won an initial verdict against the nursing home, Mr. Denz and Mr. Bennett appealed, and their lawyer, Craig Conley, said they would not discuss the case or their business while the appeal was pending.

“For more than a decade, Allenbrooke’s caregivers have promoted the health, safety and welfare of their residents,” Mr. Conley wrote in an email.

Dr. Michael Wasserman, the head of the management company for the Brius nursing homes, called the subject of corporate structures a “nonissue” and said, “What matters at the end of the day is what the care being delivered is about.”

Networks of jointly owned limited liability corporations are fully legal and widely used in other businesses, such as restaurants and retailers. Nonprofit nursing homes sometimes use them as well.

Owners can have more control over operations — and better allocate resources — if they own all the companies. In many cases, industry consultants say, a related company will charge a nursing home lower fees than an independent contractor might, leaving the chain with more resources.

“You don’t want to pay for someone else to make money off of you,” Mr. Ulrich said. “You want to retain that within your organization.”

But a Kaiser Health News analysis of inspection and quality records reveals that nursing homes that outsource to related organizations tend to have significant shortcomings: They have fewer nurses and aides per patient, they have higher rates of patient injuries and unsafe practices, and they are the subject of complaints almost twice as often as independent homes.

“Almost every single one of these chains is doing the same thing,” said Charlene Harrington, a professor emeritus of the School of Nursing at the University of California, San Francisco. “They’re just pulling money away from staffing.”

Early Signs of Trouble

Martha Jane Pierce moved to Allenbrooke in 2008 in the early stages of dementia. According to testimony in the family’s lawsuit, when her children visited they often discovered her unwashed, with an uneaten, cold meal sitting beside her bed. Mrs. Hatfield said in court that she had frequently found her mother’s bed soaked in urine. The front desk was sometimes vacant, her brother Glenn Pierce testified.

“If you went in on the weekend, you’d be lucky to find one nurse there,” he said in an interview.

After a stroke, Mrs. Pierce became partly paralyzed and nonverbal, but the nursing home did not increase the attention she received, said Carey Acerra, one of Mrs. Pierce’s lawyers. When Mrs. Pierce’s children visited, they rarely saw aides reposition her in bed every two hours, the standard practice to prevent bedsores.

Mrs. Hatfield and her brother Glenn Pierce. In 2016, the family won a $30 million verdict, which the owners of Allenbrooke have appealed. Credit Houston Cofield for The New York Times

“Not having enough staffing, we can’t — we weren’t actually able to go and do that,” one nurse, Cheryl Gatlin-Andrews, said in a deposition.

Kaiser Health News’s analysis of inspection, staffing and financial records nationwide found shortcomings at other homes with similar corporate structures:

■ Homes that did business with sister companies employed, on average, 8 percent fewer nurses and aides.

■ As a group, these homes were 9 percent more likely to have hurt residents or put them in immediate jeopardy of harm, and amassed 53 substantiated complaints for every 1,000 beds, compared with 32 per 1,000 beds at independent homes.

■ Homes with related companies were fined 22 percent more often for serious health violations than independent homes, and penalties averaged $24,441 — 7 percent higher.

For-profit nursing homes utilize related corporations more frequently than nonprofits do, and have fared worse than independent for-profit homes in fines, complaints and staffing, the analysis found. Their fines averaged $25,345, which was 10 percent higher than fines for independent for-profits, and the homes received 24 percent more substantiated complaints from residents. Overall staffing was 4 percent lower than at independent for-profits.

Ernest Tosh, a plaintiffs’ lawyer in Texas who helps other lawyers untangle nursing company finances, said owners often exerted control by setting tight budgets that restricted the number of nurses the homes could employ. Meanwhile, “money is siphoned out to these related parties,” he said. “The cash flow gets really obscured through the related party transactions.”

The American Health Care Association, which represents nursing homes, disputed any link between related businesses and poor care. “Our members strive to provide quality care at an affordable cost to every resident,” the group said in a statement. “There will always be examples of exceptions, but those few do not represent the majority of our profession.”

‘Piercing the Corporate Veil’

The model of placing nursing homes and related businesses in separate limited liability corporations and partnerships has gained popularity as the industry has consolidated through purchases by publicly traded companies, private investors and private equity firms. A 2003 article in the Journal of Health Law encouraged owners to separate their nursing home business into detached entities to protect themselves if the government tried to recoup overpayments or if juries levied large negligence judgments.

“Holding the real estate in a separate real-property entity that leases the nursing home to the operating entity protects the assets by making the real estate unavailable for collection by judgment creditors of the operating entity,” the authors wrote. Such restructuring, they added, was probably not worth it just for “administrative simplicity.”

In 2009, Harvard Medical School researchers found the practice had flourished among nursing homes in Texas, which they studied because of the availability of state data. Owners had also inserted additional corporations between themselves and their nursing homes, with many separated by three layers.

“For more than a decade, Allenbrooke’s caregivers have promoted the health, safety and welfare of their residents,” a lawyer for the owners said. Credit Houston Cofield for The New York Times

To bring related companies into a lawsuit, attorneys must persuade judges that all the companies were essentially acting as one entity and that the nursing home could not make its own decisions. Often that requires getting access to internal company documents and emails. Even harder is holding owners personally responsible for the actions of a corporation — known as “piercing the corporate veil.”

At a conference for executives in the long-term health care industry in Nashville in 2012, a presentation slide from nursing home attorneys titled “Pros of Complex Corporate Structure” said, “Many plaintiffs’ attorneys will never conduct corporate structure discovery because it’s too expensive and time consuming.” The presentation noted another advantage: “Financial statement in punitive damages phase shows less income and assets.”

A lawyer in Alabama, Barry Walker, is still fighting an 11-year-old case against another nursing home then owned by Mr. Denz and Mr. Bennett. Mr. Walker traced the ownership of Fairfield Nursing and Rehabilitation Center back to the men, but he said the judge had allowed him to introduce the information only after the Alabama Supreme Court ordered the judge to do so. That trial ended with a hung jury, and Mr. Walker said a subsequent judge had not let him present all the information to two other juries, and he dropped the men from the lawsuit. The home closed a few years ago but the case is still ongoing, after two mistrials.

“The former trial judge and the current trial judge quite frankly don’t seem to understand piercing the corporate veil,” he said. “My firm invested more in the case than we can ever hope to recover. Sometimes it’s a matter of principle.”

The complexity of the ownership in Mrs. Pierce’s case was a major reason it took six years to get to a trial, said Ken Connor, one of the lawyers for her family. “It requires a lot of digging to unearth what’s really going on,” he said. “Most lawyers can’t afford to do that.”

The research paid off in a rare result: In 2016, the jury issued a $30 million verdict for negligence, of which Mr. Denz and Mr. Bennett were personally liable for $20 million. The men’s own tax returns had bolstered the case against them. They claimed during trial they delegated daily responsibilities for residents to the home’s administrators, but they reported on their tax returns that they “actively” participated in the management. The jury did not find the nursing home responsible for her death later in 2009.

The appeal brought by Mr. Denz and Mr. Bennett challenges both the verdict and their inclusion. They argue that Tennessee courts should not have jurisdiction over them since they spent little time in the state and neither was involved in the daily operations of the home or in setting staffing levels. Their lawyers said jurors should never have heard from nurses who hadn’t cared directly for Mrs. Pierce.

“No way did I oversee resident care issues,” Mr. Bennett said in a deposition.

Deficient in the End

Whoever was responsible for Mrs. Pierce’s care, her family had no doubt it had been inadequate. Her son Bill Pierce was so horrified when he finally saw the wound on his mother’s foot, he immediately insisted that she go to the hospital.

Mrs. Hatfield said the surgeon had told the family that “he had never seen anything like it.”

“He amputated 60 percent of the leg, above the knee,” she said.

After the amputation, Mrs. Pierce returned to the nursing home because her family did not want to separate her from her husband, who was also there.

At the trial, the nursing home’s lawyers argued that Mrs. Pierce’s leg had deteriorated not because of the infection but because her blood vessels had become damaged from a decline in circulation. The jury was unpersuaded after nurses and aides testified about how Allenbrooke would add staffing for state inspections while the rest of the time their pleas for more support went unheeded.

Workers also testified that supervisors had told them to fill in blanks in medical records regardless of accuracy. One example: Allenbrooke’s records indicated that Mrs. Pierce had eaten a full meal the day after she died.

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Care Suffers as More Nursing Homes Feed Money Into Corporate Webs

Lawyer who stole $16M from purchasers headed to jail

A Las Vegas lawyer who stole $16 million from his clients‘ trust funds has been sentenced to 16 to 40 years in prison.

Clark County District Judge Kerry Earley sentenced Robert Graham on Friday after nearly a dozen victims testified about how he preyed on clients who set up trusts for loved ones, including children, the elderly and disabled.

Graham pleaded guilty in September to five felony counts, including theft and exploitation of vulnerable people. He was a frequent television advertiser before shutting down his Lawyers West practice.

Prosecutors said when Graham was indicted in January that he used a client trust fund as a personal piggy bank for his business and private bills.

Full Article & Source:
Lawyer who stole $16M from purchasers headed to jail

See Also:
Authorities consider criminal investigation of suspended Las Vegas attorney

Las Vegas lawyer accused of stealing millions from clients arrested

Millions missing from lawyer's trust account, bar alleges after he abruptly closes law firm

Guardianship firm’s former CEO admits stealing $4 million

Paul Donisthorpe, pictured here in 2003, pleaded guilty in federal court on Monday to wire fraud and money laundering. (Randy Siner/For the Journal)

During a surprise hearing in federal court Monday, Paul Donisthorpe, former CEO of Desert State Life Management, pleaded guilty to bilking dozens of New Mexico’s most vulnerable residents out of more than $4 million.

“This was a heartbreaking case. An individual was trusted by the elderly, disabled and other New Mexicans with special needs to make sure their rent, medical bills and living expenses were covered,” Terry Wade, the special agent in charge of the FBI in Albuquerque, told a news conference Monday afternoon announcing the guilty plea. “Instead, he stole a great deal of money from all of them so he could support a lavish lifestyle, like a lodge in Angel Fire.”

The federal charges against him and the agreement, in which he pleaded guilty to wire fraud and money laundering, were not made public until hours after Donisthorpe, 62, left the courthouse. The U.S. Attorneys Office then held what it called a “law enforcement announcement” and refused to take any questions.

Donisthorpe said in his plea agreement that he used his ill-gotten gains to pay mortgages on his home in Albuquerque and vacation home in Angel Fire. He will be sentenced to eight to 12 years in prison, according to the recommendation in his plea agreement.

He also must pay $4,812,857 in restitution to the victims of his crimes.

Donisthorpe ran a decadelong scheme in which he stole more than $4.8 million from many of the 70 of his nonprofit trust company’s clients, acting U.S. Attorney James Tierney said Monday.

At the end of 2016, the company should have had more than $5 million in client assets, excluding real estate and insurance policies. But it had only $926,000, according to a search warrant affidavit unsealed on Monday.

Donisthorpe, who currently lives in Bloomfield, was released on standard conditions of release after his court appearance before Magistrate Judge Laura Fashing. His sentencing hearing hasn’t been scheduled.

Ahmad Assed, Donisthorpe’s attorney, could not be reached for comment Monday.

Federal charges

Earlier this year, state financial regulators accused Donisthorpe of siphoning client money, the FBI filed for forfeiture of some of his property and the state put his nonprofit company into receivership. About 40 of his clients had been notified by the state that their trust money was missing.

But federal charges – in the form of a criminal information – were not filed until Monday, at the same time as the plea agreement.

The criminal information revealed more details about the case. It said that from 2006 through 2016, Donisthorpe on numerous occasions liquidated his clients’ investments and then had their money transferred to accounts that he controlled, which he used for his own personal expenses. He then concealed the theft by causing his accounting staff to falsely record the clients’ balances in Desert State accounting records, according to the criminal information.

He presented those false records to his company’s board of directors, the Financial Institutions Division and his clients, according to the information.

96-year-old lost $32,000

Donna Burk, of Texas, still hasn’t told her 96-year-old mother her $32,000 savings held at Desert State was stolen.

Burk said Monday that she hopes enough money will be recovered to help compensate victims for their losses.

“It’s one step out of the way. It’s tremendous. It’s great. But I’m still just going to pray.”

Under the plea deal, Donisthorpe agreed to the forfeiture of the company’s headquarters in Albuquerque, an Angel Fire vacation home and his interest in a Texas cattle ranch, in addition to the restitution.

There was no prior notice of Monday’s plea by Donisthorpe, who hasn’t been seen for months since state regulators filed their case alleging the theft. Burk said she hopes to appear at Donisthorpe’s sentencing.

“I’d love for him to be able to see faces of victims,” said Burk, who has been in contact with other victims, some of whom are being hounded by creditors. She has already had to adjust her work schedule starting in January because she’s had to reduce the hours she can pay an in-home sitter for her mother.

Search warrants

The two search warrants unsealed Monday show that in January 2017, the state Financial Institutions Division contacted Desert State and Donisthorpe to schedule an examination of the company the next month.

As the date of that examination approached, the state agency was unable to reach Donisthorpe or receive records it had requested from him.

Financial Institutions Division employees went to Desert State multiple times in late February and early March, and no one was working there, according to the warrants.

Liane Kerr, Donisthorpe’s now ex-wife, contacted the division in early March and said her husband had a stroke and was hospitalized. She said several Desert State employees and board members had recently quit or were out of the country. She said the people working there at the time would be unable to assist with the examination, according to the warrants.

In late March, Helen Bennet, an attorney and Desert State board member, told the Financial Institutions Division that Donisthorpe had recently tried to commit suicide by overdosing on prescription medication. She said he told her that he couldn’t remember whether he embezzled money but that if money was missing he must have done it, according to the search warrants.

Corrales Mayor Scott Kominiak was appointed acting CEO of Desert State in mid-March, and he took possession of a computer that Donisthorpe used while operating the company. FBI agents obtained a search warrant for that computer in early June.

Full Article & Source:
Guardianship firm’s former CEO admits stealing $4 million

Tuesday, January 2, 2018

Infection lapses are rampant in nursing homes but punishment is rare

Georgina Morris
Basic steps to prevent infections — such as washing hands, isolating contagious patients and keeping ill nurses and aides from coming to work — are routinely ignored in the nation’s nursing homes, endangering residents and spreading hazardous germs.

A Kaiser Health News analysis of four years of federal inspection records shows 74% of nursing homes have been cited for lapses in infection control — more than for any other type of health violation. In California, health inspectors have cited all but 133 of the state’s 1,251 homes.

Although repeat citations are common, disciplinary action such as fines is rare: Nationwide, only 1 of 75 homes found deficient in those four years has received a high-level citation that can result in a financial penalty, the analysis found.

“The facilities are getting the message that they don’t have to do anything,” said Michael Connors of California Advocates for Nursing Home Reform, a nonprofit in San Francisco. “They’re giving them low-level warnings year after year after year and the facilities have learned to ignore them.”

Infections, many of which are avoidable, cause a quarter of the medical injuries Medicare beneficiaries experience in nursing homes, according to a federal report. They are among the most frequent reasons residents are sent back to the hospital. By one government estimate, healthcare-associated infections may result in as many as 380,000 deaths each year.

The spread of methicillin-resistant Staphylococcus aureus (MRSA) and other antibiotic-resistant germs has become a major public health issue. While Medicare has begun penalizing hospitals for high rates of certain infections, there has been no similar crackdown on nursing homes.

As average hospital stays have shortened to 4.5 days in 2012 from 7.3 days in 1980, patients who a generation ago would have fully recuperated in hospitals now frequently conclude their recoveries in nursing homes. Weaker and thus more susceptible to infections, some need ventilators to help breathe and have surgical wounds that are still healing, two conditions in which infections are more likely.

“You’ve got this influx of vulnerable patients but the staffing models are still geared more to the traditional long-stay resident,” said Dr. Nimalie Stone, the Centers for Disease Control and Prevention’s medical epidemiologist for long-term care. “[That] kind of care is so much more complicated that facilities need to consider higher staffing.”

The Centers for Medicare & Medicaid Services (CMS), which oversees inspections, has recognized that many nursing homes need to do more to combat contagious bugs. CMS last year required long-term care facilities to put in place better systems to prevent infections, detect outbreaks early on and limit unnecessary use of antibiotics through a stewardship program.

But the agency does not believe it has skimped on penalties. CMS said in a statement that most infection-control violations have not justified fines because they did not put residents in certain danger. For instance, if an inspector observed a nurse not washing his or her hands while caring for a resident, the agency said that would warrant a lower-level citation “unless there was an actual negative resident outcome, or there was likelihood of a serious resident outcome.”

In November, CMS waived penalties for 18 months against facilities that violate the new stewardship rule. The industry had said nursing homes needed more time to prepare. (The moratorium does not affect California’s antibiotic stewardship requirement, which took effect last January.)

Holly Harmon, the senior director of clinical services at the American Health Care Assn., a nursing home trade group, said the industry has made strides in combating infections through better training and encouragement for staff members to look for gaps in infection control and to speak up about them. The percentage of nursing home residents with urinary tract infections — the only type of infection all nursing homes must report to Medicare — has dropped by more than half since 2011.

“Infection prevention control is a priority,” Harmon said. “The path really is focused on continuous improvement.”

James Morris said he did not see such dedication when his mother, Georgina Morris, entered Astoria Nursing & Rehabilitation Center in Sylmar in October 2015. “Workers were coming in and out without washing their hands,” he said.

While there, Georgina Morris, 86, fell ill to a particularly virulent strain of Clostridium difficile, known as C-diff. Morris said he insisted his 86-year-old mother, who was severely dehydrated, be sent to the hospital, where she stayed for 10 days. She has had subsequent flare-ups of the infection that required rehospitalization and, later, a fecal transplant, in which doctors transferred stool from a healthy patient into her bowels, a procedure that can treat the infection by introducing bacteria that counter the C-diff germs.

Nursing home infections
 James Morris with his mother, Georgina Morris. He said he was disturbed by the unsanitary practices he saw at her nursing home. (Heidi de Marco / Kaiser Health News) James Morris complained about Astoria to health authorities shortly after his mother left. Records show inspectors waited 18 months, until a regularly scheduled review in May 2017, before investigating her case. Such delays are common: California Department of Public Health cases remain open, on average, for nearly 20 months.

Although inspectors faulted Astoria workers for not cleaning their hands while treating Georgina Morris, they could not definitively determine whether she contracted the infection there or before she arrived. But the inspection found other infection-control lapses throughout the home. A housekeeper cleaned a wall with the same cloth used to wipe a toilet. A patient had a dirty intravenous line left in longer than necessary. The inspector watched as a worker failed to wash her hands after delivering a breakfast tray to a contagious resident in isolation.

It was the second consecutive year inspectors cited the home for substandard infection control that had the potential to harm residents. Both citations were below the level that could trigger fines.

Astoria did not respond to requests for comment.

Elsewhere, health regulators are similarly reluctant to assert that nursing home errors led to patient infections or put patients in imminent danger. Only 161 homes among the 12,056 that violated infection-control rules were cited at those higher levels since 2014, according to Kaiser Health News’ analysis.

The value of lower-level citations as deterrents is questionable: Authorities have cited 7,045 homes more than once over infection-control lapses, including 942 that racked up four or more violations, the analysis found.

“Perhaps a bigger stick might be more helpful,” said Joseph Rodrigues, California’s long-term-care ombudsman.

Inspection records show nurses and aides are often not familiar with basic protocols, such as wearing protective clothing when coming into contact with contagious residents and isolating them from others in the home and visitors. Others are not trained properly on how to clean patients. Still others, in a rush and understaffed, take shortcuts that compromise sanitary precautions.

“We’ve always been shocked at how often we’ve personally witnessed people providing care in facilities and not washing their hands, which has got to be the most basic thing in infection control and prevention,” said Sherry Culp, who as Kentucky’s long-term-care ombudsman advocates for aggrieved nursing home residents.

Another recurring problem stems from nurses and aides infecting residents because they come to work ill knowing they would not get paid for the sick time, said Dr. David Nace, an associate professor at the University of Pittsburgh School of Medicine.

During a norovirus outbreak in January at Fir Lane Health & Rehabilitation Center in Shelton, Wash., at least six infected employees returned to work without waiting the minimum 48 hours after their symptoms abated. Inspectors discovered the virus ultimately spread to 32 employees and 43 residents — more than 40% of those living in the home. Fir Lane did not respond to requests for comment.

“They have these draconian policies for taking off,” Nace said, speaking broadly about the nursing home industry. “And if you don’t have the draconian policies, then everyone takes off. That plagues the entire healthcare industry.”

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Infection lapses are rampant in nursing homes but punishment is rare