Saturday, December 8, 2018

Nursing home employee accused of raping resident with dementia

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HANOVER, IN (WAVE) – A Madison, Ind., man is behind bars, accused of raping a dementia patient.

David Garcia is charged with one count of rape, a level-three felony. Hanover police said it happened Saturday at the Hanover Nursing Center. Garcia was arrested Wednesday after a co-worker reported him having sex with a 74-year-old female dementia patient.

“He had been a past employee there and had returned recently to it as a CNA or certified nursing assistant,” said Chief Joshua Taylor, of the Hanover Police Department. “That’s the position he was working in the capacity of this evening.”

According to police records, a co-worker saw a man with his pants down and a woman on the bed, believed to be a patient, and reported it to co-workers immediately to be investigated.

When questioned, the victim told investigators she’d had sex with a man and pointed toward her groin.

“As of right now, with the information we have, we felt comfortable filing that rape charge, but will continue to review this going forward, if any additional charges will pop up during the investigation,” Jefferson County (Ind.) Prosecutor David Sutter said.

Garcia admitted he was in that room but denied the alleged assault, trying to explain to police why his bodily fluids may have been in the room.

Police said Garcia had prior arrests but nothing like this. Taylor said it’s so important to be careful when hiring people in charge of caring for vulnerable populations, like dementia patients.

“You do everything you can to ensure you have the right person for the position there,” Taylor said. “From the get go, a lot of times with investigations we have, there’s no indicators, nothing in the history, nothing in past to give the red flag.”

If convicted, Garcia could face up to 16 years in prison.

Sutter said his office is weighing the charges in the case seriously because of the kind of crime and the position of trust Garcia was in during the alleged rape.

“As a community, you always want to try to take care of your most vulnerable,” Sutter said. “We certainly feel like whether it’s infants or folks that are for whatever reason in nursing centers, those are people that we need to take care of and we obviously take that very seriously. Community safety is the utmost importance for my office and the Hanover Police Department.”

Hanover police said the investigation is ongoing, and they’re speaking with others at the nursing center to ensure there are no other victims but right now, they believe this was an isolated incident.

Garcia is expected to be in court Friday for an initial hearing.

The administrator at the Hanover Nursing Center declined to comment about the incident or about Garcia’s arrest, saying she couldn’t discuss the matter while it’s under investigation.

Full Article & Source:
Nursing home employee accused of raping resident with dementia

Brunswick lawyer disbarred over misuse of funds totaling $287K

Maine Board of Overseers of the Bar announced Wednesday that Brunswick lawyer James Whittemore will not be allowed to practice law for 10 years, citing serious professional and ethical violations that include allegations he has misused approximately $287,000 of client funds.

The Times Record reported by Whittemore, 69, also faces criminal charges in Cumberland County. He was indicted on two counts of theft by misapplication of property and one count of theft by unauthorized taking, the Brunswick newspaper reported, adding that Whittemore pleaded not guilty to those charges.

"In each instance, Mr. Whittemore's conduct demonstrated violations of duties owed directly to his clients," Superior Court Justice Nancy D. Mills wrote in her Nov. 30 decision. "In addition, Mr. Whittemore violated duties that he owed to the court, to the public, and to his profession. … As noted above, in each of the five counts, there was serious and intentional misconduct that exacted both financial and emotional injury to vulnerable clients."

According to court documents, Whittemore:
  • Mishandled and is suspected of converting "approximately $151,981.06 derived from the assets" of a trust in "a matter then pending in the Cumberland County Probate Court."
  • Improperly received and converted $100,000 in a settlement of two wrongful death claims, which had been made directly payable to his client trust account instead of the client and her son.
  • Misappropriated $15,000 sent by a donor to the Brunswick-Topsham Land Trust to be held in escrow for an easement purchase.
  • Accepted $18,790 from a client he was representing in a "right-of-way easement issue … without performing the requisite legal work."
  • Accepted a $1,500 retainer from a client and "performed minimal legal services for [the client] and then converted the remaining advanced fee for his own use."
Court documents indicate the complainants have filed or will be filing for reimbursement through the Lawyer's Fund for Client Protection.

The Times Record reported that Whittemore's lawyer declined comment on the case on Wednesday.

Full Article & Source:
Brunswick lawyer disbarred over misuse of funds totaling $287K

Fraud, waste, and abuse in the Medicare hospice program is ‘repellent’

Like many Americans, I have a story about hospice care for a loved one. When my father was dying from complications of dementia and diabetes, hospice caregivers sat with him, provided pain relief, and helped him be comfortable. They also gave my mother peace of mind that her beloved husband was receiving kind attention in his final weeks. To this day, she refers to those hospice workers as angels.

Sadly, not every family’s story is a positive one.

Some patients experience days of pain or severe anxiety because their hospices fail to provide pain management and other needed services. Some are signed up for hospice without their knowledge, including some individuals who are not terminally ill.

The Department of Health and Human Services’ Office of Inspector General, for which I work, recently published a report examining hospice practices over a decade. It showed that hospices do not always provide the services that patients need and sometimes provide poor-quality care. We also found that patients and their families often do not receive crucial information to make informed decisions about hospice care.

We uncovered multiple abuses in our investigations:

Hospice recruiters inappropriately promised Medicare beneficiaries free housecleaning and other services that are not provided through hospice without telling them they would be signed up for the hospice benefit. That means they unknowingly gave up treatments that could cure, or at least manage, their conditions and instead received only palliative care.

In a North Texas case, nurses allegedly gave high doses of drugs such as morphine, regardless of whether patients needed it, to justify receiving the higher hospice payments. Some of these excessive dosages resulted in significant injury or death.

Or take the case of Larry Johnson’s 87-year-old mother, who had dementia. Two days before she died, he learned that she had been enrolled in hospice more than a year earlier, a decision that an individual with dementia shouldn’t make without assistance. “My mother needed basic care, but not hospice ― and especially not for a year and then some!” Johnson said in an interview with our staff.

Our investigation in her case yielded results: The owner of that hospice company received a 6-1/2-year federal prison sentence for running an elaborate, $20 million hospice scheme that signed up patients who were not dying. The hospice is permanently closed.

The idea that hospice care could abuse and neglect patients when they are at their most vulnerable, or exploit them for unjust enrichment, is repellent.

Because taxpayers bankroll poor care and fraud through the Medicare hospice benefit, policymakers need to take immediate action to implement safeguards against fraud, waste, and abuse of this important benefit.

Growth in the use of hospice makes it even more important to take action now. The latest Medicare data show that hospice use has grown over the past decade: In 2006, Medicare paid $9.2 billion for fewer than 1 million beneficiaries in hospice care. Ten years later, it paid $16.7 billion for more than 1.4 million beneficiaries.

Quality hospice care can provide significant comfort and support to terminally ill patients and their families and caregivers. But we must take steps to prevent both the very human toll and the economic toll that hospice fraud takes.

The Inspector General’s office made recommendations to the Centers for Medicare and Medicaid Services, which runs Medicare, in seven key areas. Although CMS did not agree with a number of them, we believe they are essential for weeding out poorly performing and unscrupulous hospice providers:
  • Congress should give CMS the authority to hold poor performing hospices accountable and take swift action when warranted.
  • CMS should take steps to tie payments to patient care needs and quality of care, rather than the current approach of paying a flat rate regardless of how many services a hospice provides, which can create incentives to minimize services and seek patients with uncomplicated needs.
  • CMS should provide more information to the public, especially Medicare beneficiaries, about hospice performance so consumers can effectively compare hospice providers. CMS now provides such information for nursing homes on its Nursing Home Compare website; a similar offering for hospice on Hospice Compare would help consumers make informed choices.
Patients and their family members can help guard against fraud by carefully reviewing the summary notices they receive from Medicare detailing the services for which Medicare has been billed on their behalf and report those that were not authorized or received.

Medicare beneficiaries who elect hospice care should receive high-quality services, and hospices should act with integrity when billing government health programs. Most already do that, and assist dying patients with dignity and compassion.

We strongly urge CMS and Congress to implement our longstanding recommendations to protect patients and their families from hospice providers that are exploiting this vital service.

Joanne M. Chiedi is the principal deputy inspector general for the Department of Health and Human Services.

Full Article & Source:
Fraud, waste, and abuse in the Medicare hospice program is ‘repellent’

Friday, December 7, 2018

An 81-year-old, his gruesome wound, and no explanation from caregivers: The story of Phillip Kennedy’s three days in a Toronto nursing home

It’s been more than a year since 81-year-old Toronto nursing home resident Phillip Kennedy suffered a leg wound so deep and wide it looked as if he had been sliced open by an axe.

His daughter, Kathleen Kennedy, said the home has never told her family how Phillip was injured, even though it happened in the middle of the day, in a licensed Ontario long-term care facility busy with nurses and personal support workers.

Kathleen Kennedy, with her brother Greg with their mother, Teresa. Phillip Kennedy went into a Toronto nursing home on Oct. 25 2017 for a short rehab stay and three days later, suffered a massive gash that was so deep it looked like someone had struck him with an axe.
Kathleen Kennedy, with her brother Greg with their mother, Teresa. Phillip 
Kennedy went into a Toronto nursing home on Oct. 25 2017 for a short rehab
stay and three days later, suffered a massive gash that was so deep it looked
like someone had struck him with an axe.  (Steve Russell / Toronto Star)
When Phillip was injured — three days after moving in — nobody from Hawthorne Place Care Centre could, or would, say how it happened. A provincial ministry of health inspector spent six days investigating but found no explanation for the cause of the injury. Phillip died in hospital three weeks later. Kathleen said his death report cited end-stage heart disease and kidney failure.

“If they had just said to me, ‘you know what, we dropped him,’ or even, ‘you know what, he was hit with an axe, we are sorry and this is what we’ve done to make sure it doesn’t happen to someone else,’ I would have accepted it. But there was none of that. Nothing,” Kathleen said.

“It is very unsettling.”

After Phillip was injured, on Oct. 28, 2017, the inspector interviewed at least eight employees, including the home’s administrator, physiotherapist and personal support workers. While the inspector’s final report, provided to the Star by Phillip’s family, didn’t find conclusive answers, it detailed four violations, including the “abuse and neglect” that led to the firing of five workers, along with unsafe practices while moving him from sitting to standing and from chair to bed.

Last week, a spokesperson for Hawthorne Place Care Centre told the Star that its internal probe, including the work of an outside investigator, found that Phillip’s injury was likely the result of a staff error.

“All indications are that the injury was unintentional — the result of an accident which occurred while the resident was being cared for by our staff,” the emailed statement said. “This is a highly regrettable incident, and we apologize without reservation to the resident's family.”

Kathleen said this is the first she has heard of the home’s findings.

Hawthorne Place is owned by Rykka Care Centres. Its managing partner, Responsive Management Inc., said the nursing home could not go into any additional detail because of “pending legal action” by the family. Last spring, Kathleen, a registered nurse, hired a Toronto law firm to look into her father’s case.

The family’s troubles began more than a year ago, after Phillip was discharged from a Richmond Hill hospital where he had spent two months after repeated falls, along with heart problems.

On Oct. 25, 2017, Phillip moved into a shared room on the first floor of Hawthorne Place, a long-term care home built in the early 1970s near Jane St. and Finch Ave.

His time there was expected to be short, just to get him steady on his feet again, so he arrived with little more than his clothes and rosary beads. If he struggled with his balance, Phillip’s mind was sharp and he loved to read, always with a newspaper or the BBC History magazine by his side.

Three days later, a personal support worker found Phillip lying in bed, his sheets stained with blood, the worker told the inspector. A deep slash in his leg cut to the bone. Staff huddled outside his room, entering and leaving, as he lay in bed, his eyes closed, murmuring in response to a nurse’s question: “Are you okay?” The nurse could not hear what he said.

That afternoon, Greg Kennedy, Phillip’s son, was driving with his mom to visit his dad when nursing home staff called to tell him of the injury.

“When I got there, he was in bed and his leg was bandaged,” said Greg, a supervisor at Molson Coors, currently on disability leave. “There were five workers standing outside his room and nobody could say what happened. He was incoherent. He looked awful. He was grey, a kind of death look.

“I was in tears when I left there. I thought he was going to die right then and there.”

Greg said the paramedics who rushed Phillip to Humber River Hospital told his family to file a complaint with the ministry about the severity of the injury and staff’s inability to describe how it happened. Kathleen contacted the ministry, and a few days later the inspector arrived to investigate.

The home’s administrator told the inspector that “discrepancies were found emerging from staff interviews.”

Staff didn’t immediately report the injury to the ministry or police, as is required when abuse is a possible cause. After the home’s administrator learned of Phillip’s condition two days later, the ministry and police were contacted, the report said. Kathleen and the administrator separately reported the injury to Toronto Police, who told the Star officers interviewed “at least two staff members” but could not confirm how Phillip was injured. Police closed the case in January.

Hawthorne Place fired the two personal support workers and three nurses who were involved in Phillip’s care that day, the report said. The nurses were reported to the College of Nurses of Ontario, the oversight body for nurses. A college spokesperson confirmed the nurses are being investigated.

Photographs taken by Greg show the gash was on the outer part of Phillip’s right leg, just below the knee. It was a deep, gaping wound.

The timeline of Phillip’s injury and how staff reacted to it are detailed in the ministry report.

At roughly 2:30 p.m. on October 28, a personal support worker called a registered nurse to Phillip’s room, pointing to blood on his bed sheet. When the worker rolled up Phillip’s pant leg, the nurse saw a “large laceration” on his outer right shin. The nurse reported seeing “some white stuff, appeared like bone.”

This registered nurse left Phillip without assessing him, the inspection report said, and went to ask another nurse to measure and cover the wound. The first nurse called the ambulance and Phillip’s family. Nobody called the police or ministry.

The second nurse went to another part of the home to find a measuring tape before arriving in Phillip’s room, later telling the ministry inspector the wound was “deep with sloughs and it was so bad (she/he) could not look at it to measure the wound.”

This second nurse left Phillip’s room without assessing him, the report said, and went to find a third nurse.

The third nurse arrived and measured the wound at five centimetres by five centimetres, and covered it with gauze and a bandage. Kathleen said she believes the wound was larger.

The ministry inspection report said the three nurses and two personal support workers directly involved “denied any knowledge” of the cause of the injury, with staff saying it likely happened between Phillip’s lunch and 2:30 p.m.

While the inspection report doesn’t conclude what caused the injury, it notes a personal support worker’s admission that she “transferred,” or moved, Phillip on her own, even though his care plan had been updated a day earlier to say he was so unsteady on his feet that he needed two people to help him. (He weighed more than 200 pounds.)

When the inspector later tried to re-create how Phillip had been transferred into bed, she found that her knee pressed against the knob and a flat piece of metal connecting the knob with the sides of the bed rail. The report said the flat piece of metal “was not smooth.” Kathleen said the inspector told her that this detail was considered an observation, not a conclusion of what caused the injury.

The inspector noted that the home’s director of care later “acknowledged the nursing team and the physiotherapy team did not collaborate with each other” in regards to Phillip’s assessments and the requirement he have two-worker transfers.

Phillip Kennedy was a family law lawyer in Hamilton until retiring in 2008 when he and his wife, Teresa, moved in with their daughter in Richmond Hill.
Phillip Kennedy was a family law lawyer in Hamilton until retiring in 2008 
when he and his wife, Teresa, moved in with their daughter in Richmond Hill.
(Steve Russell)
On the day of his injury, after Phillip returned from the dining room in a wheelchair, the lone worker helped him out of the chair and onto the toilet. Then the worker helped him move to his bed. The worker later told the inspector that Phillip did not fall during those transfers. The report said the worker acknowledged that an extra person was required.

After the injury and Phillip’s stay in intensive care, his family requested he be transferred back to Richmond Hill’s Mackenzie Health hospital. On Nov. 19, three weeks after his leg wound, Phillip died. Kathleen said the death report cited her father’s ongoing heart and kidney problems.

The law firm, Howie, Sacks and Henry, is talking to the home through its insurance company, Kathleen said. A lawsuit has not been filed.

“This is a shocking injury,” said the family’s lawyer, Melissa Miller. “No family should have to go through this. No resident of a nursing home should have to go through this.”

Full Article & Source:
An 81-year-old, his gruesome wound, and no explanation from caregivers: The story of Phillip Kennedy’s three days in a Toronto nursing home

SC ranks last in elder abuse protections

Greenville, SC - South Carolina ranks at the bottom of a Wallet Hub study when it comes to resources in place to help prevent abuse.

Many states recognize that elder abuse is a growing issue, especially in nursing homes.

State Rep. Garry Smith (R) Greenville is working to introduce legislation that will make it more difficult for abusers to go from one nursing home to the next without being tracked.

"The agencies and departments do a real good job following up on the reports, but the legislature has done a very poor job. It's also something that we need to do to protect those who cannot protect themselves," Rep. Smith said in a phone interview.

Senior Action Executive Director Andrea Smith says that nearly 5 percent of our aging population will live in a nursing home at the end of their life.

According to WalletHub, one in five U.S. residents will be retirement age by 2030, meaning more aging adults will eventually need assistance and could potentially become vulnerable to care takers.

"Giving not only support for the seniors but for the family members that are caring for them is another important thing that we as a community really need to get our arms around. How do we support the folks that are taking care of seniors," Smith says.

Andrea and her staff know that knowledge is power, so they teach those who visit the center how to take care of themselves, emotionally, mentally and physically.

 John and Shirley Wichmann appreciate the support.

They regularly visit the Senior Action facility to see friends and get educated on issues that affect them.

"There also are classes about things like abuse, if someone is hurting you or if something is happening how you can report it, how you can be careful and let people know or you can let someone here know or it can be taken care of," Shirley said. 

Full Article & Source:
SC ranks last in elder abuse protections

New Report on National Family Caregiver Support Program (NFCSP) Outcome Evaluation

The Administration for Community Living (ACL) recently completed a two part evaluation of the Older Americans Act Title III-E National Family Caregiver Support Program (NFCSP). The newest report, Outcome Evaluation of the National Family Caregiver Support Program, is now available.
The NFCSP Outcome Evaluation focused on the following questions:
  • What types of organizational structures and/or approaches for NFCSP services are associated with the best participant-level outcomes?
  • Are services reaching the groups targeted by the Older Americans Act (OAA), including caregivers serving older adults with greatest social or economic need?
  • To what extent do NFCSP participants also receive other home- and community-based long-term support and services?
  • To what extent do NFCSP caregivers’ outcomes differ from those of caregivers who do not receive support and services from the NFCSP?
The two-part NFCSP evaluation includes a final process evaluation report, as well as examples of assessment tools collected from State Units in Aging:

Full Article & Source:
New Report on National Family Caregiver Support Program (NFCSP) Outcome Evaluation

Thursday, December 6, 2018

Editorial: Protecting seniors requires funding from the Iowa Legislature

Child abuse is not simply a “family matter” others should ignore or dismiss. We all know this.

Educational campaigns and troubling news stories prompt people to take action when they believe a child is being mistreated. In fact, we feel obligated to report it to authorities.

Yet there is less public awareness and feeling of communal responsibility when it comes to mistreatment of older people. Elder abuse may not be on our radar, even though older adults, particularly those who are frail or have diminished cognitive function, can be just as vulnerable as children.

They need to be protected too, a point made in a recent report compiled by University of Iowa researchers for the U.S. Department of Justice.

Researchers focused their study on 1,000 square miles in east-central Iowa, including Cedar Rapids and Iowa City. They held meetings, conducted interviews, compiled information from law enforcement and reviewed laws, regulations and other data.

They found prosecution of elder abuse is a relatively rare occurrence. That means abusers go unpunished, seniors continue to suffer and the rest of us are in the dark about problems.

“One thing that really jumped out at us was a sort of acceptance or lack of awareness about elder abuse in general,” said Brian Kaskie, an associate professor at the U of I and co-author of the report.

Abuse is not necessarily physical. He’s heard stories about family members moving into homes and taking advantage of seniors. A bank worker shared an anecdote about an elderly customer's relative trying to withdraw thousands of dollars. A law enforcement officer said victims themselves frequently do not want to file charges against an abuser, particularly if it is someone they rely on for daily help.

Kaskie hopes eventually there can be as much awareness about senior abuse as there is about child abuse and domestic abuse.

“Protecting seniors is a bipartisan issue,” he said.

Iowa lawmakers can do more to help. They should begin by recognizing government is not the enemy, but the best entity for helping protect the most vulnerable people, including the more than 500,000 Iowans over the age of 65. And government can do its job only if it’s adequately funded.

Recommendations from the report include: increased funding for state and county attorneys to prosecute elder abuse; involving social workers and therapists in the investigative process; funding for individuals and organizations who can serve as guardians for elders; and public awareness campaigns.

Those things are not free. Yet the GOP-controlled Iowa Legislature insists on cutting taxes and trying to shrink the size of government. A lack of funding for state agencies has consequences for not only older Iowans, but all taxpayers who fund their health care through Medicare and Medicaid.

“Victims of elder abuse have an increased risk of hospitalization and death. Victims are also more likely to be placed in a nursing home and are at an increased risk of developing mental disorders such as depression and anxiety,” according to the report.

In 2017, the Iowa Department on Aging received about $250,000 in state appropriations specifically to support elder abuse prevention and awareness, according to the report. Yet budget shortfalls meant the use of those funds was limited to supporting efforts and making referrals to understaffed government agencies.

Iowans understand the importance of looking out for those who cannot look out for themselves. The people we elect to represent us need to make sure government has the resources to do it.

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This editorial is the opinion of the Des Moines Register’s editorial board: Carol Hunter, executive editor; Kathie Obradovich, opinion editor; Andie Dominick, editorial writer, and Richard Doak and Rox Laird, editorial board members.

Full Article & Source:
Editorial: Protecting seniors requires funding from the Iowa Legislature

Elder abuse, exploitation takes a toll year-round

Lieutenant Teresa Miller, who heads the criminal investigations division of the Crisp County Sheriff’s Office, reviews online information about elder abuse and exploitation. Miller routinely investigates complaints of elder abuse and exploitation, and says she sees a high number of these types of cases throughout the year.
'Tis the season for scammers and crooks to take advantage of the unaware. The victims are often the elderly, but holiday con artists don’t discriminate by age. People who exploit or abuse the elderly operate all year long, and it happens a lot more often – and to a lot more people – than one might expect, said Lt. Teresa Miller, the chief of the Crisp County Sheriff’s Office criminal investigations division.

“In fact, we had two reports today where overseas scam artists have called elderly people and made them believe they’re winning a car, and all they have to do is send a Western Union money order for $399 to pay the taxes,” Miller said. “Often in the case of at-risk elderly, they want to believe what [scammers] are telling them.”

Elder abuse is a crime that has become more prevalent as our population ages, and it takes many forms. It could be physical or sexual abuse, emotional abuse, neglect, and financial exploitation.

And, especially in the case of financial exploitation, the victims often know the perpetrators.

“Financial exploitation is the most prevalent,” Miller said. “We see family members who have control of their own parents or grandparents’ finances and then use those funds for their own financial gain rather than just taking care of the elderly person. That requires a very in-depth investigation.”

Investigating financial exploitation of an elder takes patience and expertise because it could be years before anyone learns a crime is happening.

“In many cases financial exploitation can mean hundreds of thousands of dollars, because it can go on for so long until someone catches on,” Miller said. “The elderly person has no idea something bad is happening to them.

Allan York knows this first-hand. He has a personal relationship with at least two elderly women who have been financially exploited, one of whom was taken advantage of by someone over the phone and another who was scammed by someone face-to-face.

“Financial abuse is affecting these elderly citizens right before our very eyes. There’s a lot of people suffering from it, and we need to put a spotlight on this problem,” York said.

In the case of the woman who was victimized by someone she knows, the financial exploitation was just the beginning of her problems.

“We’ve seen a financial, a mental and a physical strain on her. Her medicines were tampered with, and she almost died. That’s nothing compared to what she lost monetarily,” York said.

Investigators take financial exploitation of the elderly very seriously and work hard with each case to see that perpetrators are punished, but they go into overdrive when it comes to physical abuse or worse.

“If we find any physical abuse, they’re going to jail. It makes the crime ‘high and aggravated’ if you abuse anyone over the age of 65. Physical or sexual abuse of an elderly person is not going to be tolerated,” Miller said.

You can find out more about elder abuse by going online to or contacting the state Division of Aging Services’ Adult Protective Services at 1-866-552-4464.

Full Article & Source:
Elder abuse, exploitation takes a toll year-round

How Everyday Language Harms People with Disabilities

At the end of an interview for a prestigious residency, I mention my physical access needs, making it clear that I can walk and manage some stairs.

“We’ve had wheelchair-bound fellows before,” my interviewer tells me.

As soon as I hear her say “wheelchair-bound,” I feel an all-too-familiar hollow in my stomach. It is as if I’ve been punched there. It is how I know a description of disabled people is awry.

I could tell her that “wheelchair-bound” is an inaccurate term, pointing out that no wheelchair user I know is bound to a wheelchair, that every wheelchair user I know has developed techniques and support to transfer into a bed, or onto a toilet. But, knowing that this is an important interview, I remain silent, which leaves my stomach feeling rather sore.

I feel this far too often. Many friends use the word “lame” to describe something, or someone, stupid. According to the Oxford Living Dictionaries, the definition of “lame” actually means “unable to walk without difficulty as the result of an injury or illness affecting the leg or foot.” But, over time, “lame” has come to connote something or someone stupid.

It is not only friends who use “lame” but also some well-known, liberal luminaries, such as Nobel Prize-winning economist and New York Times columnist Paul Krugman. In the 2012 article “An Unserious Man,” Krugman describes Representative Paul Ryan’s response to criticisms of his Medicare plan as “incredibly lame.” I’ve cringed when MSNBC’s Rachel Maddow spouts “lame” from her broadcasting desk. In a 2018 Slate article, Ben Mathis-Lilley uses “lame” in his description of the political messaging of Democratic Party leaders Nancy Pelosi and Charles Schumer.

Thus, the connection between disability and stupidity, between a physical trait and intellectual ability, lives in our popular lexicon. Why should this matter?

“Precision with language is essential,” branding expert Elizabeth Talerman told me in a recent email conversation. She continued:
We each attach a unique meaning to what we hear. We internalize language and interpret it based on our own experiences, from the past or the present, from our mood in the moment. Words are first processed in the limbic brain, our emotional center, before meaning is made through our rationalizing frontal cortex. Kick off the wrong emotion and all intended meaning may be lost.
The language we use reveals assumptions that we usually don’t realize. For example, disabled students are given “special education,” and disabled people are seen as having “special needs.” But there is nothing special about such education. The methods of learning might be different; there might be a need for certain accommodations. But how could the needs of the planet’s approximately one billion disabled people be called special?

It wasn’t until the 1970s that millions of students in the United States, as a matter of law, gained the right to receive the education they deserved. The Rehabilitation Act of 1973 required schools to make accommodations for disabled students after centuries of isolating and ignoring them. In 1975, the Education for All Handicapped Children Act enforced the right of children with disabilities to receive a free and appropriate education. There is nothing special about a “free appropriate education,” but many are still begrudged this legal right. If we didn’t call this “free appropriate education” special, might such rights be granted more easily?

How many times have you called someone a moron? When doing so, you are using a word coined by U.S. psychologist and eugenicist Henry Goddard. Goddard took “moron” from the Greek root moros, meaning dull or foolish. In true eugenic fashion, Goddard promulgated the idea that there was a correlation between low intelligence and criminality. To Goddard, so-called morons were a threat to the American social fabric.

In the first decades of the 20th century, the U.S. government oversaw the involuntary sterilization of 60,000 developmentally disabled Americans. In the Supreme Court’s 1927 ruling on Buck v. Bell, Oliver Wendell Holmes asserted that these sterilizations did not violate the due process clause of the 14th Amendment. In his decision, the much-lauded justice wrote the infamous line “Three generations of imbeciles are enough.” The ruling has never been expressly overturned.

When Goddard coined “moron,” the number of immigrants arriving in the United States was at record levels. JoElla Straley writes for NPR’s “Code Switch” that, “for his part, Goddard wanted to ensure there were no ‘morons’ among them.”

Writing in The New Yorker about recent media coverage of the group of migrants moving through Mexico, Masha Gessen notes:
Everyone, it seems, is calling the procession a “caravan.” The journalist Luke O’Neil has pointed out that the word’s Persian roots conjure the image of “people trekking across the desert with camels (ie terrorists of course).” It is less an organized trek than it is an “exodus,” a spontaneous movement of thousands who are fleeing a place more than they are pursuing a destination.
Would changing the language we use change how those deemed “other” are seen and treated? “The choice of each word may make the difference between piercing complacency or suffering the fate of indifference, between creating alignment or sowing the seeds of dissent,” Talerman observed in our conversation. “Language is the greatest tool we have for connecting with people.”

Inaccurate words deny that wheelchair users exist independent of their wheelchairs, assume that those of us who are physically disabled are stupider than non-disabled folks, begrudge the civil rights of disabled students, endanger those who are erroneously feared (like the migrants walking in the so-called caravan), and imply motivations that are instead mere projection. Inaccurate words not only sow misunderstanding but also dehumanize, which is probably why they are used — consciously or not — in the first place.

This is neither a matter of political correctness nor of hurt feelings. Underlying these words are gross misunderstandings and suspect motivations, which lead to wrongheaded policy, denial of legal rights, and mistreatment of those with perceived differences.

It’s no wonder that when I hear such words, my body revolts as forcefully as if I have been punched. Seemingly innocuous words can be just as violating as a fist. And sometimes they have just as cruel consequences — sometimes even longer-lasting ones.

We need to educate ourselves about the myriad words and phrases used to undermine the accurate description of disabled lives. We need to refrain from ablesplaining when those of us who are disabled point out these inaccurate words. We need to interrupt the use of such words, pointing out the inaccuracy in what is being said. We all need to think more clearly about what we say, as well as about what the words we use actually mean.

My residency interviewer’s words silenced me into inaction. In that situation, I didn’t feel empowered to interrupt and educate her about her inaccurate words. But my non-disabled husband did write to Paul Krugman about his use of the word “lame.” As far as we know, Krugman has not used the word since.

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How Everyday Language Harms People with Disabilities

Wednesday, December 5, 2018

2018’s States with the Best Elder-Abuse Protections

Abuse happens every day and takes many forms. But vulnerable older Americans are among the easiest targets for this misconduct, especially those who are women, have disabilities and rely on others for care. By one estimate, elder abuse affects as many as 5 million people per year, and more than 95 percent of all cases go unreported.

Unless states take action to prevent further abuse, the problem will grow as America becomes an increasingly aging nation. The U.S. Census Bureau expects the population aged 65 and older to nearly double from 43.1 million in 2012 to 83.7 million in 2050, much to the credit of aging Baby Boomers who began turning 65 in 2011. And by just 2030, 1 in 5 U.S. residents will be retirement age.

Fortunately, states recognize that elder abuse is a real and growing issue. But sadly, only some are fighting hard enough to stop it. WalletHub compared the 50 states and the District of Columbia based on 14 key indicators of elder-abuse protection in 3 overall categories. Our data set ranges from “share of elder-abuse, gross-neglect and exploitation complaints” to “financial elder-abuse laws.” Continue reading below for our findings, expert commentary and a full description of our methodology.  (Click to Continue)

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2018’s States with the Best Elder-Abuse Protections

Medicare Takes Aim At Boomerang Hospitalizations Of Nursing Home Patients

Deborah Ann Favorite sits in her Los Angeles apartment last month. Favorite’s mother died after a lapse in communication about the need to resume her thyroid medication. (Heidi de Marco/KHN)

“Oh my God, we dropped her!” Sandra Snipes said she heard the nursing home aides yell as she fell to the floor. She landed on her right side where her hip had recently been replaced.

She cried out in pain. A hospital clinician later discovered her hip was dislocated.

That was not the only injury Snipes, then 61, said she suffered in 2011 at Richmond Pines Healthcare Rehabilitation Center in Hamlet, N.C. Nurses allegedly had been injecting her twice a day with a potent blood thinner despite written instructions to stop.

“She said, ‘I just feel so tired,’” her daughter, Laura Clark, said in an interview. “The nurses were saying she’s depressed and wasn’t doing her exercises. I said no, something is wrong.”

Her children also discovered that Snipes’ surgical wound had become infected and infested with insects. Just 11 days after she arrived at the nursing home to heal from her hip surgery, she was back in the hospital.

The fall and these other alleged lapses in care led Clark and the family to file a lawsuit against the nursing home. Richmond Pines declined to discuss the case beyond saying it disputed the allegations at the time. The home agreed in 2017 to pay Snipes’ family $1.4 million to settle their lawsuit.

While the confluence of complications in Snipes’ case was extreme, return trips from nursing homes to hospitals are far from unusual.

With hospitals pushing patients out the door earlier, nursing homes are deluged with increasingly frail patients. But many homes, with their sometimes-skeletal medical staffing, often fail to handle post-hospital complications — or create new problems by not heeding or receiving accurate hospital and physician instructions.

Patients, caught in the middle, may suffer. One in 5 Medicare patients sent from the hospital to a nursing home boomerang back within 30 days, often for potentially preventable conditions such as dehydration, infections and medication errors, federal records show. Such rehospitalizations occur 27 percent more frequently than for the Medicare population at large.

Nursing homes have been unintentionally rewarded by decades of colliding government payment policies, which gave both hospitals and nursing homes financial incentives for the transfers. That has left the most vulnerable patients often ping-ponging between institutions, wreaking havoc with patients’ care.

“There’s this saying in nursing homes, and it’s really unfortunate: ‘When in doubt, ship them out,’” said David Grabowski, a professor of health care policy at Harvard Medical School. “It’s a short-run, cost-minimizing strategy, but it ends up costing the system and the individual a lot more.”

In recent years, the government has begun to tackle the problem. In 2013, Medicare began fining hospitals for high readmission rates in an attempt to curtail premature discharges and to encourage hospitals to refer patients to nursing homes with good track records.

Starting this October, the government will address the other side of the equation, giving nursing homes bonuses or penalties based on their Medicare rehospitalization rates. The goal is to accelerate early signs of progress: The rate of potentially avoidable readmissions dropped to 10.8 percent in 2016 from 12.4 percent in 2011, according to Congress’ Medicare Payment Advisory Commission.

“We’re better, but not well,” Grabowski said. “There’s still a high rate of inappropriate readmissions.”

The revolving door is an unintended byproduct of long-standing payment policies. Medicare pays hospitals a set rate to care for a patient depending on the average time it takes to treat a patient with a given diagnosis. That means that hospitals effectively profit by earlier discharge and lose money by keeping patients longer, even though an elderly patient may require a few extra days.

But nursing homes have to hospitalize patients. For one thing, keeping patients out of hospitals requires frequent examinations and speedy laboratory tests — all of which add costs to nursing homes.

Plus, most nursing home residents are covered by Medicaid, the state-federal program for the poor that is usually the lowest-paying form of insurance. If a nursing home sends a Medicaid resident to the hospital, she usually returns with up to 100 days covered by Medicare, which pays more. On top of all that, in some states, Medicaid pays a “bed-hold” fee when a patient is hospitalized.

None of this is good for the patients. Nursing home residents often return from the hospital more confused or with a new infection, said Dr. David Gifford, a senior vice president of quality and regulatory affairs at the American Health Care Association, a nursing home trade group.

“And they never quite get back to normal,” he said.

‘She Looked Like A Wet Washcloth’

Communication lapses between physicians and nursing homes is one recurring cause of rehospitalizations. Elaine Essa had been taking thyroid medication ever since that gland was removed when she was a teenager. Essa, 82, was living at a nursing home in Lancaster, Calif., in 2013 when a bout of pneumonia sent her to the hospital.

When she returned to the nursing home — now named Wellsprings Post-Acute Care Center — her doctor omitted a crucial instruction from her admission order: to resume the thyroid medication, according to a lawsuit filed by her family. The nursing home telephoned Essa’s doctor to order the medication, but he never called them back, the suit said.

Deborah Ann Favorite holds a photograph of her mother, Elaine Essa. The nursing home
and Essa’s primary care practice settled a lawsuit brought by the family. (Heidi de Marco/KHN)

Without the medication, Essa’s appetite diminished, her weight increased and her energy vanished — all indications of a thyroid imbalance, said the family’s attorney, Ben Yeroushalmi, discussing the lawsuit. Her doctors from Garrison Family Medical Group never visited her, sending instead their nurse practitioner. He, like the nursing home employees, did not grasp the cause of her decline, although her thyroid condition was prominently noted in her medical records, the lawsuit said.

Three months after her return from the hospital, “she looked like a wet washcloth. She had no color in her face,” said Donna Jo Duncan, a daughter, in a deposition. Duncan said she demanded the home’s nurses check her mother’s blood pressure. When they did, a supervisor ran over and said, “Call an ambulance right away,” Duncan said in the deposition.

At the hospital, a physician said tests showed “zero” thyroid hormone levels, Deborah Ann Favorite, a daughter, recalled in an interview. She testified in her deposition that the doctor told her, “I can’t believe that this woman is still alive.”

Essa died the next month. The nursing home and the medical practice settled the case for confidential amounts. Cynthia Schein, an attorney for the home, declined to discuss the case beyond saying it was “settled to everyone’s satisfaction.” The suit is still ongoing against one other doctor, who did not respond to requests for comment.

Dangers In Discouraging Hospitalization

Out of the nation’s 15,630 nursing homes, one-fifth send 25 percent or more of their patients back to the hospital, according to a Kaiser Health News analysis of data on Medicare’s Nursing Home Compare website. On the other end of the spectrum, the fifth of homes with the lowest readmission rates return fewer than 17 percent of residents to the hospital.

Many health policy experts say that spread shows how much improvement is possible. But patient advocates fear the campaign against hospitalizing nursing home patients may backfire, especially when Medicare begins linking readmission rates to its payments.

“We’re always worried the bad nursing homes are going to get the message ‘Don’t send anyone to the hospital,’” said Tony Chicotel, a staff attorney at California Advocates for Nursing Home Reform, a nonprofit based in San Francisco.

Richmond Pines, where Sandra Snipes stayed, has a higher-than-average rehospitalization rate of 25 percent, according to federal records. But the family’s lawyer, Kyle Nutt, said the lawsuit claimed the nurses initially resisted sending Snipes back, insisting she was “just drowsy.”

After Snipes was rehospitalized, her blood thinner was discontinued, her hip was reset, and she was discharged to a different nursing home, according to the family’s lawsuit. But her hospital trips were not over: When she showed signs of recurrent infection, the second home sent her to yet another hospital, the lawsuit alleged.

Ultimately, the lawsuit claimed that doctors removed her prosthetic hip and more than a liter of infected blood clots and tissues. Nutt said if Richmond Pines’ nurses had “caught the over-administration of the blood thinner right off the bat, we don’t think any of this would have happened.”

Snipes returned home but was never able to walk again, according to the lawsuit. Her husband, William, cared for her until she died in 2015, her daughter, Clark, said.

“She didn’t want to go back into the nursing home,” Clark said. “She was terrified.”

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Medicare Takes Aim At Boomerang Hospitalizations Of Nursing Home Patients

The number of homeless pensioners is the highest it’s been for a decade

The number of pensioners being accepted as homeless has skyrocketed by 40 per cent in five years, according to new figures.

A total of 2,520 people aged 60 and over were classed as ‘without a safe and secure home last year’ – the highest number for over a decade.

The government figures for January to March of this year also uncovered a 54 per cent rise in single parent families forced to turn to temporary accommodation.

There has been a three per cent increase on the number of families waiting for a permanent place to stay with 79,880 altogether in hostels and B&Bs. This figure has risen by 56 per cent since the onset of austerity measures in 2010.

The total number of those living in B&Bs had actually fallen by 10 per cent to 5,940, but is still up a staggering 190 per cent from the levels seen eight years ago.

Responding to the figures, Polly Neate, Shelter CEO, said: “It’s clear that our country is in the firm grip of a housing crisis as these figures starkly show, with older people and single parents both bearing the brunt. If we want to protect more people from the ravages of homelessness, the government must come up with a bold new plan for social housing and in the short term, ensure housing benefit covers the actual cost of rents.”

But it is not just the elderly and single-parent families that are at risk of homelessness.  The statistical release also highlighted non-violent breakdown of a relationship with a partner, naming it the fifth-most common reason for loss of last settled home.

Chris Sherwood, chief executive at relationship support charity Relate, has proposed for councils to offer free relationship counselling to tackle the issue.

“It’s good to see local authorities taking positive steps to prevent homelessness such as finding temporary accommodation for at risk groups, but we also need to pay closer attention to the root causes,” he said. “With non-violent relationship breakdown being the fifth most common cause of homelessness, local authorities should consider offering free relationship counselling to families and individuals who may be at risk if they haven’t already done so.

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The number of homeless pensioners is the highest it’s been for a decade

Tuesday, December 4, 2018

Feds Order More Weekend Inspections Of Nursing Homes To Catch Understaffing

The federal government announced plans Friday to crack down on nursing homes with abnormally low weekend staffing by requiring more surprise inspections be done on Saturdays and Sundays.

The federal Centers for Medicare & Medicaid Services said it will identify nursing homes for which payroll records indicate low weekend staffing or that they operate without a registered nurse. Medicare will instruct state inspectors to focus on those potential violations during visits.

“Since nurse staffing is directly related to the quality of care that residents experience, CMS is very concerned about the risk to resident health and safety that these situations may present,” the agency said in a notification to state inspection offices.

The directive comes after a Kaiser Health News analysis found there are 11 percent fewer nurses providing direct care on weekends on average, and 8 percent fewer aides.

Residents and their families frequently complain the residents have trouble getting basic help — such as assistance going to the bathroom — on weekends. One nursing home resident in upstate New York compared his facility to a weekend “ghost town” because of the paucity of workers.

Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan, welcomed the new edict but said it was only necessary because state inspectors have not been properly enforcing the rules already on the books.

“The basic problem is the states don’t take this seriously,” Mollot said. “How many studies do we have to have, year after year, decade after decade, saying it all comes down to staffing, and there are very few citations for inadequate staffing and virtually all of them are identified as not causing any resident harm?”

CMS said it will identify potential violators by analyzing payroll records that nursing homes are now required to submit. Those records, which became public this year, showed lower staffing than what facilities had previously told inspectors during their visits, according to the KHN analysis.

“CMS takes very seriously our responsibility to protect the safety and quality of care for our beneficiaries,” CMS Administrator Seema Verma said in a statement.

The nursing home industry criticized the heightened scrutiny.

“Unfortunately, today’s action by CMS will enforce policies that makes it even more difficult to meet regulatory requirements and hire staff,” said Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, an industry trade group, in a written statement. “Rather than taking proactive steps to address the national workforce shortage long-term care facilities are facing, CMS seems to be focusing on a punitive approach that will penalize providers and make it harder to hire staff to meet the shared goal of increasing staffing.”

Currently, a tenth of inspections must occur during “off hours,” which can be either a weekend, or during a weekday before 8 a.m. or after 6 p.m. But for facilities that Medicare identifies as having lower weekend staffing, half of those off-hour inspections—or 5 percent of the total — must be performed on Saturdays or Sundays.

Medicare requires nursing homes to have a registered nurse on site for at least eight hours every day, but according to the payroll records, a quarter of nursing homes reported no registered nurses available at least one day during a three-month period. Since July, Medicare’s Nursing Home Compare website for consumers has highlighted homes that lack sufficient registered nurses and lowered their star ratings. Nursing Home Compare has downgraded ratings for 1,402 of 15,600 facilities for gaps in registered nurse staffing, records show.

The new directive instructs inspectors to more thoroughly evaluate staffing at facilities Medicare flags. The edict does not mean a flurry of sudden inspections. Instead, Medicare wants heightened focus on those nursing homes when inspectors come for their standard reviews, which take place roughly once a year for most facilities.

But what may appear to be staffing scarcities in payroll records may instead be clerical problems in which nurse hours are not properly recorded, say some nursing home officials.

Katie Smith Sloan, president of LeadingAge, an association of nonprofit providers of aging services, said in a statement that some homes are still struggling to adapt to the new data collection rules.
“We’ve been voicing our concerns to CMS and will continue to do so,” she said.

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Feds Order More Weekend Inspections Of Nursing Homes To Catch Understaffing

American Airlines passenger left in wheelchair overnight after flight home was cancelled

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A 67-year-old woman who has trouble walking was reportedly left in a wheelchair overnight after her flight from Chicago to Detroit was cancelled on Friday.  

Olimpia Warsaw’s son Claude Coltea told CBS Chicago that she had flown to Chicago to attend her ex-husband’s funeral. On the way there, her luggage was lost. On the way back, she was abandoned in the airport.

Her son reportedly dropped her off at her gate, checked that her flight was on time, and then headed to catch his own flight. But when her flight ended up getting cancelled, no one helped her get to a hotel, according to her son.

“All we wanted was someone to pause and say, ‘You know what, can we just make sure this human being is safe and then we can all go home,’” Coltea told CBS. “Not one person did that.”

After a porter was assigned to help Warsaw, Coltea claims they took his mom to the front of Chicago O’Hare International Airport and then left because their shift was over. Coltea said Warsaw has trouble communicating and wasn’t able to find a way to the hotel on her own.

“She actually had to find a random passenger to help her out just to go to the bathroom because the porters had already left for the night,” Coltea told CBS.

American Airlines said in a statement to Yahoo Lifestyle that its team “is deeply concerned about what occurred Friday evening” at O’Hare. “This is not the level of service we aspire to provide to our customers, and we apologize to Ms. Warsaw and her family for letting them down.”

The airline added that it has launched an investigation with its Chicago team, and is working with the vendor it utilizes to provide wheelchair services at O’Hare to “ensure this does not happen again.” American Airlines said its staff has spoken with the family multiple times and refunded Warsaw’s ticket.

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American Airlines passenger left in wheelchair overnight after flight home was cancelled