Saturday, August 3, 2019

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

More than 20 years ago, Rebecca Fierle began to make a name for herself as a protector of vulnerable seniors.

As an employee of the Senior Resource Alliance in the mid-1990s, Fierle coordinated a program with Orange County Fire Rescue to help find elderly people in need of services such as Meals on Wheels or assistance with grocery shopping or housekeeping.

“I’ve called the abuse hotline three times since we started,” Fierle said in a 1997 Sentinel story about the program. “We’ve found two cases of neglect and one financial exploitation case."

Rebecca Fierle
Rebecca Fierle
That image of Fierle, now 50, as a watchdog for seniors stands in stark contrast to the investigations and complaints swirling around her today.
Her work as a professional guardian is the subject of a state investigation, an audit by the Orange County Comptroller and an ongoing criminal probe.

The question is how she cared for the hundreds of sick or disabled people, many of them elderly, declared incapacitated by a judge and in need of someone to handle their medical decisions, financial affairs or both.

In one case, a man died in May after she refused to lift a do not resuscitate order that he said he did not want — a desire corroborated by the man’s family and a hospital psychiatrist, according to the Clerks’ Statewide Investigations of Professional Guardians Alliance review.

Some families have told the Sentinel that they also question the care their relatives received after a judge declared them incapacitated, taking away nearly all of their rights to make their own decisions, and handed their affairs over to Fierle.

One woman said her mother died after she did not receive cancer treatment. Another woman said she found a DNR order in her grandmother’s nursing home file that the family did not know about and that a court never approved. And a mental health counselor who served on a court committee to determine whether people should have their rights taken away said she resigned from that role over concerns about Fierle’s work. But the complaint the counselor sent to the court and state office that oversees professional guardians was only acknowledged months ago, more than three years after she sent it.

Other families of the incapacitated people Fierle served, or wards as they are called in court, have expressed surprise about the allegations against her.

Dena Nazarchuk Grantham said Fierle was her brother’s guardian and brought peace of mind and was helpful during a tumultuous time for her family.

“[My brother] kept trying to tell me she wasn’t what she pretended to be,” Nazarchuk Grantham said. “It just blows my mind. She was very kind with me. … I’m hurt.”

The two images of Fierle — one as a person seen by judges, attorneys and some families as a devoted guardian and the other as the person who sits at the center of what could be one of Florida’s most complicated and bizarre elder abuse cases — collided last month at an Orlando hearing in front of Circuit Judge Janet Thorpe.

The judge revoked all DNR orders and advanced directives put in place by Fierle in her Orange County cases as a precaution after the circumstances of Steven Stryker’s death came to light.

“Rebecca Fierle has been a professional guardian for a long time. I rely on our professional guardians tremendously for what they carry,” Thorpe said, adding: “This is an extraordinary hearing that is being held on an expedited basis because of the circumstances we find ourselves in.”

Fierle and her attorney did not respond to requests for comment for this story.

Geriatric Management, Rebecca Fierle’s business at the corner of Hillcrest Street and Altaloma Avenue just northeast of downtown Orlando.
Geriatric Management, Rebecca Fierle’s business at the corner of Hillcrest Street and Altaloma Avenue just northeast of downtown Orlando. (Jeff Weiner / Orlando Sentinel)
Fierle earned a degree in psychology and a certificate in gerontology from the University of Central Florida in December 1996, just before venturing out to start a business of her own. She left her job at the Senior Resource Alliance in 1997, according to an application she filed in Seminole County court.
By December 2000 she completed the required 40 hours of training required to become a professional guardian and alerted the clerk that she would begin to take on guardianship cases, according to documents in her Orange County guardianship file.

She incorporated Geriatric Management Inc. in 2003 and, in addition to guardianship, the company specialized in helping people qualify for Medicaid benefits to cover nursing home stays and other services, according to the company web site.

No one came to the door when a reporter twice visited Geriatric Management, which is in a small converted house just northeast of downtown Orlando.

Fierle listed more than 500 people for whom she served as guardian, including 168 current cases in 10 counties and one out of state in North Carolina, on an application she filed in Seminole County earlier this year. Exact counts of her caseload varies because the Orange County auditors found her accounting of cases listed in Orange to contain duplicate case numbers and omissions of some cases.

An attorney for AdventHealth, who appeared at the July 11 hearing, told Judge Thorpe that Fierle had taken on about 50 former patients at the hospital as wards and that the hospital paid her for her services, according to a transcript of the hearing.

AdventHealth spokesman Bryan Malenius told the Sentinel that the hospital cannot discharge a patient, even after their medical treatment is complete, unless the patient has a safe place to go. And in cases when that person is unable to make decisions for themselves and when no family steps in to help, the hospital recommends guardianship as a last resort.
Typically, the hospital asks the Department of Children and Families Services to step in, but it often declines, Malenius said. A DCF spokeswoman did not respond to questions from the Sentinel.

And waiting for a public guardian to be appointed can take months, leaving a professional guardian as the most expedient way to move patients from the hospital to a nursing home or other setting.

“Petitioning the court to appoint an emergency guardian is a last resort 100 percent of the time, after the state has declined assistance and extensive efforts to find family members or friends willing to fulfill this role,” Malenius said in an e-mail. “Even after a petition for guardianship has been filed, we continue to search for family or friends willing to serve as guardians.”

Fierle registered a company with the state called Geriatric Management Hospital Consultation in 2018, but it’s unclear if that’s the company she used to bill AdventHealth. Also unclear is whether she had other arrangements with other facilities.

The comptroller’s office found she inadvertently included bills she intended for the hospital in some court files. For example, in one case the auditors found a bill for the hospital where she was charging $120 an hour. That’s higher than the maximum of $65 an hour professional guardians are allowed to charge wards for her services under court rules.

The audit said Fierle should have disclosed her payment arrangement with AdventHealth to the court, but never did.

“If the fees are billed to Florida Hospital, this creates the potential for fees to be reimbursed multiple times or a separate financial arrangement exists,” the audit report said. “All financial arrangements should be reported to the court.”

That same audit also found other questionable transactions, such as Fierle using her wards’ money for services provided by a family member or people she knew.

In 2013, Fierle used her father’s auto shop Mickeys Place for Automotive Repair to fix a ward’s car. The Orlando shop is now closed and Fierle’s father, Michael Dobbins, could not be reached for comment.

Fierle hired Steve Richardson for services such as lawn maintenance and changing locks at wards’ houses despite not disclosing to the court their previous relationship. Fierle used to have legal authority over the property of Richardson’s mother, court records show. The comptroller’s report also noted Fierle is currently “the Trustee for a family trust where the service provider currently has an ownership interest in property with the Professional Guardian as Trustee.” Calls to Richardson were not returned.

In a state Department of Elder Affairs registration document filed with the court last year, Fierle listed “none” under the area to detail any employees she had.

But the audit reported that multiple employees were billing wards for services, though they weren’t registered as guardians with the state and so did not undergo the required background checks.

Guardianship is big business in Florida. But it’s not always so easy to find a guardian to take on some of the hardest cases.

The wards can be difficult or uncooperative because of severe mental illness or other health problems. It’s not unusual for the patients’ families to be in disagreement with or estranged from the ward.

One person familiar with Fierle’s work, who asked not to be identified because the person wasn’t authorized to speak about the matter, said she was known for taking on some of the most difficult cases.

In the July 11 hearing, Judge Thorpe and attorneys for the wards and Fierle alluded to how hard it can be to find enough guardians to take on people in need, according to the transcript.

“... Where are you going to find people to take these cases?” Harry Hackney, Fierle’s attorney, asked the judge when it became clear nearly 100 cases would be removed from Fierle.

“I mean, it’s a real problem,” Thorpe replied. “We don’t have that many [guardians].”

Thorpe also pointed out that public guardians, or those funded by the state who take on cases of people who are indigent, are limited to 40 cases at a time. But there is no limit for professional guardians.

Fierle, by some counts, had more than three times that many across multiple counties.
“We overloaded her,” Thorpe said.

Some families of wards told the Sentinel that Fierle was cordial when she first took on their cases, but then they often had limited contact with her.

Someone from Fierle’s office, not Fierle herself, would often be the point of contact with family members.

Christine Tibbetts Morrison, whose mother Connie Tibbetts was under Fierle’s care before dying in 2017, said one of Fierle’s assistants called to ask her how she felt about her mother receiving chemotherapy for multiple myeloma cancer.

Despite Tibbetts Morrison telling the assistant her mother was still capable of making that decision, Tibbetts did not receive cancer treatment.

In a statement through her attorney, Fierle said she called her ward’s daughter to discuss treatment and Tibbetts Morrison “agreed that aggressive treatment of her cancer should not be pursued under the circumstances,” a claim Tibbetts Morrison wholeheartedly denies.

“At first I was relieved,” Tibbetts Morrison said. “My mother was going to have a roof over her head, she was going to get the medical care she needed. It was better than being on the street. But something wasn’t right with this guardian.”

Fierle has kept a low profile in recent weeks, appearing in court only twice — most recently in Hillsborough County — with her long red hair pulled into a neat bun and sunglasses resting atop her head as she politely answered a judge’s questions. At three hearings within the past three weeks — in Seminole, Brevard and Volusia — she was a no-show.

On July 25, Fierle resigned from all her cases statewide.

Full Article & Source:
Florida professional guardian Rebecca Fierle: Devoted or dangerous? | Exclusive

Unpaid Caregiving Increases Risk of Poverty in Retirement

GREG WILPERT It’s The Real News Network and I’m Greg Wilpert in Baltimore.

In most societies, there is a large-scale phenomenon of unpaid caregiving. People who care for children and elderly members of their family as well as those who care for friends in need, are not just doing hard work which is not remunerated with a salary, but they are also vulnerable to risk of poverty when they reach retirement age. A new report by the Political Economy Research Institute (PERI) found that unpaid caregivers in the US are more likely to have less retirement savings. The report is based on federal statistical data from 1989 to 2016 and is titled “Unpaid Family Caregiving and Retirement Savings.” The reason for the lack of retirement savings among caregivers is twofold. First, caregivers tend to have a smaller income, and thus have less money to save for retirement. And second, caregivers also tend to experience more employment volatility in the workplace so that income tends to fluctuate more, making it difficult to set aside a fixed amount of money for retirement every month.

We are now joined by one of the two authors of the study, Christian Weller, who discusses this report. He’s a Senior Fellow at the Center for American Progress and teaches Public Policy at the McCormack Graduate School of Policy and Global Studies at the University of Massachusetts-Boston. Thanks for joining us today, Christian.

CHRISTIAN WELLER Well, thank you very much for having me, Greg.

GREG WILPERT So give us the study’s results in a nutshell. What is the average impact of being a caregiver on one’s standard of living during retirement?

CHRISTIAN WELLER Well, it lowers the standard of living in retirement savings especially for single women by about ten percent, so it is a substantial impact on their retirement standard. What that means is, women already have a lot less money saved for retirement typically because they have lower earnings because they often drop out of the labor force for a number of reasons compared to men. And caregiving responsibilities for children, for aging spouses, ailing spouses, and for their parents worsens that situation over a lifetime by an estimated ten to eleven percent. Well, I don’t want to be overstating the precision here, so let’s round it to 10 percent. So you’re starting from a bad situation, and you’re making it worse. The factors by which this happens is, as you mentioned, women tend to earn less when they’re caregivers. This is particularly true for single women.

Married women tend to lower their hours, go from full-time to part-time when they’re caregivers, or drop out of the labor force entirely. And women in particular experience income volatility, adverse effects from their employers. They often don’t tell their employer because they’re afraid of being essentially fired if they disclose that they’re caring for—You can’t really hide that you’re caring for children, but you can hide that you’re caring for a disabled spouse or a sick spouse or ailing parents. And we do know from surveys that most caregivers do hide that from their employers and then, sort of, try to squeeze everything out of their current workload. That means, because they’re having dual responsibilities— caregiving and work responsibilities— that in the end, their performance suffers somewhat, and then they get disciplined. They get put sometimes in what’s called the mommy track. You could think about it in adult care as the daughter track that then ultimately means great instability.

They may lose their jobs. They may decide that that employer just no longer works for their situation and moves somewhere else. And what that means in terms of retirement savings is, it makes it much harder to plan for the future, as you said. But it also makes it under typical retirement plans, much harder to qualify. You have to work for a number of years for an employer before you become eligible to even join a retirement plan, or get an employer matched to a retirement plan. And I think all of these factors— lower earnings, fewer hours, and greater instability— all work towards building lower retirement savings. And the factor—In this study, we looked at one particular data set and compared, sort of, child care and adult care situations. We just completed another study where we looked at adult care— meaning, caring for parents and ailing spouses— and we find substantial effects there. Especially the longer somebody cares for a spouse or ailing parents, the worse the outcome is in terms of the retirement savings. Potentially, losing somewhere between 20% and 60% of their retirement savings.

GREG WILPERT Now, the issue of unpaid caregiving is perhaps one of the biggest problems in contemporary economic research because it creates a distortion in national accounting. For example, a country in which parents hire babysitters to take care of children would have a higher GDP than one in which caregiving is provided by parents or relatives for free, without anyone really necessarily being better off. Now, another recent study published in June in the Journal of Health Affairs shows that the current economic cost of unpaid care, family care, is about $67 billion and will double in the United States to $147 billion by 2050. Now, should we be including unpaid caregiving in our national accounting in some way, and what effect would that have if we were to include it?

CHRISTIAN WELLER Well, we should definitely include it. It is an activity. We’ve known this for quite some time that there is a lot of economic activity that we don’t necessarily, both on the positive and the negative side, account for. On the positive side is caregiving and care work that is unpaid, and thereby does not incur national income accounts. On the negative side, it’s environmental degradation and resource depletion that we do not account for. There are ways to account for that, but by leaving out care work we basically in the national accounts statistics, from a policy and societal perspective, we undervalue that work. And that means we’re putting too many resources for its economic growth in areas that we may not necessarily need. We don’t need necessarily another iPhone, or I don’t necessarily want to tell Apple how to do its business, but those kinds of—Like, we value creating another iPhone more than helping an ailing parent because we’re not accounting for that. That’s at the national level.

At the micro level, because that work, that unpaid care work is disproportionately done by women, we undervalue women’s work. We’re basically telling women: what you’re doing is not valuable, it’s not worth it. And we don’t necessarily then design policy to support women. Think about it the other way around. If we actually counted this as national income, then we would have a real conversation over does it make sense for family caregivers to do this free, unpaid work? Or, should we design, sort of, long-term care insurance, paid family leave insurance, and other mechanisms to help them handle the dual challenges of working and caring for somebody else? By simply ignoring that this is societally valuable work, socially valuable work, but also economically valuable work, in our statistics we disproportionately disadvantage women and we set the wrong priorities in terms of our policies.

GREG WILPERT Now, aside from including these statistics in the national accounting, your study doesn’t really get into the issue of policy alternatives, but I want to ask you about that. Based on this research, what kinds of policies would help lower the risk for caregivers that their retirement savings and incomes after retirement would be so low?

CHRISTIAN WELLER Well, there’s two things, two venues you can think of. One would be really, sort of, backing up the risks associated with caregiving. And specifically what that means is social insurance in the forms of paid family leave insurance— some states have that— and ultimately, especially around adult care and care for disabled family members and friends to long-term care insurance. There is a conversation now starting at the state level. We’ve had a conversation around paid family leave insurance for a while. And there are a number of programs like that in California, for instance. There are states now moving into the long-term care insurance space. Specifically, Washington State just announced legislation around this. So I think that’s, sort of, I think the backstop from a public policy perspective.

The other way of doing it is, and I think it is in the self-interest of employers, to better handle that. That means you do need to have not only child care support measures, basically give paid time off when people have child care needs, but also give elder care support. Elder care is becoming a growing phenomenon. Yes, we live longer, but we still have a lot of health issues around age 60-70. In a society where we don’t have a good long-term care insurance system, a lot of these care responsibilities are being taken care of by family members— daughters and sons, as well as some siblings. And we do need to address that from an employer perspective because it becomes disruptive to caregivers’ working lives, and that has productivity effects for employers. And I think there is a growing recognition among employers that something needs to happen. Although very few actually offer elder care support as a benefit to their employees.

GREG WILPERT Okay. Well, we’re going to leave it there for now. I was speaking to Christian Weller, Senior Fellow at the Center for American Progress. Thanks again, Christian, for having joined us today.

CHRISTIAN WELLER Well, thank you very much for having me.

GREG WILPERT And thank you for joining The Real News Network.

Full Article & Source:
Unpaid Caregiving Increases Risk of Poverty in Retirement

Arc of Madison Cortland guardianship program honored

Arron Hammond, left, and Bethann Lyon, guardianship and compliance coordinators at The Arc of Madison Cortland. The agency was recently awarded a grant from the Trustee Management Board of NYSARC Trust Services to support the agency’s guardianship program.
Oneida, N.Y. — The Arc of Madison Cortland, a not-for-profit organization supporting people with disabilities in Central New York, has been awarded a grant from the Trustee Management Board of NYSARC Trust Services to support the agency’s guardianship program.

NYSARC Trust Services administers supplemental needs trusts (SNT) that can make dramatic improvements to the lives of people with disabilities while enabling individuals to maintain eligibility for public benefits programs, such as Medicaid and SSI. For 2019, NYSARC Trust Services is proud to fulfill its commitment to enhancing the lives of people with disabilities by awarding over $2.73 million in grants to NYSARC Chapters statewide.

The Arc of Madison Cortland utilizes these funds to pay staff salaries, administration costs, and best of all, to enrich the lives of the individuals they support in corporate guardianship. The guardianship program has made life-long commitments to those individuals who have no one else to advocate on their behalf.

“We have made a life-long commitment to the individuals we support, and this generous funding helps the people we support live their best life,” said Karen Stace, compliance officer and director of guardianship at The Arc of Madison Cortland.

In 1993, a single mother in Cortland County was facing terminal cancer, she had a 23 year old son with cerebral palsy. With no immediate family, there was no one that could look after or advocate for his best interests and needs. The Arc of Madison Cortland became his legal guardian. He is still a part of the program today and has recently become a volunteer guardianship committee member, a role which he feels empowered by.

For more information about the services provided by The Arc of Madison Cortland, visit or call 315-363-3389.

Full Article & Source: 
Arc of Madison Cortland guardianship program honored

Friday, August 2, 2019

Father-Son Attorneys Fight Over Family Trust With Claims of Dementia, Fraud

Retired attorney Milton Wallace with his pets. In the background is a portrait of his late wife Patricia.
A state appeals court panel has rejected a bid by a lawyer for the medical records of his father, also a lawyer, in a fight over claims of dementia and financial fraud.

Mark Wallace subpoenaed the records of his father, Milton Wallace, to use in an as-yet-unfiled case to have his father declared incapacitated. But a probate court agreed with lawyers for Milton Wallace to protect the records.

Mark Wallace appealed, but a Third District panel in June split 2-1 to affirm the lower court order enjoining ex parte communications with a future examining committee to be named if Mark Wallace filed a petition for incapacity.

Todd Legon, Milton Wallace’s longtime law partner at Legon Ponce & Fodiman in Miami, said the decision was “an important victory for seniors in Florida because it prevents their constitutionally protected medical records from being used against them in legal proceedings.”

Legon flatly denied the claim that Milton Wallace has dementia.

Mark Wallace did not return a call for comment by deadline. His attorney, Brian Stack of Stack Fernandez & Harris in Miami, had no comment on the litigation.

At the appeals court, Judge Vance Salter dissented, saying the injunction was premature, unwarranted and amounted to “a prior restraint and ‘medical gag order.’ ”

He maintained Circuit Judge Mindy Glazer, who is hearing the trust case, lacked jurisdiction to issue an injunction affecting Mark Wallace’s contemplated guardianship case.

Judge Eric Hendon, writing for the majority, dismissed that concern in a footnote, saying a protective order allows “the guardianship judge to readdress matters in the order” if that case is filed.

Hendon offered a primer on incapacity provisions and said the Legislature set up “straightforward procedures” for pursuing it. Lawmakers “could have easily incorporated” a front-loaded process for attaching medical records and doctors’ reports to a petition but did not.

“It is not the function of this court to expand the controlling statutes,” Hendon wrote with Judge Thomas Logue concurring.

Social Whirl

Now in his 80s, Milton Wallace was a prominent commercial litigator with Legon Ponce & Fodiman. He became wealthy as an attorney and developer and served as chairman of the Dade Housing Finance Authority.

He and his late wife Patricia were notable donors and fixtures on Miami’s social scene. Patricia Wallace, who died in 2016, was a partner in Central Properties Co., a real estate holding company, and founded and chaired Bankers Savings Bank for 10 years.

The Wallaces owned a 2.6-acre Coral Gables waterfront estate featuring a seven-bedroom, seven-bath mansion in the gated Gables Estates, with stunning frontage on Biscayne Bay and an expansive stretch of unbuildable mangrove on the north side. The Miami-Dade County property appraiser’s office estimates the two-story, 13,604-square-foot home with a pool and tennis court has a market value of $20.3 million. Zillow pushes it closer to $26.5 million.

Milton Wallace in 2015 also bought a two-story tower suite at The Gables condominium, with a panoramic view stretching from Miami Beach to Key Biscayne and Biscayne Bay. The six-bedroom, six-bathroom unit with wide terraces and home theater is listed for sale at $6.5 million.

In their heyday, the Wallaces supported numerous Miami charities.

Patricia Wallace, daughter of a doctor, founded the Golden Angel Society in 1998 to benefit the Jackson Memorial Foundation, and she served on Miami’s public hospital board for 12 years. The Pomeranian lover also served on the boards of the Humane Society of Greater Miami, The Salvation Army and The Wolfsonian/FIU and supported the American Red Cross and Art in Public Places Trust.

Three generations of the Wallace family graduated from the University of Miami, the source of Jackson’s medical students.

Mark Wallace, a UM law graduate, is among them. The CEO of United Against Nuclear Iran took on high-profile assignments for President George W. Bush.

He worked at the United Nations, focusing on management and reform. He also served as general counsel as the Immigration and Naturalization Service transitioned from the Justice Department to the Department of Homeland Security and at the Federal Emergency Management Agency during the 9/11 recovery effort in 2001.

Mark Wallace is a Florida Bar member who lists a Roxbury, Connecticut, address. He separated this year from his wife Nicolle Wallace, an MSNBC host and Bush’s White House communications director.

A Trust Dispute

Disputes like the one between the Wallaces are normally dealt with anonymously in court. Petitions for incapacity are sealed and the hearings closed under state confidentiality law. But the dockets in the trust proceedings and related probate case are open, and the appeals court decision summarized assertions by Mark Wallace.

The Third District said Mark Wallace claimed his father was diagnosed with frontotemporal dementia in 2010, and a trust was created the following year to protect the family’s assets.

In 2016, Mark Wallace claimed in the trust lawsuit that someone outside the family induced his father to transfer funds meant for the trust. The claims laid the groundwork to have his father declared mentally incapacitated.

The 565-item trust case docket in Miami-Dade Circuit Court is populated with references to missing original stock certificates and disputed attempts to sell real estate as father and son tangled on motions.

Mark Wallace also is in litigation over his mother’s probate case. He defeated an attempt last year by his aunt to remove him as co-personal representative of his late mother’s estate, but it was quickly followed by an amended petition for removal.

A bench trial on Mark Wallace’s challenge to his aunt’s distribution from his mother’s estate is set for Oct. 21-25 before Glazer, who inherited the case after another judge’s retirement.

Full Article & Source:
Father-Son Attorneys Fight Over Family Trust With Claims of Dementia, Fraud

Woman Arrested For Allegedly Bilking An Elder’s Benefits

Mia Rodriguez
Sonora, CA – A caretaker-conservator who allegedly channeled her charge’s benefits was arrested for felony elder crimes.

Tuolumne County Sheriff’s spokesperson Sgt. Andrea Benson says in July of last year, 32-year-old Mia Rodriguez of Sonora, was removed from caring for an elderly dependent adult. However, she continued to receive the victim’s social security and other benefits totaling thousands of dollars.

Following an investigation, Rodriguez was arrested Tuesday and booked into the Tuolumne County Jail on charges of grand theft and theft from an elder or dependent adult. She was assigned a $20,000 bail.

Full Article & Source: 
Woman Arrested For Allegedly Bilking An Elder’s Benefits

Nursing home industry demands higher wages, more patient care

- As all eyes are on Detroit for the Democratic debate Tuesday and Wednesday, folks with the largest union of nursing home workers in the state, SEIU Healthcare Michigan, used that spotlight to voice their concerns dangerously short staffing issues and poverty wages.

"It's hard to go to work and not know if you have enough staff," said Trece Andrews, a nursing home employee. "It's hard to face the residents daily because they need our help. It's all about the residents really."

Fast food employees and security guards are joining the fight as well.

"I take home between $400 and $500 a month working at McDonald's," said Jamika Ruffin. "I have two beautiful children at home and we are barely surviving in the wages that McDonald's pays me."

With 73,000 cases of elder abuse each year, Michigan Attorney General Dana Nessel traveled across the state and stopped by Tuesday after launching a payroll fraud task force and an elder abuse task force.

"When these facilities are understaffed and employees underpaid, that creates situations where you have neglect of seniors," Nessel said.

Everyone there is asking presidential candidates to put working people front and center.

"We want presidential candidates to wake up every day and figure out what they are going to do to make it possible for millions of workers to have a better life," said Mary Kay Henry, the SEIU International president.

"We are shouting out, we are doing everything we can to get some politicians in office to hear us now," Andrews said.

The fight for change continues Wednesday, as security workers from across Michigan and the Midwest plan to rally in downtown Detroit.

Full Article & Source:
Nursing home industry demands higher wages, more patient care

Thursday, August 1, 2019

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

Rebecca Fierle
Amid a criminal investigation into former professional guardian Rebecca Fierle, a judge has ordered the release to law enforcement of confidential information concerning the client whose death sparked the scandal that has embroiled the state’s guardianship program.

The Florida Department of Law Enforcement confirmed last week it had launched a criminal probe into Rebecca Fierle, the Orlando-based guardian who has resigned from all cases statewide in which she was the court-appointed decision maker for incapacitated people, known as wards.

Court records show Circuit Judge Janet C. Thorpe on Thursday ordered the release to authorities of information regarding the case of Steven Stryker, 75, who died at a Tampa hospital after staff could not perform life-saving procedures because of a DNR filed against his wishes by Fierle, his guardian.

Thorpe’s July 29 order came after a court monitor in the Ninth Judicial Circuit brought up concerns to the court regarding “possible criminal activity” by Fierle in Stryker’s case, the judge’s one-page order indicates. It directs the court monitor to turn the information over to “the proper law enforcement agency.”

“The Court finds that it is necessary to release confidential information in the possession of the guardian monitor in order to facilitate a criminal investigation," Thorpe wrote, according to court records.

It’s unclear if the judge’s latest ruling was confined to Stryker’s case. One-page orders were also filed in the cases of other former Fierle wards on Thursday, but were sealed from public view.

An earlier state investigation conducted by the Okaloosa County Clerk of Circuit Court and Comptroller found Fierle refused to remove the DNR despite Stryker’s desire for life-saving actions, and that her claims about his final wishes contradicted his daughter, friend and a psychiatrist.

“The ward had never previously expressed a desire to die, and it seems unlikely that, as soon as he was appointed a guardian, he would suddenly be unwilling to tolerate a condition that he had been dealing with for many years,” wrote Andrew Thurman, an auditor and investigator under the Okaloosa Clerk’s inspector general department, in the investigative report.

Fierle told investigators she filed a DNR on Stryker because it was “an issue of quality of life rather than quantity,” and said she regularly filed DNRs for her wards, Thurman wrote.

Investigators alleged in the report that Fierle’s decision amounted to “the removal of care necessary to maintain the ward’s physical health” and cited criminal statues.

“The removal of this necessary care directly resulted in the ward’s death,” Thurman wrote in the report. “Fla. Stat. states ‘A person who causes the death of any elderly person or disabled adult by culpable negligence ... commits aggravated manslaughter of an elderly person or disabled adult, a felony of the first degree.’”

Fierle is not currently facing any criminal charges.

Thorpe sought to remove Fierle from 95 Orange County cases after finding the guardian had “abused her powers” by requesting that incapacitated clients not receive medical treatment if their heart or breathing stopped, without permission from the court or the wards’ families.

State Elder Affairs Secretary Richard Prudom on Friday announced “immediate” changes to improve the agency’s response time for complaints, though his office has not yet given specifics. The news came hours after the Orlando Sentinel reported that a 2016 complaint against Fierle had sat ignored for more than two years.

Full Article & Source:
Judge releases confidential information to authorities investigating former Orlando guardian Rebecca Fierle

Why are more mentally ill people wandering SF streets? Report gives answers

by Heather Knight

Supervisor Rafael Mandelman listens during a board
meeting in San Francisco.
Photo: Santiago Mejia / The Chronicle
We see them every day — the lost souls wandering into traffic, ranting into the air or sleeping in their own waste. And we wonder why there seems to be so much more untreated mental illness on the streets of San Francisco these days, and why City Hall doesn’t seem to be doing much about it.

A new report from the Board of Supervisors’ Budget and Legislative Analyst gives some alarming answers, and here’s hoping it spurs action from the politicians who could make a difference.

The report examines conservatorship — compelling mentally ill people into treatment even if they’re too sick to realize they need help.

Despite the growing crisis on our streets, the number of conservatorship referrals in San Francisco plunged by almost 50% percent between 2012-13 and 2018-19. Per capita, San Francisco has a smaller conservatorship caseload than nearby counties including San Mateo, Marin, Alameda and Contra Costa — and a smaller per capita caseload than California as a whole.

Progressives may say that’s a good thing since conservatorship arguably takes away civil liberties. But in doing so, they’re fighting, in some cases, for people’s freedom to deteriorate and die on our streets.

And we actually have more people per capita on short-term holds lasting up to 30 days than other counties, perhaps signaling San Francisco is OK with whisking troublesome people off our sidewalks but unwilling to ensure they get the long-term treatment they need. That may also explain why seeing clearly mentally ill people stumbling around our sidewalks in hospital gowns and ID bracelets is sadly not uncommon.

Supervisor Rafael Mandelman requested the report and plans to hold a hearing on the subject this fall. He knows the heartache of watching a loved one fall into a mental health crisis. He was raised by a single mother who was diagnosed with bipolar disorder, schizoaffective disorder and borderline personality disorder.

She suffered psychotic episodes, spent days in bed, and was in and out of the hospital throughout his childhood. Mandelman had to find food for himself by age 9 and left her Laguna Beach home at age 11 to be raised in San Francisco by a string of extended family, foster parents, classmates’ parents and teachers. She died in 2017, and Mandelman, his half-brother and aunt plan to scatter her ashes next month in Big Sur.

Despite his progressive bona fides, Mandelman vehemently disagrees that it’s compassionate to prioritize a very sick person’s civil liberties over helping them get better.

“It’s completely inhumane,” he said. “If you have known a friend or a loved one and seen that person in psychosis and seen how far that psychotic individual is from their true self, you cannot believe keeping that person in that state is somehow honoring their autonomy.”

The report Mandelman commissioned looks at San Francisco’s response to the state’s Lanterman-Petris-Short conservatorship law. The law, which took effect 50 years ago, was intended to end the indefinite commitment of mentally ill people against their will, but some think the pendulum swung too far the other way because of the long, complicated legal process it created to obtain a conservatorship.

“From a civil rights perspective, it’s good, but in terms of what’s best for the patient, it’s not,” said Dr. Paul Linde, who used to work in the psychiatric emergency room at San Francisco General Hospital.

Under the law, people causing an immediate danger to themselves or others or who are gravely disabled and cannot secure their own food, clothing and shelter because of serious mental illness or chronic alcoholism can be compelled into treatment.

A homeless man sleeps on the sidewalk on Ellis and Jones in San Francisco,
an area known for its encampments of chronically homeless people.

Photo: Amy Osborne / Special to The Chronicle

Under a complicated process, an initial 72-hour hold can be extended for 14 days and 30 days and then become a temporary six-month conservatorship before becoming a renewable, one-year conservatorship.

There are many safeguards in the law. Conservatorship starts with a recommendation from a psychiatrist and involves an investigation by the city’s public conservator within its Human Services Agency and a hearing before a judge.

If the one-year conservatorship is approved, the Department of Public Health is tasked with coordinating the patient’s care including placing him or her in a facility, which can range from a locked hospital to an unlocked board and care home. The public conservator makes decisions on the patient’s behalf during the conservatorship.

It’s not clear if the law itself is the problem or rather San Francisco’s loose interpretation of it. The report describes how some counties have more tolerance than others when it comes to referring patients to conservatorship. Counties also have different takes on the term “gravely disabled” and just how dire someone’s mental health must be to meet that standard.

San Francisco has a low tolerance for conservatorship. Fewer than 1 person per 10,000 San Francisco residents is part of the county’s conservatorship caseload versus more than 5.5 people per 10,000 in San Mateo and more than 4 people per 10,000 in Marin.

San Francisco in 2017-18 referred 141 people for conservatorships, a big drop from 284 people in 2012-13. Its overall caseload has decreased by 13% in that time.

The report says that one reason conservatorship may be dropping is that there aren’t enough beds to treat those who are held. The number of acute inpatient psychiatric beds at San Francisco General Hospital dropped from 88 in 2008 to 44 in 2011 — and they haven’t been restored during the economic boom. The number of sub-acute mental health care beds fell by a third between 2012-13 and 2017-18 to 241 treatment spots.

Jeff Cretan, spokesman for Mayor London Breed, said the mayor has added funding for 212 additional beds throughout the city for patients with mental illness, drug addiction or both. All those additional beds will be open by next year.

“There are too many people suffering on our streets who cannot care for themselves, and we need to get them the care and services they need,” Cretan said.

Another problem the report found is that the public conservator’s staff has shrunk due to retirements and delays in hiring, meaning there are fewer people to handle ongoing cases. The under-staffed office isn’t coordinating well with the Department of Public Health. The two departments are only now starting to share data on patients and to set regular meetings to discuss patient progress. (I recently called City Hall “sloth-like.” Perhaps that was too generous.)

Jill Nielsen, a deputy director in the Human Services Agency who oversees the conservatorship program, said she appreciates the report’s recommendations — and that she’s working to increase the coordination among various departments and that last year the number of conservatorship referrals rose slightly.

Breed has added two new positions to the public conservator’s office to allow for an expanded caseload.

Part of those expanded services will help address those who are severely drug addicted and can now be conserved under a change in the state law initiated by State Sen. Scott Wiener.

Wiener said he is glad the politics around conservatorship are slowly shifting in San Francisco, as evidenced by the Board of Supervisors voting to opt into his expanded conservatorship law.

“For the large majority of people on our streets, conservatorship is not the right answer — there are other tools that will help them like voluntary services or a shorter psychiatric hold,” Wiener said. “But for a small percentage of people on our streets, they are in such severe crisis, they can benefit from a conservatorship.”

“Allowing someone to deteriorate and die on our streets, allowing someone to sleep in their feces, that’s not progressive, it’s not compassionate, it’s frankly the opposite,” Wiener continued. “We need to help these people.”

Full Article & Source:
Why are more mentally ill people wandering SF streets? Report gives answers

Wednesday, July 31, 2019

Gov't Appointed "Guardian" Forbids all Contact With Elderly Woman at Hospice, Treats Her Worse Than a Prisoner

A government-appointed “guardian” has prohibited 103-year-old Marian Leonard, who has no terminal illness and is being held at a hospice against her will, from seeing any visitors.

“We are outraged at the guardian's treatment of Mrs. Leonard,” said Life Legal Defense Foundation Executive Director (LLDF) Alexandra Snyder. “The guardian – a complete stranger to Marian – has forced this elderly woman to spend the rest of her days in complete isolation, with no one to oversee her care. Marian Leonard committed no crime, yet she has been stripped of her of her civil rights and is being treated worse than a prisoner.”

The letter from the guardian banning visitors also instructs the hospice detaining Leonard not to allow anyone to photograph her. LLDF previously released a photo showing Leonard before and after her confinement began.

“When Marian was first placed into the guardian’s custody, she could walk, was energetic, and was able to eat a regular diet,” LLDF previously reported. “Now, she is bedridden, lethargic, and suffers from bedsores.”

The guardian claims visitation, even from her concerned daughter, “is not in the best interest of Ms. Leonard.”

When the friends asked the nursing home staff whether this is legal, they were told the home and guardian could “do anything they wanted to” because Marian is a ward of the state, according to LLDF.

“We are very concerned that the facility may be directed by the guardian to withdraw care from Mrs. Leonard,” LLDF posted on Facebook.

Full Article and Source:
Gov't Appointed "Guardian" Forbids all Contact With Elderly Woman at Hospice - Treats Her Worse Than a Prisoner

Father-Son Attorneys Fight Over Family Trust With Claims of Dementia, Fraud

A prominent Miami attorney-philanthropist is fighting claims that he has dementia and is a vulnerable victim of financial fraud. The assertions come from his son, a former Bush administration general counsel and U.N. representative.

A state appeals court panel has rejected a bid by a lawyer for the medical records of his father, also a lawyer, in a fight over claims of dementia and financial fraud.

Mark Wallace subpoenaed the records of his father, Milton Wallace, to use in an as-yet-unfiled case to have his father declared incapacitated. But a probate court agreed with lawyers for Milton Wallace to protect the records.

Mark Wallace appealed, but a Third District panel in June split 2-1 to affirm the lower court order enjoining ex parte communications with a future examining committee to be named if Mark Wallace filed a petition for incapacity.

Todd Legon, Milton Wallace’s longtime law partner at Legon Ponce & Fodiman in Miami, said the decision was “an important victory for seniors in Florida because it prevents their constitutionally protected medical records from being used against them in legal proceedings.”

Legon flatly denied the claim that Milton Wallace has dementia.

Mark Wallace did not return a call for comment by deadline. His attorney, Brian Stack of Stack Fernandez & Harris in Miami, had no comment on the litigation.

At the appeals court, Judge Vance Salter dissented, saying the injunction was premature, unwarranted and amounted to “a prior restraint and ‘medical gag order.’ ”

He maintained Circuit Judge Mindy Glazer, who is hearing the trust case, lacked jurisdiction to issue an injunction affecting Mark Wallace’s contemplated guardianship case.

Judge Eric Hendon, writing for the majority, dismissed that concern in a footnote, saying a protective order allows “the guardianship judge to readdress matters in the order” if that case is filed.

Tuesday, July 30, 2019

A nursing home chain grows too fast and collapses, and elderly and disabled residents pay the price

Click to Watch Video
By Laura Strickler, Stephanie Gosk and Shelby Hanssen
NEW BEDFORD, Mass. — Once a week for two years, police Lt. Jeannine Pettiford had visited the nearby nursing home where her 52-year-old cousin with cerebral palsy lived. But on their daily phone call in early May, her cousin had bad news.

"I'm getting kicked out," he told her.

In disbelief, Pettiford asked to speak with a nurse, who told her there were rumors of closure. Her alarm rose when she visited the facility and saw nurses crying. The nursing home's owner, Skyline Healthcare, had told its staff there was no more money.

Skyline's four other nursing homes in Massachusetts were facing the same crisis. Funds were so short, staff had begun buying toilet paper with money from their own pockets, according to former employees. Residents and their families discovered from local newscasts they had just 30 days to find somewhere else to live.

"Nobody from the nursing home ever called me to tell me," Pettiford said. She was angry. And, she later learned, so were many others.

At its peak, Skyline Healthcare owned or ran more than 100 facilities in 11 states, overseeing the care of more than 7,000 elderly Americans. But during the past two years, the chain has collapsed, and more than a dozen Skyline-operated nursing homes have shut their doors, throwing residents, vendors, employees and state regulators into chaos.
Image: Terri Thompson
Terri ThompsonHannah Rappleye / NBC News
Many homes ran out of money. Others were shut down over neglect documented in government records. Fourteen homes were forced to close permanently, displacing more than 900 residents to new facilities, sometimes hours away.

The story of Joseph Schwartz and Skyline Healthcare is one of swift expansion, alleged mismanagement and catastrophic failure. An NBC News investigation reveals the scale of the Skyline debacle, in which one man built an empire that quickly crumbled, with painful consequences for vulnerable people.

It also shows the failure of state and federal authorities to keep up with just who owns and runs America's nursing home facilities, which house 1.3 million elderly and disabled Americans — about three-quarters of them in beds paid for by taxpayers via Medicare and Medicaid. The states are responsible for tracking ownership and conditions at nursing homes within their borders, but only the federal government can monitor the performance of firms that own or operate facilities across the nation. The allegations of negligence at a major nursing-home chain come as the Trump administration is moving to ease, not increase, accountability for the industry, reducing penalties and terminating fewer contracts with problem owners.

Schwartz, meanwhile, still has ownership stakes in 53 nursing homes, according to federal records. He has not returned multiple messages and emails requesting comment from NBC News.

"I just don't think I've ever seen anything like it," said Stephen Monroe, an industry analyst of three decades who is the managing editor for the nursing home trade magazine Senior Investor. "I have no idea what that family was thinking. To go from 10 to 100 in two years with no real back office? I looked at that and said from day one, 'Impossible."

'The Home Life You Crave'

A Brooklyn, N.Y.-based insurance broker and landlord, Joseph Schwartz entered the nursing home business more than 10 years ago after he sold a Florida-based insurance company.

In a 2017 deposition for a malpractice lawsuit filed by a family alleging neglect at one of his homes in Pennsylvania, Schwartz explained why he'd gotten into the industry. ""Basically, I used to do a lot of servicing in selling insurance policies to long-term care industry," he said, "and I felt that I could, that I understand the quality care … and I will do a very good job in doing the quality care for residents."
Image: Joseph Schwartz listed a tiny office above this New Jersey pizzeria in Wood Ridge, NJ as the location where he ran over 100 nursing homes nationwide.
Joseph Schwartz listed a tiny office above this New Jersey pizzeria in Wood Ridge, New Jersey, as the location where he ran over 100 nursing homes nationwide.NBC News
He started with a half dozen homes, but after creating Skyline Healthcare he began expanding rapidly in November 2015 with the purchase of 17 homes.

Schwartz ran Skyline out of a tiny office above a New Jersey pizzeria. He was CEO, his wife Rosie co-owned most of the properties and his two sons, Michael and Louis, served as vice presidents. The company had a bare-bones website and a slogan, "Skyline: The Home Life You Crave."

During the 2017 deposition, he said, "Skyline is an entity that is me."

His net worth is hard to compute but real estate records show he owns over $9 million worth of real estate in the New York metropolitan area, including a gated house in Suffern, N.Y.

Within a year of his purchase of 17 nursing homes, Schwartz had taken on another 64, and by 2017 was operating more than 100.

Schwartz wouldn't provide a number when the plaintiff's attorney asked him repeatedly in June 2017 how many homes he ran. He confirmed it was more than five, but asked if it was more than 100, he said several times that he couldn't recall.
Image: Joseph Schwartz speaking to lawyers during a sworn deposition in June 2017 for a neglect case he settled.  He told the lawyers, "All our facilities are very, very, very , very compliant with all clients.  They all have every program that's necessar
Joseph Schwartz speaking to lawyers during a sworn deposition in June 2017 for a neglect case he settled. He told the lawyers, "All our facilities are very, very, very, very compliant with all clients. They all have every program that's necessary for patient care."Ace Reporters
With more than 100 facilities, experts estimate Schwartz would have been juggling a few hundred million dollars a year in taxpayer money from Medicare and Medicaid.

But problems had emerged quickly. Within six months of Skyline's entry into the Arkansas market in 2015, the state's attorney general was investigating reports of neglect in Skyline facilities.

Marcela Watkins, who visited her mother daily in Spring Place Health and Rehab in Little Rock, said the food went downhill once Skyline took over. She recalled staff serving raw vegetables and boxed pizza to elderly patients.

"It's a money-making business," she said. "And guess who doesn't get the care? Our loved ones."

Karen Coats's 57-year-old brother Donny Owens fell at another Skyline Arkansas facility in 2017, heavily bruising his face. She said he laid on the floor for 45 minutes before staff found him.

Coats said staffing was a "revolving door" and that she frequently complained, though little changed.

The state attorney general later issued Skyline facilities more than $200,000 in civil fines for neglect, preventable falls, failure to bathe residents and maggots in a resident's personal medical equipment.

In Massachusetts, staff say the Schwartz sons visited the properties before taking over, promising new resources. But cuts started within a year.

Certified nursing assistants were reduced from five to three, according to ex-employees. Staff were told that disposable briefs would be rationed to two per patient per shift, instead of as needed, meaning patients were left to languish in their own body waste. One former head of nursing told NBC News that management offered giveaways to smooth over the changes.

She said she told them, "I don't want a [free barbecue] grill, I want to save the staff I have on the floor."

As problems mounted, Skyline continued to expand. In 2017, it entered South Dakota.

Schwartz reportedly leased at least half of the homes he operated around the nation from Georgia-based Golden LivingCenters, according to local news reports and property records, which acted as Schwartz's landlord.

Last year Skyline released a statement to a South Dakota reporter blaming Golden for problems in its South Dakota nursing homes. Skyline said the chain was "dedicated to providing quality care" and meeting its obligations, but that Golden had caused the issues.

Monroe, the analyst, said landlords like Golden hold some responsibility. "How did they not do their due diligence to [vet Skyline]? That is a mystery."

A spokesperson for Golden LivingCenters conceded the company contracted with Schwartz to run 17 homes in South Dakota but would not comment on other states. The spokesperson also declined to answer if the company vetted Schwartz, saying, "He convinced a lot of people in a lot of states. He ran a big scam."

By September 2017, Skyline had taken over Ashton Place, a nursing home in Memphis, Tenn. Less than two months later, a resident with a recent leg amputation was taken from the nursing home, where he was found lying in feces, to a hospital, where nurses discovered maggots and gangrene in his leg, according to the police report obtained by local NBC affiliate WMC. His death two days later prompted a state investigation, which revealed the man had not had his dressing changed for two days. Staff said problems arose in part when Skyline told nurses to abandon electronic medical records and go back to paper record keeping.
Image: The Ashton Place Rehabilitation and Care Center in Tennessee.
The Ashton Place Rehabilitation and Care Center in Tennessee.NBC News
During the investigation, the company's medical director told inspectors, "I have no support, no direction."

A spokesperson for the state agency that approved Schwartz's takeover of Ashton Place said while Skyline had faced problems in other states, that did not disqualify it from operating the Memphis nursing home.

A month after the death, the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the nursing home industry, terminated Medicare certification for the facility and another Skyline property in Tennessee. It terminated a third in the state in 2018.

According to a CMS spokesperson, "Each individual facility is separately certified and held accountable for compliance with CMS minimum health and safety standards." The spokesperson adds that "CMS has limited authority to intervene when a facility is struggling financially.


The government, and taxpayers, were paying for Skyline's rise.

Industry analysts say nursing homes are on the decline as other options, like assisted living, emerge. The number of residents has fallen from an estimated 1.5 million in 2010 to 1.3 million in 2015. But they also say a "silver tsunami" of baby boomers in their 80's may be on the horizon.

For the time being, residents in nursing homes are likely to be poor, vulnerable and on Medicaid, which is paid for by federal taxes.

But despite being subsidized by the government, as he took over more homes, Joseph Schwartz was racking up debts.

Former staff at Skyline nursing homes say Schwartz would bring in a vendor, let the bills stack up, then find another vendor and do the same thing again.

During the June 2017 deposition for a lawsuit alleging neglect at a Schwartz-owned facility in Pennsylvania between 2012 and 2014, which he later settled, plaintiff's attorneys asked about unpaid bills and bounced checks. Schwartz insisted that he paid "everybody." But he also said there could be reasons for not paying contractors, including unfinished work. "Because a guy sends a bill in doesn't mean he needs to get paid," said Schwartz.

With residents running out of food, several states began to take extraordinary measures. Starting in March 2018, Nebraska and then Pennsylvania assumed control of some Skyline facilities and assigned third parties to run them.

South Dakota was next. In April 2018, Debbie Menzenberg, a local Skyline administrator, sent a panicked email to the state agency responsible for nursing homes, claiming Schwartz's son was telling her the company had no money.
Image: Donny Owens, a resident at a Skyline nursing home in Hazen, Arkansas, fell and bruised his face.  According to his sister Karen Coats, Owens called for staff for 45 minutes before they came to help him.
Donny Owens, a resident at a Skyline nursing home in Hazen, Arkansas, fell and bruised his face. According to his sister Karen Coats, Owens called for staff for 45 minutes before they came to help him.Karen Coats
"I just had a call from Louis Schwartz," she wrote in the email, which was later produced in court, "there is no money — he told me to discharge residents????" Later she wrote, "I need water paid at Bella Vista and Prairie Hills today or it will be SHUT OFF – Skyline is SILENT!!!"

During the 2017 deposition, Schwartz repeatedly defended the quality of care at his nursing homes, saying he tried very hard to do "whatever is needed" for residents, but seemed reluctant to talk about what he was doing with money from the homes.

The attorney for the plaintiff pressed Schwartz on whether he took cash from the facilities. He said he did, but his lawyers objected to questions about how often he took money and whether he made the decision. Schwartz then said he would take the money as needed, and would listen to the recommendation of his CFO, but would ultimately make the decision himself.

The plaintiff's attorney then asked Schwartz how much money he took out of the Pennsylvania home where the neglect was alleged.

"Those draws, for example ... they could amount to over a million dollars over the course of a year?"
"Could be," answered Schwartz.

"Now, when you're taking out draws," asked the lawyer, "that does take away from some of the cash on hand at the facility to operate?"

"I don't think so," said Schwartz.

Who is responsible?

Advocates and analysts are still wondering how Schwartz's empire was allowed to grow so large so quickly, without any state or federal authorities appearing to sound an alarm bell.

The nursing home industry is turbulent, with frequent ownership changes — one of the homes Schwartz took over in Arkansas had five owners in just six years.

While states are largely responsible for determining if a new owner is financially suitable, the process varies dramatically state by state. In Arkansas the process doesn't even require the new owner to submit financial statements.

The federal regulator, CMS, is the only oversight agency with a birds-eye view. Each time a nursing home anywhere in the country changes hands, the company has to submit a form to CMS, a regulation introduced as part of Obamacare.

A CMS spokesperson, however, told NBC News that the agency is not responsible for assessing an owner's finances, "CMS authority over nursing homes relates to compliance with health and safety requirements, not their well-being."

But CMS staff can review ownership patterns, said Alice Bonner, who served as the director of the division of nursing homes for CMS during the Obama administration.

"We would have conversations about the change in ownership," she said. "We picked up on things like that."

The Trump administration has taken a different approach to oversight. While extreme instances of neglect at Skyline facilities were stacking up, the administration was reducing fines for troubled nursing homes.

In early 2017, the nursing home industry's trade group sent President Donald Trump a congratulations on his election victory and asked for a series of regulatory changes. One request was a reduction in fines.

Six months later, the administration began implementing a rollback in nursing home fines. Regulators are now encouraged to use one time fines instead of daily fines. That's led to a 34 percent drop in overall penalties for problematic nursing homes between 2017 and 2018.

CMS says the change was to make punishment "fairer, more consistent and better tailored to prod nursing homes to improve care."

David C. Grabowski, a professor of health care policy at Harvard Medical School, disagrees. "For those more serious deficiencies it's important to hold them accountable rather than a one-time fine," he said. "The idea that a $10,000 fine will change their behavior, I don't believe that."

A CMS spokesperson told NBC the agency "is committed to protecting nursing home residents to the fullest extent within the agency's legal authority to set and enforce safety and quality standards."

The number of nursing home contracts terminated by CMS has also declined. Between 2014 and 2017 the agency stopped payments to 14-18 homes annually. In 2018, that number dropped to just three. There have been four terminations so far this year.

CMS says the drop in terminations is not the result of a policy change.

Toby Edelman is the senior policy attorney at the Center for Medicare Advocacy, a non-profit that works to improved access to health care for the elderly and disabled. Edelman says the collapse of Skyline is a warning. "We need to have very strict rules about who's eligible to operate a facility, what the standards are, what their financial backgrounds are," said Edelman. "And if the facility did a bad job in one place, it's not likely to do a good job in another facility. Why do we want to give them more?"

The Aftermath

Today, Schwartz is busy fighting more than a dozen lawsuits from residents' families alleging neglect and claiming he siphoned money out of the nursing homes. His lawyers have denied those allegations in court.

His office above the pizzeria is shut down. Litigants in these cases have spent tens of thousands of dollars attempting to serve him at his Suffern address, but he's rarely home.

Nurses have had to find other jobs. In late June the Massachusetts AG fined Schwartz nearly $85,000 for withholding pay from employees.
Image: Former Skyline facility in Massachusetts, Bedford Village Nursing Home, that was shut down by the state displacing over 60 residents.
Bedford Village Nursing Home, a former Skyline facility in Massachusetts was shut down by the state, displacing over 60 residents.NBC News
Yet the Skyline saga is not over. Last year a Skyline spokesperson told reporters the company "had been working to transition out of the nursing home industry" but a CMS spokesperson confirmed the family retains an ownership stake in more than 50 homes.

In New Jersey a home once owned by Skyline but now owned by a separate company run by Joseph Schwartz's son, Louis, is facing accusations of neglect.

Louis Schwartz did not respond to requests for comment about the facility, which is called Andover Subacute Care II.

In January, the facility was cited by the state for endangering residents after a woman with dementia wandered out of a locked unit through two sets of broken automatic doors. She was found in the parking lot at 4:30 a.m., sitting on ice-covered ground without a coat, socks or shoes. It was four degrees below zero, according to a police report, and she suffered from "severe frostbite."

Her daughter, Terri Thompson, said when she reached her mother's hospital bed that morning, she could barely hear a heartbeat. Her mother's nails, which she used to love to paint, have fallen off, as has much of the skin on her arms and legs from the frostbite.

"I never, ever imagined I would be betrayed like this," Thompson said. "They didn't even look for her. Someone else saw a woman lying in the snow, and it was my mom."

Full Article & Source:
A nursing home chain grows too fast and collapses, and elderly and disabled residents pay the price