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
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. (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.
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.
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 arcofmc.org or call 315-363-3389.
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.
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.
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.
DETROIT (FOX 2) - 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.
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 probeinto 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.
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.”
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.
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.
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.
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.
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."
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."
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.
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.
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.
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?"
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?"
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.
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."
