Sons seek guardianship of sitting appeals judge said to have received Alzheimer's diagnosis

The sons of a judge on Texas’ First Court of Appeals claim in a guardianship petition that she received a diagnosis of Alzheimer’s disease in October.

Justice Laura Carter Higley continues to drive to the court in Houston each day though she can’t do her job or manage her personal and financial affairs, the sons allege in a petition covered by the Houston Chronicle. She will turn 73 on Nov. 27.

The sons say Higley was diagnosed with a mild neurocognitive disorder in November 2017 and with a mild neurocognitive disorder due to possible Alzheimer’s disease in March 2019. On Oct. 9, she was diagnosed with a major neurocognitive disorder due to Alzheimer’s.

The sons say they believe Higley is “in the moment” only, meaning she can carry on brief conversations but can’t engage in substantive, analytical or detailed conversations with others. She struggles to remember information communicated to her and can’t remember individuals she spoke with the previous day or what topics they discussed, the sons allege.

According to the sons, Higley struggles to locate familiar locations when driving, including the appeals court.

The sons say Higley has given a power of attorney to her husband, but there are concerns he could financially exploit Higley. The sons say he has encouraged Higley not to retire or resign.
Higley has an $8 million estate, the sons say.

According to the Houston Chronicle, Higley’s name is not listed next to any decisions made by the appeals court since her October diagnosis. But she has been involved in hundreds of decisions since the March diagnosis of a mild cognitive disorder due to possible Alzheimer’s.

The Texas Constitution permits removal of a judge if that person has a disability that interferes with his or her duties, and it is or is likely to become permanent in nature.

The Houston Chronicle spoke with Lillian Hardwick, a Texas attorney who wrote the Handbook of Texas Lawyer and Judicial Ethics. She said a judge may fear leaving the bench too early because of an illness.

A judge might have trouble remembering some things, but “by golly, she can tell you the family law code backwards and forwards,” Hardwick said. In that case, the judge may feel it’s not necessary to retire.

Higley’s husband declined to comment when reached by the Houston Chronicle. Higley did not respond to the Houston Chronicle’s messages.

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Sons seek guardianship of sitting appeals judge said to have received Alzheimer's diagnosis

AdventHealth to turn over more records regarding relationship with ex-guardian Rebecca Fierle

By Monivette Cordeiro

Rebecca Fierle improperly billed AdventHealth nearly $4 million over a decade for services she provided to their patients, according to an investigation.
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AdventHealth will turn over more records regarding its financial relationship with Rebecca Fierle, the former Orlando guardian who was paid nearly $4 million by the hospital company over a decade to provide services to vulnerable patients, according to its attorney.

At a Thursday hearing in the Orange County Courthouse, AdventHealth attorney Chuck Ingram said the hospital system agreed to produce emails between Fierle or her employees at Geriatric Management and certain hospital employees regarding the care of two incapacitated patients.

The patients were Fierle’s wards until she resigned as a guardian after one of her clients, 75-year-old Steven Stryker, died at a Tampa hospital. Staff were unable to perform life-saving measures due to a “do not resuscitate” order she filed against Stryker’s wishes and refused to remove.

David A. Yergey III, a lawyer representing the two patients’ new guardian, asked Circuit Judge Janet C. Thorpe to compel AdventHealth and Fierle to produce documents regarding their multimillion-dollar relationship, which industry experts have described as virtually unheard of.

An investigation by the office of Orange County Comptroller Phil Diamond found AdventHealth paid the embattled guardian at least $3.7 million over a decade for services she provided to 682 patients.

Close to a third of those patients were placed under guardianship, but for the majority, Fierle acted as a durable power of attorney, health care surrogate or health care proxy without court oversight and under questionable legal authority, the comptroller’s review found.

Third-party financial arrangements like the one between the guardian and AdventHealth are not allowed under Florida law without court approval. A second probe also found Fierle was profiting from her work by billing an Altamonte Springs assisted living facility almost $100,000 to handle the affairs of their vulnerable patients while pocketing refunds the facility issued to her incapacitated clients.

Thorpe previously ordered the hospital company to produce a trove of billings from Fierle’s companies, and Ingram said at the hearing AdventHealth would voluntarily provide Yergey with all invoices related to the two incapacitated patients whose new guardian he represents.

Fierle is under criminal investigation, but she is not currently facing any charges.

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AdventHealth to turn over more records regarding relationship with ex-guardian Rebecca Fierle

Retirement home had bad bed bugs. It’s closing, but could residents wind up somewhere worse?

The Fort Lauderdale Retirement Home had 81 beds for people living with mental illnesses; it is closing this month. The relocation process for residents highlights gaps in monitoring of assisted living facilities. Jack Brook

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The Fort Lauderdale Retirement Home had a cozy name, but if state records are any indication, it was not a place for people to live out their golden years in comfort. The dingy facility, scheduled to shut down on Friday, has been plagued by a host of problems since the early 1980s, most recently facing ongoing scrutiny by the Florida Department of Health for a severe bed bug infestation.

But it’s not Florida regulators who decided to close the assisted living facility, home to 80 or more residents, many with mental health or past drug problems.

Instead, longtime owners and operators Rick and Jacqueline Heath are quietly giving up their license in a government-supported industry long troubled by inadequate budgets, sketchy operators and lax oversight. As South Florida ALFs go, the inspection record for the facility just south of downtown Fort Lauderdale wasn’t all that unusual, and it also served clients whose health issues can make them challenging to care for and place.

Rick Heath would not discuss details behind the closure, saying in a brief interview outside the building that he and his wife had managed the place for several decades and now were ready to retire to their ranch near Lake Okeechobee.

The future home for many residents was less clear, which is common in a strained state mental health care system that critics say perpetually struggles to meet rising costs and demands.

“Facilities will just kind of send people out and that is inappropriate,” said Eric Carlson, directing attorney for Justice in Aging, a senior advocacy organization. “You are deciding where you live. It is a big deal. And that should be based on what the person wants, not on what is most convenient for the professionals and facility people who are involved in this process.”

Earlier this month, several of the residents, who did not want to give their names, said they were confused and worried about where they might wind up. On one day, one elderly woman sat on the lobby stairs, chin resting in her hands, her possessions stuffed in four black trash bags by the front door as other residents shambled about with their own bags and boxes.

“Where are you sending me?” she asked. A woman who appeared to be a staffer from another ALF told her she would be going to a place she would enjoy. The elderly woman dragged her garbage sacks to a car outside and sat waiting. Other residents — who could frequently be found walking the streets surrounding the ALF — expressed similar concerns.

“I’m glad I’m leaving here,” said one. “But I’m not happy about where I’m going.”

Residents had learned they’d be losing their home in an abrupt manner. In late September, the owners handed out “Dear Resident” letters, citing a lease expiring on Nov. 1 and telling residents to seek help from state case managers or their insurance companies in finding new homes. The letter, provided to the Herald, added, “This facility is in no way responsible to assist in relocation.”

That last statement was wrong, according to Florida’s Agency for Health Care Administration, which oversees ALFs.

“As required by their licensure with the agency, the assisted living facility is responsible for relocating residents and must work with the residents or their representatives to ensure a safe relocation,” AHCA spokesman Patrick Manderfield said in an email statement to the Herald.

A written notice allegedly distributed to residents stating that the assisted living facility “is in no way responsible to assist in relocation.” According to an Agency for Health Care Administration spokesperson, assisted living facilities are required to help residents relocate.

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Manderfield said that other agencies, such as the Department of Children and Families and the Department of Elderly Affairs’ Long-Term Care Ombudsman’s office, would work with residents to inform them of their rights and assist them in relocation if needed. State law also requires facilities to notify residents or their “next of kin, legal representative, or agency acting on each resident’s behalf” of impending closures, he said.

Manderfield said AHCA had been properly notified by owners about the closure, but that more than a week after the ALF handed out its notice to residents, word had not reached a key state monitor tasked with protecting residents’ rights. Broward’s district ombudsman manager, Gloria Freyre, said she was not aware of the facilities closing until contacted by a Herald reporter early this month.

“I haven’t heard any residents calling,” Freyre said. “That’s usually how we know.”

Brian Lee, executive director of Families for Better Care, an advocacy group for elders in nursing homes and ALFs, said that’s a gap in oversight rules. He believes facilities should be obligated to notify the ombudsman, who can ensure residents’ rights are protected while they seek a new home but right now there is technically not a legal requirement to do so.

“They (the ombudsman) are paid for by taxpayers to fulfill that role as an advocate,” said Lee, a former long-term care ombudsman. “That’s their job. Too many facilities just kind of run roughshod over residents and their rights.”

Another agency, the Broward Behavioral Health Coalition, was also “supporting these customers throughout the relocation process to ensure their needs are met and they can maintain stability in the community,” said DaMonica Smith, a DCF spokeswoman, in an emailed statement.

Despite the initial uncertainty, the retirement home emptied out over the month. The ring of chairs outside the two-story home’s entrance, normally a popular gathering spot for residents to talk or smoke, was almost empty, with only one woman sitting there late last week. She said she did not want to speak to a reporter. By Monday, DCF and AHCA both reported that no residents remained there.

Whether they wound up somewhere better is another question. Medical and mental health privacy laws make it impossible for outside advocates to track where residents wind up or what options they might have. But it can be difficult for residents or their families to research choices on their own.

AHCA, for instance, told the Herald that it does not maintain information on vacancies in the facilities that it regulates. Yet early this month, the agency’s website showed just three facilities in Broward licensed to care for people with mental illnesses that had any beds available — a total of 79 openings. But the Fort Lauderdale Retirement Home, and an adjacent annex, had 109 beds — meaning some displaced residents might face relocation to another county.

“The choice is going to be limited,” said Lee, the elderly care advocate. “They are probably going to be shuttled out to other counties to get the services they need. And they are not going to be able to have the selection of quality.”

AHCA’s website, FloridaHealthFinder.gov, indicated little room in the 745 facilities statewide with limited mental health licenses. Overall, there were approximately 639 beds available out of 12,217 total — about a 5 percent vacancy rate. However, about half of those beds were available in just five facilities. Data on the state site was incomplete, however, with 107 facilities not listing occupancy rates.

Most of the beds in Broward County were available in Grand Court, a facility in Pompano Beach with a sordid past. An AHCA inspection cited numerous deficiencies earlier this year. The facility was found to be understaffed with unqualified workers improperly distributing medication and keeping “unclear and inconsistent” medical records. The staff allegedly put the wrong clothes on residents and one woman had her bra “put on twisted and so tight to where the skin turned red.” There were complaints from female residents of harassment by male residents, also about scant activities and bad food. At least one resident died from neglect in 2005.

After the Herald asked about vacancies at places that might take in the retirement home’s residents, the previously available occupancy on AHCA’s website vanished.

Grand Court is one of three assisted living facilities with a limited mental health specialty license — allowing it to house residents with mental illnesses — that shows beds available in Broward County, according to FloridaHealthFinder.gov. This year, the facility received numerous citations for its conditions and treatment of residents. After an inquiry from the Herald early this month, the Agency for Health Care Administration removed information on bed availability from FloridaHealthFinder.gov.

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AHCA communications director Mallory McManus said the information should not have been publicly available in the first place, calling it a “technical glitch.” McManus said “it would be incorrect to report the occupancy data.”

She added: “While the agency does not routinely track available beds, our agency is focused on ensuring that residents who have decided to reside in an assisted living facility with a limited mental health license have access to a safe and clean environment, and that their health and well-being are monitored.”

AHCA’s own inspection reports and citations show that the Fort Lauderdale Retirement Home did not always live up to those standards.

Years of reports exposed persistent problems: The facility failed to ensure that residents were receiving their scheduled medications, did not keep proper medical records and potentially falsified documentation, according to inspection reports. It was staffed with untrained employees and lacked proper food, among other citations.

The living conditions also were subpar, according to the reports. Paint peeled and plaster flaked on the walls, mold-like black stains formed on air conditioning vents, and there was a “foul odor that exists in and throughout the facility.”

Bed bug droppings covered mattresses, stained linens, encrusted walls and windows, and one of the insects was observed crawling up the leg of a resident, a report from this year stated. Employees of a pest control company working to eradicate the infestation called it “the worst ever seen” in all of their years of work. The facility had been under review from the Department of Health and had failed to resolve the agency’s concerns, records show.

In communication with AHCA and in the note to residents, the Heaths cited an expiring lease as the reason for closing the ALF.

But records show the Heaths own the corporation that holds the lease and the property. Jacqueline Heath leased the properties to 2065 INC., a corporation in which she and her husband were joint shareholders. The nearby annex also previously had a for sale sign, which was removed sometime this month, and was for a time listed as being sale for $799,000 on the website of the commercial real estate firm The Fitzgerald Group — that’s almost twice its appraised value, according to Broward County records.

The area surrounding the home, near the busy corner of U.S. 1 and Davie Boulevard, has seen increasing redevelopment. Over the last decades, aging structures like the retirement home, once a two-story apartment building now painted the color of pea soup, have been razed and replaced with new legal and medical offices. More upscale townhouses are also going up not far away.

Rick Heath said he doubts the property will sell anytime soon and had been taken off the market. He declined to answer further questions and threatened to call police on a visiting reporter.

At least one former resident, a man in his late 50s named Jessie, told the Herald by phone he had been recently relocated to a new facility in Dania Beach, though he did not know its name. He asked a nurse, who told him she did not know either. Jessie said he was happy with the new place, particularly the cuisine.

“They said they had real food here,” Jessie said. “I wouldn’t eat it at the other place. It was disgusting.”

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Retirement home had bad bed bugs. It’s closing, but could residents wind up somewhere worse?

First Court of Appeals justice in Houston serving with Alzheimer’s disease, records show

1910 Harris County Courthouse, photographed Wednesday, July 24, 2019, in Houston.

by Samantha Ketterer

An appeals court justice serving Southeast Texas continues to sit on the bench as she suffers from Alzheimer’s disease, all while facing familial discord over the control of her $8 million estate, court records show.

Her sons launched an effort this month to become her legal guardians, alleging that Justice Laura Carter Higley, 72, is continuing with her daily routine in a manner contrary to the path of her failing cognitive health. That includes driving herself to work downtown and serving in her capacity on the First Court of Appeals based in Houston, said sons Garrett C. Higley and Robert Carter Higley.

“Due to the recent (and rapid) progression of her Alzheimer’s disease, Justice Higley’s mental state has deteriorated to the point that she is no longer able to care for her own physical health or manage her own financial affairs,” the Higley brothers said in the filing for guardianship.

Laura Carter Higley became the subject of the guardianship case in mid-October, just a week after receiving an official diagnosis of Alzheimer’s disease, according to documents filed in Harris County Probate Court No. 2. Her wellness issues began more than a year earlier with a diagnosis of an unspecified mild neurocognitive disorder, the sons said in their attempt to pull decisions regarding Higley’s care away from her husband, West University Place Mayor Bob Higley.

Several calls to the judge’s office were not returned Tuesday, and on Wednesday, the court’s receptionist said that Higley was unavailable. When questioned why, she clarified that she works in a “big building” and hadn’t actually seen the justice. She confirmed that Higley was receiving the Houston Chronicle’s messages, however.

The court’s chief justice, Sherry Radack, declined to confirm Higley’s mental state, or whether she and the other justices on the bench were aware of the situation.

“You know I can’t comment on that,” Radack said.

It’s unknown whether Higley has been on the receiving end of any official complaints. Those would be brought to the State Commission on Judicial Conduct, the oversight group for judges, interim executive director Jacqueline Habersham said.

But under the Texas Constitution, a judge can be removed from office because of a disability that interferes with their duties, which is or is likely to become permanent in nature.

Alzheimer’s disease is a form of dementia that is progressive in nature, meaning it can begin with mild memory loss and become more severe, possibly causing the person to lose the ability to respond to their environment, according to the Centers for Disease Control and Prevention. It can affect the ability to complete daily activities, the agency said, and there is no known cure.

Through the guardianship filing, the Higley sons referenced previous efforts to have the justice removed from her post, but it is unclear whether those efforts come from family members, coworkers or elsewhere. The brothers’ attorneys did not return several requests for comment.

The sons called Laura Higley’s condition “in the moment” only, meaning she can carry on brief conversations with people but can’t engage in anything substantive. She struggles to remember information relayed to her or people she spoke with just a day before, according to the court filing.

Higley can’t do her job or manage her personal and financial affairs without complete assistance and supervision, meaning she’s a legally “incapacitated” person, the sons said.

The justice, a Republican, has held Place 5 on the state’s First Court of Appeals since 2002. She was re-elected in 2008 and 2014, and her term ends December 2020.

Prior to being a judge, she was an attorney at Baker Botts, L.L.P., and before that, the mayor of West University Place.

The judge began experiencing mild neurocognitive issues as early as November 2017, according to her sons’ filing. The unspecified disorder progressed to a mild neurocognitive disorder stemming from possible Alzheimer’s disease in March, which again worsened to a diagnosis of Alzheimer’s disease on Oct. 9, court records show.

The justice’s name is not listed next to any decisions made on appeals cases since her diagnosis earlier this month, according to the First Court of Appeals website. But she has been involved in hundreds of decisions on civil and criminal cases since March.

Higley is one of nine justices on the court, which serves Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Grimes, Harris, Waller and Washington counties. The judges mostly hear appeals on cases decided in lower district and county courts in their jurisdiction.

Lillian Hardwick, a Texas attorney who wrote the “Handbook of Texas Lawyer and Judicial Ethics,” said that judges may be fearful of leaving their bench too early while facing an illness. They might enjoy the work, be hesitant to cut off retirement benefits or may not know the scope of their problem.

On the other hand, a justice might feel they’re having issues remembering certain things at home, but “by golly, she can tell you the family law code backwards and forwards,” Hardwick said. Only in the event their disability impedes the ability to perform their duties would they be violating constitutional requirements.

“They should either be retired by somebody or they should be removed,” she said. “That judge is not able to be a judge, it’s pretty simple.”

The justice’s colleagues might be in the best position to notify the commission of a potential unfitness for office, said Jonathan Smaby, the executive director at the Texas Center for Legal Ethics.

The Texas Code of Judicial Conduct requires judges to be competent and diligent, he said, although the justice might not be aware of their own lack of competence.

“It’s not always obvious to the person when they’re suffering from age-related decline,” Smaby said. “To say it’s an ethics violation makes it sound like it’s intentional.”

The state commission has the ability to launch investigations into justices after receiving notifications of misconduct or disability that interferes with the performance of their duties, according to state procedural rules for the removal or retirement of judges.

That person could then be put through a formal process which could result in the commission’s recommendation for removal or retirement, or a publicly ordered censure, reprimand, warning or admonition, the rules state. After, the commission could ask a tribunal appointed through the Texas Supreme Court to make the final order.

 

Sons vs. father

In seeking to be their mother’s guardian, the brothers additionally aim to wrest decision-making powers away from their father, the mayor, according to the probate court documents.

Bob and Laura Carter Higley are still married and live together. Their sons voiced concerns, however, that their father would financially exploit and abuse their mother as he serves as her attorney-in-fact.

“Bob Higley has acted as a malevolent enabler in that he has encouraged Justice Higley not to resign or retire from serving as Justice in the First Court of Appeals and has personally opposed efforts to have Justice Higley removed.”

Bob Higley declined to speak on the allegations when reached at his office, and his attorney did not return a request for comment.

The justice made her husband her power of attorney and medical power of attorney in March.

Her eldest son, Garrett, 45, of Austin, wants to care for her instead. The younger son, 40-year-old Robert, of Jackson, Wyoming, seeks to manage her estate, which surpasses an estimated $8 million.

Already, the two feel their father’s actions to date have been “inconsistent” with their mother’s best interest and wishes, they claim, saying that his conduct has “exacerbated the present situation.”

Bob Higley encourages and allows his wife to drive herself from their West University home to the downtown courthouse, despite how she is becoming increasingly disoriented and lost while driving alone, the sons alleged in the court documents. In the late summer this year, the mayor had his sister take his wife to get her driver’s license renewed, Garrett and Robert said, even though a doctor had told the justice and her husband that she should refrain from driving.

Some of Bob Higley’s decisions are worrisome to Laura Higley’s well-being, their sons say.

“Justice Higley’s personal and financial safety are paramount, as is the protection of her reputation and preservation of her legacy as an appellate justice,” the brothers said. “Bob Higley refuses to acknowledge that Justice Higley’s recent, abnormal behavior endangers both herself and others, and Bob Higley has ignored clear indicators and explicit warnings that Justice Higley is no longer capable of serving as a Justice on the First Court of Appeals and/or managing her own personal and financial affairs.”

A probate court hearing is scheduled for 10 a.m. Monday in the guardianship case.

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First Court of Appeals justice in Houston serving with Alzheimer’s disease, records show

PG&E blackout: Elderly and disabled residents, including original Rosie the Riveter, left in dark for days

FAIRFAX, Calif. - Nearly 60 senior citizens - including 98-year-old Rosie Gould, an original Rosie the Riveter during World War II - say they have been left in the dark and without a working elevator or generator for at least four days because of the Pacific Gas & Electric power shutoff and neglectful management.

"It's dangerous for one thing," said Gould, who was one of the first female welders at the Kaiser shipyard in 1942 and a current docent at the Rosie the Rivert/World War II Home Front National Historical Park in Richmond. "Not all people have flashlights."

Although she has been through a lot in her life, she said the blackout that started last Saturday has been especially difficult.

"It's been hard mentally," Gould said. "I just broke down yesterday. I couldn't stop crying."

Seniors at the Bennett House in Fairfax have to use headlamps because of the PG&E power shutoff. Oct. 29, 2019

She and her fellow seniors live at the Bennett House in Fairfax, a three-story apartment building for low-income and disabled seniors run by Mercy Housing.

The residents say there's no manager or worker living on site. They say they've asked management for a generator before the outages began, but haven't received one. No one from Mercy called back on Tuesday night or Wednesday morning seeking comment.

PG&E spokeswoman Deanna Contreras on Wednesday morning said that Fairfax, along with Mill Valley and Woodacre, are areas still without power. In all, 10,000 customers in Marin County are in the dark, down from Saturday's peak of 118,000 customers.

"We are patrolling and inspecting lines, circuit by circuit," Contreras said. "We don't have an estimated time, but we hope it will be sooner rather than later."

PG&E has been shutting off power throughout Northern California to prevent their equipment from toppling in the high winds and sparking more wildfires. Marin County, where Gould lives, has been hit hard by the blackouts.

Gould reached out to KTVU on Tuesday afternoon in a near panic. She said she and her neighbors have been living without hot water, lights and the service of an elevator. She said residents who use wheelchairs have been unable to get downstairs or go outside. Many have gone without a cooked meal for days. They say they are angry and scared.

"I've been oxygen dependent," said Georgina Raynor, who lives on the third floor and has been confined to her bed.  "I have to rely on tanks being delivered with the power shutoff. Very frightening."

Down the darkened hallway, which had no emergency lighting set up, Charles Mason, 78, said he was down to two candles.

"What do I do after that?" he asked.

He said he received two texts in the last two days that power would be restored, and yet, he remained in the cold and dark.

"Nothing's happened," he said. "Who's responsible?"

Phyllis Gould, 98, an original Rosie the Riveter, has been living in the dark in Fairfax, Calif. since Saturday. Oct. 29, 2019

"I've been oxygen dependent. I have to rely on tanks being delivered with the power shutoff. It's, very frightening and scary," said Georgina Raynor who lives on the third floor. Oct. 29, 2019

Vicky Carruthers, 75, gave KTVU a tour of the building, using a headlamp to show the crew around in the dark.

"There are no safety or exit lights anywhere," she said. "Maybe the elevator could work so the people who are trapped upstairs who are disabled and very old can get downstairs if they need to get out. My big fear is a fire."

Those who live on the first floor are relying on a generator owned by Mark Shawn Keltner, 68, to power a television in the community room. His generators are also powering medical devices and cell phones.

"They're my neighbors," Keltner said. "They're my friends. Most of them, half of them, I don't even know because they live inside their apartments. They're in wheelchairs, totally helpless without electricity."

Residents of the Bennett House in Fairfax watch TV thanks to a friend's generator. They have been in the dark since Saturday. Oct. 29, 2019

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PG&E blackout: Elderly and disabled residents, including original Rosie the Riveter, left in dark for days

Medicare website now includes nursing home ratings, complaints

Last year, Beverly Rowe faced a difficult future. Her husband survived a stroke but needed care from a nursing home. She researched and toured facilities before making a choice.

"I needed to make a decision on where he was going to go," she said. "That choice looked wonderful, but it turned out the help was not good and my husband took a fall and got a cut on his head after one week."

After that, she brought her husband to Sarasota Memorial Nursing and Rehab Center. It's the only hospital in Florida to achieve the federal government's highest 5-star rating since 2016.

"We got it rectified immediately. Now we would go nowhere else," said Rowe.

Across the country, families face the difficult task of selecting a nursing home for loved ones. The best place to start is the medicare.gov website, where you can find reviews of 16,000 nursing homes across the nation.

Ratings are based on staff-to-patient ratios, emergency visits, and discharges.

A red hand icon will catch your attention. The newly designed icon was designed to get website visitors to stop and give them a quick glance of violations, including abuse or neglect.

"It's a new way for consumers to quickly identify a facility that might have some issues," said Paula Cunningham, the director of nursing at Sarasota Memorial Nursing and Rehab Center.

She said you can't judge a facility on looks.

"There are many facilities who present themselves as the Taj Mahal. They’re clean. They’re bright, their beautiful building, but a beautiful building doesn't necessarily indicate that the care that’s being given is the same," said Cunningham.

She urges families to start with the website and to do outside homework on a facility's past.
"That is not information that you would know just from a brief tour," she said.

To find out a nursing home's rating visit. https://www.medicare.gov/nursinghomecompare/search.html?

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Medicare website now includes nursing home ratings, complaints

Proactive Legislation And The Inclusion Of Seniors In Our Society Are Steps To Protecting Them Against Predators

A disturbing aspect of an  elder law and trusts and estates practice is the discovery of elder abuse. According to the National Institute on Aging, hundreds of thousands of adults over the age of 60 are abused, neglected, or financially exploited each year. Elder abuse includes physical, emotional, and sexual abuse in addition to neglect and abandonment.  The perpetrators are often relatives or friends who have influence over the individual who may be vulnerable due to illness, disability, or age. Sometimes the abuse occurs at the hands of caregivers, whether in the home or in a facility.

New York Senator Kirsten Gillibrand has introduced bipartisan legislation to help protect the elderly and infirmed by improving health care worker hiring practices in long-term care and medical facilities. Too often the elderly and infirmed are harmed as a result of the individuals working in the very facilities that are charged with helping rehabilitate them.

The Promote Responsible Oversight and Targeted Employee Background Check Transparency for Seniors Act, also known as “PROTECTS,” is an act that would expand access to the National Practitioner Data Bank for Medicare and Medicaid providers to conduct background checks on employees. Specifically, PROTECTS would include Medicaid/Medicare-certified skilled nursing facilities, home health agencies, hospice programs, and pharmacies.

The Act has been endorsed by the American Health Care Association and the National Association for Home Care & Hospice. The aforesaid Data Bank would reveal malpractice for potential employees and assist facility administrators in their hiring and consequently affect the standards of care.

As an attorney who regularly practices with the elderly population, I visit a lot of nursing homes. As a guardianship practitioner, I interact regularly with many professionals servicing the elderly such as nursing home administrators and geriatric care managers. Personally, I have spent many days and nights at hospitals and rehabilitation and nursing facilities for my own parents. As is the case with one’s health care, it is imperative that you learn to advocate for your needs. The problem is that those in facilities are often too sick or too intimidated to speak up for themselves. For those lucky enough to have involved friends and family, the risk of being abused or mistreated is lessened by the mere fact that they have someone present to speak for them. Additionally, would-be predators are likely aware of the patients who receive visitors and who have involved family members.

Elder abuse, however, does not just occur in facilities. It also occurs in the home. Relatives and close friends often gain access to bank books and financial accounts and take advantage of a vulnerable person’s assets. Financial scams abound wherein the elderly are lured into investing in businesses that do not exist or do not provide that which they promise. Unfair annuities and reverse mortgages are pitched at lunch events targeted toward senior citizens, eager to connect with someone or something. Savings are often divested and the reporting of these actions is low.

Sometimes the abuse is at the hands of home health aides who insist on or help themselves to gifts as a result of their “care” of the patient. In many cases, the abuse extends beyond the patient’s life, when last wills and testaments are revealed naming health care aides or others as beneficiaries, much to the surprise of family members.

New York’s PROTECTS Act is a good step towards increasing protections for the elderly and long-term care patients. Other states have made similar endeavors. From a macro perspective, it is imperative that we keep the elderly a part of our greater communities. They fall prey to abuse when they are isolated. There are many seniors who do not interact with anyone outside of their residence. Similarly, there are many who do not receive any visitors when residing in a facility. Keeping seniors a part of our society, along with proactive legislation to protect against predators who abuse in a myriad of ways, is just a start to reducing the rate of elder abuse in our country.

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Proactive Legislation And The Inclusion Of Seniors In Our Society Are Steps To Protecting Them Against Predators

Man charged after leaving elderly mother on floor for four days

PHOENIX — A Phoenix man was charged this week after leaving his elderly mother on her bedroom floor for four days.

On Tuesday, the Maricopa County Attorney's Office charged Leland Jay Wedin Jr., 59, with vulnerable adult abuse after the death of his 85-year-old mother.

Court records show that on January 9, Geraldine Wedin fell out of her bed at her home near 35th Avenue and Bell Road.

After four days, her live-in son called family members to help him get Geraldine back into bed.

Investigators say the family was "horrified at the living conditions." The home was full of garbage and human and dog feces, according to the family.

The family reportedly told investigators that Geraldine was "incoherent, lying in her own waste, with large pressure sores on both hips that were crawling with maggots."

Hospital workers reported to police that Geraldine was suffering from septic shock, Pneumonia, hypothermia, and had an open finger fracture. She died a month later.

Wedin reportedly told police that his mother refused to go to the hospital, so he fed her nutrition shakes and water, and treated her sores with peroxide and antibiotic ointment.

Court records show that Geraldine hadn't been to a doctor in two years. Neighbors allegedly told police that the condition of the home "severely declined" when Wedin moved in two years ago.

Wedin has been summoned to make his first court appearance on November 25.

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Man charged after leaving elderly mother on floor for four days

The California Landscape: Confronting the Conservatorship Crisis

Panel Discussion, 10/25/19, "The California Landscape: Confronting the Conservatorship Crisis". This event was part of a half-day workshop: "Gentrification, Wealth Transfer and Abuses in Conversatorship & Guardianship Systems" which took place at the UCLA School of Law. Panel Chaired by Anam Ella Durrani, and featuring Ann Hien Bui, Beth Ribet, and Brooke Weitzman.

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The California Landscape: Confronting the Conservatorship Crisis

California Nursing Home Residents Told To Find New Homes

(DigitalVision Vectors/Getty Images)

Some of California’s most vulnerable nursing home residents, many of whom have nowhere else to go, are receiving letters from their health care plans saying they are no longer eligible for long-term care.

In one notable example, three dozen nursing home residents in San Luis Obispo County were informed on the same day that their Medi-Cal managed-care plan was cutting off payment for nursing home care, said Karen Jones, the county’s long-term care ombudsman.

The residents included a 68-year-old amputee with diabetes, memory loss and kidney disease who required dialysis three times a week, and an 82-year-old man with congestive heart failure and diabetes who wasn’t strong enough to transfer himself from his bed to a wheelchair, Jones said.

“It just felt like we were tossing our seniors and disabled adults,” Jones said of the letters, which arrived in September 2018 and sparked a year-long dispute. “‘Sorry, we’re going to save some money here.’ That’s exactly what it felt like.”

The California Department of Health Care Services, which administers Medi-Cal, the state’s Medicaid program for low-income people, said the terminations by the managed-care plan, CenCal Health, were isolated, a perspective some long-term care advocates share. CenCal said it was just following protocol, examining the books to make sure members still met the qualifications for long-term care under Medi-Cal.

But California Healthline interviewed multiple long-term care advocates and legal aid attorneys on the Central Coast and other parts of the state who said they have witnessed an increase in coverage denials for nursing home residents covered by Medi-Cal managed-care plans. They worry such denials may soon become more commonplace: Medi-Cal nursing home care in all 58 counties will be placed under managed care beginning in January 2021, the state announced recently — up from 29 counties currently.

Under managed care, the state pays plans a monthly rate for each recipient to provide all of the medically necessary services that person needs. By comparison, under traditional “fee-for-service” Medi-Cal, the state compensates medical providers directly for each service they render.

California and other states increasingly are moving their Medicaid patients into managed care, arguing that the model saves money and also improves members’ health by coordinating care. More than 80% of the 12.8 million Californians on Medi-Cal are covered by managed care.

Long-term care advocates fear that the trend means more frail people will be forced out of nursing homes as managed-care plans look to their bottom lines.

“We’re looking at multiplying this problem across the state,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association.

The typical nursing home population in California is about two-thirds Medi-Cal, and many have given up everything — their apartments or mobile homes, their furniture, their burial insurance — to qualify, said Lonnie Golick, ombudsman for Shasta, Trinity, Siskiyou, Modoc and Lassen Counties in Northern California. Golick said she’s received a number of complaints against Partnership HealthPlan of California about coverage terminations. “They gave up their whole life,” she said. “And then they’re told, ‘It’s time to go.’”

Exacerbating the problem, Coleman added, is a shortage of assisted living facilities willing to serve Medi-Cal patients who no longer qualify for nursing home care.

To be eligible for nursing home coverage under Medi-Cal, individuals must have medical needs that require continual, around-the-clock care to prevent significant illness or disability, or alleviate severe pain.

CenCal sent the termination letters to the San Luis Obispo County nursing home residents as part of the process of reviewing their eligibility, said Bob Freeman, CenCal’s CEO. Normally that process is spread out over the year, he said, but the plan got “backed up” on evaluations, which is why so many patients were notified at once.

“We don’t like to do this,” he said. “It’s destabilizing; we don’t want to disrupt people’s lives. We do have state regulations that we have to follow.”

Last month, the Department of Health Care Services sent Medi-Cal managed-care plans a notice clarifying that federal law allows residents to stay in nursing homes to receive “intermediate care”; in essence, plans should pay for lower levels of care rather than terminating coverage.

Freeman said the plan is reconsidering some residents’ eligibility, given the clarification. And Jones, the San Luis Obispo ombudsman, said CenCal recently hired a new nurse who has begun restoring eligibility for some residents in certain homes.

But residents of other homes — and in other regions — are still facing denials.

David Green, 60, a registered nurse in Santa Barbara County, said his 90-year-old mother received a letter last year telling her CenCal would no longer pay for her care at Marian Extended Care Center in Santa Maria.

She had landed in a nursing home in 2016 after a bout of sepsis, he said. At first, she was so weak, she couldn’t walk. By the time she got the letter, her strength had improved, but she still had diabetes, kidney disease, hypertension, atrial fibrillation, breast cancer, memory loss and pain in her artificial knees, Green said.

Green sought out the Santa Barbara County ombudsman and, later, a lawyer. Eventually, he prevailed — but he’s always on alert for another letter.

“It’s very nerve-racking,” he said.

Tessa Hammer, the attorney from Legal Services of Northern California who helped Green, said she has worked on seven such cases out of Santa Barbara County, as well as a handful in the state’s rural northern counties. She’s concerned about residents who don’t have family advocating for them.
“I’m not sure where those folks might end up,” she said.

Golick, the ombudsman for several northern counties, said a man in his 80s in Trinity County received a notice from Partnership HealthPlan earlier this year that he was no longer covered for nursing care he’d depended on for a decade. Like many elderly residents, she said, he felt he had no choice but to comply. He told her he might sleep on someone’s couch, or in his brother’s car.
“Rural areas are really scary,” she said. “Where the hell do you go?”

Dustin Lyda, a spokesman for Partnership, said the plan doesn’t track data on these kinds of coverage denials, but anecdotally hasn’t noticed an upsurge. Lyda said the plan works with facilities, doctors and family members to determine a patient’s needs. If Partnership determines skilled nursing is no longer medically necessary, it works for 60 days to find an alternative solution, he said.

In the meantime, nursing homes find themselves in a difficult situation. They cannot legally discharge residents who don’t have a safe place to go, but they are no longer paid to keep them. In some cases, including in San Luis Obispo, nursing homes have kept residents without pay.

“We’re all watching this closely,” said Craig Cornett, CEO of the California Association of Health Facilities.

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California Nursing Home Residents Told To Find New Homes

Amid Rebecca Fierle scandal, Orange to add guardianship manager to identify ‘high risk’ cases

Orange County commissioners approved nearly $50,000 in federal funds last week for the Ninth Judicial Circuit to hire a court guardianship manager who will identify cases involving incapacitated people who pose "a high risk for criminal exploitation.”

The new position comes in the wake of a months-long scandal involving Rebecca Fierle, a former Orlando guardian under criminal investigation after the death of a client.

Orange-Osceola Chief Judge Donald Myers Jr. said guardianship filings have increased by 33% over the past five years, with an estimated 450 to 460 cases filed in 2019. Myers wouldn’t say if the request for a new case manager was related to Fierle and the firestorm of criticism surrounding Florida’s guardianship program.

“It was a response to where we see the need,” Myers said.

The $47,482 allocated for the guardianship case manager came from a U.S. Department of Justice grant for $359,322 awarded to Orange County. Aside from identifying guardianship cases that are at risk for criminal exploitation and neglect of wards, the case manager will provide “intensive court supervision to ensure that the interests of the ward are being protect,” according to a Oct. 14 memo to commissioners from Yolanda Martinez, the county’s director of health services.

Orange County currently has 3,500 guardianship cases that remain under the supervision of one judge, Myers said. The case manager will help identify “potential fraud or abuse” by reviewing annual accountings filed by court-appointed decision makers for their incapacitated clients, according to the chief judge.

Myers said after Jan. 1, a judge will be moved from the Ninth Circuit’s civil division so there will be two judges handling probate, guardianship and mental health cases. The division is being split into one section for probate and trust litigation and another for guardianship and mental health cases.

“We’ve determined the probate and guardianship areas have now exceeded the capacity of a single judge to handle, so we made that decision to reallocate,” he said.

The chief judge said the Ninth Circuit is looking into monitoring technology used in Pennsylvania and the 15th Circuit in Palm Beach County that requires guardians to input the amount of money they’re managing for incapacitated clients and other data.

“[The software] can trigger the need for further review," Myers said.

Fierle resigned from all cases after one of her wards, 75-year-old Steven Stryker, died at a Tampa hospital because staff were unable to perform life-saving measures due to a “do not resuscitate” order Fierle filed against his wishes and refused to remove. Two probes found Fierle was profiting from her work handling the affairs of vulnerable adults in arrangements not approved by a court, including a nearly $4 million financial relationship with AdventHealth.

She is not currently facing charges.

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Amid Rebecca Fierle scandal, Orange to add guardianship manager to identify ‘high risk’ cases

Elder Abuse Cases Likely to Remain 'Open' Investigations in San Diego County

Every year more than 9,000 cases of elder abuse are reported in San Diego County and data shows the crime is often underreported and difficult to fight in court, leaving a majority of cases "open" investigations.

Experts said those numbers are likely much higher but elder abuse crimes often go unreported leaving victims in distressing, potentially deadly situations. The San Diego Police Department Elder Abuse Unit reports on its website that one out of twenty elders will be a victim of abuse in their lifetime.

Elder abuse can include physical assault as well as financial crime against people ages 65 and older. It is often carried out by an victim's caretakers, costly nursing homes, or sometimes the victim's own children.

After obtaining documents from a public records request, NBC 7 Investigates discovered the majority of the reported cases of elder abuse remain "open" in the city of San Diego.

In 2018, caregiver William Sutton, 68, was found guilty of elderly abuse and murder. The incident, caught on video, showed a 94-year-old woman pushed through a screen door, resulting in Margaret Wood's death.

At the time, Sutton was caring for Wood's elderly best friend, Marian Kubic. Following the incident, Kubic's daughter, Reggie Brown, told NBC 7, "Don't discount anything ever. If there's a red flag -- even a yellow flag -- follow it."

Attorney Natalie Holm, who specializes in elder abuse cases, said that was good advice.

"This is not a declining problem. If anything, it's going to increase," Holm said. "The aging population is going to double by 2025. The number of elderly persons in long term care facilities is going to double by 2030."

More than 4,740 cases of elder abuse were reported to the San Diego Police Department since 2010.

Records show that of those, over 2,400 cases involve theft from an elderly person; just over 2,000 involve abuse or cruelty of an elderly person, in some cases resulting in death.

Data reveals the majority of the cases of elder abuse reported since 2010 are classified as open investigations.

"Generally speaking, elderly people don't make the best witnesses. They perhaps have some level of dementia or memory impairment. And frequently it's a 'he said, she said' situation," Holm said. So it becomes very difficult to present those cases when you don't have any hard and fast evidence."

Still, Holm said abuse often escalates if there is no intervention.

Victims can be worried about retaliation from their abusers. Some try to protect abusive family members or are too ashamed to admit they've become a victim themselves — all the reasons why loved ones need to be observant and vocal.

"Don't be afraid to make your loved one's needs known. And don't be afraid to make waves because a lot of times you're intimidated by the system. You think that this is just how it's supposed to be. But if it doesn't seem right. Trust your gut. Because usually, it's not," Holm added.

If you believe elder or dependent abuse is occurring, call Adult Protective Services at 1-800-510-2020, 24 hours a day, seven days a week. If you're outside the County of San Diego, call 1-800-339-4661.

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Elder Abuse Cases Likely to Remain 'Open' Investigations in San Diego County

North County Family Claims Elder Abuse, Fighting Over Wealthy Businessman’s Estate

NBC 7’s Mari Payton spoke to family members who said their father was duped by a woman who only wanted the man’s money.

Source:
North County Family Claims Elder Abuse, Fighting Over Wealthy Businessman’s Estate

Judge: Guardian must return $3.8 million in Gadsden case

By William Thornton

An Etowah County woman will end up returning more than $3.85 million to her mother’s estate as the result of a judge’s ruling.

The case, decided last month in Etowah County Circuit Court, dealt with the conservatory and custodial duties of a woman appointed co-conservator of her mother. Circuit Judge George Day Jr., ruled that the woman, who has not been charged with any crime, “breached her fiduciary duty to her mother’s Conservatorship estate, has failed to properly account for her actions and the funds and assets under her control, all of which has caused substantial damage” to the estate.

Additionally, the Court awarded a judgment against the daughter in relation to the custodial accounts for the incapacitated woman’s granddaughter, totaling $393,509.

Chris Hamer and Rebecca Wright of the Hamer Law Group represented the incapacitated woman’s conservator, an attorney who was appointed after the daughter resigned as conservator. The case has also generated a federal court action.

“This case represents the most egregious breach of fiduciary duties we’ve ever seen," Hamer said in a statement. “Cases involving misappropriation and misuse of assets by family members appointed as fiduciaries are especially distressing for all involved.”

As a result of the decision, all money in the estate has been accounted for, attorneys said. According to court documents, the daughter of the incapacitated woman became conservator of her then-77-year-old mother in 2014. The woman, who died earlier this year, had 12 children.

The daughter in 2017 filed a petition for partial settlement with the Etowah County Probate Court, alleging that more than $9 million from the estate and its holdings came into her hands during the prior three-year period of her conservatorship, and about $2.57 million remained in the conservatorship estate. The woman paid out about $3.9 million to family members.

The case was removed from probate to circuit court in February 2018 and a Gadsden attorney was appointed as guardian ad litem for the incapacitated woman. A month later, the daughter resigned as co-conservator and paid $1.34 million to the court.

According to documents, she attributed about $306,000 for a return of payments to her personal credit card, $760,000 to her personal E*TRADE account, and $275,000 to transfers out of the conservatorship to herself. The $3.8 million in the judge’s decision includes what she has already paid back.

Another attorney was appointed conservator in the daughter’s place, who then retained Hamer Law Group to represent him in the final settlement and accounting of the daughter’s conservatorship.

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Judge: Guardian must return $3.8 million in Gadsden case

Oklahoma County judge charged with felony tax evasion

OKLAHOMA COUNTY, Okla. (KFOR) - An Oklahoma County district judge has been charged with one count of Refusal to File Return with Intent to Evade Payment of Taxes after she failed to file income tax returns from 2015 through 2018.

Judge Kendra Coleman allegedly owes tens of thousands of dollars in delinquent taxes.

According to court documents obtained by News 4, Coleman alleges that all of the tax issues had already been taken care of before the indictment was filed.

The documents allege that she filed her 2015 tax return on June 6, 2016, while her 2016 tax return was accepted on Oct. 17, 2017. It also states that her 2017 and 2018 tax returns were filed and accepted just days before the multicounty grand jury indicted her on the charges.

Coleman reported that year she made a gross income of more than $65,000 but only made a 25 dollar payment toward a $1,200 worth of taxes after filing two deadlines for an extension in 2017.

Prater’s team says Coleman “failed to file until nearly a year past and only after it was widely publicized.”

Coleman and her attorney previously tell News 4 that the indictment is “false on its face” alleging that all tax issues were wiped clean.”

The charge filed today states Coleman failed to file her state tax return by the deadline, whether she received an extension or not.

It also claims that Coleman did file her return within the extension deadline for 2015 and 2016, but she did not pay the thousands she owed for both of those years or previous years when she owed.

The affidavit states that as of September 13, 2019, Coleman owed the Oklahoma Tax Commission over $23k.

We tried to contact her team again in response to Monday’s felony filing but her office was cleared out and a new judge was filling in.

Coleman’s attorney never returned our call.

Court records also show Coleman filed her tax returns on time in 2008 and 2009. Both years the state owed her a refund.

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Oklahoma County judge charged with felony tax evasion

Nursing home ills a red flag for state; bid afoot to look at firms’ finances

Lincoln Heights Healthcare in Star City is one of five nursing homes the Department of Human Services took over through the "receivership" process since Sept. 30. - Photo by Eric Besson

STAR CITY -- The nursing home operators whose money woes created bleak conditions at five facilities that the state recently seized were ordered to sell a different home's license last year for not paying rent, court records show.

The forced sale was among several warning signs of corporate financial stress that former business partners Keith Head and Cathy Parsons faced for years as lawsuits alleging unpaid bills piled up.

But the five properties seized by the Department of Human Services did not attract financial scrutiny from regulators until last month, even though the owners owed more than $560,000 in unpaid fees and penalties.

By the time the state intervened, more than 100 staff members had gone unpaid, utility companies had issued shut-off notices, medical supplies were on the brink of exhaustion and cash balances were gone, according to court records that the state filed to take over the homes. The homes are licensed to house a combined 466 residents.

In the wake of the takeovers, the Arkansas agency that licenses nursing homes, a Medicaid fraud investigator and industry lobbyists are working on a package of new policies, rules and laws aimed at reducing blind spots and providing earlier crisis detection.

"We want to make sure people who run nursing homes have sufficient funds," Lloyd Warford, the deputy attorney general who oversees the state's Medicaid Fraud Control Unit, said during a lightly attended rally for nursing home residents' advocates this month.

"We're expecting [the state] to change rules and improve definitions. But if things bog down, we're going to need you to show up," Warford told the advocates.

The new focus comes after Arkansas took nursing homes into "receivership" for just the second time since the 1980s.

Official attention to early warning systems follows an Arkansas Democrat-Gazette investigation in April that found that the state had taken no steps to improve how it screens owners who want to acquire nursing home licenses after the 2018 collapse of New Jersey-based Skyline Healthcare. Skyline held one in every 10 licensed nursing home beds in Arkansas, and its financial collapse prompted the state to take over two of its properties.

The Human Services Department, over Warford's objections, approved the transfer of Skyline licenses to two firms with business or management ties to Skyline. The state also allowed an Atlanta man with an $83.1 million federal civil fraud judgment against him to acquire one of Skyline's licenses, the newspaper found.

Warford, in response to emailed questions, called the national Skyline crisis an "eye-opener to Medicaid fraud investigators across the country."

"We are committed to take whatever steps are necessary to prevent another system failure of this magnitude," he said.

Leading the effort is the Arkansas Human Services Department's division that licenses nursing homes, led since last month by former department attorney Jerry Sharum.

"As we found out with these five [nursing homes] -- and perhaps before with Skyline -- finances are a leading indicator for problems," Sharum said in a recent interview. "If you can't pay for supplies, the next step is a decline in care. We're now very attuned to those issues."

Internal policy changes that do not require legislative review are targeted for a Nov. 1 rollout, Human Services Department spokeswoman Amy Webb said.

The state plans to propose new farther-reaching rules and laws after discussing ideas with the attorney general's office, the nursing home lobby, residents' advocates and others, Webb said.

"The details of those potential changes will be identified as part of [an] ongoing internal review of existing law and rules to determine what steps can be taken under existing law and rules and what additional steps would be needed to review financial factors appropriately," Webb said.

POST PROMPTS LOOK

Officials began monitoring Head's facilities Sept. 23 after noticing a Facebook post about payroll issues at one of the nursing homes and registering it as a formal complaint, Sharum said.

Inspectors found similar and severe issues at each of the homes -- vendors threatening to stop delivery, payroll checks bouncing and utilities issuing shut-off notices -- and the state petitioned circuit judges in five counties to give it temporary control of the facilities.

Judges signed orders between Sept. 30 and Oct. 3 allowing Arkansas to take over the homes, initially for a period of 30 days. The orders can be extended.

Reliance Health Care is managing the facilities on behalf of the state.

When Arkansas first filed petitions, it seized only two homes, though Sharum said at the time that the plan was to next take over the other three "unless something miraculously changes."

Head's attorney, Sean Mathis, on Oct. 2 requested that the state file receivership petitions for the other homes, according to an email he provided. The state filed court papers the following day.

As set by state law, the goal for receivership is to get nursing homes on stable footing and then return them to the owner, Sharum said. The state can petition judges to order Head to sell the licenses, but it has not done so.

Head will "do whatever is best for the residents and the employees at those facilities," Mathis said when asked whether Head wanted to regain control of the facilities.

The five nursing homes are Arlington Cove Healthcare in Trumann; Deerview in Ola; Lexington Place Healthcare and Rehabilitation in Jonesboro; Lincoln Heights Healthcare in Star City; and Prescott Manor Nursing Center in Prescott.

The homes held a combined 267 residents as of Sept. 27. By Oct. 9, that number had dropped to 252, or about 54% of capacity, according to figures Webb provided.

Head holds 75% of the companies licensed to operate the five homes, according to state records. The records list Parsons as holding the remaining 25% of each company.

Parsons, in a lawsuit filed against Head late last year, said she has not been involved in the nursing homes since the spring of 2018.

MONEY WOES MOUNT

Parsons' lawsuit is among several court filings in plain view, over a period of years, concerning purported financial turmoil at their nursing homes.

The suit accused Head of not repaying hundreds of thousands of dollars that the nursing homes and another Parsons-owned company loaned to their shared facilities.

"In late 2017, the [Head-operated] Nursing Homes needed significant operating capital to maintain operations," the lawsuit says.

Parsons' companies sent their shared management company, Hope Healthcare, $731,002 in late 2017, says the lawsuit, which is pending.

Separately, nursing homes owned by Parsons transferred $123,700 to nursing homes owned by Head and Parsons in January and February 2018, the lawsuit says. This money was largely to cover "payroll obligations," it says.

Head's response to Parsons' lawsuit denied many of the allegations but did not "admit or deny" the transfers.

Parsons told Head in March 2018 that she would stop supporting Hope Healthcare and the other nursing homes they co-owned, according to the lawsuit.

Head's response to the suit said that Parsons no longer held interest in companies they formerly shared, but did not say when they split. State records do not reflect any changes in ownership interest.

In April 2018, the landlord of a nursing home the pair was licensed to operate in El Dorado accused Head of not paying rent dating back to June 2017 -- putting Head $550,000 behind, according to a different lawsuit.

Head sold the license to operate what was formerly called Grace Point -- now known as Advanced Health and Rehab of Union County -- to a replacement firm picked by the landlord, according to an order signed by a circuit judge.

Parsons signed the change of ownership documents for that transfer, which was processed in October 2018, according to copies obtained under the Arkansas Freedom of Information Act.

Mathis, Head's attorney, said the court order stemmed from a settlement agreement and was the "quickest and most effective way" to transfer ownership of the license.

Changes of ownership are reviewed and approved by the Human Services Department. Sharum said the department was unaware of financial problems at the nursing home until last month, though he said officials have since surmised that the issues percolated for years.

Court records show other signs of money challenges Head's operations faced

Several vendors filed lawsuits against the nursing homes for unpaid bills. A food-service vendor sued for nearly $160,000 in unpaid bills in 2017, and a medical equipment supplier sued for more than $180,000 in 2016, for instance.

Deerview, the Ola facility, was habitually late on its water bill payments and then bounced a series of checks beginning in July, which prompted a shut-off notice, said Betty Bly, the city's treasurer.

Additionally, Head's five facilities owe the state $565,000 in unpaid annual "quality assurance" fees, a sum that includes sanctions for failure to pay the money on time, Webb said.

Beginning Nov. 1, Arkansas regulators plan "regular review of facilities with delinquent [quality assurance] fees to determine if increased monitoring is required," Webb said.

POSSIBLE CHANGES

The Human Services Department's longer-range review is focused on improving oversight during ownership changes and on paying specific attention to finances, Webb said.

"One of the most important parts of these reforms will be the identification of financial factors relevant to the ability of a facility to provide appropriate care for its residents and the standards used to evaluate those factors," Webb said.

The department wants to pin down what signals future problems and then use that knowledge when weighing ownership changes, inspecting existing nursing homes and deciding whether to "trigger increased monitoring," she said.

New rules and laws likely will be needed to give the department the authority it seeks to ensure stable nursing home ownership.

The change-of-ownership process, for example, allows the state to require a "broad range of evidence" as officials consider whether the applicant meets state rules and regulations, Webb said, but it allows the state to deny applicants based only on a narrow set of reasons.

"No grounds are provided to deny applicants who have loads of debt or poor financial histories," Webb said of the state law, Arkansas Code Ann. 20-10-224.

The law allows the state to consider only whether executives have been convicted of a felony, whether other facilities they own committed serious long-term-care violations, whether they have had a license revoked previously and whether their other nursing homes have been in "substantial compliance" with state and federal law.

The Arkansas Health Care Association, which mostly represents nursing homes, supports initiatives to "strengthen" the change-of-ownership review process, according to an email Executive Director Rachel Bunch sent to the Human Services Department in July.

"As a profession, the vast majority of our providers try to do the very best that they can, and the association wants to see viable operators in Arkansas that are here that provide excellent care," Bunch said in an interview. "We want the regulatory environment to support that, of course."

The point of the potential financial-based surveys would be to look for cash flow issues that can hurt care. Asked how this was different from existing health and safety surveys, which focus on the quality of care, Webb said it would specifically "evaluate financial records."

Such an analysis "could require technical assessment of financial issues, accounting practices, and complex operating and ownership structures," she said.

QUALITY METRICS LAG

Lincoln Heights in Star City and the other four homes seized by the state were cited for a combined 87 health and safety violations from August 2018 through August 2019, an average of more than one per home per month, according to a review of records provided by the Human Services Department.

Of those, 35 were violations that represented "substandard quality of care," according to the federal Centers for Medicare and Medicaid Services' grading system.

The five most serious were coded as J, or an isolated case of immediate jeopardy to health or safety.

Four of the five stemmed from an investigation Aug. 1 at Deerview that found a nurse had injected a resident with insulin against the person's wishes. Residents are allowed the right to refuse medication.

Deerview also failed to immediately investigate or report the alleged violation, which a state monitor determined was "staff-to-resident abuse."

The other 30 "substandard" violations were F's, which means the potential for more than minimal harm at a widespread scale. Many of these concerned lapses in fire control systems, such as regularly testing the alarms, inspecting equipment and making sure emergency doors worked properly.

Overall, the homes mostly ranked below average statewide, according to Medicare.gov's Nursing Home Compare tool.

Two of the nursing homes have three-star overall ratings, one has a two-star rating and the other two have one-star ratings. More stars are better, and three is the average statewide.

The ratings are based on health inspections, staffing and quality-of-care measures such as hospitalizations and use of anti-psychotic medication.

Citing resident privacy, the Human Services Department denied this newspaper's request to tour Lincoln Heights or any of the facilities under state control.

Full Article & Source:
Nursing home ills a red flag for state; bid afoot to look at firms’ finances