One nursing home offers grim advice: Take your loved ones home

by Suzy Khimm and Laura Strickler

Since suffering a traumatic brain injury five years ago, Eliot Loshak, 87, has been unable to get out of bed on his own. His eyesight is heavily damaged, and he needs help from the staff at his Manhattan nursing home just to call his only daughter, Pam.

With the coronavirus now spreading through the nursing home, Pam Loshak fears for her ailing father — and for the staff members at the Mary Manning Walsh Home, who don't have enough personal protective equipment to slow transmission of the disease, despite their hands-on care for those most vulnerable to the virus.

ArchCare, which runs the facility and four other nursing homes in the New York area, has been forced to outfit staff members in rain ponchos and beautician gowns to stretch their dwindling supply of protective gear, according to Scott LaRue, president and CEO of the company, which is affiliated with the Archdiocese of New York. Employees are given one N95 mask — meant to be single-use — to last an entire week.

"I don't feel safe," an aide at one ArchCare facility said, declining to be named for fear of retaliation.

More than 200 of ArchCare's 1,700 nursing home residents are infected with the coronavirus, and more than 20 have died, LaRue said. At least 10 staff members are also infected, with one in the hospital on a ventilator.

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The risks are so serious that LaRue is advising family members to pull residents out if feasible. "If you have the ability to take your loved one home, and that's possible, I would encourage you to do so," he said. "There will be better isolation and better limited contact in a home than there would be in a nursing home."

LaRue says just a few families have done so, as the medical and personal needs of most residents are too complex to handle at home.

The ArchCare aide said that staff members are only being given one disposable gown for their entire shift, even if it becomes soiled, and they must constantly circulate between residents who are infected and those who are not.

"How do you expect to use the same gown? We are cleaning them, wiping their mouths, there's stuff on us," the aide said. "I feel like I'm spreading the virus."

While one area of the nursing home where she works had once been designated for infected residents, there are now so many who are sick that they are mixed in throughout the entire facility, the aide added.

Pam Loshak, 42, a publicist who lives in Harlem, is painfully aware of the risks her father faces if he stays at his nursing home, but she doesn't know where else he could go. Eliot Loshak needs a motorized lift and two people just to move him to a chair, and he frequently suffers from health problems that require expert attention.

"I live alone in an apartment — there's just no way I could give him the care he needs," Pam Loshak said.

She is grateful to the nursing home staff for carefully tending to her father, but is pained to think of what could happen as the virus spreads. Her father already has respiratory problems because fluid builds up in his lungs while he's bedridden, she explained. If her father gets infected, she fears, "he would die for sure."

'It is impossible for us to stop the spread'

Over the past week, coronavirus infections at nursing homes have skyrocketed: More than 400 long-term care facilities around the United States now have infected residents, according to the Centers for Disease Control and Prevention — a 172 percent increase in a single week. In New York state, one in four nursing homes have cases of the virus; 1,228 residents have tested positive and 224 have died, according to a spokeswoman for the state health department.

But nursing homes have been unable to get enough protective gear and tests, in part because overwhelmed hospitals are getting the supplies first, industry executives and groups say.

"We seem to be a second-tier priority," said Stephen Hanse, president and CEO of the NYS Health Facilities Association-NYS Center for Assisted Living, which represents long-term care facilities.

News

That has made it harder for nursing homes to slow the transmission of the coronavirus among staff members and elderly residents. Those over the age of 70 and with underlying health conditions are significantly more likely to die from the virus.

In Washington state, which reported the first coronavirus cases in the U.S., 35 people died after an outbreak at the Life Care Center of Kirkland, a skilled nursing facility. A CDC report found that a lack of personal protective equipment and staff members who continued to work while sick helped fuel the deadly outbreak, which quickly spread to other nursing homes in the area.

In recent days, similar cases have exploded across the country. At one facility in Stafford, Connecticut, three residents have died and at least six employees are now infected, with staff reporting a lack of protective gear and limited testing. At two nursing homes in southwest Pennsylvania, infections are mounting among both residents and staff, who say they don't have enough masks to protect themselves. In Louisiana, where 13 residents have died in a single nursing home, one 130-bed nursing home reported having no personal protective gear at all.

"We're in a situation where it is impossible for us to stop the spread of the virus," LaRue said. "They say this is our highest-risk population — the one we have to protect the most — and they're not giving us what we need to do that."

Employees are trying their best to keep scarce equipment clean and to limit visits to the rooms of different patients, the ArchCare aide said. But it is impossible to avoid hands-on contact while assisting residents with eating, bathing, toileting and other basic tasks, in addition to the medical care they regularly receive from staff doctors and nurses. One supervisor suggested that staff members use garbage bags to protect their gowns, the aide said.

Protective gear is especially critical in nursing homes since many residents have physical limitations or dementia that prevent them from being able to cover their mouths when they cough, or from wearing a mask themselves.

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"Nursing homes and all long-term care providers desperately need PPE," the American Health Care Association, which represents nursing homes and other long-term care facilities, said in a statement Monday.

Last week, ArchCare executives made an urgent plea to New York City for 28,000 gowns and 28,000 face shields to protect their nurses, aides and other employees.

The city's emergency management department sent less than 1,000 of each — not even a full day's supply for ArchCare's five facilities, LaRue said.

When asked about the shortages facing New York City nursing homes, a spokesman for the city Department of Health and Mental Hygiene said officials are "working furiously" to supply them with protective equipment.

"These facilities will get weekly supplies of personal protective equipment based on need, as well as emergency orders should the need arise," the spokesman, Michael Lanza, said. The state health department said it was "communicating regularly with nursing home providers and industry leads" about their needs for protective gear.

Last week, New York state officials and a local hospital association helped ArchCare track down 4,000 gowns and 4,000 face shields, but that doesn't come close to meeting the need, LaRue said.

Supplies have been scarce on all levels of government: Many states, including New York, have only received a fraction of the personal protective equipment and other critically needed supplies that they have requested from the federal government's stockpile, prompting growing calls for President Donald Trump to use a wartime law to broadly coordinate production and distribution.

The Trump administration, however, has narrowly limited its use of the law and continues to tell states to buy the supplies themselves from private vendors. But the massive demand for masks, gowns, face shields and other equipment has created chaos as states, hospitals, nursing homes and other facilities are all competing to purchase the same critically needed supplies.

On Monday, ArchCare finally found a vendor who agreed to sell $237,000 worth of face shields and hazmat suits, shipped from China within a week, according to an invoice provided by the company.

But the deal fell through at the last minute after ArchCare discovered that a bank account set up to receive the funds was "opened with fraudulent documentation," according to a company email.

ArchCare and other nursing homes are now appealing to private donors to help fill the need.

"Everyone we serve has the right to the same resources, and their life is just as valuable as anybody else's," LaRue said.

A widespread problem

Nursing homes are also facing a lack of testing, which makes it even harder for them to contain the virus. While more private labs have begun offering coronavirus tests, testing at nursing homes remains highly limited because of a shortage of swabs and other components needed to conduct the tests, as well as restrictive state guidelines.

On March 21, New York state issued an advisory stating that any nursing home residents or health workers in the New York City area with symptoms of acute respiratory illness "should be presumed to be COVID-19," and that testing for those residents "is no longer necessary."

That has made it impossible to identify and isolate all the residents who are infected from those who are not, LaRue said. "If I had my druthers, I'd do widespread testing, and I would test every employee."

ArchCare struggled last week to find just 30 tests from a private lab, which quickly ran out.

The problem is widespread, according to the American Health Care Association: "We have heard from many providers about residents and staff getting declined when trying to be tested. This is extremely worrisome."

Highland Care Center, a nursing home in Queens that is not owned by ArchCare, had a resident hospitalized with the coronavirus last week. Other residents are also showing symptoms, which the facility reported to the city health department, but they still haven't been tested, the facility's administrator, Don Morris, said. "We don't know if they are coming to test."

A 'frightening' lack of communication

As the virus overtakes nursing homes across the country, many families feel helpless and increasingly cut off from their loved ones.

To protect residents from outside infection, New York and many other states have banned visitors from nursing homes. Updates from the management may be limited and sporadic: The Centers for Medicare and Medicaid Services requires nursing homes to notify family members if their relative has a confirmed coronavirus infection, but not if others in the facility have tested positive.

External oversight is also limited: The federal government has temporarily suspended routine health and safety inspections to focus on high-risk facilities, and state ombudsmen are also currently barred from visiting nursing homes and most assisted living facilities.

At ArchCare's Mary Manning Walsh, families were notified Monday that staff-assisted videoconferencing with residents would be suspended for safety reasons, and they were asked to limit calls to the facility. "I ask for your patience in knowing that if someone is not getting back to you immediately, they are directly treating our community," Michael Monahan, the facility's director, wrote.

In an email accompanying the notice, Carlotta Gladding, a member of the residents council, urged families to be patient as staff members are "doing their utmost best to provide safe care for your loved ones."

Image: Carlotta Gladding and her 105-year-old-aunt. (Courtesy of Carlotta Gladding)

 

But Gladding, whose 105-year-old aunt is at the facility, acknowledges how difficult it has been for families to be cut off from residents as the virus has spread.

"It's nerve-wracking and frustrating and frightening, especially since you may have no communication with your loved one," she said.

Pam Loshak has limited her own phone calls to spare the staff and last spoke with her father in mid-March, when visitors were first banned. She told him to try and cover his mouth if he had to cough, but she knew even that would be tough, given his weak muscles and limited motor control. She tried to be as reassuring as possible, and let him know she was OK.

"Just sit tight," she told him.

Editor’s Note: Suzy Khimm, an author of this article, is related to a resident at the Mary Manning Walsh Home.

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One nursing home offers grim advice: Take your loved ones home

Judge Dragged Out of Courtroom After Being Sentenced to Jail

After a judge sentenced another judge to jail time, chaos erupted in an Ohio courtroom and the defendant had to be dragged out. Former Cincinnati Judge Tracie Hunter was convicted in 2014 of misusing her position as a judge to help her brother. She was sentenced to six months in jail and has been appealing the ruling ever since. The case has drawn outrage from the African American community, who say Hunter is being treated unfairly. 

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Judge Dragged Out of Courtroom After Being Sentenced to Jail

Coronavirus outbreaks like 'wildfire' at US nursing homes under lockdowns

Pat Herrick holds a photo of her mom Elaine Herrick, 89, a resident of Life Care Center who died at the nursing home in Kirkland, Washington, on 5 March. Photograph: Jason Redmond/AFP via Getty Images

Nursing homes across the US have been in lockdown for weeks under federal orders to protect their frail, elderly residents from coronavirus, but a wave of deadly outbreaks nearly every day since suggests that the measures including a ban on visits and daily health screenings of staffers either came too late or were not rigorous enough.

Recent outbreaks in Tennessee, New Jersey, Ohio, West Virginia, Massachusetts and Maryland have pushed the death toll at the nation’s nursing homes to at least 450 and highlight the biggest gap: screenings of doctors, nurses, aides and other workers do not involve actual testing but the taking of temperatures or asking health questions that still allow infected, asymptomatic people to slip through.

“It’s still been like Swiss cheese with people coming in and out of there, and thus you’ve got these explosions in senior facilities,” said John BaRoss of Long Valley, New Jersey, who recently pulled his 85-year-old mother out of an assisted-living center out of fear of infection.

After an outbreak of 100 infections and four deaths at the Gallatin Center for Rehabilitation and Healing outside Nashville, Tennessee – where the National Guard was called in to help evacuate the facility – Sumner county mayor Anthony Holt blamed staff members who came to work despite showing symptoms for Covid-19 and “exposed a lot of patients”.

“Things got out of hand,” Holt told the Associated Press. “Once employees became symptomatic, they should have asked them to go home immediately and called the health department. I don’t think that occurred.”

After an outbreak near Dayton, Ohio, killed six people and infected nearly 50 at a pair of nursing homes less than 10 miles apart, health officials began scrutinizing medical specialists such as phlebotomists and respiratory therapists who work in multiple facilities a day. One such health worker who visited both homes tested positive for Covid-19.

In Maryland, Governor Larry Hogan said an outbreak that spread like “wildfire” at a Mount Airy nursing home, killing five and infecting 77, apparently began with an asymptomatic health worker who made it past a temperature check screening and “infected the population”.

Some relatives of those at the Sundale nursing home in Morgantown, West Virginia, where 29 residents and staff have tested positive, say more should have been done to keep coronavirus out before the federal restrictions took hold in mid-March.

“The day before the shutdown, we just walked in wherever. There was no sign-in. There was nothing,’ said Courtney Templeton about her last visit to her 69-year-old mother.

Templeton also faults the home for not testing residents fast enough and not keeping healthy ones separate from those just back from a nearby hospital showing Covid-19 symptoms, including her mother’s roommate.

“She came back coughing and had a fever,” Templeton said of a visit two weeks ago, after which she began begging the home to protect her mother. “Can’t you keep the incoming patients separate? Can’t you keep them quarantined for 14 days?”

Last week, Templeton got word both the roommate and her mom had the virus.

Though the federal government has not been releasing a count of its own, an AP tally from media reports and state health departments indicate at least 450 deaths and nearly 2,000 infections have been linked to coronavirus outbreaks in nursing homes and long-term care facilities nationwide.

And for the nation’s more than 15,000 such facilities and the 1 million people who live in them, experts say the situation could get worse before it gets better.

They say the crisis has only deepened a chronic staffing shortage at nursing homes because more workers are self-quarantining or staying home with their children.

There is still not widespread testing of staff or patients, and shortages of masks and other protective gear persist.

“It’s an emergency situation, and it’s just been totally neglected in all the national policy,” said Charlene Harrington, a professor emerita at the University of California San Francisco and former state health official. “They’re not focusing on the fact that these are the most vulnerable of people in the whole country.”

And overcrowding in hospitals has some states seeking to force nursing homes to take patients who are recovering from Covid-19, raising fears they could spread it to residents inside.

New York issued a statewide advisory last week forbidding nursing homes from denying residents admission “solely based on a confirmed or suspected diagnosis of Covid-19,” California told its nursing homes to make similar preparations.

Massachusetts announced plans to designate specific nursing homes as care centers for Covid-19 patients – a move that has set it apart from other states

“Sending hospitalized patients who are likely harboring the virus to nursing homes that do not have the appropriate units, equipment and staff to accept Covid-19 patients is a recipe for disaster,” said Mark Parkinson, president of the American Health Care Association.

Federal directives on nursing home coronavirus prevention followed the nation’s biggest outbreak in one place, the deaths of 40 at the Life Care Center nursing home near Seattle. A government inspection found infections at the home and others nearby were likely caused in part by employees working while sick.

A 13 March order from the Centers for Medicare and Medicaid Services says nursing homes should immediately halt visitors and non-essential workers, cancel communal dining and group activities, and actively screen residents and staff for fever and respiratory symptoms.

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Coronavirus outbreaks like 'wildfire' at US nursing homes under lockdowns

Ford heirs lose battle to oust mother’s allegedly abusive caregiver

Henry Ford II and Kathleen DuRoss Ford

The heirs of Henry Ford II have suffered defeat in their battle to force their mother’s companion — who, they claim, abused her — to give up control of her life, Page Six has learned.

Frank Chopin was an attorney to Ford II — the late president of the Ford Motor Co. and eldest grandson of Henry Ford — and after his death became an attorney to his widow, Kathleen DuRoss Ford. Chopin moved into Kathleen’s $44 million Palm Beach, Fla., estate and became her caregiver.

But in 2019 her daughters, Deborah DuRoss Guibord and Kimberly DuRoss, mounted a legal challenge to oust Chopin, who Kathleen — a paralyzed 80-year-old — had given power of attorney over her affairs. They allege he tried to control their access to her and, according to reports, abused her by “[forcing] pills down her throat.” Chopin vehemently denies abuse.

Then Wednesday, a Palm Beach judge denied their request, leaving Chopin in control for the rest of her life — and leaving her daughters, grandchildren and even her sister, Sharon, 82, distraught.

Her granddaughter, Tara DuRoss, told Page Six that Chopin had limited them to scheduled conference calls and meetings away from her home, and now the calls had stopped. “I used to call her every day,” Tara, 23, told us. “We just want to be able … to see her.”

Chopin told us it’s untrue that Tara spoke to Kathleen daily. He called her an “idiot child,” and said the family were “estranged” unless “they wanted something.”

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Ford heirs lose battle to oust mother’s allegedly abusive caregiver 

See Also:
Daughters claim widow of Henry Ford II is being abused by longtime companion

Former Veterans Affairs doctor in W.Va. accused of incapacitating, molesting patient

BECKLEY, W.Va. (WHSV) — A doctor who formerly worked at the Veterans Affairs Medical Center in Beckley, West Virginia, has been charged with depriving a veteran of his civil rights under the color of law.

Dr. Jonathan Yates, 51, was arrested on Thursday at his home by Special Agents of the FBI and the Department of Veterans Affairs Office of Inspector General, with the assistance of the Bluefield, Virginia Police Department.

That's according to the Department of Justice.

Federal prosecutors say the charge stems from an incident that happened while Dr. Yates was working at the VA in February 2019.

According to a criminal complaint, Yates sexually molested a patient during an exam.

The complaint says Yates also caused the veteran he was examining severe pain and numbness and temporarily incapacitated him by cracking the patient's neck after the patient explicitly requested him not to do so.

The complaint says while the patient was incapacitated, Yates sexually molested him again.

The alleged conduct, performed while Dr. Yates was acting under color of law as a federal employee at the VAMC, deprived the victim of his constitutional right to bodily integrity, the Department of Justice says.

That charge is punishable by up to life in prison.

Dr. Yates will appear before U.S. Magistrate Judge Omar Aboulhosn on Thursday.

Assistant Attorney General Eric Dreiband, U.S. Attorney Michael B. Stuart for the Southern District of West Virginia, FBI Acting Special Agent in Charge Eugene Kowel, and Department of Veterans Affairs Inspector General Michael J. Missal announced the charge.

The investigation remains ongoing. Anyone with additional information is encouraged to contact the FBI at 1-800-CALL-FBI (225-5342).

The case is being investigated by the FBI and the Department of Veteran’s Affairs Office of Inspector General, with assistance from the Veterans Affairs Police Department. The U.S. Attorney’s Office sought immediate detention in this matter. The case is being prosecuted by Special Litigation Counsel Samantha Trepel and Trial Attorney Kyle Boynton of the Civil Rights Division of the U.S. Department of Justice and Assistant U.S. Attorney Greg McVey of the Southern District of West Virginia.

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Former Veterans Affairs doctor in W.Va. accused of incapacitating, molesting patient

Letter to the Editor: Proposed elder abuse bills will not fix problem

Dear editor,

Nobody disputes financial elder exploitation is a significant problem that needs to be addressed. The disagreement is in how best to solve it.

Significant time and effort, with input from multiple agencies and organizations, has gone in to addressing the financial elder abuse issue with no easy solutions on how to protect vulnerable seniors.  The authors of bills SB 428 (AB 482) and SB 429 (AB481) and the bills’ supporters believe that banks and financial professionals are best suited to “protect” you from financial elder abuse. Yes, Banks.  Not your loved ones, trusted advisors, or your own legally documented agents (with the safeguards built into the current statute).  Banks.  Internet searches relative to banks reveal the following:

Searching “Wells Fargo Fraud Violations” shows violations including fraudulently opening up accounts in their customer’s names and charging fees.  They were fined $185 million by the US Consumer Financial Protection Bureau in 2018 and are facing another $3 billion settlement with the Justice Department and the Securities and Exchange Commission.

Searching “Bank of America Fraud Violations” shows they admitted to violating mortgage-backed security laws by failing to make accurate and complete disclosures to investors, leading to a $245 million settlement with the Securities and Exchange Commission.

Searching “US Consumer Financial Protection Bureau Enforcement Actions” produces pages and pages of actions against financial institutions for violations of law.

The question is: Are financial institutions best suited to protect consumers from financial abuse?  The authors of the bill believe that banks should be given broad power if you are 60 or over.  There are no guidelines or requirements for training on the identification of financial abuse.  In addition, there is no liability or consequence to banks if they mistakenly claim financial elder abuse has occurred.  The burden of proof falls to you, your loved ones, trusted advisors, or your legally documented agent to prove that financial elder abuse is not occurring. During that time your assets may be frozen thereby triggering fees, causing delays that can lead to loss of benefits and resulting in adverse effects to your financial health/ creditworthiness.  Other considerations include:

Will the bank reimburse you for fees/ NSF check problems caused by them?

Will the bank reimburse you for the costs of proving your position that financial abuse is not happening?

How does one prove that something is NOT happening?

Will the bank pay for your fees or lost benefits caused by delays in resolving the issues?

The banks will continue to be allowed to refuse to honor your power of attorney if an untrained bank teller believes abuse is taking place. Although current law allows this, the current law also provides safeguards that demand a written explanation to the customer, and holds banks liable for wrongfully refusing to honor a power of attorney. The new law wipes all of that out if the bank can make a claim that it believed, even wrongly, that financial elder abuse was taking place.

The result of any legislation should be to solve a problem.  We can all agree that many people with the right intentions are trying to solve the elder abuse issue.  That is a very good thing.  The concern is that these bills as written are the wrong solution for the financial elder exploitation problem.  As an elder law attorney, I believe the bills are going to have the unintended consequence of creating (not eliminating) financial problems for elders.

The proposed legislation falls short of protecting vulnerable seniors from financial abuse.

Scott Kissinger

Wisconsin Rapids

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Letter to the Editor: Proposed elder abuse bills will not fix problem

San Antonio lawyer again sued by State Bar

Maverick lawyer, Phil Ross, known for his combative style has been sued by the State Bar of Texas over a grievance filed against him alleging among other things, dishonesty.

Photo: Carlos Javier Sanchez | Contributor / pixelreflexmedia.com

by John MacCormack - San Antonio Express News

For the second time in six months, San Antonio lawyer Phil Ross has been sued in state district court by the State Bar of Texas for alleged serial misconduct in a guardianship case involving an elderly person.

According to the bar’s recent suit, Ross’s misbehavior included “habitual and intentional disregard for court orders, misrepresentations to the court, fraud upon the court, conflicts of interest, dishonesty and deceit.”

The suit stems from Ross’s role in a high-profile Bexar County case involving Charlie Thrash, 82, the longtime owner of CT Thrash Differential and Axle Service on West Avenue.

In 2017, Thrash was found to be mentally incapacitated and since 2018 he has been in the care of court-appointed guardians.

In the last two years, hundreds of thousands of dollars of estate assets have been spent on legal costs as Ross, who sought to overturn the guardianships, has battled a team of lawyers representing the guardians.

The earlier suit against Ross, filed in October, pertains to his alleged misconduct in a Comal County guardianship case involving Sybil Sims, an elderly San Antonio woman who died in 2016. That case is set for trial this summer in Bexar County.

Ross, 71, who is known for his contrarian and sometimes combative style, plans to represent himself in both cases.

“I intend to defend myself and bring to light the truth of what happened to Charlie Thrash. The story is not over,” he said. “I trust that when a jury hears the entire case, not only will I be vindicated but the news will present itself that the claims against me are false.”

The bar’s latest suit, triggered by a grievance filed last year by Tonya Barina, one of Thrash’s guardians, lists a dozen specific violations of the rules of professional conduct for lawyers.

Among the accusations are that Ross repeatedly tried to represent Thrash when he knew Thrash lacked mental capacity to hire a lawyer; that Ross took Thrash out of Bexar County, contrary to court orders, to obtain a license for an impermissible marriage to his girlfriend Laura Martinez; and that Ross was involved with Thrash’s subsequent improper adoption of two of Martinez’s adult children, which was later reversed.

The suit also accuses Ross of filing “meritless, vexatious pleadings and motions” in an “apparent effort to burden and cause expense for the estate,” charges he denies.

“All the things I did were in an effort to advocate the rights, privileges and immunities of Charlie Thrash,” said Ross, who linked the timing of the bar’s latest suit to the recent release of “Dirty Money,” a Netflix film critical of the guardians in the Thrash case.

The outcome of either trial could cost Ross his license to practice law. Or he could face lessor sanctions or be exonerated.

Last year, Ross’s misconduct in the Thrash case triggered one of the largest court sanctions ever seen in Bexar County.

In May, Probate Court Judge Oscar Kazen imposed a $220,000 penalty on Ross and several members of the Martinez family. The 35-page order listed dozens of specific acts of misconduct, including the marriage and adoption, as well as Ross’s interfering with Thrash’s guardians. Ross has appealed the sanctions.

Les Katona, one of the lawyers representing Barina, said that Ross’s actions in the Thrash case “are the most egregious I have seen in 30 years of practice, and they merit the most severe sanction available.”

“The public and our profession need to be protected against the kind of activities that Judge Kazen has already found Mr. Ross to have engaged in,” he added.

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San Antonio lawyer again sued by State Bar

Nursing homes with serious violations could receive fewer inspections under Florida bills

A patient at a Central Florida nursing home near The Villages died after being left out in the sun for three hours.

Another was rushed to a Melbourne emergency room after staff administered anti-psychotic medications at 80 times the prescribed dose.

And at a nursing home between Gainesville and St. Augustine, one patient died after staff waited five minutes before starting cardiopulmonary resuscitation, and another nearly died after he was overdosed on morphine.

Over the last three years, Florida’s Agency for Health Care Administration cited all three low-rated nursing homes with Class 1 violations – the most severe violations the agency can levy. By state law, AHCA was required to ramp up oversight, inspecting the homes every six months for two years.

But that oversight would be cut back under two bills making their way through the Florida Legislature that would reduce inspections at problem nursing homes. Advocates say it's a threat to patient safety. ACHA leaders say they're already going into poor-performing homes frequently and need more flexibility around inspections. 

And with fewer inspections, AHCA’s inspection fine would be cut in half from $6,000 to $3,000.

The nursing home provision is part of a larger legislative push by AHCA to give the agency more flexibility in how it deploys staff across the health care spectrum.

Other parts of the legislation would give AHCA leeway to extend inspection deadlines at highly rated assisted living facilities and exempt “low-risk providers” – nurse registries, home medical equipment providers and health care clinics – with excellent regulatory histories from regular inspections.

Mary Mayhew, secretary of the
 Florida Agency for Health Care
Administration (Photo: Florida
 Agency for Health Care
Administration)

The two bills – Senate Bill 1726 and House Bill 731 – have received little pushback in Florida’s regulation-averse Legislature.

AHCA Secretary Mary Mayhew said in an interview that the purpose of the legislation is to give AHCA the ability to spend less time in good health care facilities and more time inspecting problem providers. The agency’s resources are increasingly strained as the state’s population and the number of health care providers increase, agency leaders said.

“We wanted to make sure that as we look at our workload, that we are able to have a clear focus on higher-risk and poor performing providers,” Mayhew said.

But critics of the legislation worry about the ramifications of cutting back on AHCA’s mandates.

Rep. Margaret Good,
D-Sarasota (Photo: Florida
House of Representatives)

“In my opinion, oversight and inspections are critical to ensuring quality care and that residents are safe,” said state Rep. Margaret Good, D-Sarasota, who was critical of the legislation during an early February health care committee meeting. “I’m concerned that requiring fewer inspections could lead to worse outcomes to those that are most vulnerable.”

The state's nursing homes came under scrutiny in 2017 after 12 residents of the Rehabilitation Center at Hollywood Hills died following a power outage caused by Hurricane Irma.

A 2018 investigation by The News-Press and the Naples Daily News that found dozens of Florida’s worst nursing homes have long records of failing to meet state and federal standards and operate with little risk that regulators will shut them down.

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Nursing homes with serious violations could receive fewer inspections under Florida bills

More seniors are suffering from 'self-neglect.' Here's why.

State and federal data suggests there's a growing threat to the nation's senior population that experts warn can lead to poor health outcomes or death—and that threat is self-neglect, Yuka Hayashi reports for the Wall Street Journal. 

The problem of self-neglect

Self-neglect occurs when someone loses the ability to perform essential self-care, such as keeping up with personal hygiene, taking proper medications, or providing him- or herself with food and shelter. 

When left unaddressed self-neglect can lead to poor physical and mental health outcomes, Hayashi reports. XinQi Dong, director of the Institute for Health, Health Care Policy and Aging Research at Rutgers University, said the risk of premature death is 15 times higher for people experiencing self-neglect than for other adults.

And the issue is particularly prevalent among seniors, as they are more likely to suffer from illness, dementia, poverty, depression, or the loss of a caregiver.

In 2018, more than half of reported cases of alleged elder abuse or neglect investigated by adult protective services actually involved self-neglect, according to a new HHS report. Overall, those 144,296 cases accounted for more elder abuse cases than neglect, financial exploitation, physical abuse, emotional abuse, and sexual abuse combined.

And a look at state-level data suggests the problem has gotten worse in recent years, Hayashi reports. Virginia's local service providers investigated 18% more self-neglect cases in 2019 when compared with 2015, while Iowa reported a 55% increase in self-neglect cases between fiscal years 2017 and 2019.

Self-neglect, particularly in seniors, can stem from various situations, Hayashi reports. For instance, a senior who falls and fractures a hip could become bedridden and become unable to care for themselves. On the other hand, seniors who struggle to pay bills might have their utilities cut off or, in extreme cases, could lose their homes.

Lori Delagrammatikas, executive director of the National Adult Protective Services Association, said the increase in self-neglect cases can also be partly attributed to an increase in the number of seniors who live alone.

According to government data, about 25% of seniors ages 65 and older, or 14.3 million, lived alone in 2017, up 31% from 10.9 million in 2007. As a result, on average, seniors age 60 and over spend more than 10 hours of their daily measured time alone, according to the Pew Research Center.

"A lot of people end up getting very isolated in their homes," Delagrammatikas said. "That can cause a downward spiral."

How state governments are addressing self-neglect

Some experts say the key to curbing self-neglect cases is to make it easier for seniors to live in their homes. For instance, services like medical transportation services, grocery delivery, and home help with chores could make living alone safer for seniors and reduce cases of neglect.

Paige McCleary, director of Virginia's Adult Protective Services Division, said agencies in Virginia work with seniors to arrange house cleanups or Medicaid-covered home care. In other states, agencies try to move seniors into assisted-living facilities.

In extreme cases, when self-neglect is apparent but the individual refuses help, agencies turn to the courts and law enforcement to relocate individuals or place them in short-term guardianship.

But, according to Hayashi, such extreme measures are needed on rare occasions. The ultimate goal, according to McCleary, is to help people live safe and healthy lives.

"It's not uncommon that our workers face individuals who clearly can't manage themselves in their own homes but absolutely refuse to go to assisted living facilities or nursing homes," McCleary said. "We try to support them in making their own decisions about how they choose to live their lives" (Hayashi, Wall Street Journal, 2/11).

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More seniors are suffering from 'self-neglect.' Here's why.

Golden retriever helps his owner deliver groceries to quarantined neighbor

By Caitlin O'Kane

Entire neighborhoods are on lockdown due to the coronavirus crisis, but some residents are more vulnerable than others. People who want to be good neighbors and help their elderly or at-risk friends face some challenges doing so, since social distancing rules mean they need to stay 6 feet away. One woman from Colorado has found a way around that by using her dog, Sunny, to help their neighbor.

Sunny and his owner, Karen Eveleth, live in Manitou Springs and have been neighbors with Renee Hellman for over a decade, CBS affiliate KKTV reports. Hellman, who has some health issues and relies on oxygen, is self-quarantined for her own health. So she can't leave her house — even for essentials.

To avoid putting her neighbor at risk, Eveleth sent Sunny over to pick up her grocery list and then, after a shopping trip, to deliver the bags.

"She got the list, she gave it to Sunny, Sunny brought it to me," Eveleth told KKTV. "I went to the store, got her groceries, and he delivered them all to her."

Sunny the golden retriever has been making deliveries to his elderly neighbor, who uses oxygen, so she doesn't have to leave her house to get groceries. KKTV

Since then, Sunny has continued to make trips back and forth between his house and his neighbor's. The clever and helpful work-around has delighted Hellman.

"What a wonderful thing, just a sweet thing," she said. "So, he started doing the schlepping, back and forth. It's been fun. It's been a real treat."

Not only has Sunny helped Hellman get food, his visits also make her days more bearable. "Little things like Sunny coming over to visit is nice, and it makes you feel good. It's a way of communicating," she said.

"Little things like Sunny coming over to visit is nice, and it makes you feel good. It's a way of communicating," Hellman said.  KKTV

Sunny's duties do not stop there. He also helps his owner retrieve the mail and he even picks up trash when they go for walks.

Eveleth hopes their story brings a smile to people's faces. "Anybody can do something small, that can be so helpful," she said.

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Golden retriever helps his owner deliver groceries to quarantined neighbor

‘We’re going to find you and prosecute you’: Lawmakers look to protect elders from coronavirus scams

by: Basil John

WASHINGTON (NEXSTAR) — Some seniors throughout the country are the targets of scammers who are now using the coronavirus outbreak as a way to exploit the vulnerable.

“This is the worst of the worst,” Pennsylvania Rep. Brian Fitzpatrick said.

Now, members of Congress like Fitzpatrick and Pennsylvania Rep. Matt Cartwright are working to put a stop to it.

“You’re no good, we’re on to you, we’re gonna stop what you’re up to and we’re going to find you and prosecute you,” Cartwright said, addressing the scammers.

New legislation would provide funds for states to set up legal advice hotlines for older Americans.

“A lot of seniors that have relied on people that they’ve interacted with, your financial planners, attorneys or what have you, don’t have that ability because they’re staying at home for their own health and safety,” Fitzpatrick said.

The hotlines would help combat financial exploitation and elder abuse, as well as help seniors access housing and medical care.

“People have to approach anything that sounds at least suspicious, very carefully,” U.S. Attorney General William Barr said.

Barr says the justice department will show no mercy to those who target the elderly during the pandemic.

“We have all of our offices in the country on the lookout and pursuing them aggressively,” Barr said.

“Scams will continue to sneak through and that’ll keep the justice department busy as well,” Cartwright said.

Some states already have hotlines in place but are operating with limited hours. If it passes, the increased funding would help states expand their efforts, helping more people.

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‘We’re going to find you and prosecute you’: Lawmakers look to protect elders from coronavirus scams

Bill would raise fines for not reporting elder abuse in NJ

by Jen Ursillo

A bill is making its way through Trenton would increase fines on care homes and the people they employ, if they fail to report the suspected abuse or exploitation of institutionalized elderly patients.

The lead sponsor of the bill, Assemblywoman Joann Downey (D-Monmouth), said it would raise the fine on individuals from $500 to $1,500 and on care facilities from $2,500 to $5,000 for not reporting abuse by staff or other residents to law enforcement.

The proposed penalties would represent an increase from fines required by "Peggy's Law," a 2017 measure named for Peggy Marzolla. The 93-year-old Alzeheimer's patient, who resided at Brandywine Senior Living in Brick, suffered from a broken eye socket, broken jaw, broken wrist, elbow bruises and welts on her back and more, and died two months after being hospitalized in 2010.

No employee reported the abuse to the state's ombudsman office.

"By increasing the fine, we can ensure we'll have fewer cases that go unreported and that seniors are safe and better protected from abuse, exploitation and neglect," Downey said. "Caretakers in nursing homes and other senior living facilities have a responsibility to keep our loved ones safe.

The state's Office of Long-Term Care ombudsman said there was a 38% increase in the number of reported cases from 2,607 in 2015 to 3,601 in 2019.

Understaffing has also contributed to elder abuse in state facilities. Downey said.

"We're trying to be very proactive about promoting the reporting of the abuse so we can stop it quickly and make sure that we protect all of our seniors, all of our vulnerable people who we love," Downey said.

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Bill would raise fines for not reporting elder abuse in NJ

Dear Therapist Writes to Herself in Her Grief

My father died, there’s a pandemic, and I’m overcome by my feeling of loss.

by Lori Gottlieb

Bianca Bagnarelli

Dear Therapist,

I know that everyone is going through loss during the coronavirus pandemic, but in the midst of all this, my beloved father died two weeks ago, and I’m reeling.

He was 85 years old and in great pain from complications due to congestive heart failure. After years of invasive procedures and frequent hospitalizations, he decided to go into home hospice to live out the rest of his life surrounded by family. We didn’t know whether it would be weeks or months, but we expected his death, and had prepared for it in the time leading up to it. We had the conversations we wanted to have, and the day he died, I was there to kiss his cheeks and massage his forehead, to hold his hand and say goodbye. I was at his bedside when he took his last breath.

And yet, nothing prepared me for this loss. Can you help me understand my grief?

Lori
Los Angeles, Calif.

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Dear Readers,

This week, I decided to submit my own “Dear Therapist” letter following my father’s death. As a therapist, I’m no stranger to grief, and I’ve written about its varied manifestations in this column many times.

Even so, I wanted to write about the grief I’m now experiencing personally, because I know this is something that affects everyone. You can’t get through life without experiencing loss. The question is, how do we live with loss?

In the months before my father died, I asked him a version of that question: How will I live without you? If this sounds strange—asking a person you love to give you tips on how to grieve his death—let me offer some context.

My dad was a phenomenal father, grandfather, husband, and loyal friend to many. He had a dry sense of humor, a hearty laugh, boundless compassion, an uncanny ability to fix anything around the house, and a deep knowledge of the world (he was my Siri before there was a Siri). Mostly, though, he was known for his emotional generosity. He cared deeply about others; when we returned to my mom’s house after his burial, we were greeted by a gigantic box of paper towels on her doorstep, ordered by my father the day before he died so that she wouldn’t have to worry about going out during the pandemic.

His greatest act of emotional generosity, though, was talking me through my grief. He said many comforting things in recent months—how I’ll carry him inside me, how my memories of him will live forever, how he believes in my resilience. A few years earlier, he had taken me aside after one of my son’s basketball games and said that he’d just been to a friend’s funeral, told the friend’s adult daughter how proud her father had been of her, and was heartbroken when she said her father had never said that to her.

“So,” my father said outside the gym, “I want to make sure that I’ve told you how proud of you I am. I want to make sure you know.” It was the first time we’d had a conversation like that, and the subtext was clear: I’m going to die sooner rather than later. We stood there, the two of us, hugging and crying as people passing by tried not to stare, because we both knew that this was the beginning of my father’s goodbye.

But of all the ways my father tried to prepare me for his loss, what has stayed with me most was when he talked about what he learned from grieving his own parents’ deaths: that grief was unavoidable, and that I would grieve this loss forever.

“I can’t make this less painful for you,” he said one night when I started crying over the idea—still so theoretical to me—of his death. “But when you feel the pain, remember that it comes from a place of having loved and been loved deeply.” Then, almost as an afterthought, he added, “Beyond that—you’re the therapist. Think about how you’ve helped other people with their grief.”

So I have. Five days before he died, I developed a cough that would wake me from sleep. I didn’t have the other symptoms of COVID-19—fever, fatigue—but still, I thought: I’d better not go near Dad. I spoke with him every day, as usual, except for Saturday, when time got away from me. I called the next day—the day when suddenly he could barely talk and all we could say was “I love you” to each other before he lost consciousness. He never said another word; our family sat vigil until he died the next afternoon.

Afterward, I was racked with guilt. While I’d told myself that I hadn’t seen him in his last days because of my cough, and that I hadn’t called Saturday because of the upheaval of getting supplies for the lockdown, maybe I wasn’t there and didn’t call because I was in denial—I couldn’t tolerate the idea of him dying, so I found a way to avoid confronting it.

Soon this became all I thought about—how I wished I’d gone over with my cough and a mask; how I wished I’d called on Saturday when he was still cogent—until I remembered something I wrote in this column to a woman who felt guilty about the way she had treated her dying husband in his last week. “One way to deal with intense grief is to focus the pain elsewhere,” I had written then. “It might be easier to distract yourself from the pain of missing your husband by turning the pain inward and beating yourself up over what you did or didn’t do for him.”

Like my father, her husband had suffered for a long time, and like her, I felt I had failed him in his final days.

I wrote to her:

Grief doesn’t begin the day a person dies. We experience the loss while the person is alive, and because our energy is focused on doctor appointments and tests and treatments—and because the person is still here—we might not be aware that we’ve already begun grieving the loss of someone we love … So what happens to their feelings of helplessness, sadness, fear, or rage? It’s not uncommon for people with a terminally ill partner to push their partner away in order to protect themselves from the pain of the loss they’re already experiencing and the bigger one they’re about to endure. They might pick fights with their partner. They might avoid their partner, and busy themselves with other interests or people. They might not be as helpful as they had imagined they would be, not only because of the exhaustion that sets in during these situations, but also because of the resentment: How dare you show me so much love, even in your suffering, and then leave me.

Another “Dear Therapist” letter came to mind this week, this one from a man grieving the loss of his wife of 47 years. He wanted to know how long this would go on. I replied:

Many people don’t know that Elisabeth Kübler-Ross’s well-known stages of grieving—denial, anger, bargaining, depression, and acceptance—were conceived in the context of terminally ill patients coming to terms with their own deaths. It’s one thing to “accept” the end of your own life. But for those who keep on living, the idea that they should reach “acceptance” might make them feel worse (“I should be past this by now”; “I don’t know why I still cry at random times, all these years later”). The grief psychologist William Worden looks at grieving in this light, replacing “stages” with “tasks” of mourning. In the fourth of his tasks, the goal is to integrate the loss into our lives and create an ongoing connection with the person who died—while also finding a way to continue living.

Just like my father suggested, these columns helped. And so did my own therapist, the person I called Wendell in my recent book, Maybe You Should Talk to Someone. He sat with me (from a coronavirus-safe distance, of course) as I tried to minimize my grief—look at all of these relatively young people dying from the coronavirus when my father got to live to 85; look at the all the people who weren’t lucky enough to have a father like mine—and he reminded me that I always tell others that there’s no hierarchy of pain, that pain is pain and not a contest.

And so I stopped apologizing for my pain and shared it with Wendell. I told him how, after my father died and we were waiting for his body to be taken to the mortuary, I kissed my father’s cheek, knowing that it would be the last time I would ever kiss him, and I noticed how soft and warm his cheek still was, and I tried to remember what he felt like, because I knew I would never feel my father’s skin again. I told Wendell how I stared at my father’s face and tried to memorize every detail, knowing it would be the last time I’d ever see the face I’d looked at my entire life. I told him how gutted I was by the physical markers that jolted me out of denial and made this goodbye so horribly real—seeing my father’s lifeless body being wrapped in a sheet and placed in a van (Wait, where are you taking my dad? I silently screamed), carrying the casket to the hearse, shoveling dirt into his grave, watching the shiva candle melt for seven days until the flame was jarringly gone. Mostly, though, I cried, deep and guttural, the way my patients do when they’re in the throes of grief.

Since leaving Wendell’s office, I have cried and also laughed. I’ve felt pain and joy; I’ve felt numb and alive. I’ve lost track of the days, and found purpose in helping people through our global pandemic. I’ve hugged my son, also reeling from the loss of his grandfather, tighter than usual, and let him share his pain with me. I’ve spent some days FaceTiming with friends and family, and other days choosing not to engage.

But the thing that has helped me the most is what my father did for me and also what Wendell did for me. They couldn’t take away my pain, but they sat with me in my loss in a way that said: I see you, I hear you, I’m with you. This is exactly what we need in grief, and what we can do for one another—now more than ever.

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Dear Therapist is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental-health professional, or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.

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Dear Therapist Writes to Herself in Her Grief

Port St. Lucie man accused of posing as licensed plumber, stealing $5,000 from Martin County woman

Robert Hibbert (Photo: ST. LUCIE COUNTY SHERIFF'S OFFICE)

MARTIN COUNTY — A man previously convicted of exploiting others and stealing in Florida, Delaware, New Jersey and Pennsylvania has been accused of stealing $5,000 from a woman in Martin County.

On Feb. 11, Martin County Sheriff's Office detectives responded to a call from the woman's daughter about a possible fraudulent incident, according to a complaint affidavit.

The daughter told detectives Robert Hibbert, 57, of the 300 block of Northwest Concord Drive in Port St. Lucie, had exploited and stole from her mother while he was working on her plumbing in Martin County.

The woman's daughter said on Jan. 28 she looked for a plumber online and contacted Hibbert about fixing her washing machine.

Hibbert told the daughter he was a licensed plumber, but records detectives obtained showed he doesn't have the license. 

After the work was done, the woman paid Hibbert $145 for the job. The woman's mother then asked Hibbert to look at a clogged drain in her home, detectives said.

The mother told detectives Hibbert asked her for $240 for the job he had previously completed and had been paid for by her daughter. She said Hibbert told her the plumbing work she needed was extensive and "she would have toilet paper leaking into the front yard and home" if she didn't get it fixed soon.

Detectives said Hibbert charged the mother $9,100 for the second plumbing job. 

Detectives said the daughter asked a plumbing company to look at the invoice Hibbert gave her mother for the $9,100 job. The company told the daughter the job should have only cost about $1,000.

The women said she looked through her emergency cash fund and found $5,000 missing. She told detectives the only person that had access to that room was Hibbert while he was doing the plumbing work. 

The mother called Hibbert and demanded $8,100 back. Hibbert apologized and sent back $5,000 and asked the woman not to call 911.

Hibbert was arrested on charges of exploitation of an elderly or disabled adult, grand theft, contracting without a license, and depositing with intent to defraud.

He was taken to the St. Lucie County Jail. Bond was set at $85,000.

Martin County sheriff's Detective Jennifer Jaques, who investigated the case, said Friday Hibbert was convicted in 1995 and 2000 in New Jersey on charges of theft by deception; and in 2011 and 2013 in Pennsylvania and Delaware, respectively, on charges of home improvement fraud.  

In 2017, Hibbert had an address in Vero Beach when a Palm Bay couple paid him more than $9,000 for home repairs that were not completed, according to an article in Florida Today. He identified himself as a licensed plumber. He was jailed in Indian River County on 10 charges related to work done on the Palm Bay home.

Jaques said there's a strong likelihood Hibbert took advantage of other people in Martin County. 

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Port St. Lucie man accused of posing as licensed plumber, stealing $5,000 from Martin County woman

$8,000 Rolex watch listed among St. Lucie County exploitation case purchases

ST. LUCIE COUNTY — A man accused of stealing more than $11,700 from a man with Alzheimer’s disease was jailed on a host of charges, according to records obtained Thursday.

Joseph Fernandez, 56, of the 200 block of Brazilian Circle in Port St. Lucie, was arrested Wednesday on charges including exploitation of an elderly or disabled adult, grand theft, forgery, fraudulent use of credit card and organized fraud after a Port St. Lucie police investigation.

Police began investigating in January, after family members learned from the state Department of Children and Families that their relative was “possibly being exploited” by Fernandez, records show.

Family members noted at least eight automated teller machine withdrawals in June and July 2019, along with an $8,000 purchase at a jewelry business in Palm Beach County.

A detective spoke with the man, who said Fernandez helped him by driving him around for errands. He agreed to pay Fernandez $157 weekly and let Fernandez use his vehicle.

Police asked the man about documents, including one in which he was supposed to give $85,000 and his pet to Fernandez upon his death, with his signature. The victim said he never signed them.

A representative of the Palm Beach County jewelry business said a Rolex watch was purchased in July for $8,000. The invoice said it was sold to Fernandez. It was purchased with the man's debit card.

Police also accused Fernandez of forging the man's signature on the title to his vehicle to “gift” himself the man's vehicle.

Only after a detective spoke to Fernandez’s lawyer and told him of possible criminal charges did Fernandez transfer the title back and return the vehicle, records show.

Family members told police the man died Feb. 9.

Records provided to police showed the man was diagnosed with Alzheimer's disease.

A booking photo of Fernandez was not available Thursday.

Fernandez also was arrested on a charge of resisting arrest without violence after sheriff’s deputies reported he tried to hide before they forced their way into his home to arrest him on warrants related to the case.

Fernandez was held Thursday in the St. Lucie County Jail on $28,250 bond, a jail official said.

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$8,000 Rolex watch listed among St. Lucie County exploitation case purchases