Saturday, May 30, 2020

US nursing homes seek legal immunity as Covid-19 spreads ‘like brushfire’

Family members of residents at the Life Care Center home, in Kirkland, Washington, where some patients have died from Covid-19, at a press conference on 5 March. Photograph: Jason Redmond/AFP via Getty Images
The US nursing home industry is clamoring for legal immunity during the coronavirus pandemic, even as horror stories from hard-hit facilities enrage families, consumer advocates and the American public.

Healthcare organizations insist liability protections are essential for under-resourced nursing homes fighting against Covid-19, while an already staggering death toll continues to climb.

Tricia Neuman, senior vice-president of the Henry J Kaiser Family Foundation, said: “The liability issue is exposing a longstanding tension between consumer advocates, who want to see the standards enforced, and owners, who are worried about the financial implications of a lawsuit.”

The US “ground zero” for the virus was a nursing home outside of Seattle. Once the country became a global hotspot, elderly Americans suffered. In some states, nursing homes have accounted for a majority of Covid-19 deaths as facilities scrambled to adapt.

Critics say the virus has ravaged nursing homes “like a brushfire”, partly because of the industry’s disastrous track record with infection control, but also because of staffing and resource deficiencies that long predate Covid-19.

Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, said: “It’s a population at risk, but this industry has a lot of serious problems that led to these enormous outbreaks in nursing homes. So I don’t think they can just say: ‘It’s not our fault, we didn’t have equipment.’

“They were supposed to have that equipment. This isn’t new.”

Some nursing homes have also faced criticism for their responses to Covid-19 that have only fanned the outbreaks’ flames.

Mike Dark, a staff attorney at California Advocates for Nursing Home Reform, said: “Facilities mostly don’t want to flag that they have the virus even when it’s killing residents, because it’s such a publicity problem, it’s such a business problem, and they are for-profit enterprises.”

Cheyenne Pipkin (left) with her mother Loraine Franks visits her grandfather Jerry Hogan, a Vietnam veteran, at Lindsey Gardens in California. Photograph: Barcroft Media/via Getty Images
Nearly 70% of US nursing homes are for-profit, and the industry has a reputation for lackluster performance around infection control. In all longterm care facilities, which include nursing homes, somewhere between 1m and 3m serious infections are contracted annually, according to the Centers for Disease Control and Prevention.

Hundreds of thousands of people die from infections each year, even when not in the grip of a pandemic.

“Our members are working hard to do the right thing and are focused on their missions of providing care. They are on the front lines of fighting coronavirus and are full partners with hospitals and other providers,” Katie Smith Sloan, the president and CEO of LeadingAge, an association for nonprofits providing services to older people, said.

“Regulations about standards of care evolve and change rapidly; providers’ access to needed personal protective equipment and testing is limited and often insufficient.”

State officials have been quick to let nursing homes off the hook for decisions made in the midst of the public health emergency. Through a hodgepodge of laws and executive orders, at least 21 states have granted some form of civil immunity to healthcare providers, according to a tally sent to the Guardian by National Consumer Voice for Quality Long-Term Care – though in a few cases it is not clear if the immunity extends to nursing homes.

Smith Sloan wrote: “States recognize that providers require legal protection as a result of actions related to combating the Covid-19 pandemic. LeadingAge … is pursuing protections on the federal level with a coalition asking for uniform and consistent relief as well.”

Some states are including immunity from criminal liability, but policies do generally make exceptions for especially egregious treatment, including willful misconduct or gross negligence.

Richard Mollot, executive director of the Long Term Care Community Coalition, said: “To basically take away the one area of potential accountability when residents are most vulnerable to me is dumbfounding and dangerous.”

For some public health experts, however, the issue is not so cut and dried. They describe nursing homes as a sector in chronic need of reform that is nevertheless “the safety net of the safety net” for vulnerable people.

Experts acknowledge that the industry is filled with deficiencies, and is based upon a broken business model that struggles in the face of a pandemic. But they also say nursing homes have been under-prioritized by officials in a public health crisis that has disproportionately targeted their patient populations.

Michael L Barnett, a professor at the Harvard school of public health, said: “Putting a nursing home out of business because somebody died is really punishing at the wrong level, because certainly there are nursing homes that probably did not act responsibly, or they may have ignored the threat. But so did many government agencies.”

Instead of lawsuits, experts are advocating for immediate reinforcements in testing, personal protective equipment (PPE) and staff, followed by permanent fixes for longterm care. They suggest payment reform, so nursing homes are not dependent on fickle revenue streams to subsidize their Medicaid patients.

Mildred Solomon, president of the Hastings Center, warned against the “blitzkrieg of lawsuits” that these immunity measures mean to avoid.

She said: “I think we have to hold our fire, not put our energy into finger-wagging and blaming. And put more emphasis on stronger regulations, with teeth.”

Full Article & Source:
US nursing homes seek legal immunity as Covid-19 spreads ‘like brushfire’

Utah man sentenced to 10 years in federal prison for defrauding elderly Utah woman of nearly $300k

Frank Gene Powell
by: Jennifer Gardiner

ST. GEORGE, Utah (ABC4 News) – A convicted murderer on parole who bilked an 80-year-old St. George woman out of nearly $300,000 will spend a minimum of 10 years behind bars.

Frank Gene Powell, 51, pleaded guilty in March to conspiracy to commit wire fraud, money laundering, two counts of destruction of records in a federal investigation, concealment of a document or object in an attempt to impair the object’s integrity or availability for use in an official proceeding, and tampering with a witness.

Powell was sentenced Thursday morning in St. George in front of U.S. District Judge David Nuffer to 10 years in federal prison and to pay $273,849.20 in restitution. Additionally, Powell will also forfeit two vehicles and be on supervised release for three years following his release from federal prison.

At the time of the crimes, Powell had only been on parole since 2017 after spending 30-years behind bars for the 1987 murder of 20-year-old Glen Candland who Powell ran over with his truck after an argument at a party. While incarcerated, Powell was convicted of sexually assaulting an inmate.

Frank Powell admitted he conspired with several others, including his girlfriend, Faye Renteria, 42, of Hurricane, to come up with a plan to steal money from the woman. He also admitted he engaged in a fake romantic relationship with the victim as a part of this plan.

Powell also pleaded guilty to witness tampering after he attempted to stop the victim from communicating with law enforcement officers investigating the case.

“Powell is a career criminal who has fended off decades of rehabilitative attempts in the Utah state criminal justice system. He’s a convicted murderer and sexual predator, who has now turned his criminal efforts to elder fraud while on state parole,” U.S. Attorney for Utah John W. Huber said today. “With these guilty pleas, he stands convicted of unconscionable crimes against a senior member of the St. George community. A 10-year sentence is very appropriate in this case and will help ensure that Utah will not fall victim to his crimes again.”

Eight defendants in all were charged in a 10-count indictment returned by a federal grand jury in January.

“This crime is especially heinous because Frank Powell not only deceived and defrauded the victim, he made it a family affair,” said Special Agent in Charge Paul Haertel of the Salt Lake City FBI. “As a society, we should be looking out for the elderly, not exploiting them. Crimes like this will be aggressively investigated, and we encourage the public to immediately report any fraud to law enforcement or the FBI.”

Frank Powell’s mother Gloria Jean Powell, 74, of St. George, was sentenced to time served on May 1, after pleading guilty to one count of concealment of a document or object, admitting she tried to hide the stolen money and she helped her son and her daughter, Angela McDuffie, 53, of Lehi, in the scheme.

Renteria, who is in custody, will be sentenced on July 15 after pleading guilty on May 7. She admitted she engaged in misleading the victim and attempted to stop her from communicating with law enforcement.

She faces up to 20 years for conspiracy to commit wire fraud, 10 years for each count of money laundering, 20 years for each count of destruction of records or tangible objects in a federal investigation, and up to 10 years for the witness tampering conviction.

Bubby Mern Shepherd, 58, of Lodi, California, and Rocky James Powell Mott, 40, of Hurricane, both of whom are still in custody, both pleaded guilty to one count each of conspiracy to commit wire fraud. Their plea deal include a stipulated sentence of 21 months in prison.

Cases are pending against McDuffie, Terrence Quincy Powell, 24, of St. George, and Martell Taz Powell, 25, of Cedar City. Trial in those cases are scheduled for September.

The U.S. Department of Justice and the U.S. Attorney’s Office in Utah said combating elder abuse and financial fraud targeted at seniors is a key priority.

A statement issued in a press release by the U.S. Department of Justice reads:

“Elder abuse is a serious crime against some of our nation’s most vulnerable citizens, affecting at least 10 percent of older Americans every year. Together with federal, state, local and tribal partners, the Department of Justice is committed to combating all forms of elder abuse and financial exploitation through enforcement actions, training and resources, research, victim services, and public awareness. This holistic and robust response demonstrates the Department’s unwavering dedication to fighting for justice for older Americans.”

For tips on how to prevent Elder Financial Abuse, the Department of Justice has created a prevention awareness campaign with valuable information.

You can view that document: Stopping-Elder-Financial-Abuse

Assistant U.S. Attorneys in Utah are prosecuting the case. The FBI is investigating the case. Agents with Utah Adult Probation and Parole have made signification contributions to the investigation.

Full Article & Source:
Utah man sentenced to 10 years in federal prison for defrauding elderly Utah woman of nearly $300k

Mobile DA: Group home elder abuse victim tests positive for COVID-19

The Mobile County Sheriff's Office says the scribbled out portions of this photo marks out where a person is in the bed and another is in the chair.
by Toi Thornton

MOBILE, Ala. (WALA) -- The Mobile County district attorney tells FOX10 News one of the victims in a group home elder abuse case has tested positive for COVID-19 and others suffer from pneumonia.

“These individuals are all being treated in the hopsital now for various illnesses including pneumonia and COVID. They needed treatment at the facility and were not given that treatment,” said District Attorney Ashley Rich.

While DA Rich maintained the home is not a boarding house, one of the suspects' attorney Dennis Knizley said it is.

“This is a boarding house. This is not a group home. This is not a nursing home,” Knizley said. “Like any other boarding house they provide 3 meals a day and some minimal cleaning. That’s what they do. They’re not the caretakers of these people.”

Deputies with Mobile County Sheriff's Department said Wednesday the elderly veterans had no access to food and water, the a/c was broken, the fire alarm wasn't functioning and the refrigerator and cabinets were padlocked.

“I was there at the scene when it unfolded and it was deplorable. It was horrific conditions. It’s the worst possible thing that I could imagine that we could do to a veteran as a society. These individuals are going to be held accountable for what they did,” DA Rich added.

Knizley argues these allegations are overblown.

“You’ve seen these pictures of locked up refrigerators and things like that, that’s only after 5 o’clock. All during the day they have ample access to food and meals. After 5 o’clock they have snacks in their room, they have water and that’s like any other place,” he explained. “Air conditioning units in ever room, working. The smoke detectors were taken off the wall they’re fine. Where these allegations come from, you heard one that there wasn’t no one there for a week. This is totally untrue.

Deputies also found a large amount of prescription medication at the Owens' home. Knizley said they were 2 or 3 years old.

"Some of the people  that are living there, they take their medication, they don’t take it all or they get and change their prescription. They have left over medication. Those left over medications, you don’t want to leave them around the place for someone to pick up and use. They take them from the boarding home to their own home and don’t just leave them out for someone else to use. Yes they could’ve discarded them,” Knizley explained.

After authorities discovered the conditions at the group home in Grand Bay earlier this week, they made two arrests.

Donny Owens, 49, owner of One Life Management, was arrested and charged with one count of first-degree elderly abuse and neglect and five counts of elderly abuse and second-degree neglect.

Tilena Kim Owens, 49, also was charged with several counts of elder abuse and neglect.

Both have been released on bond, according to Mobile County Metro Jail records.

“This is a very, very large investigation and we have multiple disciplinarian chains from all over the state and country that are looking at this because it is veterans,” Rich stated.

The Mobile County Sheriff's Office describes the facility involved as an unlicensed group home for elderly veterans.

It was Tuesday evening, deputies said, when one of the six elderly veterans living in the home left to get help for two others who had fallen.

Full Article & Source: 
Mobile DA: Group home elder abuse victim tests positive for COVID-19

See Also:
Second person charged with elder abuse, neglect over Grand Bay group home

Man charged with multiple counts of elder abuse and neglect in Grand Bay

Friday, May 29, 2020

DATA DEBATE: When it comes to the coronavirus, nursing home secrecy frustrates family members

By Trevor Ballantyne

Some nursing homes have refused to divulge the number of people who have died from the coronavirus while they lived or worked there.

Each week, the state Department of Public Health releases information showing which nursing homes have coronavirus outbreaks.

The data the state releases is limited, showing only the general ranges of COVID-19 infections at skilled-nursing and long-term care facilities. More than 30 cases at Casa de Ramana in Framingham. More than 30 cases at Westborough HealthCare in Westborough. More than 30 cases at Sudbury Pines Extended Care in Sudbury.

When actual numbers are released, they are often far higher than the maximum range suggests. Briarwood in Needham is listed as having more than 30 cases, which is the highest range offered. But a spokesperson for the skilled-nursing facility said the actual number is 91 residents and staff who have tested positive since late March.

Conspicuously absent from the data is the number of coronavirus-related deaths at individual nursing homes.

“Due to patient confidentiality policies, we are not reporting the number of deaths by facility but are including them in aggregate,” a DPH spokesperson told the Daily News on Monday.

As of Monday, the state logged 3,574 deaths in skilled-nursing and long-term care facilities, 60.9% of Massachusetts’ total death count. More than 30% of nursing home deaths have been reported in just the last two weeks.

But other states, including Connecticut and New York, are releasing the specific number of deaths at individual nursing homes.
The New Hampshire Department of Health and Human Services releases both the number of cases and fatalities recorded at specific long-term care facilities on a weekly basis. As of Monday, 79.6% - 134 of 172 - of all deaths in the state had been reported at long-term care facilities.

“Our goal is to release as much information as possible in order to protect public health, while taking care to safeguard the private health information of individuals,” said Kathy Remillard, public information officer for the state’s health department. “New Hampshire releases data during public health outbreaks when that information is necessary to help our citizens make informed decisions about their health.”

Numbers not personal

A bill being debated by Massachusetts lawmakers would require the state Department of Public Health to release exact case numbers and exact death tolls by nursing home - data the agency already collects - to the public.

A senior Senate official who worked on the bill but did not want to be named told the Daily News last week that lawmakers believe the state DPH could release the specific number of COVID-19 cases and COVID-19-related deaths by nursing home without violating privacy laws.

Some data, including certain demographic information, could be a privacy concern, the official said, but case counts and death tolls by nursing facility should be public.

“When you’re talking about numbers, you’re not getting into personal identifying information,” the official said.
If the bill becomes law, which seems likely, the state DPH will be required to report to lawmakers within two weeks any challenges the agency faces with reporting the data.

“So if they’re having a problem with posting this number because of privacy laws, they’re going to have to put that in that report and clearly spell that out for the Legislature,” the official said.

State Sen. Patricia Jehlen, D-Somerville, is one lawmaker pushing for the release of nursing home death tolls, but she told the Daily News last week that the bill is an unnecessary delay. Gov. Charlie Baker could order the release of the data now, she said.

“They have the numbers,” Jehlen said on Wednesday. “They could be making a difference in how we act in nursing homes and assisted living and in the community, but that information isn’t available and it is extraordinarily frustrating.”

Case ranges, as published, “mean nothing,” Jehlen said, adding that privacy laws should not be a barrier to releasing the number of fatalities at individual nursing homes.

“I do not know whose privacy is invaded,” Jehlen said. “In the bill, it says if anything was in contravention with HIPAA, or any other privacy law, that the department could redact it or they could report it in a different way.”
Wednesday’s report from the COVID-19 Command Center shows that, for at least at two state facilities, privacy laws are not a concern when it comes to releasing specific case numbers and death tolls.

In that report, the state lists several specific statistics about the coronavirus outbreak at the Holyoke Soldiers’ Home, which has attracted national attention for the mounting death toll there.

According to Wednesday’s report, 89 Holyoke Soldiers’ Home residents have died, 74 who tested positive for the coronavirus, 14 who tested negative. The COVID-19 status of one person is unknown.

The state also reported that 77 current Holyoke Soldiers’ Home residents have tested positive for the virus, 58 residents have tested negative, and zero residents have pending test results. The report even went so far as to list the current location of each resident (104 are on-site, 31 are off-site, all but one at a dedicated skilled nursing unit at Holyoke Medical Center).

The report also lists specific case and fatality numbers for the Chelsea Soldiers’ Home, where 30 resident veterans who tested positive for the coronavirus had died as of Wednesday.

Information like that is crucial for families trying to make decisions about their loved ones’ care, Jehlen said.

“I have at least one constituent who is trying to decide if she wants to bring her mother home. When she knows what it is like inside the building, it is easier for her to make that decision,” Jehlen said.

On April 6, the state Department of Public Health reminded long-term care facilities to use the Health Care Facility Reporting System (HCFRS) to report any deaths presumed or confirmed to be related to COVID-19. From there, municipal health departments can access the numbers through an online portal.
The Daily News requested the number of deaths at each of the state’s nursing homes from the state Department of Public Health on May 18, and will report on the agency’s response.

Reporting requirements

CDC reporting rules announced on May 6 require the nation’s 15,000 nursing facilities to report COVID-19 data to the federal government, including the specific number of fatalities.

“All of the information we are asking for will be nationally available,” Jehlen pointed out. “There is no reason for the governor not to have done it by now.”

Because the state does not publish the number of deaths at specific facilities, Massachusetts residents usually only learn about fatalities at skilled-nursing and long-term care facilities that choose to divulge their death tolls to family members or to the media.

Ron Doty, administrator at Marlborough Hills Rehabilitation & Health Care Center in Marlborough, told the Daily News on May 15 that 21 residents and one employee of the skilled-nursing facility have died after contracting the coronavirus. At that time, 70% of Marlborough’s coronavirus-linked deaths occurred at Marlborough Hills.

Sharing the number of people who have died at Marlborough Hills is difficult, Doty said. But he thinks the information should be shared.

“I don’t want to talk about it,” Doty said. “I definitely don’t want to talk about losing a member of our family here that’s been working to keep these folks safe, but at the same time, it’s a part of it. It’s a metric that should be looked at and reviewed and measured and communicated.”

Other nursing homes have taken a different tack, refusing to divulge the number of people who have died from the coronavirus while living or working there.

In response to multiple Daily News inquiries, Casa de Ramana in Framingham declined to share the number of people who have died there after contracting the coronavirus.

“As is consistent with all of our communication, the privacy of our residents, families and staff will be respected,” a statement emailed to the Daily News read. “As always, our first priority is the health and well-being of the vulnerable population that we care for.”
Framingham Health Director Sam Wong also declined to share how many people have died at Casa de Ramana specifically. Framingham has released the number of deaths at the city’s nursing homes in aggregate, but the health department has not released the number of deaths per facility.

Wong said that if the state Department of Public Health began releasing the specific number of deaths at each facility, or even the specific number of cases at each facility, he would do the same.

“We follow their lead,” he told the Daily News.

On May 19, Shelley Buma, a lifelong resident of Whitinsville, an unincorporated village in Northbridge, emailed her local health department. She wanted to know how many residents of the town’s skilled-nursing and long-term care facilities had died.

The question was personal. Buma’s aunt, 88-year-old Irene VandenAkker, is a resident of St. Camillus Health Center in Northbridge. As her cognitive health declined, the close-knit family eventually determined that VandenAkker needed to move out of her longtime home, across the street from the homes of her three adult sons, and into a skilled nursing facility. She moved into St. Camillus in January.

‘The call’

It was a tough decision. VandenAkker was worried she would be cut off from her children, her grandchildren and her sister, Buma’s mother. The family assured her they would visit her frequently, and they did, until nursing homes across the state shut their doors to visitors in March as the virus spread.

“Things were happening throughout March and April, and we’re just all holding our breath,” Buma remembered. “And then the call.”

On May 6, St. Camillus notified Irene’s family that she had tested positive for the coronavirus. From there, the family continued to receive robocalls from the nursing home that listed the number of positive residents and the number of positive staff, but made no mention of how many people had died from the virus.

Irene’s son Keith VandenAkker told the Daily News that he has learned from friends that residents have died at St. Camillus, but he hasn’t received any formal notification of the deaths from the nursing home. The Daily News reached out to St. Camillus and but hasn’t received a response.

The public has a right to know how many people have died from COVID-19 at the state’s nursing homes, VanderAkker said.

“You don’t like to hear them sometimes, but you can’t avoid facts, and I think in a pandemic of this level, we need to know the facts,” he said. “Things can’t be hidden. If it is this deadly and it is this serious, the public needs to know. Facts can be ugly, but you can’t shy away from the facts.”

Map of virus infections/deaths in nursing homes by state


After Irene VanderAkker was diagnosed, Buma began researching how the coronavirus was affecting the state’s nursing homes. She was shocked to learn that data showing how many residents had died at St. Camillus, and other nursing homes, from COVID-19 was unavailable. She reached out to state lawmakers who offered little help, and then to her local health department.

The response she received upset her.

“That is not being tracked at the local level – you can check out the MDPH website for their data – link provided below,” an administrator for the Northbridge Board of Health wrote.

When she got that email, Buma already knew the state DPH website would be no help.

“Now that I know that DPH has the information and is keeping it from me, I’m more infuriated,” Buma told the Daily News. “No privacy issues are at stake here. That’s laughable. That’s a sham.”

One day, Buma might have to decide if her mother, Irene’s sister, needs additional care. If that day comes, Buma said, she wants to know how the nursing homes she considers fared during the pandemic.

“If that’s what’s needed, we have a right to know which homes are better able to control infection than others so we can make an informed decision,” Buma said. “In this heavily regulated, heavily subsidized industry, I am finding out that we are completely in the dark. Not only are we locked out from our loved ones, we’re locked out from the data. You get our money. We don’t get the data. It’s so wrong.”

On Friday, Buma, who has worked to get the information from other sources since her aunt was diagnosed, emailed the Daily News to say that St. Camillus staff informed her that 14 people have died there since May 3.

Doty, the administrator at Marlborough Hills, said he understands why some nursing facilities haven’t been transparent with the number of deaths they’ve sustained.

“Maybe they don’t want the attention or they don’t want the ramifications that could possibly unfold because of divulgence of information like that,” Doty said. “It could be the path of least resistance.”

But Doty thinks it is important for the public to understand how many people are dying at the state’s skilled-nursing and long-term care facilities.

″(Deaths are a metric) to measure the significance, the importance, the severity,” Doty said. “Like, people, stay home. This isn’t a joke. This is not the flu. This is killing people. Start taking it seriously and stop saying this is a government thing. I’ve heard it all and it just makes me sick because I see the folks that are flat out on 10 liters of oxygen here, trying to get their lung capacity back.”

Jehlen said death tolls are also important in terms of accountability.
She believes Massachusetts was slow in efforts to protect nursing homes, which were nationally recognized as potential coronavirus hotspots when an outbreak devastated a skilled-nursing facility in Kirkland, Washington.

“How do you get the attention of people who make decisions if you don’t have that information yourself?” Jehlen said. “And the people with decisions knew, and they did not act, in my opinion, adequately.”

Full Article & Source:
DATA DEBATE: When it comes to the coronavirus, nursing home secrecy frustrates family members

Is Elder Abuse the Real Nursing-Home Crisis?

by Andrew Moran

Long-term care facilities are now ground zero in the fight against the Coronavirus pandemic. As health authorities focus on containing the highly infectious respiratory illness, the public is learning of another outbreak that has been festering inside these nursing homes for years: elder abuse. It is estimated that more than five million seniors are abused in some form every year at these establishments. The latest clip of a suspect viciously assaulting a defenseless senior may have been the catalyst to trigger public outcry and demand some type of intervention.

Westwood Nursing Center

President Donald Trump recently reacted to a shocking viral video that showed a 20-year-old male suspect beating an elderly patient at the Westwood Rehabilitation Nursing Center in Detroit, MI. The culprit had been diagnosed with the Coronavirus and was transferred from Ann Arbor hospital to the facility. The individual was arrested, and a lot is still unknown as to why or how he was moved to Westwood. The 75-year-old victim is recovering in Sinai-Grace Hospital, and his family accused the center of “dropping the ball.” A police investigation into the incident is ongoing, and the nursing home is performing an independent probe to find out what happened.

But it has sparked a broader conversation on a system that Diane Menio, the Executive Director of the Center for Advocacy for the Rights and Interests of the Elderly (CARIE), calls “fragile.” With COVID-19 igniting a lot of panic and creating plenty of confusion throughout the health care sector, the industry might be ill-equipped to endure the public health crisis, potentially increasing abuse or neglect.

The State of Nursing Homes

Lori Smetanka, the Executive Director of the Consumer Voice, an advocacy group for quality long-term care, says the abuse of elders is tragic, and it often goes underreported.

“Families place their loved ones in long-term care facilities with the expectation that they will be safe and well cared for,” Smetanka said in an interview with Liberty Nation.

Although figures from the Adult Protective Services (APS) show that there has been an increase in the number of reported abuses, experts say many seniors are unable or unwilling to report their cases. Of the reported instances, the data have highlighted staggering findings about the state of nursing homes. One study from the National Center for Victims of Crime found that as many as 10% of self-reported elder abuse is physical, 60% is verbal, and 14% is neglect.

All 50 states have implemented anti-elder-abuse laws, but a Government Accountability Office (GAO) report discovered that state regulators had missed signs of abuse. A two-year congressional investigation also uncovered that about one-third of nursing homes were cited for violations that had the potential to inflict harm on residents.

What is going on? Diane Menio explains that you cannot point to one specific cause of the myriad of systemic challenges facing nursing homes today, which range from inadequate training to insufficient compensation for staff. While funding could enter the conversation, she does not believe it is the primary factor.

She tells Liberty Nation:
“There are so many systemic issues with long-term care. First of all, the training requirements are not sufficient. Certainly, some people may go above and beyond what their requirement is. They also might be compassionate, caring people who would never consider abusing someone. But then the fact that you’re paying people low salaries, you’re not providing the adequate training limits your pool of people to hire. What does that do? It can cause some of these problems.”
“We need to do better,” Manio said.

It might be an objective difficult to achieve during the outbreak because of a new problem that could limit accountability and transparency in the short-term: Nobody is allowed inside. The CARIE representative warns that regulators have not been permitted inside, although these restrictions have eased in multiple states in recent weeks.

“It is a time when you could imagine people are vulnerable, staff are stressed, and management may not be able to oversee things as well as they might otherwise. Regulators aren’t there, advocates aren’t there, families aren’t there,” she noted, adding that families are the best people to be there.

For those shocked by the state of the industry, it could be easy to think that this situation is only prevalent in the U.S. Elder abuse and dilapidated conditions inside these places are global problems.

An International Crisis

In Canada, approximately 80% of COVID-19 deaths have been in long-term care (LTC) facilities. The province of Ontario requested assistance from the Canadian Armed Forces (CAF) to help get the pandemic under control. During this time, officials performed an extensive probe into the state of the province’s long-term care homes and published a report that Premier Doug Ford called “gut-wrenching.”

The military discovered numerous examples of residents bullied, drugged, and left for hours and even days in soiled bedding. The overall conditions of the province’s LTC facilities were astonishing, too. One assessment of a nursing home reported “cockroaches and flies present,” the smell of “rotten food” in the hallway, and “multiple old food trays stacked inside the bed table.” The CAF concluded that “respecting the dignity of patients is not always a priority.”

Prime Minister Justin Trudeau described the report as “disturbing.”
“On reading the deeply disturbing report, I had obviously a range of emotions of anger, of sadness, of frustration, of grief. It is extremely troubling, and as I’ve said from the very beginning of this, we need to do a better job of supporting our seniors in long-term care right across the country, through this pandemic and beyond.”
In June 2018, the World Health Organization (WHO) published a report in which it forecast that elder abuse is likely to increase in many nations due to rapidly aging populations. At the same time, WHO states that “too little is known about elder abuse and how to prevent it, particularly in developing countries.”

What are the solutions?

Nurses and Families

A long-term remedy for ensuring the health and safety of society’s most vulnerable people requires both the retirement residence and patients’ families, states Lori Smetanka. Nursing homes must ensure they maintain adequate policies and procedures to protect and prevent residents from abuse, while families can hold everyone accountable and pay attention to their loved ones.
“They need to ensure that they can adequately care for any individual they admit, which includes providing all necessary services, including mental health services. Additionally, having adequate numbers of staff on hand is critical to not only ensuring that each resident’s needs are met, but also as a way of monitoring what’s going on in the facility, including frequently checking in on residents.”
Families can help protect their loved ones by being in regular communication with facility staff, asking questions about the numbers of staff providing care as well as the steps the facility takes to protect residents from abuse. They also should pay attention to their loved one and notice any changes in behavior, physical changes, or unexplained injuries. Raise any concerns with the administration immediately, and contact your long-term care ombudsman program for assistance.”
Indeed, many different types of elder abuse may be hard to notice. Over the years, it has been discovered that senior residents are victims of unwanted sexual attention, psychological abuse (criticizing, humiliating, and yelling), and financial exploitation. There has also been a slight uptick in resident-to-resident abuse, but Manio points out that this is rare due to patients’ physical health.

For families that are not with their loved ones around the clock, how could you detect signs of nursing home abuse? In addition to finding fractures or bruising, some of the other physical indicators could include frequent infections, bedsores, unexplained weight loss, and poor hygiene. There could also be a myriad of non-physical clues, such as emotional outbursts, reclusiveness, changes in mental status, and caregivers not wanting patients to be left alone with others.

The Future of Nursing Homes

Could retirement communities – public and private – experience a complete overhaul on the other side of the lockdown or will their fundamental problems be swept under the rug? Like so many other challenges facing the U.S. and the rest of the world, the Coronavirus has exposed the dire situation occurring in long-term care facilities. Many folks in charge may pay lip service to the issue, but time will tell if they will start taking the problem seriously. Time is, unfortunately, not something too many seniors in these establishments possess.

Full Article & Source:
Is Elder Abuse the Real Nursing-Home Crisis?

Second person charged with elder abuse, neglect over Grand Bay group home

Tilena Owens, left, has been charged with elder abuse and neglect, as has her husband Donny Owens.
By Lawrence Specker

A second person has been arrested in the case of a Mobile County group home where authorities say six veterans were found in “deplorable” conditions this week.

Meanwhile a Mobile County Sheriff’s Office spokeswoman said the MCSO was working with federal investigators on the case. Another sheriff’s department official said that the six residents remained hospitalized and that authorities were working to establish whether other properties owned by the home’s operators might also be used as group homes.

Jail records indicated that Tilena Kim Owens, 49, was booked into Mobile County Metro Jail shortly before noon on Thursday and remained there early Thursday afternoon. She was charged with one first-degree count of elder abuse and neglect and three second-degree counts.

She is the wife of Donny Boyd Owens, also 49, who was booked into the jail Wednesday morning. Jail records indicated that he also remained in jail Thursday afternoon. He faces one first-degree count of elder abuse and neglect and five second-degree counts.

An MCSO spokeswoman said investigators had determined that the Owens had received federal funding, though the exact amount had not been established.

Captain Paul Burch of the Mobile County Sheriff’s office said Thursday that he believed Donny Owens had been through a bond hearing at which bond was set at $20,000 for the first-degree charge and $10,000 for each of the second-degree charges. Jail records did not reflect that hearing as of early Thursday afternoon.

Burch said the sheriff’s office was aware of “several” other properties owned by the couple but had not yet established whether any of them were being operated as group homes.

As for the six men discovered in Grand Bay, Burch said they continued to receive treatment. “They are all still in the hospital and as far as we know their conditions are not life threatening,” he said.

Burch had said on Wednesday that the six residents of the home at 11050 Lakeview Lane Ext. in Grand Bay “had not seen any caretaker at the house for several days, up to a week.” Cabinets, pantries and the refrigerator were padlocked and the six residents required medical attention.

Details of their ages and medical needs have not been released.

Full Article & Source:
Second person charged with elder abuse, neglect over Grand Bay group home

See Also:
Man charged with multiple counts of elder abuse and neglect in Grand Bay

Thursday, May 28, 2020

Top nursing home executive blames 'flawed survey system' for scathing GAO report on lapses in infection prevention

By Andrew O'Reilly

The head of the National Center for Assisted Living blamed a “flawed survey system” for the recent government watchdog report that found widespread problems with infectious disease controls in nursing homes across the country.

Mark Parkinson, the president and chief executive officer of the American Health Care Association and National Center for Assisted Living, said on Sunday that people surveying nursing homes across the country were encouraged to find problems and that is why a Government Accountability Office report released last week found that eight in 10 nursing homes inspected were cited for infection-control problems.

“We have a real flawed survey system and one of the flaws in the system is surveyors are encouraged to give deficiencies and that makes the impression that even very good buildings are deficient,” Parkinson said on “Fox News Sunday.”

The GAO report comes as nursing homes across the country have been hard hit by the coronavirus pandemic.

An ongoing count by The Associated Press has found that outbreaks in nursing homes and long-term care facilities have killed more than 30,000 people, more than one-third of all coronavirus deaths in the country.

In Massachusetts, the coronavirus late last month killed at least 80 veterans – with 82 other residents and 81 staff members testing positive for the contagion – at Holyoke Soldiers' Home. Overall, the outbreak has claimed the lives of nearly one-third of all residents at the veterans' home.

“It’s horrific,” said Edward Lapointe, whose father-in-law lives at the home and had a mild case of the virus. “These guys never had a chance.”

New York, as with much of the other grim news from the outbreak, has been the epicenter of deaths in nursing homes with more than 5,000 being reported as of earlier last week. It was reported last week that more than 4,500 recovering coronavirus patients were sent to New York’s already vulnerable nursing homes under a controversial state directive that was ultimately scrapped amid criticisms it was accelerating the nation’s deadliest outbreaks.

The GAO report, which analyzed data from the Centers for Medicare & Medicaid Services from 2013 to 2017, found that 82 percent of nursing homes – over 13,000 in all – had received citations for either cutting corners or failing to implement to correct controls in that time frame.

Gov. Andrew Cuomo, a Democrat, on May 10 reversed the directive, which had been intended to help free up hospital beds for the sickest patients as cases surged. But he continued to defend it this week, saying he didn't believe it contributed to the more than 5,800 nursing and adult care facility deaths in New York — more than in any other state — and that homes should have spoken up if it was a problem.

“Any nursing home could just say, ‘I can’t handle a COVID person in my facility,'" he said, although the March 25 order didn’t specify how homes could refuse, saying that ”no resident shall be denied re-admission or admission to the (nursing home) solely based" on confirmed or suspected COVID-19.

The GAO report found that about 40 percent of the nursing homes inspected in each of the past two years were cited for problems with infection control and prevention.

Looking deeper into federal data for 2013-2017, investigators found a recurring pattern of problems. Data for that five-year period showed that 82 percent of nursing homes inspected, or 13,299, had at least one deficiency related to infection control and prevention. About half of the facilities had an infection-related deficiency in multiple consecutive years.

“Our analysis of CMS data shows that infection prevention and control deficiencies were the most common type of deficiency cited in surveyed nursing homes,” John Dicken, the director of the health care team at the GAO, wrote in a letter to Sen. Ron Wyden of Oregon, the top Democrat on a committee that oversees Medicare and Medicaid. “Infection prevention and control deficiencies cited by surveyors can include situations where nursing home staff did not regularly use proper hand hygiene or failed to implement preventive measures during an infectious disease outbreak, such as isolating sick residents and using masks and other personal protective equipment to control the spread of infection."

Dicken added: “Many of these practices can be critical to preventing the spread of infectious diseases, including COVID19.”

Parkinson said on Sunday that one of the reasons nursing homes have been so devastated by COVID-19 was that residents were not seen as high priority and the facilities lacked the proper testing supplies.

“The country was too concerned with hospitals being overrun and there were consequences to that, one of the consequences was that nursing homes were left out,” he said. “Our residents were not a high priority for testing, we weren’t given the equipment we needed."

Parkinson added: “There needs to be some accountability for all of these people that were making this fantastic estimates that all the hospitals in the country would be overrun—there wasn’t and there were consequences.”

Parkinson noted that the Trump administration has allocated $5 billion for the recovery efforts in nursing homes nationwide.

Full Article & Source:
Top nursing home executive blames 'flawed survey system' for scathing GAO report on lapses in infection prevention

Tucker Carlson: Coronavirus and the shocking abuse happening in nursing homes. This tragedy wasn't by accident

By Tucker Carlson

Months from now, if and when we're finally able to assess the coronavirus pandemic rationally and honestly, it'll be clear that it was mostly a disaster for the old and the sick. Thirty-year-olds in Brooklyn have made the most noise, flooding the Internet with their neuroses.

But it is old people who have really suffered.

About a third of all deaths in this country so far have occurred in long-term care facilities. We told you a lot about the tragedy unfolding in New York.

As of Friday night, almost 6,000 nursing home residents have died there after Governor Andrew Cuomo forced facilities to admit infected patients.

But it's not only happening in New York. In New Jersey, Connecticut and Massachusetts for example, deaths in nursing homes account for more than half of the statewide totals.

So, if you're old and in a facility, this virus has been genuinely dangerous.

But the real story is even worse than that, thanks to bad policies.

Many nursing homes have banned all visits from relatives even those who have tested negative for the coronavirus. That means for millions of aging Americans, lockdowns equal suffering alone, marooned in isolation, away from children and grandchildren, often in the final days of their lives.

It's hard to imagine anything sadder than that, but in fact, there is something sadder.

No visitors means no real supervision. No one who cares about the elderly can check-in and see how they're doing. This is an invitation to the most awful kinds of abuse.

Take a look at this video. It's from the Westwood Nursing Center in Detroit. We warn you -- and we don't say this lightly -- it is highly upsetting. We think you should see it because it's real.

VIDEO: A nursing center worker repeatedly punches an elderly man in a bed.

It goes on like that for 90 seconds, but we'll spare you.

The monster throwing those punches is 20 years old. The helpless resident he is smashing in the face is 75.

Westwood Nursing Center says it had no idea the assault even happened. The video went up on social media and apparently, it was posted by the proud attacker himself.

People saw it and called the police and they arrested him. He's in jail tonight.

Police will not tell us his name. It's not clear why. He deserves to be famous.

What is clear is that the Westwood Nursing Center was a scary place even before this assault took place.

A 2019 Medicare inspection of the facility found that a resident had vomited on a curtain. Two weeks later, Westwood staff still hadn't replaced or even cleaned it.

Imagine all of what the inspectors didn't find. We will help you imagine.

This video is from a nursing home outside Peoria, Illinois. It was recorded in 2015. An elderly man beaten to the ground by a staff member.

UNIDENTIFIED MALE REPORTER: This video is from a care facility in Creve Coeur. Watch the 84-year-old man. He comes into the room with his walker and tries to get something out of a drawer.

Police say the caregiver, Ernestine Cobbins struggles with him and then throws him to the floor. Fortunately, he was not seriously injured.

Officers reviewed the tape, Cobbins was charged with third-degree elderly abuse.

Imagine doing that to a man with a walker. The woman who did it, who committed that crime is free today. In fact, she is still in the health care business. You can look up her LinkedIn page online. We did it about 10 minutes ago and she looks perfectly content in her picture.

And then there are these three nursing home employees in North Carolina. They're accused of staging fistfights between dementia patients for their own amusement.

UNIDENTIFIED FEMALE REPORTER: They uncovered two separate incidents. In one, 32-year-old Marilyn McKey is accused of physically assaulting a 73-year-old resident, pushing her into a room while 20-year-old Tonacia Tyson and 26-year-old Taneshia Jordan filmed the encounter and did not help.

In another incident, all three are accused of encouraging a fight between two residents ages 70 and 73. Not only did the workers not stop the fight, they filmed it.

The staff members reportedly captured on the video saying punch her in the face.

That happened just this fall. From what we can tell, none of these women is currently in jail tonight. Apparently the crime wasn't serious enough. It's not like they tried to open a gym in New Jersey or dared to walk on dry sand in Los Angeles.

And by the way, these are not isolated incidents, far from it. Consider the following headlines. They're all from last year.

"Florida woman accused of raping man with dementia at nursing home."

"Nursing assistant who raped patients sentenced to 12 years in prison."

"Everett man has history of raping patients, prosecutors say."

"Hillcrest nursing home faces $50 million lawsuit over rape of elderly woman."

And then in Seattle, a nursing assistant was arrested after being caught on camera repeatedly sexually assaulting a patient.

Once again, the nursing home didn't even know what happened. They didn't detect the crime because no one was watching.

The victim's family was suspicious so they put a camera in the room.

In Texas, a nurse called Billy Chemirmir was arrested for murdering patients. Police say he killed more than 20 elderly people before anyone noticed.

Again, all of that happened in a single year, last year, 2019.

So, what's happening in nursing homes right now? Well, we don't really know. And that's the point. Family and loved ones aren't allowed in to see. Chances are, they would be heartbroken if they knew.
How did this tragedy happen?

It wasn't by accident. Our politicians did it. They did it to the most vulnerable people in our society, the ones who have earned the greatest respect. The Americans who actually did build this country.

Now, our helpless elderly are locked in stinking cells, cut off from the only ones who love them. Some of them as we said, are raped and beaten. Thousands and thousands have died alone.

They don't deserve this and the rest of us don't deserve the leaders whose neglect and bad judgment made it possible.

Adapted from Tucker Carlson's monologue on "Tucker Carlson Tonight," on May 22, 2020.

Full Article & Source:
Tucker Carlson: Coronavirus and the shocking abuse happening in nursing homes. This tragedy wasn't by accident

Man charged with multiple counts of elder abuse and neglect in Grand Bay

by Laura Barczewski | Andrea Ramey

Click to Watch Video


49-year old Donny Owens was arrested overnight on multiple charges of elderly abuse and neglect.

DONNY OWENS (MOBILE JAIL) Mobile County Sheriff's Office investigating possible elder abuse in Grand Bay

The Mobile County Sheriff’s Office says a resident of an apparent group home in Grand Bay flagged down a driver Tuesday night saying he needed help.

The driver called 911 around 7 p.m. Responding deputies found two seniors who had been left on the floor of the Lakeview Lane Extension home.

Of the six elderly residents that live there, three were immediately taken to the hospital and were in dire need of medical care. The other three were taken to the hospital just before 10 p.m.

Investigators say all of the residents are elderly veterans and they believe this is some type of unlicensed group home.

Officials say the residents claim they haven’t seen any staff or had any assistance in about a week. The residents were unable to take care of themselves because they had no access to a telephone, and food and liquids were locked inside cabinets.

MCSO says the conditions these residents were living in were disgusting.

"It’s sickening that anyone would treat an elderly person in this manner, especially a veteran who served our country. And this is the way they’re treated simply for money," Captain Paul Burch with MCSO said.

Officials say one of the owners of the home, 49-year-old Donny Owens, who was on the scene being interviewed, is now being charged with one count of First Degree Elderly Abuse and five counts of Second Degree Elderly Abuse. Owens was taken into police custody.

Investigators say they are currently in the process of obtaining a search warrant for the home and believe there are several other homes like it. The conditions of the other homes are unknown.

The investigation is ongoing.

(WPMI) Mobile County Sheriff's Office investigating possible elder abuse in Grand Bay

Full Article & Source:
Man charged with multiple counts of elder abuse and neglect in Grand Bay

Wednesday, May 27, 2020

Take Our Full Comprehensive Guardianship Survey

You are invited to take part in our full guardianship survey. Developed by ProbateWatch, it is the most comprehensive survey on guardianships and conservatorships in the United States.  The lack of data regarding the number of guardianships in the US has been a concern for both advocates and lawmakers. Indeed, the numbers to which most refer are almost a decade old. 

This new survey will not only help us gain a substantive illustration in terms of the numbers of people under guardianship/conservatorship on a state-by-state basis but invaluable information concerning the length of time a guardian has been in place, how petitions were filed, whether estate planning documents (such as a Durable Power of Attorney) were in place and whether abuse/financial exploitation has been found since the guardianship/conservatorship was initiated.

It only takes about 20 minutes to complete.

All answers will be treated in the strictest confidence and information provided will not be released to any agency outside of NASGA or ProbateWatch.

Were conditions for high death rates at Care Homes created on purpose?

During the COVID-19 pandemic, people in care homes have been dying in droves.

Why is this happening? Is it simply because older adults are very vulnerable to SARS-CoV-2 and therefore it’s not unexpected that many would succumb?

Or do care homes deserve the lion’s share of the blame, such as by paying so poorly that many workers have to split their time between several facilities, spreading the virus in the process?

Alternatively, could medical experts and government bureaucrats, with the full knowledge of at least the top tier of government officials, have created conditions shortly after the pandemic struck that contribute to the high death tolls while engendering virtually no public backlash against themselves?

This article shows that the third hypothesis is highly plausible. The people who created the conditions may be unaware of, or oblivious to, their implications. But it’s also possible that at least some of them know exactly what they’re doing.

After all – seeing it from an amoral government’s point of view – the growing numbers of elderly are a big burden on today’s fiscally strained governments, because in aggregate they’re paying much less into the tax base than younger people while causing the costs of healthcare and retirement programs to skyrocket.

Here are three sets of conditions that collectively create a framework for enabling significantly boosted care-home deaths – and doing so with impunity – even while most of each set of conditions in isolation may appear to be purely for the benefit of everyone in society:

One. Bureaucrats develop extremely broad definitions of novel-coronavirus infections and outbreaks. This is coupled with the continuing presence, in a number of care homes scattered across each jurisdiction, of at least one nurse or physician who follows every letter of all definitions and rules. (Such individuals are always present in every discipline, but in the medical milieu their actions can be deliberate, deadly and very hard to detect.)

Two. Influential organizations and individuals produce hospital-care-rationing guidelines that recommend younger people receive higher priority than the elderly during the pandemic, by giving significant weight to how many years of life patients would have ahead of them if treatment is successful. Also, some guidelines bar care-home residents from being transferred to hospital.

Three. The chief coroner and leaders of the funeral, cremation and burial industries craft procedures that fundamentally change the way care-home deaths are documented and bodies dealt with. Their stated goal is to prevent overburdening of medical staff and body-storage areas during a surge in COVID-19 deaths.

They also put them into effect very quickly with no notice to the public; this gives those directly affected very limited opportunity for input or push-back.

Among the many radical changes is death certificates are no longer completed by people who care for care-home residents; instead, they are filled in by the chief coroner’s office.

Also, examination of the undisturbed death scene is prevented, as are all but a very few post-mortems and other sober second looks at the cause and mode of death.

In the background are the complicit ranks of public-health organizations, politicians, media and many other influential individuals. When the pandemic first strikes they focus on how new, dangerous and poorly understood the virus is. As one side effect, this scares many care-home staff so much they flee in fear, leaving their overwhelmed colleagues to cope.

After a short time, they also start to distract the public and victims’ loved ones from uncovering the three sets of conditions by focusing on other factors in the rash of deaths among institutionalized elderly – and by insisting the solution to everything is more testing and contact tracing, along with accelerated vaccine and anti-viral development.

This article shows how the three sets of conditions were put in place in Ontario, Canada.

Variations on these conditions very likely have been crafted in other jurisdictions in North America, Europe and elsewhere. An exclusive interview with the daughter of one of the dozens of people who died during an outbreak at an Ontario care home illustrates how the three sets of conditions work in practice.

Condition Set One: Broad Definitions of Novel-coronavirus Infections and Outbreaks

At the start of the novel-coronavirus epidemic in Ontario, formal definitions of infections and care-home-outbreaks weren’t issued, at least not publicly.

Rather, in late March Chief Medical Officer of Health for Ontario, Dr. David Williams, and the Associate Chief Medical Officer of Health, Dr. Barbara Yaffe, described the criteria verbally during their daily press briefings.

An outbreak should be declared when two or three people show symptoms of infection with the novel coronavirus, they said.

Also, polymerase chain reaction testing for viral RNA wasn’t required for confirmation.

This is a loosened version of criteria used in the province prior to the novel-coronavirus epidemic. These previous criteria defined an outbreak as either: two people in the same area of a facility developing symptoms within two days of each other (making their infections ‘epidemiologically linked’) and at least one of them testing positive for viral RNA; or three people in the same area developing symptoms within two days of each other.

On March 30 the Ontario health ministry released new rules for defining and managing care-home outbreaks (with the document confusingly dated April 1). Staff at all Ontario care nursing homes were trained on the new rules via webinars two days later, on April 1.

The new rules included an even broader outbreak definition: the presence of only one person with just one symptom of a SARS-CoV-2 infection. Outbreaks were deemed confirmed when just one resident or staff member tested positive; subsequently, every resident in the care home showing any coronavirus-infection symptoms is deemed to have COVID-19.

Notably, however, there wasn’t a symptom list in the document. Dr. Williams said on April 1 during that day’s press briefing they deliberately did not include a list of infection.

This is because:
“to look for those symptoms [in the rest of the care-home residents after the initial case is identified] is a challenge, particularly in seniors,” […] “They may not mount a fever, they may have a lot of other symptoms and they may not have obvious symptoms. [Rather,] any change in their health condition really [can be considered a symptom].”
A few minutes later Dr. Williams added:
I don’t mind false alarms. [As a result of the looser outbreak criteria] the numbers [of outbreaks that] we see might be[come] quite [a bit] larger …. [But that’s because w]e want to ramp up the sensitivity. [That] means the number of outbreaks will go up, because we’ve widened the definition.”
One week later, April 8, a Provincial Testing Guidance Update was issued. It included the following list of symptoms (most of which are highly non-specific): fever, any new or worsening acute respiratory illness symptom – for example cough, shortness of breath, sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing – and pneumonia.

The document also listed several symptoms that are “atypical” but “should be considered, particularly in people over 65” [italics added]: unexplained fatigue/malaise, acutely altered mental status and inattention (i.e., delirium), falls, acute functional decline, worsening of chronic conditions, digestive symptoms (e.g., nausea/vomiting, diarrhea, abdominal pain), chills, headaches, croup, unexplained tachycardia, decreased blood pressure, unexplained hypoxia (even if mild) and lethargy.

Then on April 22 the province produced the first COVID-19-screening guidelines for care homes. It’s broadly similar to the April 8 document, except that two or more of some of the symptoms – for example sore throat, runny nose and sneezing, stuffed-up nose, diarrhea – need to be present for a person to be deemed positive.

On May 2 a new testing guidance and a new screening guide were released. Both documents concede that if a person has only a runny or stuffed-up nose, “consideration should be given to other underlying reasons for these symptoms such as seasonal allergies and post-nasal drip.” 

They also narrow the definition of falls considered diagnostic of a novel-coronavirus infection in people over 65, to falls that are unexplained or increasing in number.

However, they add to the symptom list another three that are very non-specific: a decrease in sense of taste, abdominal pain and pink eye.

There are enormous implications to having overly broad definitions of symptoms and outbreaks, particularly in combination with other rules put in place at the beginning of the epidemic. 

Broad definitions very likely are used in many other jurisdictions around the world, albeit perhaps masked by the use of somewhat different terms.

First, in Ontario, in every facility with an outbreak, every resident with even just one symptom is defined as being a ‘probable’ COVID-19 case. This applies whether these residents had an inconclusive or negative viral-RNA test result – or even weren’t tested at all.

Second, the cause of death of everyone who had been diagnosed with a SARS-CoV-2 infection is recorded as being COVID-19. This is a dictate of the World Health Organization and is followed throughout North America, Europe and elsewhere.

Third, COVID-19-attributed deaths are deemed ‘natural’ by new rules released by the chief coroner on April 9 (see ‘Condition Set Three,’ below). In all but an extremely small number of cases, natural deaths are exempt from any further investigations or post-mortems. (Over the last 30 years post-mortems have become rare, but to almost completely remove the possibility is another matter.)

Taken together, this may explain what the daughter of a woman who died along with dozens of others, during a COVID-19 outbreak at an Ontario care home experienced. The daughter granted the author an exclusive interview on May 13. (Under a pseudonym to shield her from possible repercussions.)

Diane Plaxton said in the interview that on April 1 she received a shocking and unexpected phone call from her mother’s care home.

“Your mother’s declining. She’s been having loose bowels and lots of diarrhea. There’s a DNR on her chart. And we’re not sending anyone to the hospital. [Likely because of ‘Condition Set Two,’ below] We’re going to have to put her on palliative care,” Plaxton recalls the head nurse telling her in a cold, uncaring voice.

Plaxton was stunned. She knew about her mother’s diarrhea: it was from bowel-cleansing meds she’d been on for about nine days, after being diagnosed with a clogged bowel. Plaxton told the nurse that if her mother seemed to be declining it probably was from the diarrhea and resultant dehydration.

She suggested to the head nurse that she give mother IV rehydration. The nurse refused, saying it would “just prolong the inevitable.”

The head nurse didn’t say the word COVID-19, nor tell Plaxton the home had been declared to have an outbreak that day.

She also didn’t mention that on March 30 the province had issued new rules on novel-coronavirus infections and outbreaks, then trained all of Ontario’s care-home staff on them via webinar April 1. As described above, the rules included very broad definitions of SARS-CoV-2 infections and outbreaks.

Therefore the nurse could well have been complying fully with the new rules by diagnosing Plaxton’s mother with a novel-coronavirus infection based on her having diarrhea alone (and without telling Plaxton any of this).

Furthermore, since transfer to a hospital was not an option (as per ‘Condition Set Two’) and since COVID-19 is deemed to be very frequently fatal in the elderly, this may be why the head nurse pushed Plaxton so hard to consent to palliative care for her mother.

Shaken but unbowed, Plaxton asked the head nurse to let her speak to the nurse who had been directly caring for her mother.

Fortunately, that second nurse was kind, and agreed that palliative care was not appropriate for Plaxton’s mother. She agreed instead to allow her to not take the bowel-cleaning meds, and to coax her to eat and drink to recover her fluids and strength. She also said she’d keep an eye on the slight fever Plaxton’s mother had.

Over the next few days this plan worked, and the nurse told Plaxton she needn’t worry.

That’s why it hit Plaxton like a gut punch when on April 10 she got a call from another nurse, who was panicking. She told Plaxton her mom was struggling to breathe and “going fast.”

The nurse said the care home couldn’t transfer her to the hospital. She asked Plaxton’s permission for the doctor to give her mother “a shot to ease her passing.”

(The nurse didn’t tell Plaxton what ‘the shot’ was. But it very likely was morphine, which is routinely used to relieve severe pain. A high enough dose of morphine slows people’s breathing and hastens their death.)

Plaxton was reeling. She immediately consulted with her sister; together they decided to give consent for the shot. Three hours later their mother was dead.

Condition Set Two: Hospital-care-rationing Guidelines

In mid-March, not long before Plaxton’s mother died, treatment-rationing guidelines for during the pandemic started to proliferate.

For example, on March 21 the UK’s National Institute for Clinical Excellence produced its guidelines.

They’re based on a frailty score and on mortality probabilities across different age groups for pneumonia and underlying cardiovascular or respiratory diseases.

On March 23 the paper “Fair allocation of scarce medical resources in the time of Covid-19” was published in the prestigious New England Journal of Medicine. The paper’s first recommendation calls for:
maximizing the number of patients that survive treatment with a reasonable life expectancy.”
(Interestingly, the paper’s lead author, Ezekiel Emmanuel, MD, PhD, is an oncologist, bioethicist and senior fellow at the Center for American Progress. The centre is secretive about its funders but according to a 2011 investigation in The Nation its supporters included dozens of giant corporations ranging from Boeing to Walmart. Today, retired general Wesley Clark and executive VP of global investment firm Blackstone Henry James are among the organization’s trustee advisory board members.)

On March 27, the equally influential Journal of the American Medical Association (JAMA) published “A framework for rationing ventilators and critical-care beds during the COVID-19 pandemic.”

The paper’s authors assert that:
[y]ounger individuals should receive priority, not because of any claims about social worth or utility, but because they are the worst off, in the sense that they have had the least opportunity to live through life’s stages.”
Ontario Health published guidelines for hospital-treatment rationing on March 28, albeit not publicly. (To this day the government hasn’t made the protocol public, nor disclosed whether or when they implemented it.)

At that time a crush of COVID-19 patients crowding Ontario hospitals wasn’t a realistic possibility for at least the short or medium terms (contrary to the pandemic-curve theoretical modelling), because all elective hospital procedures and surgeries had been cancelled or indefinitely postponed.

Toronto Star reporter Jennifer Yan obtained a copy of the Ontario treatment-triaging document and wrote in a March 29 article that:
[u]nder the triage protocol, long-term-care patients who meet specific criteria will also no longer be transferred to hospitals.”
Then on April 10, the Canadian Medical Association adopted all the recommendations by Dr. Ezekiel and his co-authors in their New England Journal of Medicine paper, and advised Canadian physicians to follow them.

The Canadian Medical Association statement (whose authors were not listed) asserted that “the current situation, unfortunately, does not allow for” the time for Canadian experts to create their own recommendations.

This is tendentious. Canadian healthcare providers and researchers have access to as much information about COVID-19 as do others around the world. In addition, many had direct clinical experience with a close cousin of the novel coronavirus, SARS-CoV, in 2003.

Indeed four Canadians co-authored an ethical framework for guiding decision-making during a pandemic that was based on their experience with SARS and published in 2006. They made no mention of age as a criterion for treatment triaging in that framework.

On April 17 the Canadian federal government released information to guide clinicians in rationing healthcare resources during the SARS-CoV-2 epidemic. Unlike at least some other COVID-19-related guidelines issued in the same period, it was not accompanied by a press release; therefore it has flown under the public radar.

The document includes an emphasis on age-based rationing. It also explicitly discourages transfer of care-home residents to hospitals:
Long term care (LTC)[care-home] facilities and home care services will be encouraged to care for COVID-19 patients in place and may be asked to take on additional non-COVID-19 patients/clients to help relieve pressure on hospitals”
This is underlined in another place in the document:
If COVID-19 does develop in LTC facility residents, they should be cared for within the facility if at all possible, to preserve hospital capacity.”
Prohibiting transfer to hospital drastically narrows the treatment options available to care-home residents.

There have been transfers of care-home residents to hospitals in Canada during the COVID-19 crisis, but until very recently they have been by far the exception.

(Instead, starting in mid-March as part of the clearing out of hospitals to make room for a putative surge in COVID-19 patients, thousands of elderly people were transferred from hospitals to care homes. This likely also contributed to the care-home death toll. More than one journalist has compared care homes to the Diamond Princess cruise ship: virus incubators with people trapped inside.)

All of this may well be why Plaxton was told by nurses at the care home that her mother couldn’t be transferred to hospital.

This also has played out at other care homes.

The medical director of the Pinecrest nursing home in Bobcaygeon, two hours’ drive northeast of Toronto, strongly advised residents’ family members against considering hospital transfer.

The Globe and Mail reported on March 29 that Dr. Michelle Snarr wrote families on March 21 (which was the day after three of the home’s residents tested positive for SARS-CoV-2) and raised the spectre of significant suffering and possible death if the elderly people were put on ventilators.

Dr. Snarr reiterated this in a March 30 television interview.

Once we heard it was COVID, we all knew it was going to run like wildfire through the facility […] The reason I sent the email was to give them a heads-up that this is not normal times. Under normal times, we would send people to the hospital if that was the family’s wishes, but we knew that was not going to be possible, knowing that so many people were going to all get sick at once and also knowing the only way to save a life from COVID is with a ventilator. And to put a frail, elderly person on a ventilator, that’s cruel.

[In another interview Dr. Snarr said they weren’t outright refusing hospital transfers.]

The last death attributed to COVID-19 at Pinecrest occurred on April 8; by then, 29 of the home’s 65 residents had perished.

“I’ve never had four deaths in a day at any nursing home I’ve worked at,” Dr. Stephen Oldridge, one of the physicians working at the home, was quoted as saying in the March 29 Globe and Mail article. “You feel helpless. Because there’s nothing you can do other than support them, give them morphine and make them comfortable.”

Dr. Oldridge told CBC a similar narrative on April 1:
“There is no vaccine, we have no effective treatment other than supportive care for these folks, and obviously there’s no cure. So when the infection takes hold in their lungs, in this elderly population we can just make them comfortable.”
Still other media reports indicate that care-home residents’ families in Canada have denied the option of transfer to hospital during the pandemic even if the residents are relatively young, do not have a DNR, and both they and their families want the option of a transfer. Instead, they are pressured to put DNRs in place. This also is happening elsewhere, such as in the UK.

Hugh Scher, a Toronto lawyer who’s been involved in some of Canada’s highest-profile end-of-life cases, strongly opposes this. He told the author in a telephone interview:

The notion that long-term-care-home or nursing-home medical directors can tell residents and their families that they can’t or shouldn’t be transferred to hospital if they need treatment for COVID or anything else – I don’t agree with that.

[But unfortunately] there’s now an aggressive push to say, ‘Granny’s already ninety-five … and sending her to hospital for a cough or a runny nose isn’t going to improve her underlying condition. And so she should be made comfortable and left to die.’

Condition Set Three: New Rules Surrounding Death Certificates and Removal and Disposition of Bodies

On April 9 the Chief Coroner for Ontario, Dr. Dirk Huyer, released rules for an ‘expedited death response’ in handling and disposition of bodies of people who die in care homes and hospitals.
The stated goal was to prevent infection spread, overburdening of medical staff, and overfilling of hospital morgues and body-storage areas in care homes in the event of a surge in deaths during the pandemic.

The new procedures were created jointly by Dr. Huyer’s office, the Ontario Ministry of Government and Consumer Services and the Bereavement Authority of Ontario (the province’s funeral-home, cremation-services and cemetery self-regulatory body).

They are a drastic sea change in the way deaths are handled in the province. Yet they were launched extremely rapidly with the only “surge” in sight one in mathematical models, and a significant body-storage-space problem based on hard data nowhere on the horizon (and still a low probability).

The new procedures went into effect immediately on April 9. Then over the next three days (the Easter long weekend), Dr. Huyer and the registrar of the Bereavement Authority of Ontario led webinars on them for staff of hospitals and care homes across the province.

“We pushed it [writing and releasing the new rules] a little more quickly than maybe was necessary because it’s a brand-new process and there’s thousands of people involved,” Dr. Huyer told Toronto Star columnist Rosie DiManno in explaining the haste.

As part of the new rules, the chief coroner’s office now completes the death certificates of every person who dies in long-term-care homes. The office also completes some death certificates of people who die in hospitals. Up until April 9, and for good reason, death certificates in Ontario were filled in by the physicians or nurse practitioners who cared for the people before they died.

In addition, as also noted in ‘Condition Set One’ above, COVID-19-attributed deaths are deemed ‘natural’ by the new rules. And all “natural” deaths are virtually exempt from any further investigations and post-mortems.

(Dr. Huyer was quoted in a May 18 Globe and Mail article as saying “a number” of COVID-19-attributed death investigations have been started – including that of a man whose daughter believes he died because of neglect at a care home and who asked the coroner’s office to investigate – but that he doesn’t know what that number is.)

Dr. Huyer said, in a phone interview:
“All of these things were added during this period of time to allow not only a timely approach but also an efficient approach to be able to ensure that people proceed to burial or cremation in a timely way without requiring extra storage space,”
Yet it was only 10 months ago that the official report on the high-profile Wettlaufer inquiry was released. It calls for many more checks and balances surrounding care – and more rather than less time and transparency in determining and documenting the causes of death.

Just 18 of the report’s 91 recommendations have been implemented. (The inquiry probed the killing in southwestern Ontario by nurse Elizabeth Wettlaufer of eight people, attempted murder of several others and aggravated assault of two more. All but two of the victims were LTCH residents.)

Moreover, the April 2020 rules also dictate that families must contact a funeral home within one hour of a hospital death and within three hours of a care-home death. The bodies are to be taken to the funeral home extremely rapidly, and from there to cremation and burial as quickly as possible.
This journalist wrote about the rules in a May 11 article.

Diane Plaxton found and read online the May 11 article. She suddenly understood more of what took place before and after her mother’s April 10 death.

She and this journalist connected, and the May 13 interview ensued.

Plaxton related, in that interview, that three hours after she got off the phone with her dying mother on April 10, a nurse called and matter-of-factly said her mother was dead. She asked Plaxton to call a funeral home.

And about an hour later, while Plaxton was still reeling, another nurse called and again told her to contact a funeral home.

“I got off the phone. That’s when I flew off the handle,” she told the author in the May 13 interview. “It’s like they’re treating her [body] like a piece of garbage: ‘Get her out of here! Ger her out of here!’”

As if that wasn’t enough trauma, at the funeral home four days later she saw COVID-19 listed as the cause of her mother’s death. Plaxton believes what really killed her mother was the combination of dehydration and chronic diseases including asthma; her shortness of breath on April 10 may have been an asthma attack, Plaxton surmises.

Making matters even worse, the funeral director told her she couldn’t take a copy or photo of the ‘Cause of Death’ form. He said she’d have to request a copy from the government and it could take months to arrive.

But the funeral director also commiserated with Plaxton. He was incredulous that her mother had gone from dehydrated to dead so fast. He also was bewildered by the requirements such as bodies having to be picked up in haste and arrangements for cremation and burial also having to be made extremely quickly.

“I’m just taking orders from the top down,” Plaxton recalls the funeral director telling her.

That’s the third of the three sets of conditions that can enable high death rates in care homes.

The three sets are the work of officials, experts and bureaucrats who – while being seen to serve the public interest and who could be unaware of, or oblivious to, the implications of the conditions – may in fact have hidden intentions.

Even if the latter is true, there’s little chance the perpetrators will be caught or punished.

On May 19 the Ontario premier announced that an independent commission will probe why so many people have died in the province’s care homes. This journalist believes it’s very unlikely the commission’s mandate will include scrutinizing the sets of conditions described in this article.

Perhaps the most elegant element of all is that just one or two people working at any given care home can suffice to translate the sets of conditions into actions – or inaction – that can be deadly for residents. And they’d probably be the only ones held responsible in the unlikely event any of this ever comes to light.

It’s all as simple as one, two, three.

Full Article & Source: 
Were conditions for high death rates at Care Homes created on purpose?