Saturday, October 24, 2020

Are nursing homes above the law? Exposing repeat offenders

Warning: This video contains graphic content. 
CBC Marketplace's new data analysis reveals 85 per cent of all Ontario nursing homes have broken the law repeatedly with almost no consequences — for abuse, neglect, medication errors and much more. This special hidden camera investigation features shocking video inside homes, a rare interview with a former nursing home inspector and our fight for answers.

26-Year-Old “Brain Dead” Coronavirus Patient Just Walked Out of the Hospital

by Anna Medaris Miller

Medical workers treat COVID-19 in Madrid.

When Tionna Hairston's heart repeatedly stopped beating for 30 minutes, her doctors worried yet again that she wouldn't make it. 

The 26-year-old in North Carolina was diagnosed with COVID-19 in May, and subsequently suffered a stroke that led to bleeding in her brain and blood clots in her heart that caused the cardiac arrest, the Winston-Salem Journal's Richard Craver reported

The conditions left her unable to fully use her arms and legs, and she was put on a ventilator for more than two months. She also suffered kidney and liver failure. 

Doctors "thought that we should take her off of life support because she had no hope for life," Hairston's mom, Stacey Peatross said, according to Rasheeda Kabba, who covered the story for multiple local outlets. "They thought she would be a vegetable. She wouldn't have any quality of life at all." 

They were wrong. After family, friends, and strangers prayed for her, Hairston began improving. She entered rehab for more than a month, where she relearned basic activities of daily living, like eating and getting dressed. 

On Tuesday, she walked out of the hospital to continue rehab at home. She had been in medical care for 137 days. "My faith in God and the fact that I wanted to walk again" allowed her to survive, Hairston said. 

While she's not fully recovered — she walks with a walker and has some memory loss — her doctors praised her recovery and the lessons it can teach others. 

First, people should know "20-somethings can get very sick from COVID and COVID complications," Dr. James McLean, director of the Novant rehabilitation hospital in Winston-Salem, told Craver. "It's not just older folks." 

The other lesson is that Hairston "demonstrated that human spirit, that little flame inside that keeps us going, shows us that people can overcome things that we could never imagine."

Other young COVID-19 patients have suffered strokes and neurological issues  

Doctors have been concerned to see strokes in young people with no prior history of strokes and, in some cases, mild or even asymptomatic COVID. 

In May, five young New Yorkers with COVID-19 were admitted to the hospital with life-threatening "large-vessel" strokes, or those caused by a blood clot that travels from the body into an artery in the brain, Business Insider's Aylin Woodward previously reported

Doctors don't yet understand exactly how COVID-19 influences stroke risk, but it may have to do with blood clots, which have appeared in other parts of coronavirus patients' bodies, like the lungs and legs. 

COVID-19 has also been linked to a range of other neurological issues, including delirium, brain fog, and memory lapses. Some experts have even warned of an epidemic of brain damage. 

"My worry is that we have millions of people with COVID-19 now. And if in a year's time we have 10 million recovered people, and those people have cognitive deficits ... then that's going to affect their ability to work and their ability to go about activities of daily living," Adrian Owen, a neuroscientist at Western University in Canada, told Reuters.

 Michael Goldsmith returns home

Michael Goldsmith returning home April 19.
Abbie Sophia

It's unclear why some young critically ill patients who were previously healthy recover and others die, but Hairston is not the only success story.

Michael Goldsmith, a 34-year-old husband and father in New Jersey, was in a medically-induced coma and on a ventilator for 22 days while fighting a severe case of COVID-19. At the same time, his family and community advocated for access to the drug remdesivir, which they thought might be his only chance of survival. 

He never got the drug, but recovered, and doctors don't know why. 

After returning home, Goldsmith told Insider he cherished simple moments like snuggling with the family while watching TV. "It's the little things that you hope for, and I would say 'you dream about,'" Michael said, "but after going through the coma, I don't know for sure that was the case."

Editor's note: This story was updated to remove medical information provided by another media outlet that Business Insider was unable to verify. 

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Florida police department celebrates 100-year-old veteran's birthday with car parade

The Fort Pierce Police Department in Florida threw a parade on Tuesday honoring military veteran Clarence McDuffie in celebration of his 100th birthday. placeholder

Officers organized a patrol car parade for the Georgia born U.S. Army veteran, to salute his service in World War II, CBS 12 reported

McDuffie has lived in Fort Pierce since the 1950s, following the war.

We’re have a special centennial #birthday drive-by for a City of Fort Pierceresident and WWII vet, Clarence McDuffie. Like or share to help us salute Clarence!

McDuffie is reportedly a father of seven and has 17 grandchildren. 

He also has close to 35 great-grandchildren, some of whom participated in parade festivities and stopped by to wish him a happy birthday. 

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Dying of loneliness a real concern for families with loved ones in long-term care

by Kevin Doran
Can a person really die of loneliness? Yes, they can, according to KSTP Medical Expert Dr. Archelle Georgiou.

"Absolutely, it's toxic and is as dangerous as smoking 15 cigarettes a day," Dr. Georgiou said.

Dr. Georgiou said families worried their loved ones in assisted living or nursing homes will die of loneliness over the winter have a real concern. And, she welcomes the news that the state of Minnesota is easing visitor restrictions starting Saturday, Oct. 17.

FILE - In this July 17, 2020 file photo, a senior citizen holds the hand of a care coordinator at a Health facility in Miami. One in five U.S. nursing homes say they still faced severe shortages of protective gear like N95 masks this summer, according to a study Thursday that also found facilities struggled with a lack of staff as COVID-19 cases rebounded.

FILE - In this July 17, 2020 file photo, a senior citizen holds the hand of a care coordinator at a Health facility in Miami. One in five U.S. nursing homes say they still faced severe shortages of protective gear like N95 masks this summer, according to a study Thursday that also found facilities struggled with a lack of staff as COVID-19 cases rebounded.

"I am so thrilled we're balancing the risks and benefits of keeping people in nursing homes and the elderly isolated," said Dr. Georgiou. "It's just been so difficult for everyone. People just want to be together."

To learn more about what happens inside our bodies when we're lonely that can make us sick, click on the video box above.

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Friday, October 23, 2020

The Corporatization of Nursing Homes

A tragic history of how we’ve treated elderly citizens, for profit

by Maureen Tkacik

Maureen Dittmar of Rochester, New Hampshire, was sifting through junk mail one Saturday in early August when she found an envelope obviously sent by a human being. It began: “The content of this letter may be hard to hear … But you deserve to know the truth.” The anonymous author was a staffer at her mother’s nursing home.

Dittmar’s rush of cortisol was familiar. Every day for months, the virus had engulfed another crop of facilities. Residents are elderly, frail, and housed in close quarters; they are sitting ducks for a pandemic. By mid-September, the nationwide death toll from long-term care facilities had reached more than 77,000 residents and staff, 40 percent of the country’s total. For some reason, New Hampshire had only lost a relatively small number, but Dittmar knew better than to believe everything she was told, or assume they were out of the woods.

There wasn’t an outbreak, though; the letter was about staffing. Genesis HealthCare, the 357-facility nursing home chain that ran the Colonial Hill Center and by late May had already seen about 1,500 of its residents die, had slashed payroll so drastically that on many shifts, the primary unit had one nursing assistant responsible for 39 patients. Supervisors helped out on the floor whenever they could, but the last nursing manager who had gone to bat for them had been fired.

New Hampshire had been lucky to avoid the worst of COVID-19, but the minimum staffing requirements it imposed on nursing homes were the most lenient in the Northeast—and now their residents were paying the price. “It has always been a known rule in any health care facility to NEVER mention to family or residents that we are having staffing issues,” the author warned. “We feel that the current restrictions on in-house visitations from the families is allowing a veil of protection for corporate and management. Families are unable to see the full affects [sic] on their loved ones.”

Roughly 70 percent of the nation’s 15,400 nursing homes are for-profit, and the gross understaffing on display at Colonial Hill is the flip side of extreme profiteering. Hundreds of thousands of nursing home residents survived the bloodbath of 2020, only to spend the summer, no doubt, wishing the virus would come back for them. State health departments suspended Medicare inspections during the pandemic; it has been 18 months since Colonial Hill saw one. So management is no longer even trying to avoid the most conspicuous signs of neglect: filthy clothing, odd facial hair, urine on the floor and in the air.

In many hard-hit homes, dead friends are being replaced with psychiatric referrals from psych wards and homeless shelters; in more selective ones, dementia sufferers are being ejected into psychiatric hospitals. At a facility in Pennsylvania with one certified nursing assistant for every 22 residents, eight assistants teamed up to tell the evening news their patients were going months without a bath. The average resident in one facility in suburban Illinois lost 3.7 pounds between February and April alone, with nearly a quarter losing more than 5 percent of their body weight. The evening news in Minneapolis in late September tells us of a bird-watcher in his eighties with Lewy body dementia whose daughter takes him home after spying him through a window, disheveled and confused and so bottomlessly sad. He has bruises everywhere, an untreated infection has turned his genitalia bright red; he dies quickly.

Amplifying this neglect are the dozens of state laws passed hastily in the spring, granting the entire health care industry immunity from legal liability. “Dehydration, malnutrition, falling, bedsores—they’re saying, ‘Look, we’re not liable for any of that right now because of COVID,’” says Steven Levin, an Illinois trial lawyer who has spent his career suing nursing homes and is working on more than 100 wrongful-death suits right now. These laws comprise the single coherent national policy response to the nursing home bloodbath of spring 2020.

In the absence of an accessible long-term care system for all families, older Americans are callously warehoused in these institutions, which in the crisis have descended into death traps. But for decades before the pandemic, for-profit nursing homes have been robbing seniors of their dignity and their money. And where you find extraction of value and indifference toward horrors inflicted on human beings, you inevitably find a financier’s spreadsheet.

THE AMERICAN NURSING home industry is a hellscape whose history is generously paved with bad intentions. I began my research under the assumption that senior care facilities were much like other private equity–stripped health care institutions: bought up and saddled with debt and forced to cut costs wherever possible, leading to unconscionable outcomes for workers and residents. I assumed financial firms perverted a formerly well-intentioned system for providing vital care. The truth is almost the inverse. The private equity guys learned a lot of their tricks from the original nursing home predators. Most good people were driven out of the business generations ago, and the ones who have hung on have been mostly punished for refusing to play the game.

Roughly 70 percent of the nation’s 15,400 nursing homes are for-profit, and gross understaffing is the flip side of extreme profiteering.

“Bad nursing homes seem to be contagious,” wrote the pre-eminent nursing home muckraker Mary Adelaide Mendelson, in her 1974 exposé Tender Loving Greed: How the Incredibly Lucrative Nursing Home “Industry” Is Exploiting America’s Old People and Defrauding Us All. She traced the origins of this devolution to about 1950, when an amendment to the Social Security Act allowed nursing homes to collect benefit checks and stipends from the Veterans Administration directly, on behalf of their residents, generating a small windfall for operators shrewd enough to appoint themselves middlemen between senile geriatrics and their assets. Twenty years later, of the more than 200 facilities Mendelson had personally toured, “I could honestly call only one a good home.”

As Mendelson explains, the entire nursing home system had by the late 1960s come under the near-total control of a predator class known in some corners as the Syndicate, a sprawling and incomprehensible collection of nursing home owners, front men, and ethically deficient mortgage bankers, doctors, and public officials made famous by an Orthodox Jewish rabbi who was its New York boss, Bernard Bergman. Dubbed the “meanest man in New York” by the Village Voice, Bergman by 1975 had reputedly built a nursing home fortune worth $100 million (a lot of money in those days), according to the memoir of one of the endless string of attorneys he retained to defend it, the then-youthful Alan Dershowitz.

We think now of the inception of Medicaid and Medicare as a glorious milestone to recognizing health care as a human right. The Syndicate correctly saw a massive fire hydrant of cash with the capacity to make them all rich, though its leaders got a bit too greedy in the early years. Social Security Administration economists had forecast that Medicaid would spend $25 million to $50 million on nursing home care in its first year of coverage; when the reality turned out to be something more like $300 million, auditors began sniffing around.

Much of what we know about the Syndicate emerged in a probe into a gruesome nursing home on 106th Street near Central Park called the Towers, which under the ownership of a mysterious figure named Anne Weiss—who turned out to be Bernard Bergman’s wife (it took the health department, by its own admission, “quite awhile [sic] to figure out” this little nugget)—had billed Medicaid for 926 days of care for eight patients who had died or been discharged from the home. Inside the facility were flies, urine stench, and dirty beds with no sheets.

The ownership of the Towers and many other nursing homes had gone to dizzying lengths to conceal itself. Wherever Mendelson went she heard rumors, often from government officials, of Mafia connections—who else would be so diabolical? But her digging yielded evidence of a specialized nursing home mafia, a linked set of dons that attached itself parasitically to our most honorable social programs.

Two of the era’s most prominent bosses were Bergman and a Rolls Royce–driving former duffel bag manufacturer named Joseph Kosow, known in New England as “King of the Nursing Homes.” Like Bergman, Kosow had his own endless network of associates, straw buyers, shadowy front groups, and highly placed regulatory and law enforcement officials. Kosow had some troubles with the feds, but only Bergman ever served any time, and when both died in 1984 extremely rich, protégés brought their business model into the modern era.

Abe Gosman was a longtime associate of Joe Kosow’s, probably from their days in the Boston shoe business. He was a quintessential Bonfire of the Vanities mogul, with a 143-foot yacht named Octopussy, an oceanfront palace in Palm Beach bought from Les Wexner that he would later sell to Donald Trump, and assets worth nearly a half billion dollars, following a string of deals in which he repeatedly sold, bought, and repackaged the same group of nursing homes and psychiatric facilities. Bernard Bergman’s lower-key protégés Moshael and Daniel Straus, the sons of his old Connecticut deputy Joseph Straus, launched a nursing home chain called Multicare in 1984 that they sold for more than a billion dollars cash in 1997 to Genesis Health Ventures, another of the high-flying chains founded in the ’80s during the Reagan era of deregulation. Daniel Straus’s second act, the nursing home chain CareOne, suffered by far the worst outbreaks in their home state of New Jersey, but made lots of money doing it, as a ProPublica investigation explored.

Many profitable industries are incestuous and dominated by the sons and grandsons of tycoons. It’s just harder to track in nursing homes, whose trade publications fill my in-box each morning with incessant announcements of the buying and selling, recapitalizing and reorganizing of assets. The New Jersey consultancy commissioned to review the state’s devastating nursing home death toll found that some changed hands “multiple times in a single week.” When a registered nurse named Angela Ruckh decided to sue her old nursing home for defrauding the government, she ended up suing seven different companies. A defense attorney who tried to sue the same chain for wrongful death discovered it was spread out over 15 different entities. But all those entities originated with Formation Capital, a private equity giant founded by Arnold Whitman and his shadowy partner, Steve E. Fishman. “You could spend forever trying to untangle this stuff,” said Ernie Tosh, an Austin-based attorney who runs a side business analyzing nursing home data. “The nursing home industry as a whole should not be looked at through the lens of normal corporate America. If you think of it as organized crime it will make a lot more sense.”

WHITMAN, A FORMER college basketball player from just outside Boston who had dabbled in advertising and worked at a brokerage, entered the nursing home scene in 1984 when he was 31. Abe Gosman was bringing Joe Kosow’s business model into the junk bond era, and he saw in Whitman a natural networker who could bring in deals. “I was one of those guys who wanted to be in something glamorous—advertising, entertainment, something along those lines,” Whitman later said of his younger self. But then he went to meet Abe Gosman in the basement of one of his “totally depressing” nursing homes. “I remember being overcome by the indignity,” he said. But “I realized that, unglamorous though the nursing home industry is, it was where a good future might indeed be had.”

A fixture of Syndicate nursing homes was an early version of what is now called the OpCo/PropCo model, wherein the nursing home’s operating company (OpCo) was separated from the real estate property company (PropCo) in a series of complicated transactions that usually left the OpCo paying massive interest payments, rental payments, or both. The setup lowered taxes for both the OpCo, which appeared to be losing money, and the PropCo, which used the structure to trade the real estate back and forth between entities, collecting profits each time that were taxed as capital gains. OpCo/PropCo, also known as sale-leaseback, is today a common feature used by private equity firms to suck assets out of its portfolio companies, and keep them out of the hands of vendors, employees, and plaintiffs’ attorneys in the (likely) case that the OpCo is forced to file for bankruptcy.

Mendelson’s digging yielded evidence of a specialized nursing home mafia, a linked set of dons that attached itself parasitically to our most honorable social programs.

Gosman was one of the first nursing home moguls to establish his PropCo as a publicly traded real estate investment trust (REIT), which didn’t have to pay any taxes so long as it paid out most of its profits as dividends to investors. Gosman dispatched Whitman to find other nursing home chains interested in sale-leasebacks through the REIT, and he brought in hundreds of millions of dollars in deals before striking out on his own in 1992.

By the late 1990s, most nursing home OpCos were going bankrupt, done in by a destructive feedback loop of debt, austerity, and illegality. Congress had cut Medicaid reimbursement rates in many states, which caused nursing homes to slash labor and investment in their facilities. A report commissioned by former Rep. Henry Waxman (D-CA) revealed that reports of serious elder abuse had more than doubled between 1996 and 2000, by which point they had implicated nearly one-third of the nation’s nursing homes. Litigation insurance premiums had surged as a result, especially in Florida, where lawsuit and legal costs for nursing homes had risen tenfold between 1990 and 1998.

Whitman saw this cycle of despair as a window of opportunity. Along with Fishman and the owners of a nursing home chain near his office in Atlanta, his company Formation devised a strategy of buying up distressed homes, with a focus on Florida, outsourcing operations to contractors and letting standards fall even further. He paid an unheard-of $27,000 a bed, virtually all of it debt, for a portfolio of 54 facilities previously owned by Beverly Enterprises. He kept going back to the strategy, buying unwanted, mostly Floridian properties for rock-bottom valuations from Genesis, Mariner Health Care, Laurel Health Care, and others.

Most states have minimum staffing requirements for nursing homes, though they’re usually far lower than experts say they should be. But the new chain, which would come to be called Consulate Health Care, had no compunction about scheduling well below Florida’s minimums. A 2018 presentation for a Formation deal with another private equity firm called Allegiant gives a sense of how these policies are pitched to investors. The new consortium promised to generate 12 percent annual returns by ending the “mismanagement and spiraling costs” of its “infamous” previous operator, vowing to chop annual payroll $16 million a year across 18 homes.

Formation set a model mimicked in the 190 private equity deals in the nursing home industry since 2015, a $5.3 billion bonanza. The script, written by Arnold Whitman, is familiar: facilities saddled with debt, short-staffed and underpaid workers, residents left to rot, a lack of preparedness that looms large in a pandemic. Much of the tumult seen today is a by-product of the slash-and-burn strategy practiced by Formation and its imitators.

This year, thousands of infected humans have been gratuitously transferred in and out of different nursing homes, depending upon where they would be the most profitable. More than 6,400 residents found themselves evicted to homeless shelters and other facilities. In New York, 4,500 patients infected with coronavirus were sent back to nursing homes, where they spread the disease. Others were dumped into ambulances to die in hospital parking lots, or stuffed into a closet for the police to find, for reasons unclear but possibly having to do with life insurance policies purchased in their names. Hundreds of operators seized $1,200 CARES Act stimulus checks of their patients. After the Federal Trade Commission banned the practice, some threatened to evict residents who didn’t “voluntarily” hand theirs over. Dozens more residents participated in massive amateur hydroxychloroquine experiments. Nurses were fired for wearing masks, calling out sick, or speaking to the media about how direly they needed PPE and extra help. Nursing assistants, whose pay is so abysmally low that they are more likely to work three jobs than one, shared microbes with dozens of other homes as they ferried from morning job to afternoon job to overnight job in cramped shuttle buses and Uber pools. An 88-year-old advanced dementia patient, found wandering the highways after his nursing home evicted him to make way for COVID patients, ended up spending his 89th birthday in jail after he stabbed the nephew who had taken him in with a kitchen knife. A nursing home resident in Brooklyn who died of COVID-19 was buried in a Catholic cemetery and billed $15,000 for makeup, limousine service, and $200 in rosary beads before anyone at the home informed her Jewish family—which had long before informed the facility of her already-purchased family burial plot in a Jewish cemetery—that she had died. A nursing home watchdog and attorney told me about nursing home bosses in Connecticut emptying one of the facility’s supply closets for PPE to sell on the black market, and says that when the street value of N95 masks peaked in April, multiple investors approached her to draw up documents enabling them to discreetly sell off their inventories.

These borderline or sometimes flat-out criminal activities, which became front-page news during the pandemic but were a feature of the industry for years, are born of a frantic desire to feed interest and rent payments to legal loan sharks and their investors. The typical COVID-19 superspreader home was afflicted by the same problems that abuse and kill residents in ordinary times: minimal supply budgets, threadbare staffing, and “zero infectious disease avoidance protocols,” which regularly wipe out dementia wards during flu season. When critical senior care is given over to the free market, their well-being is subordinated to the balance sheet of people like Arnold Whitman. And the would-be regulatory guardians of the elderly, housed mostly in the Centers for Medicare and Medicaid Services and focused on other matters, are at best unaware of the abuse, and at worst complicit by their negligence.

THERE WERE A FEW important exceptions to the radical austerity imposed over Formation’s Florida homes, of course. The budget for incentivizing Medicare fraud, for example, expanded considerably. In a whistleblower suit filed by a consulting nurse who went to work coding Medicare claims at two Formation homes in 2011, spreadsheets defaulted to the highest possible “ultra” level of care, even though no one got anything approaching that. The whistleblower’s bosses schemed daily to rehire the drug-addict predecessor who’d been escorted from the facility in handcuffs during his third week on the job for stealing thousands of painkillers, because nurses like him understood “how to boost the bottom line.” Bosses gave cash bonuses to nurses for bringing their average reimbursement levels up, while patients’ open wounds went undressed for days at a time, a patient’s leg brace went missing for a month, and one resident subsisted on a liquid diet for a full year because a nurse couldn’t be bothered to retrieve his dentures from a dresser drawer.

In a particularly brutal scene, a 40-something Medicaid patient immobilized from a violent mugging begged an administrator to see a physical therapist as someone at the hospital had told him he would. After his repeatedly being told there’s “no payor” for physical treatment because he’s on Medicaid, the administrator said: “You will never walk again.” The patient died of a painkiller overdose a few years later.

Formation also spared no expense, predictably, on political contributions. Between the dozens of Consulate Health Care facilities it now controls, Formation has given close to a million dollars to elected officials. Two months after former Florida Gov. Rick Scott signed into law a 2014 bill granting immunity from liability to “passive” investors in nursing homes, he received the beginnings of what would be $240,000 in contributions. Consulate and its related entities also spent between $260,000 and $540,000 lobbying in favor of the bill. The following year, Formation helped a near-identical bill pass in Georgia. This isn’t anything new; nursing home tycoons have been investing in high-placed friends since Bernard Bergman cultivated New York Gov. Nelson Rockefeller and Joe Kosow bought off the Massachusetts health department. In May, Politico called nursing homes “the lobbying world’s quiet powerhouses.”

Formation homes also got creative with liability insurance, buying a new product for the Consulate homes called an “eroding policy,” allowing the company to deduct its own legal fees from its ceiling. This enabled the homes to tell plaintiffs a few months into litigation that the money was all gone. “A lot of lawyers won’t even take a case when they learn there’s an eroding policy on the other side,” says Tom Edwards, a Jacksonville trial lawyer who has won numerous out-of-court settlements from Consulate.

In 2007, The New York Times published an investigation into the efforts of a few mourning family members to sue a Formation property where 15 residents had died over the course of three years. “Lawyers were suing nursing homes because they knew the companies were worth billions of dollars, so we made the companies smaller and poorer, and the lawsuits have diminished,” Whitman matter-of-factly told the newspaper.

The chain has since won some unlikely allies in its bid for tort reform. In June, after a judge reinstated $255 million of the $350 million a jury had awarded Ruckh in her whistleblower case against Consulate, representatives of both the Center for Medicare Advocacy and the nursing assistant union expressed concern that the judgment would cause the chain’s standards to fall even further. That wouldn’t be a long fall: In a survey of the 54 worst nursing homes in Florida conducted by the Naples News in 2018, 26 were run by Consulate, and 55 of its 77 statewide facilities were in danger of losing their licenses.

When things grow untenable, Whitman trades himself out of trouble. Formation sold the underlying real estate of the Consulate homes to the now-imploded General Electric Capital in 2006 for $1.4 billion. The sale of the real estate netted more than twice what Formation had paid for the homes, and nearly ten times what it had invested in cash, freeing Whitman and company to set about replicating their successes, and our health care system’s failures, hundreds more times. By 2017, Formation had acquired—at minimum, because it’s not easy to track—an additional 60,000 beds in 590 facilities in the United States, along with rehab hospitals in four states, a mobile diagnostics company called Trident, and 275 nursing homes in the United Kingdom, some of which endured their own vicious COVID-19 outbreaks in February.

Between the roughly 150 Consulate Health Care facilities it now controls, Formation has given close to a million dollars to elected officials.

Genesis HealthCare was the biggest prize. Formation took it private for $1.7 billion in 2007, sold its real estate to a REIT for $2.4 billion in 2011, spent an extra $275 million buying the remains of Gosman’s Mediplex, then in 2014 merged with another nursing home chain in California in a “backdoor” IPO. Having financed all the deals with debt, and having used more than $700 million of the proceeds to pay Formation a dividend, “Genesis went public with 531 homes, virtually no real estate and $17.6 billion in long-term financing obligations,” on which it was paying interest rates as high as 22.2 percent. The company was glaringly insolvent, and it had sold most things of value it had owned. So it did the only thing it could: cut staff.

A Boston Globe analysis of the deal’s aftermath reported that nearly half of the homes under Genesis management had seen their Medicare star ratings downgraded since 2010. These ratings, designed to give families insight into the quality of nursing facilities, are based on limited and often self-reported information, making the downgrades all the more remarkable. In line with Formation’s other properties, more than 70 percent of Genesis nursing homes now had either a one- or two-star rating on the five-star system, and registered-nurse hours were drastically lower than the averages; meanwhile, serious infractions were on the rise.

“I would argue that the traditional REIT structure in skilled nursing has been proven to be a failure,” Genesis CEO George Hager told an industry panel in 2019. There was, he reasoned, just too much money in the real estate, and it was too tempting to cash it all out and leave seniors and nursing assistants holding the bag.

This unusual admission of something like guilt offers a painful lesson to policymakers interested in designing a more sustainable and humane elder care system. Although Genesis oversaw thousands of deaths, although it undoubtedly committed innumerable sins of both commission and omission that caused the pandemic to spread much further in both its homes and their surrounding communities, and although the company’s fiscal woes are rooted in its structural embodiment of a system that siphons billions of dollars from our taxpayer-financed insurance system and exports them gratuitously into the offshore bank accounts of billionaires, it is not an anomaly relative to its peers in the nursing home business. The model of anything-goes for-profit facilities is as perfunctory as it is immoral.

There are solutions available. The federal government supplies a significant portion, as much as 72 percent, of the nursing home industry’s revenue, a figure that will undoubtedly rise this year as taxpayers blanket the sector with bailouts. It must overhaul the ways it both follows that money—to curtail the amount that can legally be consumed on rent, interest payments, and pricey “management fees”—and administers it in the first place. Rotating Medicaid patients in and out of $600-a-day Medicare-funded rehabilitation regimens has become an art form at many chains; the system as currently designed literally rewards homes that chronically neglect patients to the point that they require hospitalization.

What we actually need is a public-health corps that can assume the reins of a perilous health care provider. The Federal Deposit Insurance Corporation has the ability to temporarily nationalize banks when it senses they have devolved into Ponzi schemes; health care regulators need to recognize that a nursing home that pays 22 percent interest on its credit lines but fails to bathe its patients is just a Ponzi scheme with humanitarian implications, and develop protocols for intervening before these develop into mass casualty situations.

After all, anyone who follows nursing home finance could have told you companies like Genesis and Consulate were going to have an especially tough time fighting a pandemic. “I mean, we all knew it was going to be bad,” says Alex Spanko, an editor at Skilled Nursing News. “It still kind of surprises me that it was as bad as it was, given that they all knew it was coming. But we knew it would be bad.”

Genesis, having spent the past four or five years trying to sell its way out of its fiscal hole, has tapped former Trump official and CNN regular Jim Schultz, a bald, broad-shouldered, sleepy-eyed former White House counsel, to lobby for a bigger bailout. In August, George Hager told the one analyst who still covers the company’s stock, which trades below $1, that they wouldn’t make it without one. A slide into bankruptcy would inevitably lead to another shadowy LLC or two picking through the remains, repeating the churn cycle again. Whatever the case, without substantial reforms, our elderly, our nurses, and our tax dollars are likely to again be the losers.

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Polk pastor tried to bilk elderly woman with physical impairments out of $35,000, police say

by Bill Kemp

Abner Anibal Rolon
WINTER HAVEN — A Haines City pastor was arrested and charged with exploiting an elderly woman with physical impairments.

Abner Anibal Rolon, 46, a Davenport resident and senior pastor at Calvary First Assembly in unincorporated Haines City, allegedly attempted to bilk an 85-year-old woman with visual, hearing and mobility impairments for more than $35,000, according to a Haines City Police Department press release.

He also was charged by HCPD with scheming to defraud in the amount of more than $20,000 and presenting himself as a contractor without a license. Rolon turned himself in on Friday. He was subsequently released on $10,500 bond, according to Polk County Jail records.

According to HCPD, the victim, who resides with a caretaker, was seeking flooring and roofing repairs in preparation to sell her home. Rolon allegedly handed the woman “A Servant’s Hand” business card in June in which he presented himself as a licensed contractor capable of multiple services.

HCPD stated while the caretaker was away, Rolon insisted more services were necessary. He eventually billed the woman six times between July and September for work totaling $36,440.

According to police, the Haines City Building Division and Code Compliance unit discovered a water heater, ceiling fans, windows, electrical work and light fixtures were incorrectly installed and must be reworked. Rolon allegedly also billed the woman for roof and porch repairs that were not done.

HCPD stated Rolon was not licensed for electrical and contracting work and failed to procure permits for the work.

“To take advantage of an elderly woman trying to sell her home and to this extent, is simply unconscionable,” HCPD Chief Jim Elensky said. “We should be able to rely on our local pastors to serve as community leaders — not lying, stealing and taking advantage of people.”

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Depression spiked among nursing home residents during pandemic, report finds

By Peter Yankowski

After nursing homes around Connecticut slammed their doors shut to visitors this spring, care providers saw a spike in symptoms of depression among residents, according to a new report released Thursday.

As the COVID-19 pandemic reached a peak, cases of unplanned weight loss almost doubled, while symptoms of depression increased by 15 percent.

Those outcomes suggest the true impact of the pandemic brought on by the novel coronavirus stretch far beyond the thousands of deaths and infections recorded at the state’s long-term care facilities over the past seven months.

Earlier this week, the state began allowing indoor visits for nursing home residents, a decision officials said was largely prompted by concerns about residents well-being in isolation.

The virus exacted a heavy toll as it tore through nursing homes and assisted living facilities, some of which are still grappling with outbreaks this week.

Nearly two-thirds of the state’s deaths attributed to COVID-19, the disease caused by the virus, were among residents of nursing homes.

As of Thursday, 2,849 nursing home residents and three staff members have had their deaths attributed to COVID-19, according to the governor’s office. A further 381 residents of assisted living facilities have died.

The 157-page report released Thursday by Mathematica, a Cambridge, Mass.-based research foundation, concluded the state did not recognize long-term care facilities as critical parts of its emergency health care plan early on.

Long Term Care Facilities Final Report by Peter Yankowski on Scribd

 “Compounded by a lack of knowledge about how the virus spreads, (long-term care) facilities did not take prompt and immediate action to limit entry to their buildings, enforce staff screening measures, and implement universal mask wearing,” the report reads.

An interim report released by the organization over the summer came to similar conclusions, including recommending nursing home staff should not work at multiple facilities, to prevent the virus jumping from home to home.

Asked about the final report during his Thursday news conference, Gov. Ned Lamont said the state is already implementing most of the recommendations raised by Mathematica.

That includes working with nursing homes on training around infection control. “Those nursing homes that didn’t get that right are really the ones that suffered the most,” Lamont said.

The report also found that nursing homes in communities with high caseloads, as well as homes with a large number of patients who had to go offsite for dialysis or cancer treatment, had higher numbers of cases and deaths.

It recommended the state find ways to reopen facilities to visitors, make infection control specialists required under federal law at nursing homes into a full-time position, increase staffing minimums and ensure access to protective garbs and sick leave for staff.

Deidre Gifford, acting commissioner for the state Department of Public Health, said the agency has not stopped working on intervening at nursing homes since Mathematica was contracted to write the report in June.

“What I found very reassuring about the report was the strategies that we’ve been putting in place to prepare for a second wave were validated,” Gifford said.

She said the agency will look at the report’s longer term recommendations — including engaging the nursing homes in the planning process — as the fall goes on.

Shortly after the press conference, Republican state Sen. Kevin Kelly blasted the governor over the report, calling it “an indictment on the state's response to the pandemic in our nursing homes.”

“Connecticut must make patient-centered care a priority and guarantee that care plans address the prevention of isolation and loneliness,” said Kelly, whose district includes Monroe, Seymour, Shelton and Stratford.

“We have to make sure the terror, fear and isolation that nursing home residents experienced never happens again,” he said.

A joint statement from two nursing home organizations said the pandemic “is not over.”

“We are committed to reviewing and implementing Mathematica’s short-term and long-term recommendations as we continue to partner with Connecticut to prepare for the challenges ahead and put this virus behind us,” said Matthew Barrett of the Connecticut Association of Health Care Facilities and Mag Morelli of LeadingAge Connecticut.

The report comes as several high profile outbreaks have been reported at Connecticut nursing homes in recent weeks.

On Thursday, Harrington Court, a nursing home in Colchester, reported 56 new cases of COVID-19 among staff and residents there. The outbreak prompted the home to move some residents, the chief medical officer for the home’s parent company said.

That came after four people tested posistive for the illness at Fairview Rehabilitation and Skilled Nursing Care Center in Groton the week before.

Earlier in September, the state appointed an interim manager at Three Rivers, a nursing home in Norwich, after at least 21 people fell ill with the virus and four infected residents died. The state later ordered the facility to close.

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Thursday, October 22, 2020

Woman arrested on suspicion of more than 100 instances of elder abuse

by  Jordyn Brown

Junction City police are seeking help identifying pieces of stolen jewelry.  Photos of the jewelry can be viewed online at  Junction City Police Department

A 25-year-old woman is potentially facing 99 felony charges and 11 misdemeanor charges after admitting to withholding vital medication and stealing from elderly people at care homes the past five to six years. 

Noelle Jendraszek was arrested Wednesday by Junction City police on suspicion of stealing money, jewelry and drugs from residents at a Junction City assisted-living facility, according to a news release from police.

Jendraszek later confessed to doing so in a notarized affidavit, as well as to similar crimes at previous care facilities where she worked, according to police.

Jendraszek was booked in Lane County Jail on suspicion of the following charges: 55 counts of first-degree criminal mistreatment, 44 counts of tampering with drug records, five counts of second-degree theft and six counts of third-degree theft.

The release said police began investigating on Sept. 10, when the son of a resident at Junction City Retirement and Assisted Living reported someone had stolen cash from his father. Investigators eventually interviewed Jendraszek, who within hours of the first interview gave up about 275 pieces of jewelry she had admitted to stealing from residents in care facilities where she was employed in the past five or six years, police said.

"Jendraszek has also admitted withholding vital and medically necessary medication from 44 vulnerable and elderly residents whom were (in) her care," the release stated.

Over the years, Jendraszek has worked at the Junction City facility, River Grove Memory Care in Eugene and six care facilities in Salem: Cedar Village Assisted Living Community, Capital Manor Retirement Community, Four Seasons Residential Care, Gibson Creek by Bonaventure, Prestige Senior Living Orchard Heights, and Redwood Heights Retirement and Assisted Living Community.

In her statement of guilt, Jendraszek said the following, according to police: “I am very apologetic for any harm I have done and/or any sadness I have caused. It is my intent to correct my wrongs and do the right thing by taking responsibility for my actions. I hope someday that all the families and persons I have harmed can find it within themselves to forgive me because I know what I have done is wrong and I am seeking the help I need to recover and become a better person.”

Junction City police are seeking help identifying the pieces of stolen jewelry. They are asking people with a friend or relative who lived at any of these care facilities in the past five years who believe their jewelry may have been stolen to examine the photos posted on this website:

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Local man admits to impersonating a nurse for nearly 4 years

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WKRC) – A Clifton man pleaded guilty to impersonating a nurse for nearly four years. Martez Morris, 28, used a stolen identity to get hired as a licensed practical nurse at a couple of Tri-State locations.

Morris stole the identity of a real nurse and created fake documents to get jobs at Cincinnati area home health agencies.

Ohio Attorney General, whose Health Care Fraud section prosecuted the case, said Morris cared for several children and a disabled adult. He gave breathing treatments to a toddler, administered medicine and cleaned the child's feeding tube, in one case.

Morris worked for Target Home Healthcare in Springdale for a time. An official there said there were no complaints about him from patients.

He also worked at Loving Care Transitional in Butler County. A patient complained that Morris was late several times to appointments. That's when Medicaid started to investigate and then alerted the attorney general's office.

Morris pleaded guilty to identify fraud, tampering with public records, Medicaid fraud and practicing nursing without a license.

He'll be sentenced on Dec. 17.

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Man to be sentenced Tuesday for elder abuse in group home

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A man accused of abusing elderly people in an unlicensed group home is scheduled to be sentenced on Tuesday. Las Vegas police say Bruce Wycoff and three other employees were exploiting people who were mentally handicapped dependable or homeless but qualified for federal benefits.
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Wednesday, October 21, 2020

10 people have died after every resident of a Kansas nursing home got Covid-19

By Joe Sutton and Hollie Silverman
Dr. Gupta says nursing homes were tinderboxes for pandemic03:30

(CNN)Ten people living at a Kansas nursing home have died after an outbreak of Covid-19 infected every resident, according to a news release Monday from the Norton County Health Department.

All 62 residents at the privately owned Andbe Home in Norton have tested positive for the virus, the release states. 
"Steps are being taken to prevent any further outbreak including quarantining residents in their rooms and not allowing outside visitors into the facility," the release says, adding that relatives of all residents have been notified.
Some staff members have also tested positive, and the rest are being tested, the release states. 
Nationwide, some 252,939 confirmed cases of coronavirus have been reported among nursing home residents, and more than 59,600 have died, federal data show. Nursing home workers also have contracted the disease, and some have died. 
One resident of Andbe Home is hospitalized and the remaining 51 are being cared for at the facility, the health department said. Norton, near the Nebraska line, is about five hours' drive west of Kansas City. 
Some of the first US cases of Covid-19 were reported at the Life Care Center in Kirkland, Washington. Several states soon placed limits on visitations due to the virus, but many have since loosened the restrictions so loved ones can visit.
In July and August, on average, "more than one nursing home resident was infected every minute, and 11 residents died every hour," a US Senate report released last month found. And despite calls for help from communities across the country, some nursing homes still lacked adequate testing capacity and suffered staff and PPE shortages, the report found.
Kansas has reported 71,557 cases of Covid-19 and 870 deaths as of early Tuesday morning, according to data from Johns Hopkins University.
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Britney Spears fans concerned after star posts bizarre video of herself dancing

By Tyler McCarthy

Britney Spears fans are voicing their concern after the star’s latest bizarre Instagram post. 

The star, who is currently embattled in a legal struggle over her conservatorship, took to Instagram on Monday to share a video of herself dancing in her home in nothing but high heels, a bikini bottom and revealing red halter top. 

The minute-long video shows her performing some seductive moves while staring into the camera with an expressionless face. The video includes jump cuts implying that she edited the video to put some of the moves on a loop. 

“Ps ... I usually never dance with my hair in a bun like this ... I didn’t have a rubber band so I did the magic kind without one,” she captioned the post. “Look … it stayed.” 

While a professional singer and dancer posting a video of herself isn’t necessarily odd, the general vibe of the video had many of her fans taking to the comments section of the post to express that they’re concerned for her well-being. 

“Where in Gods name is her family ... she’s not well and she keeps posting stuff like this,” one user wrote. 


“She is not okay,” a more blunt user noted. 

Meanwhile, others took to the comments to simply mock the star for the “cringey” video.

Britney Spears' fans are voicing concerns for her wellbeing after she posted a video of herself dancing with an expressionless face.
Britney Spears' fans are voicing concerns for her wellbeing after she posted a video of herself dancing with an expressionless face. (J. Merritt/Getty Images for GLAAD)

Britney Spears' fans are voicing concerns for her wellbeing after she posted a video of herself dancing with an expressionless face. (J. Merritt/Getty Images for GLAAD)

“I feel like I wasn't supposed to see this. How awkward,” another person noted. 

“This is so cringey…” someone else wrote.

“I’m concerned,” a third user noted. 

Spears’ mental health is being called into question amid a legal battle with her father, Jamie Spears, as she reportedly seeks to revoke his conservatorship. Right now, Jamie is in charge of her finances and everyday life and has been for more than a decade. The conservatorship was recently extended until February 2021, but Spears was given permission to expand her legal team to potentially fight for herself in court.

The star is reported to be "strongly opposed" to Jamie acting as her sole conservator and has reportedly requested that a trust company take over the role.

Other members of the star's family have gotten involved as well, as it was reported that her mother, Lynne, filed docs requesting to be informed of her daughter's finances.

Additionally, Spears' sister Jamie Lynn is reportedly acting as her trustee while her brother, Bryan, has publicly disclosed that Spears has "wanted to get out of [the conservatorship] for quite some time."

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Federal Agency Recommends Ending Government Disability Jobs Program

by Michelle Diament

The National Council on Disability says that the AbilityOne Program should wind down and be replaced by government efforts to get people with disabilities employed in integrated settings. (Nick Sabula/NCD)

An independent federal agency says it’s time for a decades-old government jobs program for people with disabilities to come to an end.

The National Council on Disability, which is charged with advising the president and Congress on disability issues, is calling for the AbilityOne Program to be phased out.

The 82-year-old program funnels government contracts to a network of 500 nonprofits across the nation that make products or provide services to federal agencies. At least 75% of the direct labor hours undertaken by the nonprofits must be performed by people who are blind or who have significant disabilities.

However, in a report out this month, the National Council on Disability said the program is antiquated and is failing to increase employment opportunities for people with disabilities.

“The AbilityOne Program is a federally sanctioned segregated jobs system,” said Neil Romano, chairman of the council. “Not only is its effectiveness in question based on our research, it is a policy relic in tension with current national disability policy.”

Currently, about 45,000 people with significant disabilities or blindness are employed through AbilityOne, according to NCD. And, in the 2018 fiscal year alone, the federal government allocated $3.6 billion worth of contracts to the program through a mandatory preference system.

Nonetheless, the National Council on Disability found that in the last eight years of available data, employment of people who are blind through the program has stagnated and positions for those with significant disabilities have declined even as overall program sales have increased. Accordingly, the percentage of AbilityOne Program revenue going toward wages for people with disabilities has dropped each year since 2011.

Meanwhile, there are concerns about transparency and oversight, particularly in regard to spending on executive salaries and lobbying. And, the NCD report said that the requirement that people with disabilities perform 75% of work hours reinforces an outdated model of employment.

“The ratio inherently creates pressures on the AbilityOne (nonprofits) to place workers with disabilities into more segregated settings, whether as work crews or on the production floor, while the entire program perpetuates a separate system for people who are blind or have significant disabilities at the same time federal laws seek to achieve greater integration,” the report states.

Only about 4% of AbilityOne workers leave the program each year for competitive, integrated employment, the NCD report notes.

The National Council on Disability is recommending that the government phase out the AbilityOne Program over an eight-year period. Instead, all federal contractors and subcontractors with at least $200,000 in contracts and a minimum of 50 employees should be required to hire a certain percentage of people who are blind or who have significant disabilities, the council said.

“The phaseout must be conducted in such a way to ensure that all employees working under the program are prepared to transition to the new requirement to avoid job loss, unemployment or underemployment, or lower wages,” the report indicates.

Officials with the U.S. AbilityOne Commission, an independent federal agency that administers the AbilityOne Program, said they are currently reviewing the report and declined to provide further comment.

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Tuesday, October 20, 2020

Two Sexual Assault Investigations At Different El Cajon Nursing Homes Turned Over To DA’s Office

By Amita Sharma

Photo by Roland Lizarondo

Above: Pictured above is Avocado Post Acute in El Cajon, May 29, 2020.

El Cajon police have referred an investigation into accusations that a caregiver sexually assaulted two seniors at separate nursing homes to the San Diego County District Attorney’s office for possible prosecution.

Police sent their findings to prosecutors following an investigative report by KPBS last week and more than one year after the alleged assaults took place.

“Sometimes, it’s better to hang on to a case to try to investigate it as much as we can,” said Lt. Keith MacArthur. “We only get one shot at this. You don’t want to turn stuff over prematurely.”

Catherine Gotcher-Girolamo, 73, accused certified nursing assistant Matthew Fluckiger of sodomizing her with his fingers while changing her diaper on June 19, 2019.

Gotcher-Girolamo said she told other caregivers at Avocado Post Acute immediately after the alleged incident. 

She also said she reported the alleged sexual assault that same day to Avocado’s administrator Dina Mookini.

Mookini, however, told state investigators that she was only aware of “rough handling” by Fluckiger and that Gotcher-Girolamo’s story seemed to evolve. Another manager told state investigators, however, that Gotcher-Girolamo’s account never changed.

Avocado waited eight days before reporting the allegations to El Cajon police even though the law requires every member of a nursing home’s staff to report abuse within two hours.

“The law says immediately,” MacArthur said. “The faster that we’re notified, it makes it a whole lot easier for us to get cooperation from victims and take them for a sexual assault exam and talk to witnesses.”

El Cajon Police also turned over to the DA’s office its investigation into an allegation that Fluckiger sexually assaulted a resident at San Diego Post Acute nursing home in August of last year, after he was fired from Avocado.

Gotcher-Girolamo expressed satisfaction that prosecutors are actually reviewing her case for possible charges against Fluckiger.

“I’m very pleased that happened,” Gotcher-Girolamo said. “I’m kind of surprised that it took so long.”

Lawyer Tony Chicotel of California Advocates for Nursing Home Reform said the year lag time between the alleged sexual assaults and the police department’s referral of the two cases to the DA’s office would enrage communities had the victims been younger.

“From a nursing home resident advocate perspective, this is par for the course, the victimization of older people is tolerated in a way that we don’t tolerate in society at large,” Chicotel said.

He added there might be another reason for the police department’s delay.

“Their failure to turn it over to the DA sooner indicates that they didn’t think there was any possibility that the DA would take it or they didn’t have a lot of outrage about what was in those cases to compel them to move on it,” Chicotel said.

He added that the DA’s office should also consider prosecuting Avocado staff who failed to notify police immediately after Gotcher-Girolamo told them she had been sexually assaulted.

A California Department of Public Health investigation of Gotcher-Girolamo’s allegations found that Avocado also failed to submit its own probe of her complaint to the state within five working days, as required.

The state’s inquiry also concluded that Avocado’s allowance of Fluckiger to return to work just days after he had been accused of sexual assault jeopardized the safety of Gotcher-Girolamo and other residents at the facility.

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Woman arrested after authorities say she's accused of stealing from an elderly man with dementia

By Angela Saxon

COLUMBIA COUNTY, GA (WFXG) - The Columbia County Sheriff's Office arrested a 22-year-old woman after she was accused of exploitation and intimidation of an elderly man.

According to a police report obtained, the executive director of the Claiborne Premier Retirement on Furys Ferry Rd, home stated she believed a current employee took an elder's credit card and used it in several stores. According to the executive director, she said she had received emails from the elderly man's son, stating he had observed suspicious activity going on with his father's bank account. 

According to the report, the son stands as his father's power of attorney since his father suffers from dementia and has access to his father's bank account. 

The report goes on to explain that the executive director said that the elderly man had not left the retirement home in several days and was unable to locate his credit card. The report states the only transactions that were made were in Columbia County at Walmart on Evans to Lock Rd, Dicks Sporting Goods, Target, and unknown locations at Super Express, Wendy's, and McDonald's. 

Authorities say they believe the suspect involved in this incident is Lateakerria Michan Laney who's currently being held at the Columbia County Detention Center. 

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