Judge accepts plea deal for Florida guardian accused of neglect

by:  Anthony Talcott, Digital Journalist
       Christie Zizo, Digital Editor

Sentencing for Rebecca Fierle scheduled for March 23

Rebecca Fierle-Santoian is accused of giving "do not resuscitate" orders to people who didn't want them. (Marion County Sheriff's Office)

HILLSBOROUGH COUNTY, Fla. – Rebecca Fierle, a state-appointed guardian accused of abuse and neglect in the 2019 death of a man under her care, had a plea deal accepted by a judge Thursday, according to court documents.

Fierle was arrested in 2020 after the death of Steven Stryker, 75, who was under a “do not resuscitate” order that prosecutors said was filed by Fierle, as Stryker’s legal professional guardian, without the man’s permission.

Court records released Thursday show that Fierle pleaded no contest to the charges.

Fierle was stripped from hundreds of cases following Stryker’s death, as it was learned that she had placed numerous DNR orders on clients without the consent of family or wards. A judge said Fierle had “abused her power” and had not disclosed related interests and payments.

The Fierle case sparked changes to the Florida guardianship system to better protect seniors.

Sentencing in Fierle’s case is set to take place on March 23.

Full Article & Source:
Judge accepts plea deal for Florida guardian accused of neglect

'You'll get hoodwinked;' Family warns against emergency temporary guardianships

by Danielle DaRos

After getting their father out of a two-year guardianship that was only supposed to last 90 days, daughters Zoraida and Martiza Navarro are reunited with their father Benito (WPEC).

WEST PALM BEACH, Fla. (CBS12) — When sisters Maritza and Zoraida Navarro initiated an emergency guardianship for their father, they had the best intentions.

After the death of their mother, they worried their elderly father, Benito, was falling for a romance scam and about to lose everything to a woman he barely knew from Peru.

They petitioned the court for an "emergency temporary guardianship," or an ETG, which they believed would be just that: temporary. ETGs are supposed to last for 90 days.

Because Martiza and Zoraida are both medical doctors and were designated power of attorney for their father, they asked the judge to be appointed his guardians. But for some reason, a judge decided to appoint someone else: a professional guardian -- a complete stranger -- to manage Benito's money and medical care.

That was the start of a two-year nightmare for their daughters, who only recently got their father freed.

After getting their father out of a two-year guardianship that was only supposed to last 90 days, daughters Zoraida and Martiza Navarro are reunited with their father Benito (WPEC).

"[ETGs] are supposed to be temporary, but if you don't know the law, you'll get hoodwinked," Zoraida said. "The system is broken. It has to be fixed."

For nearly two years, the CBS12 News I-Team has been investigating Florida's guardianship system. We've shown the loopholes that allow bad actors to exploit the people they are being paid to protect, stealing their money, and isolating their wards from their family.

Court records show the daughters fought the guardianship every step of the way, objecting to the way Benito's money was being spent. They didn't want him to be moved to an assisted living facility, and they didn't want the guardian to put his house in Greenacres up for sale.

But a judge signed off on all of it -- and even extended the emergency "temporary" guardianship for another 90 days, when it was set to expire.

"Once you are in an ETG, an emergency temporary guardianship, it is anything but temporary," said Hillary Hogue, a guardianship reform advocate who sat on the statewide Guardianship Improvement Task Force.

In Florida, there is no limitation in guardianship statute for the number of times an ETG can be extended.

Hogue believes it's too easy for a guardian to claim the emergency conditions still exist, and keep getting paid to manage their ward.

"That is the way to get someone under the control of the court system," Hogue said. "To say they are wandering, to say they don't know their family's names, there's a financial risk of exploitation. That's all the judge needs to read or here, without even meeting the alleged incapacitated person who never goes in front of the judge."

In Benito's case, his ETG was extended three times before a judge decided to make the "emergency" guardian the permanent, or plenary guardian.

"If we didn't have access to him, a stranger could have him medicated, move him out, could keep him from us forever," Zoraida said.

The situation escalated when the daughters received permission from the guardian to take their father out to lunch. In court documents, they state that they observed their father's diminished mobility, swollen legs, and bed sores.

Fearing congestive heart failure could occur, they took Benito to Palm Beach Gardens Medical Center for treatment. But because they did not communicate with the guardian right away, they got in trouble with the courts -- were threatened with kidnapping charges -- and were handed a "stay away" order that prevented them from seeing their father.

It took an unusual legal maneuver to turn things around: the daughters filed a notice in court claiming rights to their father's house, and named the judge as a defendant. This forced the judge to recuse herself from the probate case. And when a new judge reviewed the docket, he came to a very different conclusion.

"He said look, I've read this file quite extensively," said Zoraida. "Is there anybody here that these two girls should not be the guardians? Nobody said a peep. Because the gig was up."

The guardian resigned and the new judge appointed Zoraida and Maritza to oversee their father's care. He is now living with them, and says he is happier than ever.

"Being around my two daughters, I"m perfect," Benito said. "The guardianship I had -- no good."

Full Article & Source:
'You'll get hoodwinked;' Family warns against emergency temporary guardianships

Limestone Co. man arrested for alleged financial exploitation of his mother

By Charles Montgomery

ATHENS, Ala. (WAFF) - A Limestone County man was arrested on Wednesday after he allegedly wrote seven checks to himself and took money from his mother.

According to a spokesperson for the Athens Police Department, a mother filed a report on Jan. 17 and said her son wrote seven checks to himself from her. The checks were worth about $8,000.

Gary Graham, 47, was arrested and charged with financial exploitation of the elderly.

Full Article & Source:
Limestone Co. man arrested for alleged financial exploitation of his mother

Embattled former professional guardian signs plea deal before trial

Rebecca Fierle could spend up to 5 years in prison

Full Story: https://wfts.tv/3SrZ86Y Former Florida professional guardian Rebecca Fierle, who was charged in 2020 in connection with the death of a man under her care, has entered into a plea deal.

By: Adam Walser

HILLSBOROUGH COUNTY, Fla. — Former Florida professional guardian Rebecca Fierle, who was charged in 2020 in connection with the death of a man under her care, has entered into a plea deal.

It’s the latest development in a story the ABC Action News I-Team has covered for over three years.

Fierle was supposed to stand trial next month on two felony charges, including aggravated abuse of an elderly person and neglect of an elderly person.

MARION COUNTY SHERIFF'S OFFICE

Her first trial, last September, lasted a week and ended in a hung jury.

During a pretrial hearing Wednesday, Fierle signed a plea agreement form pleading “no contest” to the charge of neglect of an elderly person.

That was the lesser included charge, but Fierle still could face up to five years in prison.

Credit: KIM STRYKER

Fierle was arrested in February 2020 in connection with the death of Stephen Stryker a year earlier.

Stryker depended on a feeding tube because of a medical condition that made swallowing hard for him.

But when Fierle couldn’t find a nursing home to manage his care, she ordered his feeding tube plugged.

Fierle then requested a “do not resuscitate” order from doctors at St. Joseph’s hospital in Tampa, where Stryker choked to death days later after telling staff he didn’t want to die.

The case drew national attention and led to changes in state law.

WFTS

Professional guardians must get a judge’s permission before signing a DNR order.

During the September trial, Fierle’s attorneys prevented jurors from hearing testimony or evidence about the DNR.

Fierle is scheduled to be sentenced by a Hillsborough County judge on March 23.

If you have a story you’d like the I-Team to investigate, email adam@abcactionnews.com

Full Article & Source:
Embattled former professional guardian signs plea deal before trial

See Also:
Trial scheduled to begin for former professional guardian accused in man's death

Ex-guardian Rebecca Fierle may not stand trial in ward’s death until 2021, attorney says

Ex-guardian Rebecca Fierle asks judge to pause lawsuit by family of man who died under DNR

Marion deputies release video of arrest of former Florida guardian Rebecca Fierle

Attorney General Ashley Moody fires back at embattled former Florida guardian

Guardian at center of Florida scandal appeals judge’s ruling that she broke state rules by misusing DNRs

Ex-guardian Rebecca Fierle charged Altamonte Springs facility $100K, illegally pocketed refunds, investigation finds

Florida Elder Affairs chief announces ‘immediate’ changes as embattled Orlando guardian Rebecca Fierle resigns from all cases

Florida professional guardian Rebecca Fierle: Devoted or dangerous? | Exclusive

Cremated remains of 9 people found at Orlando office of disgraced former guardian Rebecca Fierle

Expert’s complaint against Florida guardian Rebecca Fierle was ignored for years before scandal erupted | Exclusive

Orlando guardian accused of filing unauthorized ‘do not resuscitate’ orders resigns from Seminole cases

Watchdog: In Short Hearing, Fierle Given Guardianship Over Patient

Judge releases confidential information to authorities investigating former Orlando guardian Rebecca Fierle

Clinton Twp. woman questions probate court’s decisions for sister’s care

Woman is caregiver but denied guardianship by judge

Kim Edwards, left, and Melissa Edwards in their Clinton Township home. JAMESON COOK — THE MACOMB DAILY

By Jameson Cook

A Clinton Township woman who takes care of her cognitively impaired sister says she has been locked out of the decision-making process by the Wayne County Probate judge, and the trustee of her sister’s estate is not providing sufficient funds.

Melissa Edwards, 40, who takes care of Kim Edwards, 46, says the trustee of Kim Edwards’ $1.4 million estate won’t provide funds to purchase a needed new vehicle, new computer and other items, including home repairs, and a Wayne County Probate judge denies her challenges to his and officials’ decisions.

Melissa Edwards says it’s what she believes is part of long-term mistreatment of her family by the court and its officers.

“My sister Kim Marie Edwards and my family’s rights have been getting violated for years by officers of the Wayne County Probate Court,” Melissa Edwards said.

Kim Edwards has cognitive issues resulting from going without oxygen for nearly 15 minutes in 2004 when she had a cardiac arrest during childbirth. She gained a $3 million settlement with the hospital.

Melissa Edwards, who is a paralegal, was denied guardianship over her sister by Judge David Braxton after their mother, who was the guardian, died in 2018. The current guardian is Joya Garland of Michigan Guardian Services in Taylor.

The judge also denied Edwards’ attempt to move the case to Macomb County.

Melissa is her sister’s caregiver, earning a salary of $18 per hour for 40 hours per week although she says the job is around the clock. The sisters reside with Kim Edwards’ 18-year-old daughter, Taylor, in the 2,500-foot single-family home off Clinton River Road. The house was bought by the Kim Edwards trust in 2011 for $330,000, according to township records.

Braxton indicated appointing Melissa Edwards would be a conflict of interest, according to Edwards’ retained attorney Phillip Strehle, who says Braxton should have appointed Melissa to the post.

“There is no other person who understands Kim’s needs better than Melissa,” Strehle said. “There is no conflict of interest. The court can only appoint a (non-relative) guardian when no one else is available.”

He said Melissa was denied guardianship and lost other court rulings because she is outspoken and “challenges everything the guardian and trustee does.”

“The sole job of all of the people appointed to the case and the judge is to protect Kim, and none of that is happening,” he said.

James McCann, the guardian ad litem for Kim Edwards, defended the court and officials, saying that after the sisters’ mother died, officials discovered poor conditions at the house, where Melissa Edwards was residing and had influence. He said there was a cockroach infestation, holes in walls, and a lack of dressers to store clothes in the bedrooms. “Conditions were impossible,” he said.

“There have been numerous issues that have come up over the years regarding the care by Melissa,” he said. “That is why, in my opinion, the court has not acted to appoint her.”

But Edwards disputes those claims, saying there was a delay by the trustee in hiring a pet-control company to eliminated the roach infestation in 2011 or 2012; the company was successful. She said dressers were situated in large closets.

She said she disputes other information McCann has included in his reports.

She said the estate’s trustee, Mark Haywood, has responded slowly to needed repairs at the house, causing some things to go into disrepair, in addition to not providing funds to buy a new car, furniture, TV and computer.

She said she has dipped into her own funds for some repairs, and to purchase a couch-loveseat set and a preowned Jeep, which carries a $15,000 loan. She said she bought the car because Haywood has not allowed for repair of the transmission of Kim Edwards’ Kia Sorrento, which stopped running last July. The Sorrento was used to transport Kim Edwards, who can’t drive. Edwards said she also has an old Ford Taurus that is broken down.

She questioned other decisions by Haywood over the years and a drop of nearly $300,000 drop in the estate’s value during a recent period. McCann said Haywood accurately reported the loss, which was a result of the March 2020 stock market crash.

Haywood declined to comment to The Macomb Daily on Monday, saying he does not comment on ongoing cases.

Attorney Bruce Rice, representing Michigan Guardian Services, said Melissa Edwards has been uncooperative. His client recently withheld Kim Edwards’ $1,100 monthly Social Security payment because Melissa Edwards has not allowed the guardian a personal visit.

“We want to find out where she is and her living conditions,” Rice said.

Melissa Edwards earns $37,400 per year for her caregiver duties.

Braxton also has ruled that Edwards does not have “standing” to object to his decisions since she is merely her sister’s caregiver. After he denied a motion by Edwards, he ruled that she must post a $2,000 bond to file future motions, according to Edwards.

Strehle said his client should have standing.

“She is greatly affected by everything that’s done with the trust,” he said. “She’s out $18,000 as a consequence of these decisions.”

Strehle criticized the fact that Braxton on Monday approved Haywood’s “12th accounting” of the estate for the year ending February 2022 without conducting a hearing.

A court official merely told onlookers at the Zoom hearing that the accounting was “approved.”

Strehle did not get a chance to speak; Braxton recently ruled that Strehle also does not have standing, Strehle said.

The accounting was reviewed and OK’d by McCann. The only part questioned by McCann was $10,000 spent for electricity. Edwards she has no explanation for it because they do not overuse electricity.

The report says the trust gained a net value of $2,000, with $104,000 in income and $102,000 in expenses.

Strehle, who was hired by Edwards less than a year ago, said the lack of input allowed for the report is an example of “strange” and improper court procedures since he joined in the case.

“I’ve been an attorney for over 30 years and never have seen this before,” he said. “It’s just bizarre.”

Wayne County Probate Court remains closed to the public due to COVID-19 protocols so the use of Zoom and online access are required for hearings and to access documents, though Strehle said he has been unable to access documents that are over a half-year old.

Now that Taylor Edwards is an adult at 18, the Chippewa Valley High School senior is seeking to become her mother’s guardian. A hearing is scheduled for March 9.

“I have to step up,” Taylor Edwards said. “Being the only child, I think legally I should be the next one up to take care of her.”

Rice said Michigan Guardian Services does not object to a qualified person taking over as guardian. Michigan Guardian will support Taylor Edwards’ request if she is qualified. The guardian would oppose Melissa Edwards as the new guardian.

“My client has no problem resigning as long as someone suitable takes over,” he said. “We don’t think Melissa Edwards is suitable.”

Melissa Edwards, right, is joined by her sister, Kim, and Kim’s daughter, Taylor, on their living room couch in their Clinton Township home.JAMESON COOK — THE MACOMB DAILY

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Clinton Twp. woman questions probate court’s decisions for sister’s care

Senate panel: Guardians must see incapacitated charges 3 times a year

by David Ress

Court-appointed guardians responsible for ensuring that incapacitated adults are treated well should check in at least three times a year, the Senate Judiciary Committee agreed Monday.

House Bill 2028, sponsored by Del. Danica Roem, D-Prince William, requires guardians visit their charges every 120 days, with at least one face-to-face visit a year. The other visits can be done virtually or by video call.

“This is simply to make sure they are checking in on people they’re responsible for,” Roem said. Courts appoint guardians to look after the affairs of people found to be unable to do so themselves.

She said she has been concerned about lax practices by guardians ever since a constituent told her about a sister’s death while under the oversight of a guardian.

“She died because of inattention and neglect,” Roem said.

Public guardians — individuals financed by a state program to look after indigent, incapacitated adults — are required to check on their charges once a month.

But unlike other states, which typically require guardians make at least four in-person visits a year, Virginia has had some cases in which incapacitated Virginians are not seen even one time in a year, Roem said. 

Mason pushes bill inspired by RTD's 'Unguarded' investigation

A 2020 Joint Legislative Audit and Review Commission study recommended a four-visit-a-year standard, but concerns about a lack of people to fulfill this requirement led Roem to compromise on the lower standard. JLARC found 11 guardians with caseloads of more than 20 people, and one who was responsible for 110 individuals.

Jane Powell, president of Central Virginia Families and Friends, said the once-a-year in-person standard is too onerous for family members, named as guardians, for residents in the state’s sole remaining facilities for people with intellectual or developmental disabilities, which are in Chesapeake and at the Hiram Davis center in Petersburg.

Many of those family members are elderly parents or aging siblings of the residents, and live hundreds of miles away, she said.

State Sen. Richard Stuart, R-King George, said he was concerned the bill gave guardians cover for not doing their jobs.

“I don’t know how you can look out for someone if you only see your charges a few times a year,” he said.

Roem said courts can demand guardians see their charges more frequently and that her bill simply sets a minimum standard.

The committee approved the bill 12-1.

It also approved another Roem guardianship bill that says a guardian shall not restrict an incapacitated person’s ability to communicate with, visit or interact with other people with whom the incapacitated person has an established relationship, unless that visitor is likely to harm or steal from that incapacitated person.

JLARC’s 2020 report found guardians have too much discretion to restrict contact with adults under their guardianship, noting that contact with family, friends and others can help prevent the abuse, neglect and exploitation of incapacitated adults.

A Richmond Times-Dispatch investigation reported in 2019 that VCU Health System and other health care providers had used the guardianship process to remove poor patients from hospital beds, sometimes against the wishes of family members. 

VCU Health exploring community collaborations for guardianship cases

The Senate committee on Monday also approved a measure largely aimed at helping families deal with inherited property. It involves old liens for judgments held by out-of-state buyers of debts who never bothered to file notices of repayment with Virginia courts.

Those liens can be a major headache when heirs want to dispose of property; the result is often that property ends up being lost in a tax sale, said Del. Carrie Coyner, R-Chesterfield.

The bill passed 13-1, with one abstention.

Full Article & Source:
Senate panel: Guardians must see incapacitated charges 3 times a year

Police: Reckless care led to death of West Des Moines man; 2 charged with his murder

by Chad Thompson

WEST DES MOINES, Iowa — Police say it was reckless care that led to the death of a West Des Moines man, and they have now charged the man's son and his partner with murder.

Jacob Schaper, 24, and Jocelyn Grisham, 23, both of West Des Moines, are charged with second-degree murder in the death of 58-year-old Steven Schaper.

Steven Schaper had a medical emergency on Aug. 10. When first responders arrived at 228 First St., they found Schaper laying in what they call "deplorable conditions." Police say he had also suffered severe bedsores.

Schaper was transported by EMS to a local hospital, where he later died.

Police say evidence suggests that Steven Schaper’s son and his girlfriend intentionally or recklessly denied him adequate medical care and proper living conditions, which resulted in his death.

On Tuesday, Jacob Schaper and Grisham were arrested and transported to the Polk County Jail.

Full Article & Source:
Police: Reckless care led to death of West Des Moines man; 2 charged with his murder

Florida nursing home wins whistleblower lawsuit but not $400,000 in defense costs

by Jessica R. Towhey

A Florida nursing home is not entitled to nearly $400,000 in attorney’s fees despite prevailing against a former employee who filed a whistleblower lawsuit alleging Medicare fraud, a US magistrate ruled. 

Former employee Delia Bell alleged that Cross Garden Care Center submitted claims to the US government for “unnecessary services, improperly characterizing the level of services needed, and improperly extending periods of service,” according to reporting by Bloomberg Law. She filed a qui tam — or whistleblower — suit in April 2016. However, a District Court judge granted a summary judgment win to Cross Garden in March 2021, saying that Bell had not proven the facility had filed false claims.

The US Court of Appeals for the Eleventh Circuit upheld the decision in November 2021.

Following that, Cross Garden filed for approximately $375,000 in attorneys’ fees and approximately $8,000 in costs, according to Bloomberg.

Attorneys for Cross Garden Care Center and Bell did not respond to a request for comment from McKnights Long Term Care News. Despite the win, no one was available at the facility to comment.

In his ruling, US Magistrate Judge Anthony E. Porcelli said that Cross Garden was not entitled to fees because there was “insufficient evidence” to claim that Bell brought her case to harass the facility or that she “pursued the litigation with an improper purpose.” Indeed, the federal government investigated Bell’s allegations for three years under seal, and the investigation remains open, Porcelli wrote.

“The United States’ position suggests that the case was not wholly frivolous,” Porcelli wrote. “Therefore, although [Bell] did not ultimately succeed, [Bell’s] claims presented sufficient allegations to not be considered groundless.”

As McKnight’s recently reported, the federal government notched the second-highest number of False Claims Act settlements in history and judgments, many of them related to healthcare entities, in the last fiscal year.

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Florida nursing home wins whistleblower lawsuit but not $400,000 in defense costs

Man arrested in sexual assault of 80-year-old woman in Ocala

Taquino Williams, 31, was accused of raping an elderly woman at her Ocala apartment, according to police.

Source:
Man arrested in sexual assault of 80-year-old woman in Ocala

14 Names of Nurse Licenses Connected To FL Fake Nursing Diploma Scheme Released in WA

By: Kathleen Gaines

On Thursday, February 16th, the Washington Department of Health releases the names of ten registered nurses (RNs) that have failed to provide adequate qualifications for licensure. In addition, denied the applications of four individuals that had qualifications from schools involved in the Florida nursing school scandal. 

The announcement over the arrests of 25 individuals in the fake nursing diploma and certificate scandal rocked the nursing profession. As the weeks go by, more information is being released as the names of those nurses involved. 

The Nursing Care Quality Assurance Commission (NCQAC) released the statement indicating it would be taking non-disciplinary action and rescinding RN licenses immediately. According to their website, the NCQAC’s mission is to “protects the public's health and safety by regulating the competency and quality of licensed practical nurses, registered nurses, advanced registered nurse practitioners and nursing technicians. The purpose of the NCQAC includes establishing, monitoring, and enforcing licensing, consistent standards of practice, continuing competency mechanisms, and discipline.”

Employers are encouraged to verify nursing licenses through the state’s verification portal and/or contact the state board of nursing. 

The ten nurses named in the document all have “CLOSED” when run through the Washington license verification. Interestingly, several of the names on the list hold other certifications in Washington. Several hold LPN or CNA licenses. Those licenses remain active at this time. 

Washington is still currently investigating others that could possibly be involved in the nursing school scandal and will continue to inform the public as more information becomes available. For those applying for Washington nursing licenses with documented education from a Florida-based nursing program, additional information and documents are being requested. 

Full Article & Source:
14 Names of Nurse Licenses Connected To FL Fake Nursing Diploma Scheme Released in WA

OIG signals new focus on nursing homes

by Neville M. Bilimoria

The federal Office of Inspector General recently published  its “OIG’s Top Unimplemented Recommendations: Solutions To Reduce Fraud, Waste, and Abuse in HHS Programs.” 

In the 94-page document, the agency focuses on the top 25 unimplemented recommendations it believes would most positively affect U.S. Department of Health and Human Services programs by way of either cost savings, public health, and program effectiveness and efficiency.

I’ll give you one guess at what type of healthcare provider the first two recommendations dealt with… yes, nursing homes.  

The previous year’s OIG top 25 recommendations also dealt with nursing homes as the first listed recommendation. That focused on ensuring that nursing homes are implementing actions to prevent COVID-19 and protecting residents, placing a higher priority on infection control surveys.  Probably not surprising given the pandemic and the Centers for Medicare & Medicaid Services’ view of nursing homes during the pandemic. (Check out this.)

Significantly, OIG explicitly states in each of its top recommendations that the order of listings in its top 25 recommendations does not necessarily indicate the agency’s priorities. But certainly being at the top of the list perhaps signals something about OIG’s focus these days, and that focus seems to be nursing homes.

This year, not only were nursing homes listed as part of the top recommendations, but they were listed in both numbers 1 and 2 of OIG’s top 25 recommendations to reduce fraud, waste and abuse. Specifically, OIG listed the below recommendation measures that it also believes would assist in protecting patients:

1. CMS should take actions to ensure that incidents of potential abuse or neglect of Medicare and Medicaid beneficiaries, including those in nursing homes and hospice care as well as children enrolled in Medicaid, are identified and reported. 

2. CMS should address inappropriate nursing home discharges through training, by implementing deferred initiatives, and by assessing the effectiveness of its enforcement against inappropriate facility-initiated discharges. (This is the first time this particular recommendation is appearing).

These two (again, listed as the first two) top unimplemented recommendations are telling for a few reasons.  First, with regard to No. 1, clearly OIG sees that CMS enforcement is somehow lax, because by making it a top recommendation, the watchdog is signaling that this is an “easy” way, in its eyes, to help eliminate this noted problem for waste, fraud and abuse. Namely abuse and neglect in nursing homes. 

That is troubling, as we have certainly seen increased enforcement by CMS over the last two years in nursing home surveys and penalties. But OIG is basically saying that abuse and neglect must be focused on even more through CMS’ survey process.

Second, with regard to No. 2 above, OIG believes that nursing homes are inappropriately discharging residents, and that they are being cited for not complying with involuntary discharge notice requirements. OIG noted that CMS is attempting to fix this problem, and it remains a top focus for both agencies:

CMS stated that it plans to provide training, including clarification of guidance around facility-initiated discharges and/or transfers. CMS will also incorporate an assessment of the effectiveness of enforcement actions in response to inappropriate facility-initiated discharges.  Top Recommendations, p. 7.

If that weren’t enough, OIG also provided an update on last year’s infection control recommendations for nursing homes. In the Top Recommendations, OIG stated that it is aggressively focusing on staffing as a way to improve infection control, suggesting OIG’s belief or assumption that staffing shortages are causing infection control problems:

“Regarding nursing home staffing data, in January 2022 CMS began posting weekend staffing and staff turnover measures on the Care Compare website. CMS also shares Payroll Based Journal staffing data, including lists of facilities that potentially have insufficient weekend staffing, with state survey agencies.”  Top Recommendations, p. 10.

OIG goes on to highlight its heightened focus on nursing homes in this regard:

“This progress is part of larger nursing home reforms that the administration and CMS are pursuing. OIG continues to invest substantially in oversight of nursing home quality and safety and will continue to monitor CMS’s progress on related reforms.”  Top Recommendations, p. 10 (emphasis added).

So clearly, OIG and CMS are working together to “reform” nursing home care, and OIG is fixing its gaze on nursing homes. But their idea of reforming nursing homes is not to physically or monetarily help facilities per se with staffing shortages or by providing money for more staff.  

Their idea of reform is further enforcement, more aggressive enforcement, and a focus on monitoring and enforcing against facilities with staffing shortages. Ignoring the exorbitant CMS fines and penalties in the survey process currently, and the difficulties that facilities are having with recruiting and maintaining adequate staff, the OIG recommends that increased oversight and enforcement will force facilities to improve staffing as a means to affect change (… that “reform” they are focused on) in nursing homes for years to come. 

Neville M. Bilimoria is a partner in the Chicago office of the Health Law Practice Group and member of the Post-Acute Care And Senior Services Subgroup at Duane Morris LLP; nmbilimoria@duanemorris.com.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Full Article & Source:
OIG signals new focus on nursing homes

Florida clerks working to implement guardianship database

Pinellas County Clerk of
Court Ken Burke

The Florida Clerks of Court Operations Corporation is hard at work creating a statewide database of guardian and guardianship case information as prescribed by the Florida Legislature last year.

The database came at the recommendation of the Guardianship Improvement Task Force to create greater transparency in the guardianship process. The legislation, HB 1349, was signed into law by Gov. DeSantis on June 28, 2022.

From its first meeting on July 21, 2021, to its last meeting on November 15, 2021, the task force studied problems in Florida’s guardianship system and made recommendations for improvement.

Pinellas County Clerk Ken Burke, chair of the task force, says media interest in guardianship drove the Legislature to put the database into action.

“There was a constant barrage of news stories about problems in the guardianship arena,” Burke said. “It was evident that there were flaws in the system and we wanted to get everyone who had a stake in the process involved in the task force to find common areas we can all agree on.”

Members of the task force included legislators, court clerks, court system employees who work with guardianships, lawyers from the Elder Law and Real Property, Probate and Trust Law sections, consumer advocates, a former ward, and others. Their goal was to make recommendations for improving the system.

Burke said the high national media interest in guardianship, specifically with the Britney Spears case, led to the Florida Legislature acting quickly on the task force’s recommendations.

“For something this complex, you definitely need a champion, and thankfully Rep. [Linda] Chaney and Sen. [Jennifer] Bradley stepped up very quickly,” Burke said.

Rep. Chaney, R-St. Petersburg, and Sen. Bradley, R-Fleming Island, helped guide the bill through four House and three Senate committees during the final month of the 2022 session.

Burke said the task force used “every tool in our toolbox,” to get this legislation through.

Florida courts define a guardian as a surrogate decisionmaker appointed by the court to make either personal and/or financial decisions for a minor or for an adult with mental or physical disabilities. After adjudication, the subject of the guardianship is a “ward.”

Currently, there is no way to track guardianship cases in the state and no reliable data to show how many guardians there are, how many wards they have, and how much money they control.

“We needed a way to get better data in guardianship,” Burke said. “A judge cannot answer how you can reform the guardianship system without data, and that is what the database intends to do.”

Once completed — the database can only be accessible to judges, magistrates, court clerks, and certain court personnel — the searchable database would include such things as the registration status and “substantiated” disciplinary history of professional guardians.

The bill called for the Florida Clerks of Court Operations Corporation to build the database. The CCOC put out a request for proposals and finally decided to use Cloud Navigator as its vendor in late December.

Burke says the initial meetings with Cloud Navigator have been good and they are currently working to build the stakeholder data dictionary as well as working with the Department of Elder Affairs to get that department’s data fed into the new database.

The legislation passed last year also requires the Office of Public and Professional Guardians, by July 1, to post searchable profiles of registered professional guardians on a website.

The profiles would include such things as whether the professional guardian meets educational and bonding requirements, the number and types of substantiated complaints filed against the guardian, and any disciplinary actions imposed by Elder Affairs.

It also requires the Legislature’s Office of Program Policy Analysis and Government Accountability (OPPAGA), to use the database information to generate annual reports suggesting reforms.

The task force also called for barring hospitals and nursing homes from recommending a specific guardian when they file for a guardianship, including consideration of powers of attorney and advanced directives previously signed by a ward when a guardianship is set up, and improving training and education for everyone involved in the guardianship process.

Burke says while all the task force’s recommendations are important, the database is paramount.

“We provided the Legislature with 10 recommendations, but the database is the most important one,” Burke said. “How can you make a compelling argument for change unless you have real data?”

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Florida clerks working to implement guardianship database

High court judge ‘deeply frustrated’ by NHS delays in suicidal girl’s care

12-year-old has been held alone in a locked, windowless room for three weeks because doctors disagree on her diagnosis

An NHS hospital corridor. The delays caused Mrs Justice Lieven to tell North Staffordshire combined healthcare NHS trust: ‘You are testing my patience.’ Photograph: Anki Hoglund/Alamy

by Louise Tickle

A high court judge has expressed her “deep frustration” at NHS delays and bureaucracy that mean a suicidal 12-year-old girl has been held on her own, in a locked, windowless room with no access to the outdoors for three weeks.

In a hearing on Thursday, Mrs Justice Lieven told North Staffordshire combined healthcare NHS trust “you are testing my patience”, after she heard that a proposal to move Becky (not her real name), could not progress until a planning meeting that would not be held until next week, and that a move was not anticipated until 2 March.

Three sets of doctors at the hospital trust have disagreed as to Becky’s diagnosis; at her most recent assessment doctors said she was not eligible to be sectioned, which would trigger the protections provided by the Mental Health Act, because her mental disorder was not of the “nature and degree” as to warrant her detention.

In the absence of medical consent to section her, and because of previous incidents of self-harm including an attempt to throw herself from a building on to a motorway, judges have decided Becky must be deprived of her liberty by court order for her own protection.

Becky has been held in a hospital seclusion room since 27 January, her only human contact via a hatch in the door. All parties to the case agree that her deterioration while in hospital is due at least in part to her prolonged isolation in a room that has fewer home comforts than a prison cell.

The idea of moving Becky to a paediatric mental health unit, requiring renovations to make it suitable for her care, had “only recently been floated”, counsel for the trust told the court, “and unfortunately public bodies are required to go through a bureaucratic and procurement process”.

In a robust exchange, the judge demanded: “Where’s the urgency in this … I cannot believe that the life and health of a 12-year-old girl is hanging on an issue of NHS procurement, when you cannot tell me what it is you’re trying to procure.

“If the delay is procurement, I’m not having it,” Lieven continued. “I will use the inherent jurisdiction to make an order. We have a 12-year-old child in a completely inappropriate NHS unit for about three weeks, and it’s suddenly dawned on your client that ‘actually we’ll put her in a Tier 4 unit and we might have to do some [building] work.’”

Sometimes, the judge said, “public bodies have to move faster”.

The trust told the court that cost issues were not a consideration.

When asked to return her iPad to hospital staff last week, Becky broke it and attempted to swallow the glass. After being subjected to what the local authority described as “full restraint” in the course of which she assaulted staff, Becky attempted to make a ligature with a drawstring from her clothing. She was found huddled under a blanket by hospital staff and required oxygen to save her life.

Warning that Becky’s “risk of deliberate or accidental death is very high”, her guardian, who is appointed by the court, pointed out that the state had a positive obligation to protect her life. She also highlighted the state’s positive obligation to protect Becky’s human right not to be subjected to torture or inhuman or degrading treatment.

In a statement that emphasised the court must keep at the forefront of its mind the legality of Becky’s situation, the guardian stated her view that the conditions the child was living in “takes to the extreme what is permissible within the boundaries of article 5 [of the European convention on human rights] within which ‘deprivation of liberty’ authorisation operates”.

Becky’s mother is permitted to speak to the media about her daughter’s case thanks to a transparency order made by the judge.

“It’s four weeks tomorrow since I last hugged her,” she said. “I can only stroke her hair and wipe her tears through the hatch. Even now she’s in hospital seclusion she’s been able to attempt her life. I still fear a knock at the door.” 

In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org.

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High court judge ‘deeply frustrated’ by NHS delays in suicidal girl’s care

Retired Valley couple avoids scam thanks to store clerk

The couple was scared and completely convinced the scam was legitimate until a CVS worker realized what was going on and stepped in to help.

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Retired Valley couple avoids scam thanks to store clerk

Woman, 83, Denied Former Fiancé's Friend Request 60 Years After He Broke Her Heart — Now They're Newlyweds

Ed Sneckenberger, 85, wanted to apologize for ending his engagement to Priscilla Matheny in a 1963 letter, but she just wanted to "get rid of him" until they met for coffee last year

By Diane Herbst

Priscilla and Ed Sneckenberger at their nupitals Dec. 7, with Rev. Ron Schlak. Photo: Brian Green

Ed Sneckenberger didn't know what to expect when he walked into a Panera restaurant in Hagerstown, Md., a day before Easter last year.

He was going to meet his first love, Priscilla Matheny, whom he hadn't seen in 60 years after he ended their engagement in 1963 with a surprising Dear John letter.

"I remembered this lady that I had probably hurt 60 years ago," Ed tells PEOPLE. "And I needed to say I'm sorry."

Priscilla didn't want to have anything to do with him but reluctantly agreed to meet the man who broke her heart decades ago.

Nearly eight months after their reunion — which she thought would begin and end over coffee at Panera — Ed and Priscilla married on Dec. 7, 2022, at St. Mark's Lutheran Church in Hagerstown, where Ed and his family were members when he was a child.

"A miracle happened," he says. "I feel so blessed to be with this lady." 

Priscilla and Ed Sneckenberger on their wedding day. PHOTO: Brian Green

Prior to their meeting in spring 2022, Ed, now 85, last spent time with Priscilla, 83, in early 1963. They'd gotten engaged the previous September, in 1962, announcing their good news in a local paper, The Herald-Mail.

Around that time, Ed, who grew up on a farm outside of Hagerstown, went off to college a few hours away at West Virginia University.

Priscilla, a Hagerstown native, took the bus to visit her fiancé at his school in Morgantown a few times. But in March 1963, she received a unexpected letter.

"Of course I was excited because I thought it was one of my nice letters I'd been getting," she recalls in an interview with PEOPLE. "And it was a Dear John letter [saying] that he was breaking our engagement." 

Ed admits now that when he wrote that letter, he was feeling the financial pressures of school and that the idea of marriage had become overwhelming.

"It broke my heart, which he never even knew," Priscilla says, "because I never saw him or talked to him after that letter."

She moved on with her life and was working as a secretary when she met Wally Matheny. In November of that year, they wed.

"I just really thought," she says of her first husband, "that the Lord sent him to me to heal my broken heart." 

Priscilla and Ed Sneckenberger on their 2-month wedding anniversary. PHOTO: Courtesy of Priscilla and Ed Sneckenberger

Meanwhile, Ed became consumed by his studies, earning a master's and PhD in mechanical engineering at WVU. In 1968, he married, saying "I do" to Scottie Hansbrough, another woman from his hometown.

For 36 years, Ed taught at WVU in the Department of Mechanical and Aerospace Engineering. He also worked for federal agencies, including NASA.

Both couples had children — and later, grandchildren.

When Priscilla's husband Wally died in 1986, she remained in Hagerstown, devoted to her Lutheran church and family.

In October 2021, Ed's wife Scottie died. After 53 years of marriage, he was a widower and began nightly calls with his two sisters. Those conversations led him to the realization that he had unresolved business with the woman he'd wanted to marry in 1962.

"I was grieving," Ed says. "And my youngest sister, sometime in the spring of last year, said, 'Priscilla was such a good lady.'"

So, he decided to find her. "I just took it upon myself to say, 'I need to say I'm sorry," Ed explains.

Within a week, in April 2022, he saw a Priscilla Matheny commenting on the Facebook page of St. Mark's Lutheran Church in Hagerstown, the church he attended as a child.

He sent her a friend request. She denied him.

"I thought, 'What is with this guy?' Priscilla recalls. "I don't want to be friends with him on Facebook."

She ignored the notes he sent to her via Facebook messenger.

"I told her she was my heart's desire," Ed says.

"I thought that took a lot of nerve," Priscilla adds. 

Priscilla and Ed Sneckenberger. PHOTO: Brian Green

Undeterred, Ed reached out to the church and asked its secretary to pass along his desire to get together with Priscilla when he returned to Hagerstown for Easter.

"I told the secretary, 'You tell him I don't want to see him," Priscilla recalls to PEOPLE. "I thought 'What's going on? Why does he want to see me now after what he did to me?'"

Priscilla decided the only way to "get rid of him" was to meet Ed for coffee at Panera when he came back to town. On Good Friday, she messaged him.

"I'm going to find out what's going on," she says, "and that'll be the end of it."

The pair ended up talking for two hours. Ed asked for Priscilla's phone number and address. "But really, when I walked away from Panera, I had not expected to see him again," she says.

That night, Ed called. "I had a pretty bad evening with tears, because I think I realized that there was still some love there for him," Priscilla says. "Which I probably would have denied." 

Priscilla and Ed Sneckenberger at a restaurant the night of their wedding. PHOTO: Courtesy of Priscilla and Ed Sneckenberger

To avoid seeing Ed again, Priscilla skipped church and watched Easter service on the Internet. After it ended, Ed called — he was outside her door.

"She let me in," he says. "Sunday afternoon was the time when the flames — we couldn't hold them back."

The pair hugged. "For me it was like 60 years just went away," says Ed, who once again asked Priscilla to marry him that afternoon.

"And I'm kind of like, 'Whoa, I'm not ready for this, it's way too soon," Priscilla recalls of the surprise proposal. "And I said, 'I have no plans to get married again.'"

After Ed drove back to his home in Morgantown, he couldn't stop thinking about Priscilla. He even told his daughters he was in love with a woman he knew before he met their mom.

Just about every weekend, Ed drove to Hagerstown to visit Priscilla. By June, she accepted his proposal and they were engaged again.

"One of the things that brought us together to begin with was our belief in God and our Christian background," says Priscilla, who first met Ed in her late teens through their Lutheran churches' activities.

"I knew he was still a good Christian guy, and he's very caring, a sweet guy," she says. "These are some of the things that I loved about him before." 

Priscilla and Ed Sneckenberger. PHOTO: Brian Green

For Priscilla, a long engagement sounded perfect, but Ed suggested a fall wedding. "It was a gradual weakening on her part from never to eventually her agreeing to do it," he tells PEOPLE.

Now, after two months of marriage, with the pair living in Priscilla's home, "I couldn't be happier. I felt like this was God's gift to me," says Ed.

Priscilla, meanwhile, feels the same. "He is still a good man overall, kind, thoughtful, caring. It's nice to have somebody like him in my life and share the rest of our lives together."

Now the couple, who are finally married, enjoy day and overnight trips, attending church, seeing movies, and going to symphony concerts together.

"She makes me feel five years younger," Ed says. "I'm overwhelmed with happiness."

Priscilla, meanwhile, has some advice for the lovelorn.

"Never give up hope," she says. "In my case, it was shocking. Just hope that someday there's somebody who's going to come along."

Or, in her case, back.

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Woman, 83, Denied Former Fiancé's Friend Request 60 Years After He Broke Her Heart — Now They're Newlyweds