WA to pay $8M to resolve claims it ignored disabled Pierce County woman’s abuse

By Shea Johnson

Washington state will pay $8 million to settle claims that it failed to act on years of warnings about the abuse and neglect of a developmentally disabled Pierce County woman under her family’s care, court records show. 

In June 2023, the now 25-year-old woman’s court-appointed guardian and conservator sued the Washington State Department of Social and Health Services (DSHS) and the Washington State Department of Children, Youth, and Families (DCYF). 

The lawsuit, filed in Pierce County Superior Court, alleged that state case workers didn’t investigate allegations of mistreatment or take any meaningful action to shield the woman from potential harm, despite a dozen known referrals dating back to 2018 that raised concerns about her well-being. Another referral was received when she was younger than 2 years old, according to the suit. 

The referrals to the state agencies responsible for adult or child welfare had expressed concerns that the woman was being neglected, sexually abused and exploited for disability benefits while living in a run-down home that social workers refused to visit without law enforcement, the suit said.

She was allowed to remain under the care of her mother, who allegedly had a history of drug addiction before her death in 2022, and alongside others who purportedly resided in vehicles on the property, used drugs and brandished swords and other weapons. 

A court filing in March from Dan Lazares, the court-appointed overseer of the settlement, detailed some of the allegations: The woman’s legal guardian reported to Lazares that her client had been locked in her room, was emaciated and had physical wounds described as “branding” that resulted from drug users in the home. She also reportedly bathed in a sink in an apparent effort to avoid being naked in front of others at the home. 

Attorney Ian Bauer, who represented the plaintiff, previously told The News Tribune that doctors, neighbors and multiple family members reported warnings to the state, and others such as Pierce County code officers expressed concerns about the condition of the woman’s home. 

“The settlement reflects the inexplicable failures on the part of (the state agencies) over 20 years,” Bauer said in an interview Friday, adding that it was a “remarkable case in terms of (the) depth and breadth of their negligence.”

Judge Stanley Rumbaugh approved the $8 million settlement to resolve the litigation on June 13, court records show. The state, which denied allegations of wrongdoing, entered into the agreement without admitting liability, according to a court filing Wednesday. 

DSHS and DCYF have different responsibilities. Adult Protective Services and the Developmental Disabilities Administration fall under the umbrella of DSHS, while Child Protective Services is overseen by DCYF. 

“We hope that this settlement will provide support and assistance as (the plaintiff) continues her journey toward healing from the abuse and neglect she endured,” DSHS spokesperson Adolfo Capestany said in a statement. “DSHS remains committed to serving the health, wellbeing and protection of vulnerable adults, and assisting them with living in safe and supportive environments.”

The News Tribune isn’t naming the woman, who now lives in an adult family home in Tacoma, because she is an alleged victim of sexual abuse. 

“DCYF hopes this resolution supports (the plaintiff’s) well-being as she moves forward,” DCYF spokesperson Kortney Scroger said in a statement. “DCYF remains dedicated to its mission of protecting children and strengthening families.”

Funds will ensure lifelong care 

The woman was born with microcephalus — a condition in which a baby’s head is smaller than normal — and was diagnosed with moderate to severe intellectual disability, according to the lawsuit. She is essentially non-verbal, has moderately impaired vision and hearing, and requires routine supervision.

She is totally dependent on others and requires assistance in all activities of daily life, according to court records. 

Of the settlement proceeds, roughly $4.7 million will be placed in a trust for the plaintiff and $3.2 million will go toward legal fees, according to the June 13 court record approving the deal. 

The trust funds will ensure that the woman will have lifelong access to adult care and be able to lead a safe, healthy and happy life while feeling secure in interactions with caregivers, according to Bauer. Due to her disabilities from birth, she has never been in a position to advocate for herself, which made the state’s failures so significant, he said. 

His client’s situation was preventable but requires that the state invest in protective and supportive services and “stand up and do the right thing from day one,” Bauer added.

Asked why he believed the state settled for the amount that it did, Bauer responded that it was clear his client had been left in the care of drug-addicted people and at the whims of transient addicts who would cycle through the home. 

“This case was indefensible in every respect,” he said. 

History of red flags 

The first warning sign about the woman’s home life came when she was 20 months old. 

A doctor reported to Child Protective Services that her mother’s eyes were glassy, her speech was slurred and she was lying on the floor during a medical visit, the lawsuit said. The doctor refused to release the girl to her mother, who he believed was incapable of taking her daughter home. 

While the allegations were determined to be founded, the state didn’t intervene, according to the suit. When the plaintiff’s grandmother died in 2018, the plaintiff’s mother became her sole caretaker. Over the next four years, there were 12 more referrals to the state about potential child abuse. The suit said case workers repeatedly “screened out” reports, which by definition under state law indicates that a complaint doesn’t rise to the level of credibility.

In May 2021, the state received the ninth referral regarding concerns about the plaintiff’s care within a three-year span. By that time, law enforcement had visited the home nine times in the past month, and there were four prior Adult Protective Services investigations into claims of neglect, physical abuse, improper use of a restraint and sexual abuse — the latter which was closed as “inconclusive,” according to the suit. 

An Adult Protective Services case worker in May 2021 noted the “horrible” condition of the woman’s living situation, the suit said. The home was dark, smoky and in disarray with much debris and trash that attracted rats and other animals, according to the suit, drawing on previous court filings and Pierce County Code Enforcement records. 

The case worker noted a handgun and drug paraphernalia on a table and that the plaintiff appeared neglected and had bruises on her forehead and arm, the suit said. Although she was taken to a hospital for an evaluation, the state allegedly didn’t meaningfully act upon learning that she was being discharged two days later to her mother. 

A final referral was received in January 2022, when the woman’s mother was “dope sick,” screaming outside and seeking help because someone had stolen her drugs, according to the suit. First responders took the mother to a hospital, and they insisted that her daughter receive medical attention, too, the suit said. 

The following day, the plaintiff’s mother, who had been adamant about being discharged, was found dead in the home, according to the suit.

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WA to pay $8M to resolve claims it ignored disabled Pierce County woman’s abuse 

Mission Point Care facility responds to report

By DREYMA BERONJA

ISHPEMING — The Michigan Department of Licensing and Regulatory Affairs released a 179-page report citing Michigan Point Nursing & Physical Rehabilitation Center of Ishpeming for abuse and neglect earlier this month.

According to the report, all 48 residents of the facility were impacted by insufficient practices that led to the potential for abuse and neglect.

The state also found that out of 17 allegations of abuse and neglect, the facility failed to report eight of them.

LARA said Mission Point did not meet 29 requirements including treating residents with respect; keeping residents safe from abuse, neglect and exploitation; reporting alleged violations; and providing basic life support to residents, which may have led to one resident’s death.

Mission Point of Ishpeming released the following statement on Facebook.

“Upon receiving the report and further internal investigation, we immediately removed three administrative staff members and prioritized Mission Point of Ishpeming with heavy support from our regional care team,” Mission Point’s post said.

A firm representing the Mission Point said the company had no further comment.

LARA said its report was based on observation, interview and record review. It said in part that Mission Point failed to immediately initiate CPR and call 911 in one case, which likely caused serious injury, harm and death to a resident.

The resident referred to in the report as Resident #12 was found half on the floor and the upper body on the bed without a pulse or respiration.

“We have since hired replacements for the key administrative roles,” it said. “While our regional leadership continues to spend a great deal of time with the new administrative team members and on site at the facility to ensure a smooth transition, we have received overwhelmingly positive feedback from our residents, families and staff on the changes. Also, we are aggressively developing our plan of correction and have submitted it to LARA for approval.”

LARA also said the facility failed to allow residents the right to be treated with respect and dignity, including the right to retain and use personal possessions.

For example, Resident #7 was interviewed about the respect and dignity requirement. LARA found this practice resulted in psychosocial harm, fear, increased anxiety, increased insomnia, feelings of insecurity and exacerbation of the resident’s post-traumatic stress disorder.

“A (certified nursing assistant) decided to change things up in my room. She came into my room at night and rearranged my whole room. She threw out a lot of my stuff,” Resident #7 said. “My safety and security has all been shot to hell.”

Resident #7 said the change in her room made her feel violated in some way.

“When I came back, and everything had been changed … I have never had my home invaded. I have to move forward,” Resident #7 said. “I don’t feel safe anymore. I don’t feel as secure as I did before.”

The state also said residents’ right to be free from abuse, neglect and exploitation was not met. Mission Point failed to provide necessary care and services for six residents out of 15 sampled for abuse and neglect.

The report said this resulting in a finding of staff inaction resulted in residents being left saturated in urine and feces. Inadequate nurse staffing resulted in a lack of consistently scheduled showers for residents, delayed medication administration and failure to ensure residents were dressed, groomed and able to get out of bed.

In a phone interview with a guardian of one resident at Mission Point, the guardian said the facility doesn’t have enough staff to take care of everyone.

“I don’t want this facility shut down because then it would just be worse for me, I don’t know what to say,” the guardian said.

When the state asked if the guardian found the resident saturated with urine all the way down to his shoes and soiled with dried feces, she confirmed that was the case.

“We take very seriously our responsibility for and commitment to the health, welfare and safety of our residents. That care starts and ends with strong onsite leadership,” Mission Point said. “Moving forward Mission Point Healthcare Service’s leadership and facility leadership will continue to monitor the plan of correction to ensure substantial compliance.”

To read the full report, visit val.apps.lara.state.mi.us/Files/ViewDocument/58133.

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Mission Point Care facility responds to report

Knoxville woman charged with crimes against the elderly

Constance Porter

BY CHERI REEVES

A Knoxville woman has been arrested and charged with theft and willful abuse and neglect of her 81-year-old Clarksville uncle.

Constance Porter, 56, who was entrusted with the man’s finances and personal care, reportedly had been making charges and transactions with her uncle’s personal account without permission prior to abandoning his care.

An agent with the Adult Protective Services Association alerted Clarksville Police to the alleged exploitation of the man’s bank account, according to the affidavit.

Porter was the authorized user for the victim’s bank account, but was to use the account specifically to benefit him.

An investigation revealed the man’s bank account had been charged several times by Clarksville Enterprise Rent-A-Car, according to court records.

Porter reportedly rented a vehicle in September 2019 making approximately $2,469 worth of transactions from the same account.

After a trip to Knoxville, Porter allegedly abandoned her duty as caretaker, but other family members stepped in and were able to replace her.

On Wednesday, Jan. 5, Porter was arrested and booked into the Montgomery County Jail on a $10,000 bond.

She’s been charged with auto theft and willful abuse, neglect or exploitation of the elderly.

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Knoxville woman charged with crimes against the elderly

From The Silver Standard’s Elder Abuse Reform Now Project: In 2020 America Animals Receive More Humane Care Than Our Senior Citizens

By Mary West

Studies show that the care of America’s elderly and infirmed not only fails to meet federal nursing home regulations but federal laws governing the treatment of animals 

Just how badly are some nursing home residents treated? Do they receive better care than animals in a zoo or dogs in a kennel? A recent report issued by the Long Term Care Community Coalition (LTCCC) compared animal care standards to the experiences of individuals in long-term care facilities. The authors concluded that care of the elderly and infirmed often not only fails to meet federal nursing home regulations—it also falls short of requirements for humane animal treatment.

A 2014 study by the OIG found that one third of Medicare 

beneficiaries who enter a nursing home are harmed 

within approximately two weeks. 

 

The LTCCC report was based on research that evaluated several categories such as abuse, nutrition, and medical supervision. Guidelines for animal care mandated by federal law and oversight agencies served as standards on which to base the comparisons of nursing home experiences. Each category assessed revealed cause for alarm. It’s frightening to think that a precious parent, grandparent, aunt, or uncle may not receive even the basic treatment due a pet.

Abuse and Neglect

According to the Standards for New World Primates, physical abuse and punishment-based training should never be used in handling non-human primates. While federal standards prohibit the abuse of nursing home residents, state and federal oversight agencies are lax in enforcing them.

Mistreatment and neglect top the list of concerns relating to long-term care because they cause suffering that takes many forms. The harmful effects can be so severe that they culminate in death.

Statistics like a 2019 report issued by the U.S. Department of Health and Human Services Office of Inspector General (OIG) underscore how abuse has serious outcomes. It estimated that one in five Medicare claims from nursing home residents visiting the emergency room stemmed from mistreatment.

Furthermore, once someone is admitted to a long-term care facility, the abuse frequently starts quickly. A 2014 study by the OIG found that one third of Medicare beneficiaries who enter a nursing home are harmed within approximately two weeks.

46 percent of older residents in long-term care facilities 

had impending or current dehydration 

 

Nutrition and Hydration

The Animal Welfare Act states that hamsters and guinea pigs should be fed daily and that the chow needs to be palatable, free of contamination, and sufficiently nutritious to meet the animals’ needs. Federal standards for nursing home residents stipulate that meals be appetizing, healthy, and appropriate in size.

Sadly, individuals in long-term care facilities aren’t always treated as well as rodents. It’s not unusual for them to receive insufficient food and water, the fundamental necessities for life.

A 2004 study published in the Journal of Gerontology discovered that 64 to 80 percent of nursing home residents consumed less fluid and food than amounts recommended in federal guidelines. In a 2020 article featured in Age Ageing, the authors estimated that 46 percent of older residents in long-term care facilities had impending or current dehydration.

Dehydration is a condition that can be life threatening if not caught in time. In a 2019 hearing held by the U.S. Senate Committee on Finance, legislators heard the account of an Alzheimer’s resident in an Iowa facility who was denied water for several days. The person died after developing dehydration.

Food and water safety is also an issue. A 2019 report in Fair Warning detailed often-unreported problems in nursing homes such as moldy ice machines and food-borne disease outbreaks.

Freedom from Restraints

Guidelines from the 2016 American Association of Zoo Veterinarians note that physically restraining animals without sedation should be reserved for use only during medical procedures. Federal requirements mandate that nursing homes shouldn’t use physical or chemical restraints on residents for purposes of convenience or discipline.

All of us have felt sympathy for a dog that is chained much of the time and not allowed to run loose within a fenced-in enclosure. Individuals in long-term care facilities are sometimes similarly restrained.

Bedrails, one form of physical restraint, represent a source of preventable harm because residents can climb over and around them. A New York Times review reported that from 1995 to 2012, bedrails were implicated in 550 deaths. These restraints are sometimes necessary, but they shouldn’t be used without supervision.

Nursing homes frequently use drugs to sedate residents for the convenience of caregivers. A 2018 Human Rights Watch report said that in an average week, they administer antipsychotic medications to 179,000 individuals who haven’t been diagnosed with the disorders. The drugs promote docility, but their sedating actions have significant side effects. Use of medications as chemical restraints is unacceptable.

Skin Care

In 2020, standards listed by the Associations of Zoos & Aquariums advise staff to inspect the skin of elephants daily and treat problem areas. Federal nursing home standards specify that residents receive skin care to prevent and treat pressure sores.

Because of mobility limitations, individuals in long-term care are in constant danger of pressure sores, but they aren’t afforded the skin care recommended for elephants. LTCCC reported that more than 93,000 nursing home residents have these maladies. Pressure sores can become infected and take months to heal; if untreated, they result in complications, some of which lead to death.

Medical Supervision

Under the Animal Welfare Act, attending veterinarians should examine each marine animal in their care once a month, which must include an interview with a staff member familiar with the creature. Federal rules for nursing homes call for a doctor to examine every resident once a month for the first three months after admission and once every two months thereafter.

Adequate medical supervision can prevent or reduce many perils of living in a long-term care facility. If problems are caught early, they can often be remedied; but when staff is short, many issues go undetected. Data from Medicare.gov showed that in 2018, oversight agencies issued 3,876 citations for insufficient numbers of nurses and doctors in nursing homes.

The LTCCC report cited several cases of disorders that occurred due to a lack of doctor and nursing care. One involved the failure to monitor an individual getting intravenous therapy, which resulted in electrolyte imbalances and a decline in neurological functions. In another case, the lack of staff compliance to provide doctor-ordered range of motion exercises and splints to a resident’s impaired joints led to the worsening of contractures. Surveyors noted both violations as “no harm.”

Most people have heard of the mistreatment that some nursing home residents endure, but it’s sobering to know the extent and scope of the problem. The reality that individuals often don’t get the quality of care experts advocate for animals is a terrible indictment of America’s health care system. Although we treasure our pets, the value of human life is so much greater. Our country’s seniors, who have given decades of love and service to their families and communities, deserve that the same care be reciprocated to them when they are frail and infirmed.

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In 2020 America Animals Receive More Humane Care Than Our Senior Citizens

AJC’s ‘Unprotected’ spurs outrage, calls for change in senior care

By Brad Schrade Carrie Teegardin

The Atlanta Journal-Constitution’s investigation detailing abuse and neglect across Georgia’s senior care industry prompted dozens of readers to share their own harrowing experiences and call for improvements to a system that impacts thousands of families.

“I felt like somebody was shining a light on a problem,” said Karen Goode, who said her mother with Alzheimer’s died in August, just 12 days after a serious fall at a facility in North Fulton where she had lived for a decade.

Like many families, Goode said they paid thousands a month, yet the facility always seemed short-staffed with a new director who cycled through almost every year. Goode was among the readers who emailed or called the AJC after publication of the series, which identified more than 600 cases of neglect and 90 of abuse in assisted living communities and large personal care homes across the state.

“The industry is so broken,” Goode said. “Even a series so compelling like this will not fix anything unless lawmakers get off their butts and do something.”

Gov. Brian Kemp’s office and several lawmakers said the series revealed problems that needed to be addressed.

“Every Georgian should be able to age gracefully and with dignity in their communities,” said Cody Hall, Kemp’s press secretary. “These reports highlight serious issues involving care for aging adults, and we look forward to working with the Department of Community Health, state leaders, and local partners to review the current framework and identify areas for improvement.”

State Rep. Sharon Cooper, R-Marietta, who chairs the House Health and Human Services Committee, said she plans to introduce legislation when the Georgia General Assembly convenes in January. She wants to look at high staffing ratios at facilities, adding more state inspectors and other changes.
She said she’s heard from constituents about the AJC series, many of whom are bothered by the way seniors are treated.

“I tell them I’m working on it,” she said. “I don’t believe there’s a panacea that will make everything perfect, but there are certainly changes we can make that will move us a long way to the goal that we treat our seniors with the respect, dignity and care they deserve.”

State Rep. Jesse Petrea, R-Savannah, who chairs the House Human Relations & Aging Committee, said the Legislature has been proactive in recent years to protect seniors. He wasn’t ready to submit policy proposals in response to the series, but said he hopes lawmakers will do “anything in our power” to protect the most vulnerable in society.

“I’m all in for that,” he said. “The difficulty is knowing exactly how we could have altered some of these terrible outcomes.”

State Sen. Kay Kirkpatrick, R-Marietta, said the state has a responsibility to protect its vulnerable citizens, but the senior living industry also needs to take a “serious, introspective look” at itself and find ways to improve care.

“It’s in the best interest of the industry to be proactive and work on these issues,” said Kirkpatrick, a physician who is a member of the Senate Health and Human Services Committee. “Otherwise, it’s just a black eye on them. I think they should be leading the charge on this.”

Industry: some change needed

The AJC uncovered conditions and incidents in senior care homes that must be “halted, corrected and punished,” said Vicki Vaughn Johnson, chair of the Georgia Council on Aging, a 20-member body created by the General Assembly to advise elected officials and state agencies.

The council includes both consumers and senior care service providers.

Johnson said the state must dramatically increase fines against facilities for violating care standards. The current fine structure    allows a $601 penalty against facilities in serious first-offense cases involving harm and death.

She called that amount “incredible, unbelievable and unacceptable.”

Johnson praised the thousands of direct care workers in Georgia who have the best interests of residents at heart, but she said they are often asked to care for too many people and with too little training. She called for the state to increase staffing and training requirements. Johnson urged Georgia citizens to contact state lawmakers to push for change.

“It’s in the best interest of the industry to be proactive and work on these issues. Otherwise, it’s just a black eye on them. I think they should be leading the charge on this.” —State Sen. Kay Kirkpatrick, R-Marietta

The senior care industry also responded to the AJC’s reports and acknowledged that some changes may be needed.

Saying it had “great intolerance for wrong-doing or substandard care,” the Georgia Senior Living Association said in a statement that it would support more state inspectors and “robust, unannounced inspection efforts.” It also called for more training for workers, as well as best practices in Georgia to reduce falls and improve care for residents with dementia.

The association said it would support enhanced reporting requirements in cases of suspected crimes and abuse.

“As an association that wants the best operators in the country, we will continue to advocate for high standards of care for all citizens of Georgia,” the association said in a statement.

Still, the association objected to the way the AJC investigation portrayed the industry.

“The AJC’s spotlight seems to only illuminate the negative, while the stories of hundreds of thousands of positive outcomes within the industry go unreported,” the association said in the statement.

‘Exploitation is unacceptable’
 
The Georgia Health Care Association, which represents nursing homes, assisted living communities and other senior care providers, said it has a history of working with state government officials to make improvements, including a better background check system for caregivers that went into effect this month.

GHCA’s president Tony Marshall said the association supports better education for operators about the reporting requirements for abuse, neglect and exploitation.

“The safety and well-being of elderly Georgians is GHCA’s highest priority, and any instance of poor care, neglect, abuse or exploitation is unacceptable,” said Tony Marshall, GHCA’s president.

The Culture Change Network of Georgia, a coalition of senior care providers, consumers and advocates, also responded to the AJC’s series, saying the coverage “shines a light on cases of inadequate care, abuse and neglect” that it wants the state to address through a careful review of current policies, laws and enforcement.

“We believe that everyone must be a stakeholder in improving the quality of care and quality of life for older Georgians,” the network said in a statement.

While many readers expressed gratitude that the AJC investigated the senior care industry, some were painfully reminded of their own family’s story.

Dave Markus’s 89-year-old father died nearly four years ago when he choked to death on a piece of steak in a Buckhead facility’s dining area. He said no one at the facility did anything to save him.

Markus just retired himself and he thinks the state needs to do more to regulate caregivers and companies. He and his wife wonder where they’ll turn when they need care.

”I’ve got no family behind me, no siblings. I’ve got no children,” Markus said. “We’re kind of concerned when one of us goes we don’t think there’s going to be anybody to look out for us.”

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AJC’s ‘Unprotected’ spurs outrage, calls for change in senior care

OIG Issues Stark Warning to Skilled Nursing Facilities: Potential Abuse or Neglect of Residents Receiving Emergency Room Services is Being Underreported to Law Enforcement

Introduction

On August 24, 2017, the Office of Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) issued an “Early Alert” that disclosed the preliminary results of its ongoing review of abuse of Medicare beneficiaries in skilled nursing facilities.  Specifically, OIG determined: (i) that a significant number of incidents of potential abuse or neglect of nursing facility residents receiving emergency care has not been reported to law enforcement as required under the Elder Justice Act; and (ii) that the Centers for Medicare & Medicaid Services (“CMS”) lacked adequate procedures to ensure proper reporting.  The Early Alert, which includes a list of suggestions for immediate remedial action to be taken by CMS, highlights the increased scrutiny that nursing facilities will face for failing to comply with the Elder Justice Act’s reporting obligations, and points to proactive measures nursing facilities can take, now, to mitigate risk of any enforcement action. 

Requirements to Report Abuse or Neglect of Residents of Skilled Nursing Facilities

The “Elder Justice Act,” adopted with the passage of the Affordable Care Act (“ACA”) effective March 23, 2011 (see 42 U.S.C. § 1320b-25), requires “covered individuals” -- including an owner, operator, employee or agent, of a long term care facility -- to [A] report to HHS (or the State Survey Agency) and one or more law enforcement entities any reasonable suspicion of a “crime” against any individual who is a resident of the facility; and [B] make such report within two hours after forming the suspicion that the resident suffered serious bodily injury, or within 24 hours if there is no serious bodily injury. 

Failure to make the required reports could result in civil monetary penalties of up to $300,000 and exclusion from participation in the Medicare and Medicaid programs.  Id.  Although the law went into effect in 2011, the corresponding regulations requiring skilled nursing facilities to develop and implement conforming policies and procedures do not go into effect until November 28, 2017.  See 42 C.F.R. § 483.12(b).

Separately, skilled nursing facilities must also report resident abuse, neglect, mistreatment, injuries of unknown origin, and misappropriation of resident property to the administrator of the facility and the State Survey Agency.  See 42 C.F.R. § 483.12(c); see also N.Y. Public Health Law § 2803-d and 10 N.Y.C.R.R. § 81.1 et seq.

OIG’s Audit

Although its review of skilled nursing facility abuse reporting is not yet complete, OIG issued its preliminary audit results through the Early Alert because of the “importance of detecting and combating elder abuse.”

Audit Methodology and Findings:  To conduct this audit, OIG reviewed hospital emergency room records of 134 residents of skilled nursing facilities transferred to the hospital, in which the emergency room staff assigned one of 12 primary diagnoses codes utilized for Medicare reimbursement claims that indicate potential abuse or neglect (e.g., adult sexual abuse, adult physical abuse, adult maltreatment).  OIG also reviewed the State Survey Agency records for each of the relevant skilled nursing facilities.  Based on these records, OIG found that, for 28% of these cases, there was no evidence that the underlying incident had been reported to law enforcement.  Notably, OIG assumed that every emergency room visit associated with one of the 12 “abuse” diagnostic codes was an incident reportable under the Elder Justice Act.  OIG, however, did not independently verify whether there was actual abuse or neglect of these individuals. 

Based on its findings, OIG concluded that CMS lacks procedures to enforce the Elder Justice Act, and specifically to ensure that incidents of abuse or neglect of nursing facility residents are being properly reported to law enforcement.  In particular, OIG noted that CMS does not “match” hospital Medicare claims for emergency room services with claims for nursing home reimbursement, to identify instances of potential abuse or neglect.

CMS acknowledged that it has not identified any instances in which a covered individual failed to make a report to law enforcement.  In its defense, CMS informed OIG that it has not taken any enforcement action yet because HHS has not yet delegated enforcement authority to CMS.

  

Furthermore, CMS stated that it has recently updated the State Operations Manual, used by the State Survey Agencies, to reference the applicable Elder Justice Act regulations, with an effective date of November 28, 2017. 

OIG’s Recommendations to CMS

In the Early Alert, OIG provided the following “suggestions” for CMS to take immediately:

• Implement procedures to compare hospital Medicare claims for emergency room treatment with nursing home claims to identify incidents of potential abuse or neglect and to periodically provide the details of this analysis to the State Survey Agencies for further investigation of compliance with Elder Justice Act reporting obligations;
  
• Continue to work with HHS to secure the authority to impose the civil monetary penalties and exclusion of providers pursuant to the Elder Justice Act;
  
• Promulgate additional regulations, if necessary, to impose penalties for non-compliance with the reporting requirements;
  
• Impose penalties when appropriate; and
  
• Direct State Survey Agencies to refer suspected violations of the reporting obligations to CMS for appropriate action.
  
  

Lessons for Skilled Nursing Facilities

• With the issuance of the Early Alert, the mandate to report to law enforcement, suspected crimes against residents, including abuse and neglect, will continue to be a compliance focus of OIG and will likely be an enforcement priority for CMS going forward. Nursing facilities need to revisit and, to the extent they have not done so already, update their policies and procedures to comply with the reporting obligations contained in the Elder Justice Act -- before the applicable regulations go into effect on November 28, 2017.
  
• OIG focused its attention on skilled nursing facility residents receiving emergency room services. Skilled nursing facilities should likewise be particularly focused on resident transfers for emergency care for potential incident reporting pursuant to the Elder Justice Act.
  
• OIG equated any emergency room visit associated with one of the 12 “abuse” diagnosis codes to be reportable under the Elder Justice Act. However, at the time of an emergency room transfer, nursing facilities in some cases may not have identified evidence of potential abuse of a criminal nature, and would not have the benefit of the emergency room physicians’ evaluation when the resident arrives at the hospital.  As a matter of course, skilled nursing facilities should consider requesting records of the emergency room diagnoses and, whenever one of the 12 codes has been assigned, presume that the incident should be reported to law enforcement if it has not been already, unless the evidence clearly indicates the coding is mistaken and no abuse took place.
  
  

Bottom Line:  Nursing facilities -- and “covered individuals” -- that fail to heed OIG’s alarm may be putting themselves in regulatory jeopardy.

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OIG Issues Stark Warning to Skilled Nursing Facilities: Potential Abuse or Neglect of Residents Receiving Emergency Room Services is Being Underreported to Law Enforcement

Springfield Advocate Testifies At Senate Aging Hearing

Pushing to better protect seniors from neglect and abuse by court-appointed guardians, Missouri Senator Claire McCaskill helped lead a hearing on this topic today.

Jessica Kruse with Ozarks Elder Law in Springfield testified that many judges and clerks, especially in rural areas, can’t oversee every move by guardians.

Medical wishes, family support, and money are all on the line.

"Funding for monitoring programs is one area where the federal government can assist and reduce financial abuse in guardianship cases," said Kruse.

Kruse says, especially in rural areas, the systems are strained.

"It is very difficult for the judges and clerks to keep tabs on each guardian and conservator in their jurisdiction.  In addition to this, each state has it's own statutory system for guardianships that are carried out inconsistently within each county and each state," added Kruse.

The Senate Aging Committee hearing was led by Missouri Democratic Senator Claire McCaskill and Maine Republican Senator Susan Collins.

 According to the most recent published statistics, the Missouri Department of Health and Human Services received over 17,000 initial reports of abuse, neglect, and financial exploitation of seniors in one year. It’s unclear how many of these cases involve financial exploitation specifically.

Pointing to a recent report recommending better inter-governmental communication, McCaskill asked, “The problem is, when Social Security finds out there is fraud they are not sharing that information with state courts, even though they share it with other federal agencies—what’s the rationale for that? The (Social Security Administration) have caught someone ripping someone off, what in the good lord’s name are they doing keeping that information from state authorities?”

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Springfield Advocate Testifies At Senate Aging Hearing

Signs of Nursing Home Neglect, Abuse

There may come a time when some of us face the painful decision of putting our parents or grandparents in a nursing home because they need full-time professional healthcare.

If you or a loved one does have family in a nursing home, you should be aware of a new rule that the Centers for Medicare and Medicaid Services (CMS) says will, for the first time, allow consumers to sue nursing homes for neglect. Before now, most long-term care facilities have included arbitration clauses in the contracts that would block the family from suing over alleged neglect. According to the ABA Journal, healthcare industry lawyers say a challenge to the new rule is likely.

Ginalisa Monterroso, CEO of the Medicaid Advisory Group Opens a New Window. , who has spent more than 25 years in the healthcare industry, discussed with FOXBusiness.com what the new ruling means for nursing home residents and what you can do to ensure your loved one is placed in a safe environment for long-term care. Here is what you need to know.

Boomer: What rights do consumers and families now have under this new rule?

Monterroso: The new ruling, allows nursing home residents and families to take residential facilities to court and pursue justice for wrongful care. This decision is long overdue and a victory for all families and former nursing home residents, who, were unable to sue their nursing homes even when they were negligent. Before this ruling, families and patients were forced into arbitration where they frequently did not have the justice system by their side. In most cases, the public never got to hear about these cases of abuse because the dispute was discussed behind closed doors where the media and others couldn’t hear the allegations. And worse, when the arbitrator ruled against the nursing home and forced a ruling, no one got to hear the end result, or even the initial claim.

Boomer: What steps should family members take in researching nursing homes – before signing a contract?

Monterroso: Most important, don’t ever feel rushed to pick a facility because a hospital is pushing a discharge. The hospital is aware you are allowed to view facilities and make the appropriate choice for your loved one.

When making a decision to admit a sick loved one into a long-term care facility, never act on impulse, or even take a quick recommendation from the treating health professionals (who may recommend any facility to quickly discharge the patient). Medicaid Advisory Group recommends scheduling a tour of the facility before being admitted. Everyone has a right to pick and visit a facility. Medicaid Advisory Group urges everyone to visit the exact floor and room the potential resident may be admitted. You can also research the nursing home on this government website: https://www.medicare.gov/nursinghomecompare/search.html Opens a New Window. .

That Medicare website is star rated - one star being the lowest score and five being the highest and most recommended facility.

Think of a nursing home admission as picking a babysitter for your child. We as consumers forget our elderly, sick and disabled need all the essentials our children require when making a placement.
Google the facility and click news to see if the facility has had any negative press. Check references and ask to speak to any residents or families at the facility. You should also check online with the State Department of Health to see if the facility was ever sanctioned or fined. Most of all go with your gut feeling. If something doesn't feel comfortable, believe your instinct.

Boomer: How can family members detect if their loved ones are at risk of abuse?

Monterroso: When visiting their loved ones in long-term care facilities, if you see your loved one suddenly change in behavior and they seem agitated, irritable and being aggressive, that’s an indication something is not right. Many patients who have dementia are the ones who are being abused due to the fact everyone thinks they are forgetful or making things up. If a loved tells you, someone, physically or verbally abused them -- investigate the allegation. Speak with the nursing station, ask questions. Report the concern to the facilities administration, never ignore the resident. 90% of the time there has been some mistreatment, whether they were being yelled at, shoved or ignored that would make that resident tell you about an incident.

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Signs of Nursing Home Neglect, Abuse

Abuse and neglect of the Alzheimer’s patient -red flags

By Micha Shalev

Micha Shaley

This is part one of a two-part series. Part two will be in the October issue of the Fifty Plus Advocate.

Elder Abuse is one of the most overlooked public health hazards in the United States. The National Center on Elder Abuse estimates that between one and two million elderly adults have suffered from some form of elder abuse. The main types of elder abuse are physical abuse, sexual abuse, emotional and psychological abuse, neglect and self-neglect, abandonment, and financial exploitation. Elders with dementia are thought to be at greater risk of abuse and neglect than those of the general elderly population.

One occasionally reads of sensationalized newspaper stories of elderly Alzheimer’s and dementia victims who were subjected to abuse or neglect while they were residents in long term care facility.

Based on such newspaper accounts, one would have the impression that most cases of the abuse or neglect of Alzheimer’s or dementia victims takes place in such facilities. While such sorry events and incidents rarely do take place in such facilities, they are far from the norm. Recent studies however, have established rather clearly the troubling fact that most cases of the abuse of Alzheimer’s and dementia victims actually take place in the family home setting, by their own family members or paid care givers.

Potential indicators of abuse
Below are some potential indicators for each type of elder abuse. Please be aware that this does not represent a definitive listing.

Passive and active neglect

• Evidence that personal care is lacking or neglected
• Signs of malnourishment (e.g. sunken eyes, loss of weight)
• Chronic health problems both physical and/or psychiatric
• Dehydration (extreme thirst)
• Pressure sores (bed sores)

Physical abuse

• Overt signs of physical trauma (e.g. scratches, bruises, cuts, burns, punctures, choke marks)
• Signs of restraint trauma injury – particularly if repeated (e.g. sprains, fractures, detached retina, dislocation, paralysis)
• Additional physical indicators – hypothermia, abnormal chemistry values, pain upon being touched
• Repeated “unexplained” injuries
• Inconsistent explanations of the injuries
• A physical examination reveals that the older person has injuries which the caregiver has failed to disclose
• A history of doctor or emergency room “shopping”
• Repeated time lags between the time of any “injury or fall” and medical treatment

Material or financial abuse

• Unusual banking activity or bank statements (credit card statements, etc.) no longer come to the older adult
• Documents are being drawn up for the elder to sign but the elder cannot explain or understand the purpose of the papers
• The elder’s living situation is not commensurate with the size of the elder’s estate (e.g. lack of new clothing or amenities, unpaid bills)
• The caregiver only expresses concern regarding the financial status of the older person and does not ask questions or express concern regarding the physical and/or mental health status of the elder
• Personal belongings such as jewelry, art, or furs are missing
• Signatures on checks and other documents do not match the signature of the older person
• Recent acquaintances, housekeepers, “care” providers, etc. declare undying affection for the older person and isolate them from long-term friends or family
• Recent acquaintances, housekeeper, caregiver, etc. make promises of lifelong care in exchange for deeding all property and/or assigning all assets over to the acquaintance, caregiver, etc.

Psychological abuse

• Psychological signs:
  • Ambivalence, deference, passivity, shame
  • Anxiety (mild to severe)
  • Depression, hopelessness, helplessness, thoughts of suicide
  • Confusion, disorientation
• Behavioral signs:
  • Trembling, clinging, cowering, lack of eye contact
  • Evasiveness
  • Agitation
  • Hypervigilance

Sexual abuse

• Trauma to the genital area (e.g. bruises)
• Venereal disease
• Infections/unusual discharge or smell
• Indicators common to psychological abuse may be concomitant with sexual abuse

Full Article & Source:
Abuse and neglect of the Alzheimer’s patient -red flags