DOJ Report to Congress Details Fight Against Nursing Home Neglect, Elder Abuse and Financial Fraud

Federal regulators have made significant progress combating elder abuse and financial fraud since July 2023, according to a new report.

By: Michael Adams 

In recent years, the U.S. Department of Justice (DOJ) has been working in tandem with federal, state, local and Tribal law enforcement agencies to target financial fraud and abuse involving elderly Americans, as well as their risks of nursing home neglect due to grossly inadequate care in long-term facilities.

Older individuals face an increased risk of falling prey to various financial fraud schemes, and they face particular dangers of abuse at the hands of caretakers, both at home and in nursing home facilities.

As a result of these dangers, a number of new federal programs have been started, and legacy programs have continued gaining traction, to help curb the physical and financial abuse of elderly Americans.

Last month, the DOJ released its sixth Annual Report to Congress on Activities to Prevent Elder Fraud and Abuse, which outlines programs the agency has put in place to combat elderly fraud and abuse, as well as how those programs performed from July 1, 2023 to June 30, 2024.

National Nursing Home Initiative Addresses Elder Neglect

The DOJ report indicates that the agency’s Elder Justice Initiative is cooperating with 94 U.S. Attorneys’ Offices across the country to implement the National Nursing Home Initiative, which will help identify nursing homes that do not provide adequate staffing numbers or skill to provide for resident care.

The National Nursing Home Initiative also tracks and identifies nursing home facilities that do not adhere to basic nursing standards, or provide their residents with enough food, as well as those that use inappropriate physical and chemical restraints to sedate residents.

Government officials are already enforcing actions against nursing home facilities that have committed fraud, provided unnecessary medical services, or been unable to care for residents in the manner that the law requires.

The report also indicates the DOJ’s Office for Victims of Crime (OVC) awarded nearly $6 million to 12 different organizations that will support local communities over a three year period, by providing services to elderly victims of abuse and exploitation.

In addition, the agency reports that between July 2023 and March 2024, more than 9,750 individuals over the age of 60 applied for compensation through the DOJ’s Victims of Crime Act (VOCA) Formula Grant Program.

VOCA addresses the emotional and financial needs of crime victims, by advocating for them and assisting with medical services, counseling, transportation, funeral and burial costs, as well as lost work. During the reporting period, VOCA awarded more than $79 million specifically to organizations that assist individuals who experience elder abuse.

The DOJ has also pursued at least 300 enforcement actions against hundreds of fraud defendants, returning more than $31 million to elderly victims of financial scams during the covered period. In fact, the report points out that the National Elder Fraud Hotline has fielded more than 139,000 calls across all 50 states, as well as 44 other countries and territories since it was launched in 2020.

“Raising public awareness is an essential part of the Department’s efforts to combat and reduce elder abuse, neglect, financial exploitation and fraud,” said Andy Mao, National Elder Justice Coordinator Deputy Director of the Civil Fraud Section. “With so much elder abuse hidden from the public eye, it is imperative that we arm our communities with the information and red flags they need to identify and recognize potential abuse when they see it.”

Nursing Home Abuse Affects All Americans

Nursing home neglect and elder abuse affect thousands of individuals. However, the damage associated with these issues is not confined to the elderly.

Recent studies have revealed that many nursing homes accused of neglect are overbilling taxpayers, with some facilities, termed “opportunistic systems,” overcharging Medicare by $4.3 billion. Since Medicare bills are covered by the Centers for Medicare and Medicaid Services (CMS), which is funded by U.S. tax dollars, these overcharges impact all American taxpayers.

Staffing has been another area of increasing concern for nursing home facilities, with the U.S. Department of Health and Human Services publishing a report earlier this year, which indicated that less than one-third of U.S. nursing homes have enough nurses on staff.

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DOJ Report to Congress Details Fight Against Nursing Home Neglect, Elder Abuse and Financial Fraud

Wilmington nursing home neglect: Here's how to report abuse

by Sydney Hoover

The North Chase Nursing and Rehabilitation Center

Treesie Paradis wasn't allowed to visit her mother at NorthChase Nursing and Rehabilitation Center due to COVID restrictions. Her mother, Juanita Hale, told her nurses weren't responding when she pressed a call button asking for help using the bathroom.

Once Paradis was able to visit, she said she found Hale with a puddle of urine under her wheelchair and all her clothes soaked through. Before she was able to meet with administrators, her mother contracted a urinary tract infection that led to her being hospitalized. Paradis’ mother died a month later.  

While Hale was in the hospital, a nurse referred the family to a social worker for a "safety evaluation," according to medical records. 

Julian March, media relations coordinator for New Hanover Regional Medical Center, said anyone "with a reasonable cause" to believe an older adult or an adult with a disability is in need of protective services would report that information to local social services. 

But for many families, neglect doesn’t reach the point of hospitalization, leaving them to navigate the reporting process on their own. 

What is nursing home neglect?

Around 5 million elderly Americans experience nursing home abuse each year, according to the National Association of Nursing Home Attorneys. One in 10 people age 60 or older experience some form of elder abuse, which can include psychological, physical or sexual abuse, neglect, or financial exploitation. 

The association also reported as many as 90% of nursing homes are not staffed adequately, and the nurse's aide-to-resident ratio is typically one-to-15, when it should be closer to one-to-six. 

In Wilmington, NorthChase was not the only nursing home to have been in the spotlight this year for allegations of neglect. An April investigation of Spring Arbor of Wilmington revealed neglect in care for residents when a man died after being assaulted by another resident. The family of the man, Garland Garrett Jr., filed a lawsuit against the facility.

Both facilities were previously found in violation of state rules and regulations.

When a nursing home resident is admitted to the New Hanover Regional Medical Center, policy requires any suspected neglect be reported to social services. But other families have taken it into their own hands to report neglect and abuse in nursing homes to the state, which then ultimately resulted in investigations.  

Christane Long said her grandmother, a former NorthChase resident, was often found with soiled underwear or with bruises. She died in June after suffering a stroke. 

Long filed a complaint with the state by phone and was informed an investigation would be conducted. She later received a letter that outlined findings from the investigation, which informed her one of her claims was substantiated, though the letter did not specify which one.

Reporting and inspecting facilities

North Carolina nursing homes are licensed by the Division of Health Service Regulation’s Nursing Home Licensure and Certification Section and are required to follow state rules and regulations.

Most nursing homes in the state are also in the Medicare/Medicaid program and are then required to follow federal rules and regulations as well, said Kelly Haight, communications manager for the state’s Department of Health and Human Services. 

Nursing homes are regularly inspected, typically every nine-to-15 months, Haight said, and surveyors check for compliance for a number of residents’ rights identified by the state, like the right to be free from abuse, neglect, and exploitation, and the right to a quality of life and care, among others. 

Additional inspections can come out of complaints made to the department by residents, their families or others made by phone, fax or mail.

Complaints are only investigated if the incident occurred within the last year and are prioritized by level of severity. Investigations are unannounced, unlike in routine inspections, and complainants' identities remain confidential throughout the process. Any complaints submitted to the state are “reviewed and triaged for appropriate follow-up,” Haight said.  

Any issues found during the inspection will result in a “Statement of Deficiency” report, and the facility must create a plan of correction for those deficiencies. Haight said facilities could also face other penalties. 

Surveyors will then follow up with the home to make sure it corrected any deficiencies that were cited. Reports made during and after inspections can be viewed on the Division of Health Service Regulation website.

If you believe your loved one is being abused or neglected, you can file a complaint with the N.C. Division of Health Service Regulation. Complaints can be filed over the phone by calling 1-800-624-3004 or 919-855-4500 between the hours of 9 a.m. and noon and 1 - 4 p.m. Monday through Friday.

Complaints can also be faxed to 919-715-7724 by printing and filling out the complaint form found on the division's website, or you can mail the complaint form to Complaint Intake Unit, 2711 Mail Service Center, Raleigh, NC 27699-2711.

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Wilmington nursing home neglect: Here's how to report abuse

Jury awards woman $1.2 million over nursing home's neglect

Shirley Burrows with her granddaughter.

Shirley Burrows needed follow-up treatment for three “superficial” bedsores when she was discharged from a Lockport hospital to a Newfane nursing home.

Instead of getting better, Burrows’ sores worsened, her attorneys said. The wounds became infected, and a bone in Burrows' lower back was exposed.

A Niagara County jury earlier this week awarded $1.25 million to the 72-year-old woman, after determining Newfane Rehab & Health Care Center was negligent in its care of her.

The jury award was unusual: Most lawsuits against Western New York nursing homes are settled before trial and the amount is kept private at the nursing homes' request.

“She had gone to the nursing home for wound care treatment and they horribly neglected her,” said Brian R. Hogan, one Burrows’ attorneys at Brown Chiari law firm. “What makes this egregious is they knew she had sores and she was not seen by a doctor at the nursing home.”

Burrows was transferred from Eastern Niagara Hospital to the nursing home on March 3, 2015, following her approximately two-week hospital stay. After her bedsores worsened, she was taken to Mount St. Mary Hospital’s wound care clinic in Lewiston.

“When she arrived at the clinic, the staff was saw the size and and depth of the wounds they became emotional and immediately admitted her to the hospital for surgery,” Michael C. Lancer, Burrows' other attorney, said.

Her wounds were on her sacrum and backside, the lawyers said.

Bedsores, also known as pressure sores, occur when a section of the body is pressing against a surface for too long and not repositioned to alleviate the pressure. Medical protocol to prevent sores calls for repositioning every two hours.

These injuries remain an ongoing issue in nursing homes despite efforts in recent years in New York State to drive down the number of residents who end up with them.

At Newfane Rehab, 6.02 percent of the long-term, high-risk residents developed bedsores from July 2017 through June 2018. Only 0.2 percent of the short-term residents there had new or worsened bedsores. Both marks were better than the statewide averages: 6.8 percent for long-term residents and 0.8 percent for short-term residents.

“This is the sort of thing we see over and over again at different nursing homes. All they’re doing is documenting, but not really treating the wounds,” Lancer said.

The lawsuit was filed in June 2015 against the Newfane facility, Integrated Care Systems LLC, and Eastern Niagara Hospital in Lockport. The nursing home was operated until June 2015 by Integrated Care Systems LLC and the real estate was owned by the hospital. Companies run by out-of-town investors in Maximus Newfane LLC bought the operating license and the property at 2709 Transit Road that same month, according to state and federal records.

Attorney Seth A. Hiser, who defended the nursing home and Eastern Niagara Hospital in the two-week trial before State Supreme Court Justice Daniel J. Furlong in Niagara Falls, declined to comment. Craig Shaffer, the administrator at the nursing home, did not respond to requests for comment.

The federal government rates Newfane Rehab as a two star, or “below average,” facility in its five-star rating system.

After her surgery, Burrows was discharged from Mount St. Mary and she now lives at her home in Newfane.

“It took two years of treatment at the wound clinic and she still has an open wound, but it is a lot smaller and her daughter is caring for her,” Hogan said.

Of the verdict amount, the jury awarded $475,000 for past pain and suffering, $300,000 for future pain and suffering, and an additional $475,000 for violating a state public health law that requires special protections to nursing home residents, for the total of $1.25 million.

Attorney Don Chiari said his law firm was initially told by attorneys for the insurance company covering the nursing home that it “would never pay a dime on this case.”

Medical Liability Mutual Insurance Co. provided the insurance for the facility.

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Jury awards woman $1.2 million over nursing home's neglect

Family: Veteran died from nursing home neglect

A Seymour family is demanding answers after they say their loved one died as a result of nursing home neglect.

Tim Johnson died in a Columbus hospital Oct. 11, 2014, at the age of 43 as a result of sepsis and cardiac arrest after spending four years at the Seymour Crossing nursing home.

“You put your loved one in there and you expect them to be taken care of,” said Rebekah Klaus, Johnson's sister.

State inspection reports and police records obtained by Call 6 Investigates raise questions about whether the nursing home adequately cared for Johnson.

Klaus tries to remember her brother, a Navy veteran, for how he lived, not how he died.

“He loved his daughter, he loved his family, he loved animals, he loved life in general,” said Klaus.

Tim Johnson battled rheumatoid arthritis and other health issues, and spent the last four years of his life in Seymour Crossing.

“He couldn’t walk, that’s the reason he was at the Crossing,” said Klaus. “His knees wouldn’t go.”

Following the death of Johnson, the Indiana State Department of Health/federal Centers for Medicare & Medicaid Services (CMS) conducted an investigation and inspection at Seymour Crossing on November 3, 5 and 6, 2014.

The report shows on October 4, a staffer went to check on Johnson and found him lethargic, disoriented, whimpering and saying ‘please.’

Johnson ended up in the hospital with sores and wounds on his body.

The state/federal report said an Intensive Care Unit nurse at the hospital noted Johnson was unkempt, unclean and had a very strong smell.

“(The right arm dressing) was saturated and foul…smelled like it had been there a while and we were all wearing masks,” an ICU nurse told investigators.

Johnson’s family took pictures of the wounds, too graphic to show, including one on his right arm so deep it went down to the bone and muscle.

“I became infuriated,” said Johnson’s 15-year-old daughter, Sydney. “They didn’t care for him the way they should have.”

Johnson developed an infection complication known as sepsis, went into cardiac arrest, and was taken off life support at the age of 43.

“I have cried every single day for a year,” said Klaus. “I still look at those pictures. I still go out to that graveyard every day and it haunts me.”

Klaus and Sydney Johnson said they never noticed a wound on Tim’s arm because he was wearing a gown in his final weeks at the nursing home.

“He was constantly wearing a gown,” said Klaus. “I feel like there was more that I could do.”

Johnson’s family members said because they suspected he wasn’t getting adequate care, they tried to find another place to take him, but it was difficult to find another facility close by that accepted Medicaid.

State/federal records show the dressing on Johnson’s arm wound had not been changed since September 26, a week before he ended up in the hospital, on October 4.

Previously, the dressings were changed every Tuesday and Friday, records show.

According to the inspection report, the nursing home’s wound nurse was not following protocol, and ordered Johnson’s wound treatment to be discontinued.

“It’s abuse and neglect,” said Klaus.

The wound nurse is no longer with the facility, according to the Seymour Police Department report.

The Jackson County Prosecutor has decided not to file criminal charges in the death of Tim Johnson.

“We did receive an investigation from Seymour Police Department, as well as from the Office of the Indiana Attorney General,” said Amy Marie Travis, Jackson County Prosecutor, in an email to Call 6 Investigates. “Neither entity found evidence to support the filing of criminal charges in this matter and did not recommend charges. My office did an independent review of the matter and did not find probable cause to file criminal charges.”

Johnson’s family is disappointed.

“I won’t have someone to walk me down the aisle on my wedding day, and I won’t have someone to look up to the rest of my life,” said Sydney Johnson, daughter of Tim Johnson. “It infuriates me that somebody did this to him and made us go through all this pain and suffering and they’re not going to be punished for it.”

The state/federal investigation found Seymour Crossing failed to provide necessary care and services, and noted a deficiency in “Provide Care/Services for Highest Well Being.”  (Continue Reading)

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Family: Veteran died from nursing home neglect