Ileana Garcia bill would guarantee nursing home patients the right to record their rooms

by Jesse Scheckner

The measure follows a spike in serious violations at Florida nursing homes, including many instances of abuse, poor care and neglect.

Florida’s oldest and wisest residents are also among its most vulnerable, and Miami Republican Sen. Ileana Garcia just introduced legislation designed to better protect them.

Garcia filed a bill (SB 64) that would guarantee any nursing home and assisted living facility (ALF) resident or their guardian the right to install and use an electronic monitoring device — a camera, audio recorder or combination of the two — in their room.

The long-term care facilities wouldn’t be able to block the use of the devices or retaliate against residents or their guests. Violators would face a $500 fine per violation.

People other than the residents, their guardians, or third parties they authorize would be prohibited from tampering with the devices. Violators would face a first-degree misdemeanor punishable by up to a year in prison and a $1,000 fine.

Garcia’s measure comes amid a spike in serious violations at Florida nursing homes, including many instances of abuse, poor care and neglect. A review of Florida Agency for Health Care Administration (AHCA) data found that between 2012 and 2018, the number of serious nursing home violations in the state averaged about 32 a year. Between 2019 and 2022, it more than doubled to 71 yearly.

Some of those cases led to criminal charges, a troubling share of them stemming from cases of alleged physical abuse. Meanwhile, nursing home residents have said fear of reprisal has deterred them from reporting poor treatment.

The issue has inspired some to protest and call for action, such as Stephanie Sifrit, whose elderly mother suffered unexplained bruising to her private area and internal trauma during a monthlong stay in 2021 at a Bradenton care facility.

Sifrit told the Sarasota Herald-Tribune in January that she tried to install a camera to monitor her mother, who has Alzheimer’s disease but was prevented from doing so by the facility, which later told Sifrit she’d have to pay a $6,000 bill to bring her mother home early.

She’s since sued the facility’s parent company, 6305 Cortez Road West Operations LLC, and held public protests to call for the changes Garcia’s bill would create. Sifrit told the Herald-Tribune that cameras wouldn’t just help catch abusers; they could also speed up response to accidents, as was the case when her father fell at another long-term care facility.

“The cameras don’t only, you know, catch bad people doing bad things. Cameras can help others support the facility if something comes up,” she told the outlet. “Working in those facilities is extremely demanding, and they can’t be there in every room to monitor everything.”

SB 64, which had no House analog as of 4 p.m. Tuesday, would go into effect July 1 if approved in the upcoming Session.

It includes some restrictions.

Residents or their guardians would be responsible for installing and maintaining the recording equipment, including all associated costs.

The bill also has sections to address cohabitation. If a resident seeking to install a recording device in their room shares the space with someone else, they or their guardian must get the other person’s or guardian’s consent. That person or their guardian would then be able to place conditions on the device’s use, including what kind of device or devices are used and what they record.

If the other party refuses, the facility would have to make a “reasonable attempt” to accommodate both parties by moving one to another room with consent from the relocated resident or their guardian.

The bill also makes clear that residents authorizing the installation and use of monitoring devices could withdraw their consent at any time. In turn, nursing homes would be able to post signs identifying rooms that have monitoring devices.

Unauthorized viewing, listening, recording, or sharing of video, images, or audio from the devices would also be prohibited. The AHCA would enforce this provision.

Garcia has strongly advocated for Florida’s vulnerable residents since she narrowly won her Senate District 36 seat in 2020.

In 2021, she successfully sponsored measures to improve domestic violence centers and advocates. The following year, she passed the “No Patient Left Alone Act” to strengthen patient visitation rights after the pandemic and bills to improve care for students with seizure disorders and boost access to education and social services for youths experiencing homelessness.

Last year, Garcia passed legislation updating training requirements for providers licensed by the Agency for Persons with Disabilities, authorizing elder and vulnerable adult abuse fatality review teams and holding nursing homes to more stringent standards.

During the 2024 Legislative Session, bills she carried that received Gov. Ron DeSantis’ signature included measures to protect minors from online dangers and increase patient access to health care costs and coverage information.

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Ileana Garcia bill would guarantee nursing home patients the right to record their rooms

Flushing doctor settles health care fraud claims for $1.3 million after over-billing nursing home patients: Feds

By Bill Parry

U.S. Attorney Breon Peace reached a $ 1.3 million settlement agreement with a Flushing doctor after he allegedly over-billed Medicare for services provided to residents of Queens nursing homes.

File photo courtesy of the EDNY

A Flushing-based pulmonologist will have to pay $1.3 million in restitution as part of a settlement agreement with the U.S. Justice Department after he over-billed nursing home residents for years, U.S. Attorney Breon Peace announced last week.

The deal addresses allegations that Dr. Arun Arora violated the federal False Claims Act by billing Medicare for critical care services to residents of nursing homes in Queens when he provided only routine care, such as regular medical checkups.

Critical care services involve imminent life-threatening deterioration of a patient’s condition and Medicare reimburses health care providers at a higher rate for critical care services than for routine care, according to federal prosecutors. By billing for critical care services when he provided only routine care, as the government contends, Dr. Arora received extra payment for care that he did not provide.

Under the terms of the agreement with the U.S., Dr. Arora will pay the $1.3 million for conduct that took place in the years 2019 to 2023. In addition to the payment to resolve the government’s fraud claim, Dr. Arorahas entered into a separate “integrity agreement” with the U.S. Department of Health and Human Services, Office of Inspector General, which imposes a number of obligations meant to ensure he complies with Medicare rules and regulations going forward.

“Our Medicare program, which provides health care services to the elderly, works only if its funds are expended properly,” U.S. Attorney Breon Peace said. “When health care providers over-bill the program, Medicare cannot ensure that services are going to the people who need them most.”

He added that the claims resolved by the settlement are allegations only and there has been no admission of or determination of liability.

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Flushing doctor settles health care fraud claims for $1.3 million after over-billing nursing home patients: Feds

Nursing Home Patients Saved From Covid-19 Are Dying of Loneliness

By Peter Coy

Five-star nursing homes have lower death rates from Covid-19 but higher death rates from other causes, apparently because some patients who are isolated for their own good are dying from loneliness, says a study by two economists from the University of Notre Dame.

“These homes exposed their residents to severe isolation in an attempt to prevent infection, subsequently leading to premature death by other causes,” says the study, a National Bureau of Economic Research working paper (PDF) by Christopher J. Cronin and William N. Evans. 

In parts of the country where the rate of Covid-19 infection in the community is low, five-star nursing homes “have significantly more deaths than their low-quality counterparts,” the study says.

“No way around it—these numbers are incredibly sad,” Cronin says in a video presentation of the paper on the NBER website.

The excess deaths from causes other than Covid-19 are concentrated in places where the rate of infection in the community is low. It’s possible that in places where the community infection rate is high, “the most fragile patients” die of Covid-19 before loneliness and despair can take them away, the authors write.

One hopeful sign for lonely, isolated nursing home residents is that in September the Centers for Medicare & Medicaid Services changed their guidance to permit more visitors. In fact, if a facility has had no COVID-19 cases in the last two weeks and the local infection rate isn’t high, a nursing home “must” facilitate visits, the government says. Its memo (PDF) is blunt:

While CMS guidance has focused on protecting nursing home residents from COVID-19, we recognize that physical separation from family and other loved ones has taken a physical and emotional toll on residents. Residents may feel socially isolated, leading to increased risk for depression, anxiety, and other expressions of distress. Residents living with cognitive impairment or other disabilities may find visitor restrictions and other ongoing changes related to COVID-19 confusing or upsetting. CMS understands that nursing home residents derive value from the physical, emotional, and spiritual support they receive through visitation from family and friends.

 

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Nursing Home Patients Saved From Covid-19 Are Dying of Loneliness

Corporate America's Latest Target: Nursing Home Patients

Photo: Mark Phillips | Flickr

John Mitchell, only 69 years old, was recovering from a stroke at a nursing home in Dennis, Massachusetts when -- one week after he was admitted -- staff dropped him while moving him from his bed to a chair. A call to an ambulance was made, but then cancelled when his vital signs seemed to stabilize. Later that night, John became unresponsive. After he was rushed to the hospital, doctors discovered that the fall had caused extensive bleeding in his brain; he died a few days later. It was only after his sons hired an attorney to investigate the circumstances surrounding their father's death that they found -- among dozens of pages in the admission contract signed by John's guardian -- a pre-dispute arbitration agreement.

Fortunately for John's family, a court ruled the clause in their contract unenforceable. But that isn't always the case.

John's story underscores the reality that many new residents face. Nursing homes have complete control over some of the most vulnerable and fragile people in the entire country: people who are gravely ill, who are often cognitively impaired in ways that make it hard for them to protect themselves, are completely at the mercy of these institutions. Unfortunately, nursing homes are increasingly being taken over by huge corporate entities that are often driven more by profit than a sincere commitment to taking care of residents. Thousands of nursing homes across the country have been snapped up by large Wall Street companies. Sixty percent of the market is now occupied by for-profit entities, increasingly private equity groups. One report discovered that in 60 percent of the homes purchased, managers cut the nursing staff to the point where they were providing only one clinical registered nurse for every 20 residents.

Just as they've done in other parts of our economy, these giant corporations are using forced arbitration clauses -- contract terms that say that people cannot sue them, no matter what laws they break, and instead people harmed by illegal acts can only bring cases before private arbitrators who are generally beholden to the corporations. These clauses make it far harder for the victims of mistreatment to hold a facility accountable where there's abuse or serious negligence, and they minimize the incentive to provide the highest quality of care.

The Obama Administration is seriously considering doing something about this. The Centers for Medicare and Medicaid Services has an opportunity to say that nursing homes can no longer receive federal funding if they use arbitration clauses in their contracts. If CMS will take this step, it will return to the nation's most vulnerable population their basic constitutional rights, and let people hold nursing homes accountable in case of abuse and neglect. My organization, Public Justice, just filed extensive comments with CMS urging it to take this opportunity to protect these vulnerable residents.

The Stakes are Huge. While millions of people get caring and competent treatment every day, there are times that the system fails disabled and often elderly nursing home residents in horrifying ways. Far too often, people who can't move are left in one place for so long that they develop pressure sores, and then far too often, are left in their own excrement until the pressure sores become infected. There are other instances where people have actually been intentionally physically abused by people who never should have been put in charge of vulnerable patients. Our comments trace through a number of instances of genuinely horrific treatment, as do comments to CMS from a number of state attorneys' general. Our comments also document in detail how neglect and mistreatment spread and expand when nursing homes are bought up by large Wall Street entities, and how harmful these corporate acquisitions are for real people who are completely dependent on the facilities for medical care, food, everything.

The circumstances surrounding admission to a nursing home are uniquely stressful. It's often an emotionally devastating experience for both the patient and their family. These facilities are often a last resort for patients and families, and the decisions are often made under emergency circumstances. No sane person in that setting is going to be focused on the fine print of an admissions contract, looking to see if the facility is trying to gain some legal advantage and strip the patients of their rights. People are understandably thinking about different things, filled with other feelings. For nursing homes to use these painful moments as a chance to slip arbitration clauses past families is ugly and unreasonable, and the argument "well, everyone knowingly agreed to give up their right to go to court" is unrealistic.

Arbitration Clauses Enable Abuses. As our comments establish, nursing home industry consultants have openly acknowledged and other studies support that arbitration clauses reduce the liabilities of nursing homes. When liabilities are reduced, there is strong evidence that the quality of care gets worse.

In addition, unlike the public court system (where trials are open to the public, press and regulators), nursing homes benefit enormously from the secretive system of arbitration, where the facts about abuses can be (and often are) buried. "Confidentiality" provisions - which really translate into gag orders - and non-transparent, non-public handling make it easier for systemic problems to stay hidden, and to continue.

If nursing homes are permitted to continue opting out of the civil justice system, we can expect to see lower levels of care, and higher numbers of preventable injuries and deaths.

Now Is the Time. CMS has a historic opportunity to do something about this ugly, abusive practice. It should tell nursing homes that they can't use arbitration clauses and still benefit from federal dollars. Protecting desperately vulnerable people is more important than squeezing out an extra percentage of profit for hedge fund owners.

This is not a problem that the government can solve on its own. CMS does some great work, but it doesn't have the resources to police the thousands of nursing homes spread throughout the country. When patients are injured or die due to mistreatment or neglect, they and their families should be able to go to court to protect their own rights. It's been the American system for hundreds of years that injury victims have a right to a day in court, and it shouldn't be thrown overboard at the whim of some Wall Street guys who find secretive private judges a more congenial system.

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Corporate America's Latest Target: Nursing Home Patients