MDH report highlights senior care drug diversions

Drug diversions in health care facilities accounted for about 20 percent of the 141 substantiated allegations of abuse, neglect, or financial exploitation of vulnerable adults between July 2013 and June 2014, according to a new MDH report.

MDH investigators substantiated that 14 health care workers diverted drugs from 27 vulnerable adults in the one-year period ending June 2014. MDH received a total of 192 drug diversion allegations involving thefts from individuals and facilities during this time. Allegations are considered substantiated when a majority of the evidence supports a finding of fault.

“Drug diversion and prescription abuse is a growing area of concern nationally and in Minnesota,” said Minnesota Health Commissioner Dr. Health Ed Ehlinger. “We want patients to be aware of the possibility of drug theft, we want workers to know it will not be tolerated, and we want providers to help prevent it by using best medicine management and tracking practices.”

This is the first year MDH has collected these data as part of its report on the maltreatment of vulnerable adults (PDF). In previous vulnerable adult reports, MDH included drug diversion cases in the financial-exploitation category but did not break them out separately. MDH investigates allegations of drug thefts from individuals under Minnesota’s Vulnerable Adults Act, whereas MDH investigates thefts from facilities under different regulations.

About 70 percent of the substantiated cases of a worker taking medications from a vulnerable adult occurred in nursing homes. The rest occurred in assisted living facilities or care provided in homes. In all of the cases, MDH investigators found the individual workers at fault for the diversions, rather than the facilities. After finding evidence of a drug diversion, facilities typically notified the police and terminated the employee. Some facilities also took steps to prevent future events, such as daily narcotic counts, narcotic counts between shifts, training nurses to identify the signs of drug diversion, changing locks on medication storage boxes, and requiring two staff members to sign off on medication flow sheets.

A joint MDH and Minnesota Department of Human Services (DHS) work group charged with improving care for vulnerable adults has selected control and storage of medications as a key focus area. At the direction of the Governor and the Legislature, DHS has also formed an expert work group to address the wide availability of prescription opioids and provide recommendations that will guide Minnesota’s response to the crisis of opioid overuse and abuse.

The Maltreatment of Vulnerable Adults Update includes mistreatment allegations of vulnerable adults occurring in facilities licensed by MDH including nursing homes, hospitals, boarding care homes, supervised living facilities, assisted living providers, home care providers, hospice providers, and free standing outpatient surgical centers. The full report is available at the MDH Health Regulation Division website at Maltreatment of Vulnerable Adults Update (PDF).

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MDH report highlights senior care drug diversions

Care workers jailed after patient dies in home

Lily Campbell

Two care workers have been jailed after lying to police about the death of a pensioner with dementia. 89 year old Lily Campbell was left dying at the Laburnum Court care home in Salford after she developed severe intestinal problems last October.

Manchester Crown Court has heard that Abdul Khan, who is 22 and of Roland Road, Bolton, and 53 year old Pratima Munjal from Montana Square, Openshaw, failed to check on Mrs Campbell through the night. When they eventually discovered that she had died they altered records to show that they had visited her and they also changed the bedding and washed her before calling the emergency services to report her death.

Paramedics became suspicious when they discovered evidence of rigor mortis suggesting that Mrs Campbell had been dead for hours, despite Munjal's claims that she had been breathing when she checked her less than an hour before. Munjal continued to lie when interviewed by police, and a post mortem examination showed that the pensioner had been dead for hours.

Munjal has now been jailed for 10 months for her part in the deception, and Khan imprisoned for six months.

Mrs Campbell's son and daughter, Clinton and Linda Credit: MEN

 The last year has been horrific. It has devastated the entire family and only now can we have any closure. My mum was an inspirational, strong woman. For her to have died in agony in her care home bed with no one checking on her is terrible. We are angry, she didn’t deserve that. But we are happy to see both Khan and Munjal behind bars, and for the judge to say that he wanted to make an example of them. Hopefully now we can find some peace.

– Linda Campbell, Lily Campbell's daughter

Our thoughts and sympathies go out to Mrs. Campbell’s family for their loss. We deeply regret the distress that was caused to Mrs. Campbell in her final hours and to the family. Following Mrs Campbell’s death the home manager and our regional management team cooperated with the police and Salford Council’s Adult Safeguarding Team in an investigation into her care records and a call that was made to the emergency services. These investigations led to a nurse and care assistant being charged in relation to attempting to pervert the course of justice. The overwhelming majority of nursing and care staff do a difficult job extraordinarily well, day after day to make life better for the people living in care homes. It is deeply disappointing and upsetting whenever we come across the exceptions who let down their colleagues and the people in their care. What these people did was not just against all their professional training and the company policies and procedures to support the well-being of residents, it was a criminal act.

– Spokesperson for Four Seasons the company which runs Laburnum Court care home in Salford

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Care workers jailed after patient dies in home

Woman Arrested For Stealing Jewelry From Hospice Patients

December 28, 2015
By Tamas Mondovics

The news of the arrest of a pair of healthcare workers in Ruskin, who robbed the elderly patients they cared for last summer, was much welcomed.

Experts in the field also acknowledged that the level of elder exploitation may well exceed what has been reported to authorities and documented by researchers.

While the Hillsborough County Sheriff’s Office was pleased to make the arrests, detectives continued their investigations and had asked any other victims to contact the department.

The effort paid off and resulted in an arrest as District 4 investigators pursued a case concerning a hospice patient having items stolen from a residence in Sun City.

According to detectives the items stolen were mainly jewelry that included rings, necklaces, bracelets and earrings.

Investigators identified Theresa Belekevich, 44, of Plant City as a suspect, whom they said was a hospice employee at the time of the thefts.

Sadly, the investigation also revealed additional victims in Plant City, Tampa and Gibsonton dating back to October 2014.

Multiple items of stolen jewelry were returned to victims and their families.

Belekevich turned herself in to detectives early last month and was booked into Orient Road Jail for four counts of Grand Theft, seven counts of Dealing in Stolen Property and seven counts of False Information to a 2nd Hand Dealer. Belekevich admitted to the offenses and is no longer an employee of hospice.

“The investigation totaled over one year to investigate thoroughly,” said HCSO Public Information Officer Cristal Nunez.

According to the National Institute of Justice, the U.S. has no national reporting mechanism to track the financial exploitation of the elderly.

One recent study of 2,000 community-residing elderly individuals in Florida as well as in Arizona found that nearly six percent reported being victims of financial mistreatment, such as someone stealing or spending their money, selling or taking their property, or forging their signature.

As the investigations in these cases by the Sheriff’s Office continues, residents and any other victims are asked to contact the Hillsborough County Sheriff’s Office at 247-8200.

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Woman Arrested For Stealing Jewelry From Hospice Patients

Design Thinking Can Help Improve Care for the Elderly

By 2050, the number of Americans over age 65 will more than double. Our current health care system is ill equipped to accommodate their growing needs. The challenge for health providers, payers, business, and government is to redesign services to address those needs.

In response, the tech community is creating an abundance of devices to monitor and motivate an older population to exercise, eat well, take their medications, and live more engaged lives. But to make a difference, these products must be integrated into the daily lives of the population and the daily workflow of health care providers. Design thinking — which one HBR author describes as “an essential tool for simplifying and humanizing” — can help do this. A case in point is using technology to assist the elderly in adhering to their medication regimens.

Adherence is one of the most intriguing and complex dynamics in health care. According to the Centers for Disease Control and Prevention, about 40% of people over 65 take five or more medications per day. There is ample opportunity for them to be confused and overwhelmed.

Researchers have shown even e-prescriptions do not fix this issue: Meta-analysis has revealed that more than 20% of first-time prescriptions for chronic conditions such as hypertension, hyperlipidemia, and diabetes are never filled. Medication nonadherence undermines even the best cost-saving and clinical intentions of evidence-based care.

Various solutions have been tried over the years, ranging from labeling the humble pillbox with the days of the week to internet-connected pill dispensers to simple reminder systems. None of these solutions is ideal since they require patients or caregivers to organize, combine, and synchronize the dispensing of numerous prescription medications.

To overcome these limitations, developers came up with software solutions. App stores have a wealth of smartphone reminders that allow users to create a daily schedule for their meds. At preset times, the app sounds an alarm. Most apps also show an image of all the pills to take at that moment, matching them to a database such as Pillbox, from the National Institutes of Health’s National Library of Medicine.

But in spite of developers’ best efforts, no app can prevent medication errors if it is physically disconnected from the dispensing mechanism. Ignoring for a moment the fact that some older adults may encounter difficulties using smartphones, reminder apps are at least two behavioral steps disconnected from medication intake. Users have to look for their pill bottles, take the right pills, and then inform the app that they have done so. Even a minor cognitive impairment makes this routine unreliable.

Internet-connected pill dispensers, which try to increase adherence by coupling reminder and dispensing actions, also have limitations. The dispensers have either cellular-connected caps that fit on a regular pill bottle or systems that replace the traditional pillbox with a dispenser that tracks the opening of the pill compartment or the amount of medication inside the bottle. While these systems represent an advance in preventing medication errors (such as an accidental overdose) and getting patients to adhere to their medication regimens, they are not without flaws. For one thing, most of them require setting up a smartphone app for communication, which makes them challenging for the elderly. Also, users are still faced with needing multiple medication trackers or needing to periodically refill pill compartments on the devices.

In our research and practice of health care for the aging population, we iterate on its design, observing patients as they consume new products to promote their health. We have observed the following requirements for improving the health status of the elderly:

Synchronization. Having multiple medications with different refill dates creates too much complexity. Patients are often tempted to wait until more than one medication needs a refill before returning to the pharmacy. Synchronizing the dispensing process requires taking into account all the various medications that the patient is taking — something that often is not done.

Personalization. Generate labels that are easy to read and understand, with larger, legible type or icons to illustrate dosing and schedules, and explicit instructions that incorporate graphics.
Reminding. Provide reminder cues that have a built-in reinforcement mechanism designed to enhance adherence.

Integration. Create a system around medications, devices, and digital reminders to help keep patients on track and engaged with their care, a system that seamlessly works with their lifestyles.

One system that meets these requirements is PillPack, a service that simplifies medication dispensing. (One of us, José, works for IDEO, the company that helped PillPack design its products, services, and communication. IDEO has a financial stake in the company, but José does not.) Users contact the service to have their prescriptions as well as supplements transferred to PillPack. Then a box with pills packaged in daily packs is delivered to users on a regular schedule. PillPack uses robotic lines to consolidate multiple medications into individual packs labeled by time of the day. It also takes care of refills by contacting prescribers before the last refill.

While PillPack was conceived as a hands-free, convenient service for patients, we think it can also increase adherence and reduce medication errors. Synchronizing the schedule for taking medication and consolidating multiple pills into single discrete packs reduces the chances of intake or dosage errors. Individual packs can be detached and carried outside home by patients according to their needs and can also function as a tangible reminder. PillPack removes most of the friction from the experience of taking medications, including picking up medicines at the pharmacy, contacting prescribers for refills, sorting medications into pill boxes, and managing multiple drug schedules. In addition, PillPack provides a free smartphone app to give users reminders that are triggered by time and location.

PillPack’s ability to consolidate patients’ medications into discrete packs with patient name, room number, and instructions could also help prevent medical errors in the hospital setting.

How do we ensure our elderly population is taking proven medications to alleviate suffering, treat disease, and promote health? By understanding end users and their environments, which is what design thinking is all about. Studying how patients consume their medications is key to generating better health outcomes. Design matters, especially for our aging population.

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Design Thinking Can Help Improve Care for the Elderly

Community Care Licensing "Confounded" by Elder Abuse

Elder rights advocates testified to failures of Community Care Licensing (CCL), a Division of California's Department of Social Services (DSS). Testimony addressed CCL's failure to intervene in crimes against elders, failure to assess penalties for crimes, and failure to report crimes to law enforcement. Crimes disregarded by CCL included sexual assault, battery, false imprisonment, isolation, and financial exploitation.

Department Director Will Lightbourne testified that he was "confounded" by the Department's backlog. Lightbourne is California's highest paid government employee, receiving $343,000 in pay and benefits annually.

Lightbourne was formerly Director of Santa Clara County's Social Services Agency. Santa Clara County's Public Guardian was in the news for abuse of conservatees, some of which occurred during Lightbourne's tenure in Santa Clara County.

Source:
Community Care Licensing "Confounded" by Elder Abuse

See Also:
Investigating the Public Guardian

Ex-Broward judge Watson won't get job back

Former Broward Circuit Judge Laura Watson won't be getting her job back.

Watson, who was removed from office seven months ago, had appealed to the U.S. Supreme Court in a last-ditch effort to hang onto her job, arguing that the proceedings to remove her from office were flawed. Watson was accused of unilaterally negotiating a settlement with an insurance company in 2004 and freezing out fellow attorneys representing the same clients in related actions.

The Florida Bar wanted to act against Watson but waited until after legal action between her and the complaining attorneys was resolved. But soon after the Bar found probable cause to initiate its proceedings in 2012, Watson was elected to the bench.

The Bar cannot discipline judges, so the complaints were turned over to the state's Judicial Qualifications Commission, which eventually found Watson's conduct merited removal from her job.

The Florida Supreme Court forced her out last June.

The U.S. Supreme Court decided Monday not to hear Watson's appeal.

Florida Gov. Rick Scott is considering candidates to replace Watson and another judge, Lynn Rosenthal, who resigned last October rather than face JQC hearings.

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Ex-Broward judge Watson won't get job back

Is taking fees before a judge approves them legal?

The attorney for professional guardian Elizabeth Savitt — the wife of a Palm Beach County circuit judge — claims her client is well within her legal rights to take money out of the accounts of seniors in guardianship without a judge’s prior approval.

But local attorneys who practice elder law — as well as the auditor of guardian cases for the Clerk & Comptroller’s Office — say they’ve never seen another professional guardian take retainers or fees without judicial approval.

Lannis Waters

Attorney Ellen Morris, who often works for Elizabeth Savitt, said, ‘You will not find anything that says guardians need approval to pay their fee.’ (Lannis Waters / The Palm Beach Post)

“I know I’ve never seen that before,” said attorney Michael W. Connors of Juno Beach. “I don’t know what the judge would think about that.”

Savitt is married to Palm Beach County Circuit Judge Martin Colin. Her fees are approved, sometimes after she has taken them from the senior’s account, by Colin’s colleagues who preside over her cases. Savitt’s “wards of the court” are mostly seniors citizens deemed incapacitated because they no longer can care for themselves due to senility or other medical problems.

In three of Savitt’s guardianships, involving Robert Paul Wein, Albert Vassallo Sr. and Lorraine Hilton, family members have complained about her taking tens of thousands of dollars in retainers or fees before a judge approved them.

Florida Statute 744.108 says: “A guardian, or an attorney who has rendered services to the ward or to the guardian on the ward’s behalf, is entitled to a reasonable fee for services rendered and reimbursement for costs incurred on behalf of the ward.”

The judge is the one who determines what’s reasonable, the law states.

Savitt’s attorney Ellen S. Morris, though, cites subsections of the guardianship law. Florida Statute 744.444 (16) says under the heading of “Power of guardian without court approval”: “Pay or reimburse costs incurred and reasonable fees or compensation to persons, including attorneys, employed by the guardian … from the assets of the guardianship estate, subject to obtaining court approval of the annual accounting.”

However, guardians taking their own fee is not mentioned.

Morris said, “You will not find anything that says guardians need approval to pay their fee.”

Connors said he’s never heard of anyone interpreting these sections of guardianship law as meaning a guardian can take fees from a guardianship account before submitting them for determination by a judge.

“That is an overly expansive interpretation,” he said.

Anthony Palmieri is the senior internal auditor of guardianship cases for the clerk. He has reviewed more than 800 cases and, except for the judge’s wife, has never seen a professional guardian take a retainer or fee before a court has had the chance to approve it.

Attorneys in Miami-Dade and Broward counties say it is verboten by their local courts for guardians to take fees without prior court approval.

The Broward County Guardianship Association states on its website: “The court must approve any fee requested for reimbursement of expenses. You should keep good records of time you spend on guardianship matters. The burden is on you to show you are entitled to the fees you request.”

When Morris was asked about this, she responded in an e-mail: “I can’t answer why an association misquotes the law.”

Fellow respected elder law attorney Scott M. Solkoff of Delray Beach said the short answer is that professional guardians shouldn’t be able to take fees without approval. “Laws are subject to interpretation and it is conceivable that a guardian might argue that court approval is not mandated by statute,” he said. “It is also conceivable, in the right case, that a court might not require it, though this would be a big exception and not the rule.”

Paul Auerbach, an elder law attorney from Palm Beach Gardens, said taking a fee before a court approved it is certainly something he would not advise his guardian clients to do.

“A guardian’s fee is to be determined by the court upon of a proper bill presented,” he said. “I feel that a fee before starting would be frowned upon.”

Boca Raton elder law attorney Michelle Hollister sided with Morris’ interpretation, saying there is no direct prohibition on retainers or taking fees beforehand of money from incapcitated seniors in court-ordered guardianships.

Still, Hollister added, “I require my clients to petition for fees and to receive a court order prior to taking fees,” she said.

Full Article & Source:

Is taking fees before a judge approves them legal?

Marti Oakley Guests on "Time Out" With Kevin Gallagher

Part 1:
YouTube: Time Out: Marti Oakley Elder Abuse 2015-11-20



Part 2:
YouTube:  Time Out:  Marti Oakley Elder Abuse 2015-11-20

See Also:
NASGA Victims Page:  Gary E. Harvey
Help Bring Gary Home

Elder Abuse Task Force sends General Assembly eight recommendations

NASHVILLE, TN (WJHL) Tennessee legislators will soon consider eight recommendations aimed at preventing elder abuse and responding to it when it occurs.

The state’s Elder Abuse Task Force signed off on its final report today. Lawmakers created the task force after a 2013 Community Watchdog investigation into the state’s abuse problem.

The recommendations include changing state law, pushing for more education and prevention, requiring background checks for unlicensed home health employees, creating a statewide website to warn of scams and asking the District Attorney General’s Conference to research and suggest possible changes to Tennessee Code Annotated that can help with the prosecution of elder abuse, neglect and exploitation.

“We have a responsibility to try to deal with elder abuse and to try to prevent it,” Elder Abuse Task Force Chairman Jim Shulman said. “Hopefully, with these recommendations and this report, we are taking a major step forward with our efforts.”

The task force will turn in its report to legislators and the governor Friday. Lawmakers will then decide which recommendations, if any, to implement.

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Elder Abuse Task Force sends General Assembly eight recommendations