500,000 People Die Every Year from Infections Caught in Long-Term Care Facilities

Despite longer live spans, almost half a million people die of healthcare-associated infections (HAIs) each year, many of them preventable.

The decision to move a loved one into a long-term care facility is difficult. Besides worry about how an elderly loved one will adjust, there are concerns about care, potential abuse, and infection.

The graying of America is creating a large-scale reshuffle in how Americans handle healthcare at older ages.

A recent report suggests a decrease in the number of nursing home facilities, with an attendant increase in home care services and assisted living facilities. Baby Boomers, in better health than their predecessors, are pushing for a better quality of life — and better healthcare — than is typically conjured by the term "nursing home." As well, continuing dramatic swings in federal healthcare policies are resetting reimbursement policies for which long-term healthcare facilities have long made a profit.

The economics and demographics of long-term health care impact the service provided to one of the most vulnerable sectors in America — the elderly. A recent presentation delivered at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC) laid out stark facts about some of the nation's 15,654 nursing facilities.

Assisted living facilities are residential communities that provide limited nursing or supportive care. Nursing homes are medical care facilities that also provide housing. In some areas, there are many complexes that have areas for assisted living, with the capability of moving into nursing facilities when the need arises.

Poor Practices Lead to Higher Rates of Deadly Infection

In a press release discussing the research, APIC shared sobering facts about life in long-term healthcare facilities. Over 1.4 million people live in a nursing home in the United States. Despite rules for infection control and requirements for antimicrobial stewardship programs, many nursing facilities just don't measure up.

The results in the presentation were from assessments of 43 long-term healthcare facilities in Tennessee and Washington by public health officials. They were looking to gain an understanding of how regulatory tools and assessment practices are applied. The results are not pretty.

Tennessee: In the state of Tennessee, healthcare officials used an assessment tool developed by the Centers for Medicare and Medicaid Services (CMS) to survey infection prevention protocols in long-term care facilities.

• Between January and November 26, 23 assessments were conducted throughout the state. These surveys looked for adherence to the criteria mentioned in the CMS tool.
• In Tennessee nursing homes, an average of only 12.5 total staff hours were spent on prevention of infection per week.
• The officials found 72% of facilities offered online training for hand hygiene, but only 50% offered in-person feedback on performance.
• Similarly, although 62% of facilities offered online training on the use of personal protective equipment (PPE), approximately 50% never checked how the staff was using the PPE.
• On requirements for antibiotic stewardship programs, nine out of ten facilities were out of compliance.

Washington: in the 20 assessments performed in Washington state, the statistics were sadly somewhat similar:

• Although all the facilities had the required infection prevention professionals on staff, only 10% of the infection prevention specialists had training in infection prevention or control.
• These staff members spent only 11 hours per week on infection prevention, and many had little experience, and operated with "limited guidance."
• Of these facilities, while 75% had infection control policies in place, only 40% reviewed their policies on an annual basis.
• Only 15–30% of these nursing homes engaged in ongoing assessment of feedback process to improve best practices.

In the press notice, study researcher, Dorothy MacEachern, an infection preventionist with the Spokane Regional Health District, noted: "Our analysis identified clear gaps in infection prevention practices and the urgent need to improve infection control infrastructure in long-term care facilities."

The Danger of HAIs and the Elderly

Choosing the right long-term healthcare facility can be a matter of life and death. In grades assigned by a non-profit group, unrelated to the study and based on federal statistics, Tennessee got a "D," for nursing care, and Washington a "C."

Besides the very young, the elderly are a group susceptible to frequent and serious infection. Often, older adults are already suffering from a chronic ailment like diabetes, heart disease, or respiratory problems. These issues put them at greater risk for infection in a facility without good disease prevention protocols.

HAIs contracted in a long-term care facility can become chronic, and even deadly. Infections common to healthcare facilities include:

• Methicillin-resistant Staphylococcus aureus (MRSA): A multi-drug resistant staph infection, MRSA is more prevalent in nursing facilities and hospitals. The infection can be intractable, causing chronic infection, or death.
• Clostridium difficile (C. diff): This chronic and often deadly diarrheal infection can quickly kill an elderly patient. Triggered by antibiotics wiping out the body's natural gut bacteria populations, C. diff is difficult to treat once established. The infection causes about half a million HAIs per year in the US.
• Urinary tract infections: UTIs are a common HAI, and are contracted in healthcare settings by patients who require a urinary catheter. According to the Centers for Disease Control and Prevention, between 15–20% of patients receive a catheter during hospitalization. These infections also occur in residents of nursing homes with catheters.

Despite population trends toward longer life, patients residing in some long-term health care facilities in the US may have life cut short by preventable healthcare-associated infections.

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500,000 People Die Every Year from Infections Caught in Long-Term Care Facilities

Gulf Breeze attorney sanctioned for embezzlement, money laundering

A Gulf Breeze attorney has been effectively disbarred in connection with federal charges of embezzlement, money laundering and fraud, according to a news release from the Florida Bar.

Richard Micheal Colbert, received a disciplinary revocationwithout leave to seek readmission, effective immediately, following a May 11 court order, the release said. The release notes, "disciplinary revocation without leave to reapply is tantamount to permanent disbarment."

Colbert was admitted to practice in 1987, according to the release.

Last year, Colbert pleaded guilty in court to 13 federal felonies including theft, embezzlement and misappropriation of bank funds, money laundering, bank and mail fraud and false statements to a financial institution.

The charges stem from Colbert's conduct while he was the manager of Beach Title Services, a subsidiary of Beach Community Bank, according to a news release from the U.S. Department of Justice. Colbert reportedly signed and submitted false documents to Bank of America and Beach Community Bank. He also embezzled and misapplied funds being held at Beach Community Bank, then conducted a series of financial transactions to launder the funds he had embezzled, according to the release.

Colbert is still awaiting sentencing in connection with the charges, according to court records. The DOJ release says Colbert faces a maximum of 30 years in prison for each of the conspiracy, false statement, and theft/embezzlement/misapplication of funds charges. For each of the money laundering charges, Colbert faces a maximum of 10 years in prison.

The sentencing hearing is currently scheduled for 1 p.m. July 17.

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Gulf Breeze attorney sanctioned for embezzlement, money laundering

NHS Tayside patient’s five-and-a-half-year wait for discharge from hospital

New figures have revealed that one NHS Tayside patient waited five-and-a-half years in hospital after being declared fit for discharge.

A Tele investigation shows one patient’s discharge was delayed for 2,017 days due to “complex arrangements to live at home” needing to be carried out.

Another two patients were kept in hospital for the same reason for three-and-a-half years and just under three years respectively.

In Dundee, two patients needed to wait 615 days while arrangements were made for them to live at home and another waited a total of 444 days. In Angus, one patient had to wait 343 days for a specialist facility to be found.

Another three patients were held up in hospital while guardianship was established, with the trio spending 289, 279 and 194 days respectively waiting to be discharged after being declared medically fit.

John McAllion, executive for Dundee and Scotland Pensioners Forums, said more funding was required to provide the services necessary to allow patients to be cared for in the community.

He said: “The theory behind the new system is to reduce the number of beds in hospitals and increase the number of people being cared for in the community so that they can be discharged.

“The theory behind their policy is fine and I don’t think anyone would disagree with the idea that people who don’t need to be in hospital should be brought back into the community.”

Mr McAllion said the health board was on the brink of a “crisis”.

He added: “We will probably end up in a situation where there are not enough beds to meet he demand of people who need to be in hospital.

“Taxes will need to rise to pay for things if public services, like the NHS, are to cope with the demand that is being placed upon them.”

Age Concern Dundee’s senior manager Patrick Delargy said that resources and funding were meaning that care packages were not in place in time for people to transition from hospital into the community.

He added: “The central issue that we hear about is how does the resources get to the person at the time when they need it, when they need to get out of hospital.”

People have also experienced standard delayed discharges — ranging from 89 to 233 days.

The longest wait was for a patient in Perth and Kinross who waited 233 days for an assessment.

Another waited 168 days for specialist housing provision.

In mental health services around the region, 20 people saw their discharges delayed.

There was 13 men and seven female patients delayed in Carseview Centre, Kingsway Care Centre, Murray Royal Hospital, Royal Victoria Hospital, Strathmartine Hospital and Whitehills Health and Community Care Centre.

An NHS Tayside spokeswoman said: “NHS Tayside has been working very closely with the three health and social care partnerships and third sector partners in Angus, Dundee and Perth and Kinross to build sustainable solutions that seek to reduce unscheduled care and demand and avoid unnecessary delays in discharging patients from hospital.

“We are also expanding our enhanced community support model of services that cares for people in their home settings, helps avoid unnecessary hospital admissions and ensures patient discharge from hospital is not delayed.”

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NHS Tayside patient’s five-and-a-half-year wait for discharge from hospital

Who’s guarding the guardians? Court oversight didn’t stop trust account looting

Attorneys on June 21 rushed to remove Desert State Life Management trust company as conservator for a 65-year-old developmentally disabled woman living in Albuquerque.

But, a new lawsuit alleges, the looting of a $600,000 trust fund she and three other disabled women relied upon to live had already happened.

What makes the case of J.W., as she is referred to in the lawsuit, different from other tragic client stories that have come to light is that Desert State Life Management, in addition to being J.W.’s trustee, also was appointed by a state district judge to act as conservator to help manage her finances.

That court appointment in 2014 added – or should have added – another layer of oversight.

Desert State already was subject to review by the state Financial Institutions Division as a nonprofit trustee company certified to invest and manage client funds.

In its additional role as court-appointed conservator with broader powers, Desert State also was required by law to submit an annual report and financial accounting to the judge.

Publicly available docket sheets on J.W.’s conservator case show Desert State filed annual reports in 2015 and 2016 with state District Judge Valerie Huling of Albuquerque.

But an attorney for J.W. says neither report showed how much remained in J.W.’s Desert State trust account, although each of the annual reports included notes stating that accountings were attached.

“But they weren’t attached,” said Kelly Stout Sanchez, an attorney for J.W., on Friday. “There was no accounting.”

Stout Sanchez said she isn’t blaming the judge or court administration and doesn’t know where the accountings went, if they were filed at all.

Guardianship/conservatorship case files are kept secret from the public by law, but J.W.’s new attorneys were able to obtain them.

“At this point we have what’s in the court file. Unfortunately, the conservator reports did not clear anything up. It just gave us more questions and concerns about what’s going on,” Stout Sanchez said.

A Bernalillo County District court spokeswoman said Friday she couldn’t comment about the annual reports, citing the confidentiality law. The Code of Judicial Conduct in New Mexico bars judges from commenting about pending cases.

Since the financial loss, J.W. and “those responsible for her care, have been unable to pay the bills at her assisted care facility and all other bills for her daily necessary living expenses,” states a lawsuit filed against Desert State by Stout Sanchez and her law partner Michael Hart on June 28.

“Specifically, Defendants (Desert State and others) billed for services and work as though the services were professional and in the best interests of J.W. when in fact professional services were not performed competently or not performed at all, and upon information and belief, misspent and embezzled J.W.’s funds.”

Huling appointed Desert State as conservator without requiring the company post a bond. A check of other such cases shows judges typically don’t require such bonds to ensure performance of conservators.

Huling appointed attorney Charles Reynolds as J.W.’s new conservator on June 27. Because of her disabilities, J.W. also has a court-appointed guardian.

Her lawsuit is among the latest developments in the legal saga of Desert State. State regulators say a recent financial examination showed more than $4 million missing from client trust funds. The nonprofit trust company was subject to annual examinations by the state Financial Institutions Division, but Desert State hadn’t been examined since 2008.

State and federal court records allege Desert State CEO Paul Donisthorpe began moving client trust funds into his own personal bank accounts and companies beginning in 2013.

FID is currently seeking court approval to assume receivership of the company and wind down operations.

J.W. and her sister were among four disabled women who were beneficiaries of a special needs trust set up by a Sandia Laboratory engineer who died in 2008.

Wilkerson M. Howard, a U.S. Army veteran of World War II, adopted the sisters when they were girls and set aside funds for their long-term care and for the other two beneficiaries.

The trust fund amounted to about $600,000 when Desert State assumed trusteeship in 2013, according to J.W’s lawsuit. Now the FID has advised “there’s almost no assets left with Desert State,” attorney Stout Sanchez said last week.

The lawsuit names Donisthorpe, his recently divorced wife, Liane Kerr, Desert State director Helen Bennett and Donisthorpe’s four other business ventures as defendants.

Bennett, who served as a volunteer board member, has been assisting authorities in their investigation, and contends in court records that she had no access to or control over trust funds.

At the time of the FID examination that began in March, only Donisthorpe and Bennett remained on the board of the nonprofit trust company.

Previously, under different management, Desert State specialized in providing guardianship and conservatorship services for special needs clients like J.W.

Donisthorpe, who reportedly suffered brain damage in February after a suicide attempt, is no longer operating the company, located in Downtown Albuquerque.

A state FID attorney said last week it is unclear where Donisthorpe is living. Meanwhile, the U.S. Attorney’s Office, contending in a court document that Donisthorpe defrauded trust clients through a criminal scheme, is seeking forfeiture of three of Donisthorpe’s properties, in Albuquerque and Angel Fire.

Attorney Stout Sanchez said on Friday that J.W.’s lawsuit is an attempt to recover as “much money as possible from what was in the trust.”

And what will happen to J.W. and the other beneficiaries?

“That,” she said, “is the concern.”

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Who’s guarding the guardians? Court oversight didn’t stop trust account looting

See Also:
FBI joins probe of trust company accused of taking clients’ funds

Panel fields input on adult guardianship system, plans Santa Fe meeting Friday

A commission tasked with studying the state’s guardianship system for adults who lack the capacity to make decisions about their own care and financial management has been gathering public input from around the state on how courts can improve the way they handle these sensitive cases.

A legal guardianship — usually for an elderly person, or a person with mental illness or a developmental disability — removes some of a person’s rights and often involves family disputes.

State Sen. Gerald Ortiz y Pino D-Albuquerque, one member of the commission, said the panel has heard about several frustrations that family members and others face while trying to navigate the guardianship system. One of the main issues raised so far, he said, is that confidentiality in the cases — aimed at protecting the privacy of people with guardians — makes it difficult for family members to get information about how a case is proceeding or the care of a loved one.

The 16-member New Mexico Adult Guardianship Study Commission, appointed in April, will hold a public meeting Friday in Santa Fe — its fourth in the state but its first in the city — to collect comments from local people on how to overhaul the system.

The commission is scheduled to give an initial report to the state Supreme Court in October.

Ortiz y Pino said some of the concerns raised about the guardianship system involve procedural barriers and delays. For instance, he said, court-appointed guardians are required to file annual reports disclosing fees and other information, but the court does not have a system in place for ensuring the reports are filed and that the information in them is accurate.

And, he said, hospital representatives in Alamogordo told the panel that when they petition the court to appoint a legal guardian for a patient who cannot make medical or financial decisions, it can take up to two months for a hearing to be set.

The commission also will examine the use of mediation to try to solve some issues before a case goes to court, Ortiz y Pino said.

Right now, he said, mediation is optional, not mandatory.

Commission members Tim Gardner, president of the nonprofit advocacy group Disability Rights New Mexico, said his organization opposes guardianship petitions on behalf of people with disabilities who don’t want to give up all of their decision-making power and still have the ability to make some decisions for themselves.

For example, he said, some people are able to make decisions about health care or housing, but not financial management.

Other people, he said, might be mentally capable of making decisions for themselves, but don’t have the communication skills to voice their wishes.

“So they get put into guardianships that seem inappropriate,” Gardner said.

He proposes examining new approaches to guardianship petitions that give people involved more say and creating a system that allows for limited guardianships, which would provide safeguards but also protect a person’s independence, he said.

“Not to say we don’t think there is a role for guardianships,” Gardner said. “But we have found there are many cases of folks put into guardianship petition where there could be less invasive alternatives put into place.”

Patricia Galindo, a staff attorney for the state Administrative Office of the Courts and vice chairwoman of the commission, said the state has made changes to the way guardianship cases are tracked.

Officials hope to examine the first full year of data available under the new system at Friday’s meeting, scheduled from 8:30 a.m. to 4 p.m. in Room 317 at the Capitol.

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Panel fields input on adult guardianship system, plans Santa Fe meeting Friday

Jim Flynn: Help for seniors in danger of exploitation

Jim Flynn

Although senior citizen status has its advantages ($1 fishing licenses, for example), most people would agree they are outweighed by the disadvantages.

One disadvantage is susceptibility to financial exploitation. A case recently decided by the Colorado Court of Appeals reminds us that elder financial exploitation is on the rise, in part, because of a growing elderly population.

In the Court of Appeals case, Angela Dominguez, a caregiver for an elderly man, Arlen Owens, managed to get herself named as the pay-on-death beneficiary on three of Arlen's bank accounts that totaled more than $100,000.

After Arlen's death, these pay-on-death designations were challenged by Arlen's brother and, after a trial, a judge ruled that Dominguez indeed used "undue influence" to add herself to these accounts. The judge ordered the funds be returned to Arlen's estate, and he tried to keep the horse in the barn with a legal device called a constructive trust - essentially, the court taking control of the accounts.
But this was apparently too little, too late, and Dominguez pocketed the money. When she couldn't - or wouldn't - return the money, the judge slapped her with a contempt citation and sentenced her to six months in jail.

"Undue influence," as you might expect, is a squishy legal concept. Under the Colorado Criminal Code, at least, it's defined as "the use of influence to take advantage of an at-risk person's vulnerable state of mind, neediness, pain or emotional distress." Undue influence along with incapacity are the two main tools in the toolbox of someone wanting to challenge a will.

Per the Court of Appeals decision in the Owens case, these same tools are available to challenge nonprobate transfers.

There are lots of these around, in addition to pay-on-death designations on bank and brokerage accounts. Included are beneficiary designations on life insurance policies and retirement accounts; beneficiary deeds, which allow for the nonprobate transfer at death of real property; and, newest on the list, a nonprobate transfer on death procedure for motor vehicles.

Although Dominguez's jail sentence came out of a contempt citation in a civil probate case, elder financial exploitation - and other kinds of abuse of at-risk individuals - is a crime. In fact, an entire article in the Colorado Criminal Code deals, in great detail, with crimes against individuals who are vulnerable to exploitation and abuse because of age, mental or physical impairments, or both. This portion of the Criminal Code begins with a legislative declaration that penalties for crimes against at-risk persons should be more severe than crimes against the rest of society.

In addition to bulking up the Criminal Code to deal with the exploitation and abuse of at-risk individuals, the Colorado General Assembly also has imposed a mandatory reporting obligation on people involved in health care, law enforcement, fire protection, social work, banking, government services and just about everyone else who comes in contact with elders.

If someone covered by this obligation observes exploitation of an at-risk elder, or has reasonable cause to believe an at-risk elder has been exploited or is at risk of being exploited, the matter must be reported to a law enforcement agency within 24 hours. For purposes of this reporting requirement, an at-risk elder is anyone 70 or older, regardless of physical or mental condition.

A willful failure to report is a Class 3 misdemeanor. Once a report is filed, law enforcement and county social services agencies are supposed to go into action to investigate and protect the victim.

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Jim Flynn: Help for seniors in danger of exploitation

Marti Oakley to Moderate Panel at the Annual Whistleblower Summit

Every year, whistleblowers involved in many different human rights issues gather at the annual Whistleblower Summit in Washington, DC. It's a huge event and is expected to be even bigger this year.

This year, for the first time, guardianship abuse will be included as a summit topic of the Judicial Integrity Panel. Marti Oakley will be moderating a panel consisting of Danny Tate (NASGA Legislative Liaison), Jean Kasem (personal experience) , and Brian Kinter (Judicial Accountability Movement activist).

For those who don't know Marti, she has been devoted to this cause for seven years, after interviewing NASGA member Sara Harvey (wife of victim Gary Harvey) on her radio show (T.S. Radio) and then not being able to sleep after that interview. Over the years, her show has given victims a platform to tell their stories and to discuss reform and remedies. Those who never had a voice before were given a voice on Marti's show.

She has given of her time unselfishly, researching cases, interviewing potential guests ahead of her show, and following up with guests after the show is over. She was the first person to take on this issue on the radio and her particular style has earned her a growing audience that has become a force in this movement.

And she does it all for free, because she cares about guardianship abuse and those who are suffering because of it, and she wants to fix the problem. She is the very definition of an advocate/activist and she is an inspiration for those who are afraid to stand up when standing up is essential. It is more than fitting that she be honored by being selected as a moderator of this important forum.

The Whistleblower Summit is July 27th and 28th and the public is welcome to attend!

CLICK HERE for more information on The Whistleblower Summit

Newbury Park nursing home pays in class-action settlement

A highly-rated Catholic nursing home in Newbury Park has agreed to pay $345,000 and will undergo spot inspections of health records in the settlement of a class-action lawsuit alleging patients were being given powerful drugs without required consent.

The long-awaited settlement was approved by Ventura County Superior Court Judge Rocky Baio in May and involves the nonprofit Mary Health of the Sick Convalescent and Nursing Hospital and family members of former residents of the facility. It calls for the nursing home to use procedures to ensure doctors explain the benefits and risks of psychotherapeutic drugs to residents or their legal representatives.

Those discussions encompass drugs that carry black box warnings of extreme side effects and increased death risks for patients with dementia.

"I'm an only child and my dad was the whole world. I trusted them with his life," said Melisse Sullivan of Thousand Oaks, alleging her father was prescribed black box drugs at Mary Health of the Sick without her informed consent. "I just want them to be held accountable. I just don't want it to happen to anyone else. That's my point."

Representatives of the nursing home — run by nuns from the Servants of Mary, Ministers of the Sick, who live on the premises — denied all allegations of wrongdoing as part of the settlement. They said they agreed to the settlement to avoid the costs, risks and distraction of continuing a legal fight that started nearly five years ago.

"Anyone can say anything they want in a complaint," said Dawn Phleger, a San Diego lawyer who said the decision to settle was aimed at allowing the sisters to focus their resources on care, not litigation.

"The sisters had a really good reputation in the community and we wanted to make sure they were able to keep that reputation going," she said. The nursing home has a five out of five stars rating from the federal agency that runs Medicare and Medicaid.

Plaintiffs say the high rating attracted them. But they alleged doctors at the nursing home prescribed powerful drugs without discussing the impact of the drugs to residents, family members or people with power of attorney designations.  (Click to Continue)

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Newbury Park nursing home pays in class-action settlement

North Carolina Lawyer Convicted of Embezzlement From Clients

WINSTON-SALEM, N.C. (AP) — A disbarred lawyer who had offices in three major North Carolina cities has pleaded guilty to charges that he embezzled about $100,000 from clients.

The Winston-Salem Journal reported that 47-year-old Devin Ferree Thomas of Charlotte entered the plea I nWinston-Salem on Monday to six counts of embezzlement.

Thomas had been a personal injury lawyer with offices in Winston-Salem, Greensboro and Raleigh.
Forsyth Superior Court Judge David Hall ruled that Thomas must serve 10 days in jail, as well as 50 hours of community service and five years of supervised probation.

Thomas has paid $100,000 in restitution to the North Carolina State Bar, which distributed the money to those from whom Thomas took the money.

He is also subject to random drug tests and searches and seizures without a warrant.

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North Carolina Lawyer Convicted of Embezzlement From Clients