by Tyra Phipps, Ed. D. (tyra.phipps@gmail.com)

Picture from Candela Law website.

According to Ms. Tara Candela, RN, MSN, JD, of Virginia, “Safe staffing can prevent nursing home abuse and neglect.”  She further explained, “Often, safe staffing discussions focus on nurse staffing.  For the nursing home, this is a mistake.  When we look at the typical problems encountered in nursing home abuse and neglect cases (e.g., bedsores, malnutrition, falls, etc.), we will see that many cases could have been prevented if sufficient staff were available to turn and reposition patients, feed patients nutritiously, and to frequently engage with them.  These activities and interventions do not require skilled nursing experience.  In fact, volunteers could likely be trained to help with basic patient care activities.”  The article titled, Safe Staffing Can Prevent Virginia Nursing Home Abuse and Neglect, is available online at the Candela Law website.

New Jersey struggled with a bill that passed the state Assembly yet needed the governor’s final approval to make changes in long-term care.  The bill requires a nursing assistant quota of one nursing aide for eight patients for the day shift, ten patients for the evening shift and a nursing aide for every sixteen patients on the overnight shift.  A sponsor of the bill reassured constituents that they deserve the comfort of knowing there is a sufficient level of care that also minimizes the chance for neglect and improve the quality of care as reported by Ms. Melissa Small on January 12, 2016.

Mr. Matt Sedensky with the Associated Press, quoted Dr. Charlene Harrington on May 8, 2016, in an article, Nursing Homes Turn to Eviction to Drop Difficult Patients.  Dr. Harrington is a Professor at the University of California San Francisco and her research has focused on nursing homes.  Her studies include low manpower levels in long-term care.  She emphatically states, “These worst homes are allowed to have staffing at dangerously low levels.  If they had staffing at the level that’s recommended they wouldn’t have problems with these patients.”

The Associated Press article from New York reports that nursing homes are increasingly evicting their most challenging residents.  People advocating for the aged and disabled explained that this is testing protections for some of society's most vulnerable. Those targeted for eviction are frequently poor and suffering from dementia, according to residents' allies. They often put-up little fight, their families unsure what to do. Removing them makes room for less labor-intensive and more profitable patients, critics of the tactic say nothing, it can be shattering.

Ms. Allison Hirschel is an Attorney who directs the Michigan Elder Justice Initiative and has dealt with discharges. She states, "It's not just losing their home. It's losing their whole community, it's losing their familiar caregivers, it's losing their roommate, it's losing the people they sit with and have meals with.  It’s completely devastating. "Complaints and lawsuits across the United States point to a spike in evictions even as observers note available records only give a glimpse of the problem. An Associated Press analysis of federal data from the Long-Term Care Ombudsman Program finds complaints about discharges and evictions are up about 57 percent since 2000.  In the same May 8, 2016, Associated Press article, noted that it was the top-reported grievance in 2014, with 11,331 such issues logged by ombudsmen, who work to resolve problems faced by residents of nursing homes, assisted living facilities and other adult-care settings.

The lay term for working the populace of long-term care is cherry picking.  Keeping the patients who are endowed with money, least problematic, and compliant, means less staff and a smaller payroll.  Is the bottom line or profit the only reason for eliminating elderly or disabled that require more time?  Is there a bigger problem with the workforce or lack of qualified people to meet the demands of this growing continual care industry?  Is it a family situation that precipitates legal challenges?  Too often, family members just want to drop off their older, dementia parent, grandparent, aunt, or uncle and expect the staff of a long-term care facility to take care of their so-called, loved one until they die.  Ms. Peggy Krepelka, retired nursing aide with a GNA/CNA license and years of experience stated very bluntly with a somber look on her face June 16, 2016, “Families send their loved ones to these places to die.  People go to nursing homes to die!  When I saw how my mother was being treated at Meadow View, I got her out of there in two weeks and took care of her until the day she died.”

How does an industry meet every need for every special person who enters a facility and becomes a resident or patient?  Industry experts frequently comment that it is virtually impossible to address every need for each person who resides in a long-term care facility and also meet the demands of their family.  The reality is that more and more people who are disabled or aging need long-term care.  Five star rated facilities are few in number, can demand a premium price or daily rate, and the consumer or resident is at the mercy of the management that may be just as vulnerable to buyouts, mergers, and acquisitions.  Golden Living, Mid-Atlantic, Consulate, Brookdale, Genesis, Lifecare and more than 100 other companies are providers of assisted-living and nursing facilities in America.  This is big business with numerous resources and all too often, a cavalier attitude.  

Reasons Why

The following observations and personal stories provide testimony for legal reasons why long-term care may not be the best placement for the population of elderly and disabled people.

Ms. Lori Smetanka, Director of The National Consumer Voice for Quality Long-Term Care concurs.  She wrote about long-term care on April 5, 2016, “...  it is a nasty business.”  Mr. Garth Clark wrote on May 8, 2016, “I am stunned by the total lack of humanity.  I cannot imagine being that heartless.”  Ms. Jackie Bosco added on the same day, “Heartless seems too gentle a word.”  Ms. Lashonda Johnson shared her personal story on May 25, 2016, “I have a grandmother in a home in Baltimore.  Fortunately, my mom and aunt check on her twice a day to make sure she is bathed and fed.  We see many other residents not so fortunate.”  Ms. Sharon Fryer also sent this message on the same day, “My mom has been in a medical facility for Alzheimer’s patients for 6 years.  We have private duty nurses working with her in addition to what she receives medically.  This journey has been gut wrenching for our family.”  Dr. Gerald Thompkins who lost his mother to an untimely death while she stayed in Hooverwood commented on May 29, 2016, “What you are dealing with is criminal and a blatant disregard.  You have to remain encouraged and steadfast.”

Ms. Jean Tyler added on May 30, 2016, “My grandmother passed away at home and, as well, my mother did die in a nursing home with hospice care.  My grandmother suffered with asthma and when in the hospital during the late 40s early 50s, on several occasions we were told by the family doctor that at some point the hospital stopped giving patients nourishment.  We had no choice with my mother because she was released from the hospital but sent to a nursing home on doctor’s order.  Grandmom died at home in the early 1950s in a bedroom which was not air-conditioned, and I am sure if it had been, it would’ve been easier on her breathing and to this day it bothers me that she did not have air conditioning.”

Dr. David Press is a Retired Professor and doctoral graduate of Carnegie-Mellon.  His brother, a pharmacist with a severe back problem was a resident of Montefiore, a Jewish faith-based continual care facility.  During late spring and early summer, Dr. Press told the story of his brother’s treatment.  “My brother was highly educated and noticed right away that even the registered nurses had very poor grammar when he moved to Montefiore.  He also noticed that many people were not medicated correctly and that gave him a great deal of concern.  He registered this concerns in Council meetings but was largely ignored.  He did not get the treatment he expected.”

Very interested in getting the story out, Dr. Press continued in June 2016.  “Here is another incident to add to the list.  My brother is now in a Cleveland Clinic hospital.  He has been in a highly regarded rehab facility near Cleveland, the Montefiore.  My sister in law tells me that Montefiore allowed a bed-sore to develop and deteriorate until it infected.  He was hospitalized for a skin graft.  He returned to Montefiore, suffered cardiac arrest, was resuscitated, and now is back in the hospital in cardiac critical care.  Poorly motivated staff or insufficiently trained staff at Montefiore, in my sister in law’s opinion, are responsible for the bed-sore.

My sister in law says that I shouldn't come because he is on the ventilator and can't talk.  Montefiore is not part of Cleveland clinic.  He wasn't in the Cleveland Clinic system hospital when the bed sores developed, he was in the rehab section of the Montefiore Home, I believe it is called.  I think the large elder care complex with the separate large rehab building may be sponsored by or is a division?  department? of Montefiore, an international Jewish charitable foundation that seems to have been in operation since the 18th century.  Not all beneficiaries/clients there are Jewish, by the way.”

The final correspondence regarding Dr. Press’ brother was sent June 18, 2016.  “I overheard my brother's step-daughter tell the chaplain for Montefiore that there were problems at Montefiore that need to be addressed.  My pharmacist brother evidently irritated his caregivers because he kept catching them making mistakes with his medications.  There were also problems of theft.  For example, I bought him a tablet so he could email or read e-books, etc.  It quickly disappeared.”   They buried his brother on June 21, 2016 in Cleveland.

Mr. Randall Evans, Jr. wrote in a letter on June 9, 2016, of hardships he has in dealing with his mother’s care in North Carolina.  Mr. Evans is a retired firefighter and resident of Florida.  He explained, “The first year the doctor would not cooperate by signing off on required medical forms for North Carolina.  She paid out of pocket for a year.  They finally got enough doctors to sign off for her.  Then they found out that the facility owners did not keep good records of patient’s care and payment and the insurance company wouldn’t pay.  They even gave the insurance company an expired operating license to do business.”

Planning for Change

Ms. Susan Aycock Webb wrote on May 30, 2016, “My husband and I both have advance directives and medical power of attorney who has been given very specific direction as to what we want and don’t want.”

A final comment for this blog post came from Ms. Vicki Silverfeather on May 30, 2016.  She is a personal health care attendant and writes, “I returned home in the early 90s to do my mother’s hospice care.  I have since cared for at least a dozen high level care and hospice patients.  We should all have the right to choose our pathwith as much support as we need.”

Questions for Consideration

1.  Mr. Richard Shapiro, attorney was interviewed May, 2016, on Good Morning America.  He commented on the O.J. Simpson trial on the twentieth anniversary, that there is legal justice and then there is moral justice.  “The jury rendered the decision for legal justice.  Moral justice is another decision.”  Long-term care is not an O.J. Simpson trial, but is moral justice the real case to be made for care of the elderly?

2.  “Silence like a cancer grows...”  Lyrics from the song by Simon and Garfunkel, The Sound of Silence with  an August, 1965, release date resonates now through Disturbed, a heavy metal band out of Chicago.  David Draiman is the vocalist with Disturbed, who has the endorsement of Paul Simon.  Fifty years later August, 2015, is there still a warning about the dangers of silence?  The atrocities of the nursing homes in the 60s and 70s brought about legislation, but did it really help the most vulnerable people who cannot speak up for themselves?  Is out of sight, out of mind an easier way to be silent and deal with the aging population?

3.  Mr. Steve Franklin wrote the book that was published July 1, 2013, Celebrate 100: Centenarians Secrets to Business and Life.   He was interviewed on the NPR program, Growing Bolder, June 26, 2016.  After interviewing a large group of 100+ individuals, it became apparent that attitude is everything to growing old successfully.  People suffering heart attacks, strokes, setbacks in life and struggles of all kinds dealt with their problems by having a good attitude.  They wake up in the morning and say “Good morning, God” instead of, “Oh God, morning.”  Financial planning along with wellness planning and a good attitude are the mix for living to 100.  With staggering numbers of more than half the population in nursing homes and most of those individuals dying in nursing homes, as Mr. Franklin suggests, can attitude make the big difference to maintaining independence?

4.  Dr. Louis Profeta advised on June 10, 2016, “There still are good nursing facilities out there, don’t lose faith...”

June, 2016