Insight into Nursing Home Abuse and Neglect

Recent news of a local, Kansas nursing home employee raping a 86-year-old resident reminds us how often nursing home abuse happens. It is important to recognize and understand the warning signs. Common signs of abuse can be classified into two categories: emotional and physical. Being aware of your loved one’s emotional and physical status is important and can help you determine whether they are exhibiting any of the following signs of abuse:

Emotional signs of nursing home abuse:

Mood swings and emotional outbursts

Reclusiveness or refusal to speak

Refusal to take medications or eat

Unusual or sudden changes in behavior (fear of being touched, sucking, biting and rocking)

Poor physical appearance or lack of cleanliness

Physical signs of nursing home abuse:

Bed sores

Bruising, cuts or welts

Broken bones or fractures

Falls

Head injuries

Unexplained weight loss or weight gain (signs of malnutrition)

Dehydration

Frequent infections

Unexplained illness or infections

When you notice these changes in your loved one, the first step should be to contact the nursing staff to understand the problems. However, if you find it is difficult to get into contact with staff at the nursing facility, this can also be a sign of a problem. Lack of staff support is a common underlying cause of inadequate care. If it is clear that you have spotted signs of abuse, don’t hesitate to intervene. This may include making a hotline complaint to the licensing agency in the state. Contact an attorney and they will assist you by listening to your problems, looking at the facts, and advising you on the best decisions.

One of the hardest hit and most at risk age demographics for Coronavirus of COVID-19 are people over 60. A segment of our population that is already vulnerable has become even more so due to this pandemic. Our elders in nursing homes and assisted living facilities are a major source concern. This concern was heightened even more by outbreaks in homes, like the one in Washington, where U.S. spread began.

Nursing home, skilled nursing facilities and assisted living centers have been on lockdown since March 13, when Coronavirus was declared a worldwide pandemic. While this ban was beyond necessary, it has led numerous people and agencies to further question these facilities capabilities to keep its residents safe.

Many of these facilities have long struggled with inadequate staffing, difficulty providing the level of care needed and having the appropriate medical support. What are these facilities doing to combat the Coronavirus? What should you be looking for? What can we learn from all of this to be ensure the health and safety of our loved ones?

The Facts

Let’s begin by reviewing the facts when it comes to the impact of the Coronavirus on people over 60.

• Symptoms – they are the same for people of all ages – fever, cough, shortness of breath.
• Why is it impacting the elderly more – simply put, they have weakened immune systems. Many also have underlying health conditions that make them not as strong to combat this infectious disease. In Europe, 80 percent of those who have died have had an underlying medical condition, particularly cardiovascular diseases, hypertension and diabetes.
• Death Rate – In the United States, eight out of 10 deaths are those 65+ years old. According to the CDC, of those that contracted COVID-19:
  • 31-70% of those 85+ and 31-59% of those 65-84 – have required hospitalization
  • 10-27% of adults 85+ and 4-11% of those 65-84 – have died.
• Number of Nursing Homes Impacted – Since the first case in Washington, the Centers for Medicare & Medicaid Services (CMS) and CDC have found at least 400 nursing facilities have a positive COVID-19 Case.

How are Nursing Homes Responding?

Since the first major outbreak in Washington where two-thirds of the entire home tested positive for Coronavirus and at least 37 have died, the government has updated its guidance for nursing homes. These include:

• No outside visitors.
• Restriction on all volunteers and non-essential employees.
• All group activities canceled and common areas closed.
• Active screening of residents and staff for fever and respiratory symptoms.

Similar to the social distancing measures we are seeing across the country, these measures are helping, but the spread is still occurring.

According to a recent The Hill article, “Controlling the spread of infectious diseases has long been a problem at nursing homes. Advocates say a combination of factors created a perfect storm for outbreaks of COVID-19 at these facilities. About 75 percent of nursing homes are understaffed, forcing employees to juggle multiple patients and making it harder to follow proper infection control protocol.”

Nursing homes and skilled nursing facilities are facing similar medical and personal protective equipment shortages as the medical community as a whole. Like so many places throughout the country, they need more tests as well. How well these homes are handling this virus can be attributed to their performance and safety ahead of the virus hitting.

The Example: Life Care Center

There are more than 200 Life Care Center facilities in 28 states. Its Kirkland location was the epicenter of the U.S. outbreak. Since then several more of its facilities have COVID-19 positive cases, including homes in Kansas and Missouri.

When you look at the Kirkland home’s response, many missteps were taken. The first being it was supposed to alert the Public Health Department of any suspected or confirmed influenza within 24 hours. Documents show they had concerns starting on February 10, but didn’t report this until February 26. By then, the virus had already spread.

This coupled along with other severe issues have been found in subsequent days by the CMS, leading the government to warn the home of a $611,000 fine if it does not correct course.

On March 13, the first person in Kansas died of COVID-19. He has a man in his 70’s who lived at the Life Care Center of Kansas City. This facility was listed as “much below average” on the Medicare.gov’s. According to research by The Kansas City Star, “ the Wyandotte County facility received 18 health deficiencies as a result of an Aug. 22 inspection, more than double the average for both the U.S. and Kansas.”

Life Care Centers has seen spikes at two other facilities, another one in Kansas and one in Missouri. At its Burlington location, a 90-year-old resident has died. Currently, 11 patients and seven workers have also texted positive. In its St. Louis home, six cases have been confirmed including four residents and two staff.

Life Care Centers are far from the only facilities dealing with this virus. In our own backyard, new clusters of cases are constantly popping at nursing homes. Riverbend Acute Care Center has had four deaths, and 33 residents and four staff members test positive.

While no one could have predicted the Coronavirus, seeing how these nursing home and assisted living facilities responded to it reminds us of the importance of doing your research prior to selecting a home for your loved one.

Picking the Right Home, What to Look For

When looking for a nursing home or assisted living facility for your loved one, clearly you have to look at location and what type of care they need first. Once you have that narrowed down, the next most important step is doing your research on those facilities.

One of the best resources is Medicare.gov. This website allows you to search for homes within your desired area and provides you with overall ratings on these homes’ health inspections, staffing and quality measures.

In addition, look at online review sites and discussion boards. How are these places ranking on social media channels and what are people saying about them? The more stars and positive reviews, the better, especially after this current pandemic.

Once you have this part of the research done, consult a lawyer, like Dollar, Burns & Becker, who specializes in nursing home abuse and neglect cases. We can research any public suits or litigation brought against those places. We know the substandard homes and can steer you in the right direction to avoid these places.

Finally, once this pandemic has passed, and it safe to visit each other and nursing homes, go visit the facility. Talk to staff, residents and their families about what it is like there, and what it was like during the Coronavirus spread.

All of this should paint a solid picture of how that facility handles day-to-day as well as crisis.

If this pandemic has taught us anything, it is how much life matters. When it comes to picking a new home for your loved one, you can never be too careful. Let this pandemic serve as your reminder.

For most of our clients, reaching a settlement isn’t just about money; our clients aren’t filing lawsuits merely to recoup compensable losses. Instead, they file suit to hold wrongdoers accountable and to prevent others from having to bury their loved ones or wake up every day to a life that is forever changed. We understand that our clients aren’t only seeking reparations – they seek necessary change.

In some cases, our settlements include specific safety and administrative requirements for a particular care facility. For instance, we might require that a company pay to have a comprehensive care standards audit performed on its facility by an independent party. We have also required facilities to hire a consultant to make ongoing safety recommendations.

Obviously, settlement is not always the answer; some cases simply have to go to trial, and trials yield their own kind of accountability, as well as pressure for change and improvement. Regardless of the facts of your case, or the manner in which your legal matter may best be resolved, we are committed to ensure that full and fair compensation is paid, accountability is had, change is made, and future wrongdoing is deterred.

It’s important to pay attention to the language of a settlement in these cases. The terminology of settlement agreements can be confusing. Some include confidentiality or indemnification clauses or exclude factoring fees and other expenses. Our experienced team is well versed in these terms and will advocate for you and your loved one.

Nursing home safety awareness, more effective regulations, regulatory compliance and enforcement, and ensuring full and fair compensation for victims and their families are causes in which we are actively involved, and to which we are fully dedicated. Dollar, Burns, Becker & Hershewe is a law firm where clients can expect more than a fair verdict or settlement; they can expect a team dedicated to helping them make a difference.

No one expects you to know the important next steps if you or a loved one has been abused by a nursing home. It’s called the “unthinkable” because none of us thinks this kind of tragedy could happen to us. Nobody is ever prepared for this sort of life-changing event.

That’s why it’s crucial you seek expert legal counsel as soon as possible after abuse. Immediate investigation and making sure critical evidence is neither disturbed nor destroyed are extremely important, because time-sensitive physical evidence, records from the facility’s database and any electronic footage or correspondence are often critical components of your case. An attorney can also ease your burden by working directly with police agencies and insurance companies for you.

It doesn’t matter where you’re from or where the abuse happened; we help victims all over the country and can meet with you in person to discuss your situation, and begin assisting you as soon as we are contacted.

Let us be your voice.

The time immediately following the discovery of abuse can be difficult, confusing and overwhelming. Insurance and legal representatives and police will likely want to question you. Not all victims want to tell their story or relive what happened. Whether it happened to you or a loved one, you’re likely shaken up, traumatized or even in shock. If the victim has been hospitalized, they could be taking medication that impairs their thinking and ability to communicate. It’s not the best time to answer probing questions.

In a serious incident involving a large facility, immediate steps are often taken with the intent of reducing the facility’s liability. Even if you are represented by counsel, you still may be contacted directly. Any calls of that nature should be directed to your attorneys. When they talk to an attorney experienced in neglect and abuse cases, they know right away you won’t accept anything less than fair and just compensation for abuse, which, in addition to money damages, also often includes requirements for the facility to incorporate new safety policies, safety audits, background checks, or an overhaul of the company’s abuse prevention protocols.

I’m worried I can’t afford a strong legal team.

You needn’t worry about expense. Dollar, Burns, Becker & Hershewe works on a contingency basis only, which simply means you are not charged for the hours we spend on your case. Instead, we are paid a percentage of the compensation we secure for you.

Our track record in this very specialized field is well-documented. Make sure the legal team you decide to work with is well-qualified to represent you. For a free initial conversation, just give us a call. Our toll-free number is 877-816-2600.

When it matters most, we’re with you all the way.

More than 3 million elderly Americans currently reside in nursing homes or utilize nursing home services, and this number is expected to grow as the baby boomer generation ages. As the population shifts and expands, we hope to see more attention paid to an issue that affects millions of people: nursing home abuse and neglect. For many, this has already become a concern. If you suspect your loved one or a resident is being abused or neglected, there are steps you can take to open an investigation and get them the help they deserve.

Signs of Abuse

According to the U.S. Department of Health and Human Services’ Administration on Aging, the most important step you can take to prevent elder abuse is to stay involved in your loved one’s life. This way, you’re able to monitor them for signs of abuse or negative changes. Some signs of abuse or neglect include:

Bruising, cuts or abrasions that are not easily explained.

A noticeable change in personality, such as withdrawing from activities, or unusual depression.

Sudden changes in overall health or well-being. Indicators typically include weight loss or hygiene changes.

A shift in normal relationships. For instance, your loved one refuses to speak to a caregiver or quits communicating with companions.

Reaching Out

If you suspect abuse or neglect, consider changing the routine of your visits. Try showing up at a different time of day and you may witness a very different environment than what you are used to seeing.

It is important to know there are state and local resources and organizations dedicated to preventing and stopping elder abuse.

Kansas Elder Abuse Hotline: 1-800-842-0078 or click here.

Missouri Elder Abuse Hotline: 1-800-392-0210 or click here.

Illinois Elder Abuse Hotline: 1-866-800-1409 or click here.

If you have questions or concerns and need to take the next step in protecting your loved one, don’t hesitate to contact me. Taking legal action is a significant but often necessary step in keeping loved ones safe and preventing abuse.

For more information and to learn more about signs of elder abuse, visit the National Center on Elder Abuse website.

By Dollar, Burns, Becker & Hershewe

In February 2015, the Centers for Medicare & Medicaid Services (CMS) implemented changes to the nursing home rating system. The five star rating system sets the bar for nearly 16,000 nursing homes across the country. Families rely on the system as they choose the best facility for the care of their loved ones. Criteria include the processing and analysis of standards of care regarding performance on quality measures, staffing levels and health inspection results.

Recent reforms to the system were made in light of a growing number of five-star ratings that didn’t match up to patient outcomes. The old ratings were often self-reported by the nursing homes and easily skewed. According to a New York Times article, about “80 percent of the nation’s nursing homes received a four- or five-star rating on their quality measures score (before the changes); afterward, nearly half did.” As a result, staffing scores decreased significantly with the new changes to the system.

Per CMS, a few of the main changes to nursing home star ratings involved:

• Improved calculation and verification of staffing levels. We find that staffing is a strong indicator of quality levels in nursing homes and certainly tied to a family’s peace of mind.

• Raised standards for achieving higher ratings on the quality measure dimension on the Nursing Home Compare website.

The administration of antipsychotic medications in relation to diagnoses that do not warrant use. Two quality measures regarding antipsychotics for short-stay and long-stay patients will now be configured into the quality measures star rating.

If you, a family member, or a friend is considering a nursing home placement, these changes are good news. But, of course, the rating system is not the only measure that should be taken when selecting a facility. For more on choosing a nursing home, check out one of my previous articles right here.

Putting the health of someone you love into another’s hands is never an easy decision but an easier one to make when you’re informed. If you have questions or concerns about your loved one’s nursing home, please do not hesitate to give us a call.

Even though you’ve gone through the process to find the right nursing home for your friend or family member, there’s more you can do to ensure they have the best care possible. This creative approach was recently shared with me by one of my clients.

Create a one-page introduction for the resident or future resident. Similar to a short biography, these introductions provide a lot of useful information for nursing home caregivers. Even if your loved one is already living in a nursing home, these notes to caregivers are something you can and should do.

They will encourage the staff get to know your loved one beyond the basic information they would normally receive in a medical chart. Mostly, it demonstrates to the nursing home staff that there are people who care about this person’s health and his or her well-being, enough to go above and beyond. The written notes will keep your wishes, and the resident’s wishes, front and center, even when you can’t be there to advocate in person. Finally, by creating this paperwork, you help remove the possibility that a staff member could claim that they “didn’t know” about your friend or family member’s needs or preferences.

These introductions aren’t hard to create. Use the following examples to help create one of your own:

• Include a recent photo of your loved one. Place the image at the top of the page to make it clear whom you’re discussing.

• Write it in first-person tense, as if your loved one had written it him or herself. If possible, engage him or her to either write it or assist you so nothing important is left out.

• Tell a little about the person’s life, such as their family’s names, their former career and hobbies they enjoy.

• Explain what sort of foods they prefer, and what beverages they like to drink, including when and how often. For instance, it might be important to say they love an early breakfast, or a late snack. List allergies and foods they simply don’t like.

• Emphasize that there’s nothing wrong with their mind, if that’s the case, and that they understand everything that’s said to them. If they’re talkative, mention that. The opportunity for their caregivers to know them on a personal level can only improve the care they receive.

• If religion is important, mention it.

• Everyone has favorite television shows, magazines or authors. If the resident is going to be there awhile, it’s important that they aren’t cut off from things they love. Don’t forget to mention if your loved one uses glasses for certain activities.

• Personal preferences for certain types of pillows, or how many blankets to put on the bed, are helpful.

• Even though caregivers know that residents need to be turned or have their positions changed every two hours, it doesn’t hurt to remind the staff.

• List and explain any health issues you can think of, and don’t assume everyone will read the resident’s chart or be familiar with their case.

Lastly, thank the caregiver in advance for the wonderful treatment they provide and how important that is to you and to the resident. With your effort and the understanding of the staff, the time your loved one spends in a nursing home can be peaceful and restorative.

I’m passionate about doing everything I can to ensure our elders have a really good experience moving to a place where they can get the support and care they deserve. Sometimes, elderly people don’t have a voice. We can be their voice. Please don’t hesitate to contact me with any questions or concerns you have about your loved one’s nursing home experience.

By Dollar, Burns, Becker & Hershewe

The question I am asked more than any other is, “How do I choose the very best place for my family member or close friend who needs to move out of their home and into a facility that offers assistance?” It’s a good question, frankly, because it is one of the most important decisions you’ll ever make.

The good news is, it’s not as daunting as you may think. There are resources you can rely on to make the decision more clear. Our federal government regulates the nursing home industry, and provides research you can use to make an informed decision. This is one of those times your tax dollars really do work to your benefit.

If you visit Medicare.gov/nursinghomecompare, you’ll find incredibly useful information about every nursing or convalescent facility in your area, to help you make a truly informed decision.

Noting the differences in facilities is important. You can compare their size, overall ratings, and how they were rated on government-mandated health inspections by the Department of Health & Senior Services. You will also be able to see their staff-to-resident ratio and quality measures. Most importantly, you can see if any complaints have been lodged against them and, if so, how many, over what period of time, and what was done to resolve the complaint.

Some things to consider:

• Independent vs. chain – Many of my clients have had success with smaller, locally run homes that have an established track record.

• Small vs. large – I think smaller is better as long as there is a good staff-to-resident ratio.

• Nonprofit vs. for profit – Because they are not driven by profit, I’ve found nonprofit facilities may be less likely to cut corners.

• Religious vs. non-religious – In my experience, I’ve found that nursing homes with a religious affiliation tend to have better care than those that do not. It’s not true in every case, but generally speaking it seems to work that way.

Even if you don’t immediately find the perfect place, hopefully you will feel better knowing the real story about how the facilities in your area operate now and in the past.

I suggest narrowing your choices to three or four, then visiting them in person to give them your own “eye test.” Visit with their administrators and ask questions. Trust your intuition.

Personal experience and references are also incredibly valuable. Talk to friends or people you know about what experiences they’ve had with their family members.

And remember, I’m here to help you, too. I have seen the good and the bad here and all over the country. I am passionate about doing everything I can to ensure our elders have a really good experience moving to a place where they can get the support they need. Isn’t that something we all deserve? This is one decision where you want to be as well informed as you can be.

By Tim Dollar

If the people of Jackson County reach the point where they no longer have confidence that our judges are impartial and free of prejudice, our legal system will collapse. We can never allow that to happen.

That’s why the Missouri Nonpartisan Court Plan was created years ago, to ensure the public is served by qualified, impartial and nonpartisan judges. When we allow money to determine who our judges are, or allow it to influence those we have elected to be judges, we are sowing the seeds of injustice. All attorneys should be able to try their cases in front of a judge who is free from obvious political biases.

Under Missouri’s Plan, nonpartisan judicial commissions are created at every level of the legal system to review applications and help seat potential judges. After a rigorous selection process, we narrow the list to those we consider the three best candidates, and forward those names to the governor. Following a careful review, the governor chooses the best candidate in his or her opinion. Periodically, the public decides in general elections whether or not a judge continues.

I was elected by my peers to serve on one of these commissions for six years.

In all of those years, not once did any of the commissioners I served with ask a candidate about his or her political affiliation. We never had any idea whether the candidates who appeared before us were Democrats, Republicans or independents; and that’s how it should be.

It probably won’t surprise you that the Missouri Plan has powerful opponents who want to dismantle it for political reasons. A few people, who would benefit from judges they controlled, are largely behind these efforts. To date, we have been able to defeat these attempts and it’s a good thing for everyone that we have.

I am a strong advocate for the plan. While not perfect, I believe it is the best way to make sure our judges are fair and impartial. Most of the time, we get it right. And when the public feels otherwise, they can vote any judge out of office.