A new study is revealing an alarming trend among nursing homes – facilities are increasingly providing elderly residents with intensive, costly, and possibly unnecessary therapy, even in the last weeks of their lives. The study, conducted by the University of Rochester and published recently in the Journal of the American Medical Directors Association, is raising concerns about the necessity and potential dangers of intensive therapy, as well as whether profits may be prompting their use.

Here are a few key details about the study:

• For the study, researchers gathered and reviewed data from over 600 nursing facilities in the state of New York and the records of nearly 56,000 deceased individuals who were long-stay residents.
• The study had a special focus on residents who received “ultrahigh intensity” rehabilitation services in the 30 days prior to their death. These services, including various forms of physical, speech, and occupational therapy, are classified at “ultrahigh” by Medicare if they are provided for more than 12 hours in a week, which is equivalent to 2 hours of rehab a day.
• According to researchers, nursing homes are increasingly utilizing ultrahigh intensity therapy. From October 2012 to April 2016, the study notes, there was a 65 percent increase in the proportion of residents who received these services.
• Most of the ultrahigh rehabilitation services residents received was provided during their final days of life.

America’s growing elderly population has facilitated the expansion of a booming industry tasked with providing the support, care, and services they need. Unfortunately, the proliferation of nursing homes, assisted living facilities, and companies offering daily care and living assistance services has also created growing concerns over the safety of our most vulnerable population, especially in terms of elder and nursing home abuse. Those concerns were a significant factor behind the recent passing of Act 53.

Act 53, which has been praised by victims’ advocates and State Attorney General Josh Shapiro, is a legislative act designed to combat elder and nursing home abuse. Though the legislation has been introduced by Pennsylvania lawmakers every session since 2007, it was only passed and signed into law earlier this year. Here are few important facts about the new law:

• Act 53 expands the authority of the state’s Attorney General’s Office in prosecuting matters involving the abuse and neglect of elderly individuals, including those who suffer harm as a result of abuse and neglect in nursing homes and assisted living facilities.
• Prior to Act 53, the Attorney General’s office was limited to bringing allegations against facilities and wrongdoers for cases involving neglect, but not abuse. Instead, abuse allegations against nursing homes and assisted living facilities were handled by local prosecutors.
• The new law removes a provision that previously required prosecutors handling neglect cases to prove that victims suffered actual physical injuries.

Act 53’s expansion of prosecutorial powers is significant for several reasons. First and foremost, it sends a clear message that Pennsylvania takes cases of elder abuse and neglect seriously, and that offenders can and will be held accountable for their wrongdoing and failures. In addition to expanding prosecution power and resources for these cases, the new law also expands the rights of victims and their families, many of whom often struggled under previous laws to bring at-fault parties to justice.

Families face a difficult task when deciding whether or not to place their elderly loved ones in a nursing home or assisted living facility, not to mention a challenge in finding the right one. To aid them in this journey, many families will utilize various resources that provide insight into the level of care and support facilities will provide their family member. This may include visits and consultations at the nursing homes themselves, and the use of online tools like Medicare’s five-star nursing home rating system. Unfortunately, as recent federal data indicates, those tools, even when curated by a government agency, may not always provide a full or accurate picture about the quality of care provided at facilities.

According to a recent report from The New York Times, newly acquired federal data has revealed that most American nursing homes over reported staffing levels for years as a way to game Medicare’s five-star system and benefit from higher ratings.

The findings, which came from new payroll data submissions only recently required by Medicare, showed that many U.S. nursing homes had substantial gaps in the numbers of staff and aids on duty, especially during weekends and at night. In fact, some nursing homes had staff-to-resident ratios of 1 for every 18, or even less during their lowest staffing periods, despite having reported higher staffing rates to the U.S. government. The data also revealed significant staffing gaps in the numbers of qualified nurses on duty, which were again often at their lowest during weekends and nights.

How Staffing Problems Pose Risks of Nursing Home Injuries

The new data has made waves throughout the U.S., and has prompted Medicare to reevaluate its rating system and make adjustments based on the new numbers, which had escaped oversight due to the fact that under previous policies, nursing facilities could submit staffing data that was unverified by regulators.

It is also raising awareness about just how important staffing is in nursing homes, especially when it comes to reducing risks of preventable injuries. Below, our legal team at Shrager & Sachs discusses a few ways that staffing problems can pose increased risks of nursing home injuries:

• Neglect-related injuries – Without sufficient staff on duty, there is greater potential for the staff who are working to become overburdened by numerous tasks. These can include tasks such as responding to calls made by residents for assistance with basic needs, such as getting dressed or using the restroom, as well as time-sensitive tasks for checking in on residents, ensuring they have food and water, addressing any medical needs, and more. Unfortunately, that means residents are at risk of suffering harm and injuries that could and should have been prevented if not for neglect and oversight, including dehydration and malnutrition, injuries caused by falls, infections, and worsening of bed sores.
• Medical problems – Many residents in nursing homes and similar facilities have extensive and evolving medical needs. This often means residents require regular check-ins, assistance with daily tasks, and time-sensitive administration of medications or forms of treatment for a given condition. When staff are overburdened and facilities understaffed, there are greater risks that such medical issues will turn into medical problems and preventable injuries, including those caused by medication errors, missed treatment, and more. It may also mean that untrained staff will administer medical care that registered and licensed nurses or medical professionals should provide.
• Emergencies – Inadequate staffing is especially dangerous when it comes to responding appropriately to emergencies. This may include any number of medical emergencies and issues such as falls, assaults between residents, and more. Because time is often of the essence in such situations, a lack of timely response and a lack of appropriate immediate treatment can prove disastrous when emergencies occur.
• Nursing home abuse – Abuse in nursing homes is unfortunately more common than most think, which is why vigilance and adequate staffing are so critical to reducing risks that a resident will become a victim. With insufficient staff, however, overburdened aides or nurses are more likely to become abusers themselves, often as a result of stress, fatigue, and more. They are also less likely to provide the care and monitoring needed to spot warning signs when abuse does occur, whether that involves physical, emotional, financial, or sexual abuse committed against residents by other staff members or by other residents.

Our legal team at Shrager & Sachs regularly features posts on our blog about nursing home abuse and neglect, as well as important issues that affect nursing home residents and their families. In light of the new findings, we want to remind families of the importance of choosing a nursing home facility carefully, and regularly checking in on the health and affairs of a loved one. We also want to remind families that they have legal rights should an elderly family member suffer preventable harm in a nursing home as a result of abuse, neglect, insufficient staffing, medical malpractice, and any other form of negligence.

If you have questions about a potential nursing home injury case, your rights when pursuing the justice and compensation your deserve, and how our award-winning Philadelphia nursing home injury lawyers at Shrager & Sachs can help, contact us for a free and confidential consultation. Our firm proudly serves nursing home residents and families throughout the state of Pennsylvania and beyond.

The Pennsylvania House of Representatives recently voted against a bill that would have put a cap on the punitive damages that could be awarded to victims in verdicts against nursing homes in the state.

This bill sought to apply the Medical Care Availability and Reduction of Error (MCARE) Act to assisted living facilities and nursing homes, which would have capped these damages to 250 percent of the compensatory damages awarded.

“This bill demonstrates that the Pennsylvania legislature, which remains majority-controlled by Republicans, works very hard to balance the interests of its individual constituents and the business interests here in Pennsylvania,” attorney Robert L. Sachs, Jr. said in an interview with the Pennsylvania Record. “And I think that this outcome is a very good example of them striving to strike a balance. From our perspective, we think they have found an appropriate balance at this time.”

With the recent attention on nursing homes resulting from the death of H.R. McMaster, Sr., who died in the Cathedral Village nursing facility in Philadelphia, Sachs noted that this bill was brought to the House at an inopportune time.

A recent article from the Philadelphia Inquirer is shining a spotlight on a local nursing home owner that profited despite declining care at its facilities. According to the article, nursing homes once owned by the Archdiocese of Philadelphia went from barely breaking even to becoming some of the most profitable nursing homes in the region after being bought by Charles-Edouard Gros. One of the nursing homes included the St. Francis Center for Rehabilitation & Healthcare.

As reported by the Inquirer, Gros-owned nursing homes comprised four of the area’s five most profitable assisted living facilities. Those profits, however, were driven by staff cuts and increased acceptance of sicker patients. As care began to decline, regulators found ample evidence of neglect and revoked St. Francis’ license, which is a step taken only in the most serious cases. They also noted an increase in incidents involving actual harm to residents since the homes were bought by Gros.

In January, officials reported on what they called “extreme” conditions at facilities like St. Francis, including a lack of nursing care, wound treatment, and a patient death which occurred during the time regulators had been conducting their investigation. That patient suffered from severe bed sores and various infections acquired during her stay at the nearly 300-bed facility in Delaware County.

Now, the poor quality of care at St. Francis and other facilities owned by Gros’ Center Management Group is forming the basis of a lawsuit filed last month. In the suit, the victim’s daughter states that although a doctor ordered facility staff to adjust the victim’s position every two hours to prevent bed sores, nursing home staff failed to follow instructions.

State officials have revoked the licenses of two personal care homes in Lehigh and Northampton County over the past few days, both of which have been linked to resident deaths.

Back in April, 84-year old veteran Daniel Scanlan died as a result of “complications of blunt force trauma” after being pushed by another person living at Arden Courts of Old Orchard. Although a staff member witnessed the incident and reported it to the executive director, the director failed to mention the push in a report to the state. After the coroner’s office released the certificate of death, Mr. Scanlan’s death was ruled a homicide. As a result, the state revoked the facilities license for failure to comply with the department’s regulations, gross incompetence, negligence, misconduct in operating the facility, and fraud and deceit in attempting to obtain a license.

Robert Sachs, Esq. of Shrager & Sachs is representing the family of Mr. Scanlan to investigate and pursue a claim against Arden Courts of Old Orchard. The company operates over 50 facilities across the country for people diagnosed with Alzheimer’s disease or related dementia, according to their website.

Northampton County Coroner, Zachary Lysek, has ruled that Daniel Scanlan, an 84-year-old veteran and long-time resident of the Lehigh Valley in Pennsylvania, died on April 4, 2017 as a result of “complications of blunt force head trauma” which occurred at Arden Courts of Old Orchard in Bethlehem Township, Pennsylvania. The certificate of death from the coroner’s office states that Mr. Scanlan was “pushed by another resident causing him to fall and strike his head.” As a result, the coroner marked “homicide” as the “manner of death” on the certificate of death issued on September 14, 2017.

The children of Mr. Scanlan have retained Robert Sachs, Esquire, of Shrager & Sachs, a nationally-recognized nursing home and assisted living negligence lawyer from Philadelphia, PA, to investigate and pursue a claim against Arden Courts of Old Orchard. Arden Courts is owned by HCR Manor Care, Inc., which is owned by the Carlyle Group, one of the nation’s largest private equity groups.

Last year, the Centers for Medicaid and Medicare Service (CMS) finalized a new rule that bans nursing homes from forcing patients and their families into private arbitration. These mandatory arbitration clauses were hidden in the contract’s fine print, and many families were unaware of the term or misunderstood what private arbitration entailed. This type of arbitration is a practice that keeps any potential nursing home abuse charges out of the public court system, which weakens a patients’ legal leverage.

On June 5, 2017, CMS released another proposed rule that would almost entirely do away with the ban on mandatory arbitration clauses in nursing home contracts. These supposed changes are to “strengthen” the transparency in the arbitration process. However, consumer advocates quickly condemned the change with the Fair Arbitration Now (FAN) Coalition arguing the reversal will hurt nursing home residents, who are at the most vulnerable time in their lives.

This almost complete 360-degree turn is largely the result of the change in power this January. The current presidential administration will be forcing seniors to sign contract terms that negate their right to sue the court if they are victimized by neglect or abuse.

In previous years, the Pennsylvania Department of Health has been rather lax in its penalty system regarding complaints of substandard and negligent care in nursing homes. However, within the first four months of this year, there has been a drastic change. In fact, the state has exacted more fines during this period than the previous three years combined, hinting at a much-needed change in how the industry’s failings are handled.

While it is promising to see substandard nursing care finally being addressed, it is still to be seen if improved regulations and strict enforcement of fines will improve the state’s 700 nursing homes. A spokesman for the industry claimed these heavy sanctions would only result in financial strain on operators, rather than contribute to better outcomes for nursing home residents.

For too long, nursing homes were allowed to provide poor care, resulting in an epidemic of injuries and death to nursing home residents across the state of Pennsylvania, most of which were all preventable and easy to avoid through more attentive treatment. Without the fear of penalties looming over them, nursing home operators and staff were not inclined to rectify their shortcomings. That is, until now.

The total thus far for the first four months of fines amounts to about $796,750. For the three years that ended December 31^st, records show fines totaling up to $639,500. These numbers do not include federal fines recommended by the state, which are also usually more substantial. State surveyors sanctioned 86 facilities so far, whereas only 72 were sanctioned last year, and 47 in 2014 and 2015 combined. These numbers make it clear that things are changing, even if it is still unclear where these changes will lead.

There are more than 2 million cases of elder abuse every year, and those are only the cases that are reported. One out of every 10 people will experience some form of elder abuse. Because families often don’t have the time or resources to devote to the full-time care that seniors sometimes need, they depend on skilled nursing facilities to provide help where they can’t. When skilled nursing facilities care for elderly people, they and their friends and relatives are placing their trust in these businesses. When that trust is broken, it is usually the result of negligence or outright abuse of the elderly person.

Because the senior population has started to grow as more baby boomers continue to age, big corporations have taken to buying or starting skilled nursing facilities. Around 70% of all skilled nursing facilities are run by for-profit companies, and some of them are being purchased by Wall Street investment firms. Unsurprisingly, the new administration has taken note of another way it can assist hedge funds and banks.

In 2016, the Centers for Medicare and Medicaid Services enacted a policy that said nursing homes would no longer receive federal funding if they used forced arbitration clauses in their contracts. Forced arbitration clauses are contract terms preventing people from suing a facility, no matter what laws it breaks. Anyone harmed by illegal acts in these institutions can only bring cases to private arbitrators, who are generally beholden to the nursing homes or the corporations that own them.

Now, the current administration is proposing to lift the ban on forced arbitration clauses. Now, if a nursing home abuses a senior, the family can use the public court system to seek justice. If the ban is lifted, nursing homes benefit from the secretive system of arbitration, which isn’t open to the public, press, or regulators. It also allows gag orders in the form of confidentiality provisions, allowing them to hide their crimes easily.