Tag Archives: elder abuse

Under The Whitewash: Is Your Loved One Safe In A Nursing Home?

You would think that someone who reads about elder abuse and neglect on a daily basis would stop seeing red after a while.  Yesterday, however, while reading an account of nursing home neglect that resulted in a death, I was struck by a statement from an Illinois official responsible for regulating nursing homes that was so out of touch with reality that my fingers shook as I hit the keys on my laptop to respond.

An investigative piece by NBC Chicago5 tells the sad story of Joseph Karney, a Chicago man who moved into The Renaissance Park South nursing home in 2005 after having a stroke and heart attack. Joseph was later diagnosed with gastrointestinal cancer and placed on a medication to which he was responding well. Over time, his sister noticed he was failing. They investigated and learned that the nursing home had failed to give him his cancer drug for almost a year and hadn’t taken him for follow-up appointments with his oncologist. It was too late. Joseph’s cancer had spread and he died. The investigative report included an analysis of Illinois Department of Public Health data where state health inspectors documented 384 nursing home medication errors since 2011. These errors resulted in two deaths and an amputation. Full story here.  http://www.nbcchicago.com/investigations/Nursing-Home-Medication-Errors-Leading-to-Hospitalizations-243618471.html

Here’s what Dr. LaMar Hasbrouck, the head of Illinois Department of Public Health (Illinois’ nursing home regulatory and oversight agency) said about these errors:

“You’re going to have errors, unfortunately. But we hope that there are no errors due to negligence,” said IDPH director LaMar Hasbrouck, MD.

So this is where my blood begins to simmer. Are you kidding me, Dr. Hasbrouck?  Where have you been? You do know that Illinois nursing homes, based on inspection data, have an F grade on Nursing Home Report Cards, right?  http://nursinghomereportcards.com/

Do you know that Illinois ranks dead last in direct care staffing hours? Those are the people who pass medications and provide care to residents in your nursing homes.

Still simmering, I read on because, of course, we’ve still got to hear from the well-paid talking head from IHCA (Illinois Health Care Association, a state trade organization for nursing home corporations). Mr. Vrba, whose main job is to put lipstick on pigs, tosses in this red herring about medication errors in an effort to make the public think, “Oh yeah. I mean, that could happen to anybody.”

Facility staff members are also using TALL MAN letters, Vrba said, to differentiate look-alike drug names. For example, noting predniSONE as opposed to prednisoLONE.

TALL MAN letters! A man went without his cancer medication for a year and Mr. Vrba wants us to believe that it’s because the staff wasn’t using their latest best practice named TALL MAN letters.

So what kind of letters should have been used so that the nursing home staff would have noticed that Joseph didn’t get his cancer medication–FOR A YEAR? Are there special letters or numbers that would have ensured he was taken in for his follow-up oncology appointments?

Perhaps the problem lies a bit below the surface here, at a depth that the likes of Mr. Vrba never want us to reach. Let’s take a look at Medicare’s Nursing Home Compare Website and see what’s up with Renaissance Park South. http://www.medicare.gov/nursinghomecompare/profile.html#profTab=0&ID=145764&loc=CHICAGO%2C%20IL&lat=41.8781136&lng=-87.6297982&name=RENAISSANCE%20PARK%20SOUTH

We learn they’re a for-profit nursing home owned by several players who run other substandard nursing homes in Illinois. They have a 1 star rating for both Staffing and Health Inspections. A one star rating by CMS (Center for Medicare Services) on this site means Much Below Average.  It’s as low as they go.  There have been a total of 6 complaint inspections in 2013 alone with repeated deficiencies related to poor staff training, abuse and neglect, and lack of therapeutic programs for residents with mental illness.

One of Renaissance’s owners, David Hartman, also owns Symphony of Crestwood, Illinois. Sadly, the name is the only nice thing about this nursing home. Data from Nursing Home Compare show us that Symphony is plagued with many of the same problems as Renaissance.  Poor staffing, neglect, use of chemical restraints (over-drugging residents to keep them quiet), failure to provide activity programs, failure to report theft, and failure to prevent pressure ulcers to name a few. The most egregious finding was in a complaint inspection report from last July, 2013:

Based on interview and record review facility failed to ensure necessary treatment to promote healing and prevent infection of a wound for one (R1) of three residents reviewed for pressure ulcers. Failure to provide dressing changes as ordered, resulted in R1’s right foot harboring purulent drainage with maggots on the wound.

Maggots in a wound in what is supposed to be a health care facility! This lack of care goes beyond any dribble about nursing error. This is absolute and blatant negligence that begs for public outrage over this less than Third World level of care.

I must admit though, of all the inspection reports and comments I read yesterday, this statement by Dr. Hasbrouck,  blew my blood pressure beyond the pale. Keep in mind, Dr. Hasbrouck is director of nursing home oversight in Illinois so common sense would suggest that he is on the side of protecting nursing home residents.

“Safety and quality of care is a collective responsibility,” Hasbrouck said. “The family has a responsibility to do their due diligence.”

Family responsibility?  Is he suggesting that Joseph’s family is to blame for putting him in this substandard nursing home that receives his agency’s stamp of approval to remain open? Guess who the usual suspects are when it comes to calling in nursing home complaints.  Families!

Do you know how many families across Illinois, across our country, need to make sure someone checks on their loved one each day just to make sure they’re fed and not soaking in their waste?

What about all those people who don’t have families or are estranged from their families?  Everyone deserves decent and humane care.  No exceptions!   And substandard care is never the fault of grieving family members who are floundering through our system, begging for someone to care about what is happening in nursing homes.

What about your responsibility, Dr. Hasbrouck? I believe part of your job description as director of Illinois’ Department of Public Health would be to enforce nursing home regulations that have been put in place to protect our most vulnerable citizens?

How do you suggest citizens do their due diligence?   How can we protect our vulnerable brothers and sisters from the kind of human neglect that results in maggots infesting their wounds?  Help us understand how is it that public money continues to flow into the hands of nursing home owners who accept that money as their entitlement while their nursing homes flounder?

Channel 5’s news piece provides us all with a perfect example of the deplorable care given in many of our nursing homes.  The players in this story show us why it won’t change anytime soon.

Even when someone does speak out, as Joseph’s sister did, and even when their voice is heard by many, change doesn’t result.  Instead, the guilty deflect the blame. Wealthy nursing home corporations blame reimbursement, government officials deny the seriousness of the problem and, in this case, lay the blame at the feet of families who choose homes that provide poor care.   The nursing home industry invents some shiny new “campaign for excellence” developed for the sole purpose of lulling the public back to sleep with visions of things like TALL MAN letters.

And while we sleep, nursing home corporate owners get richer, their ‘perception managers’ get slicker, and government oversight becomes more and more impotent.

Citizens of Illinois, I suggest you follow the advice of Dr. Hasbrouck and do your due diligence.  Do it by banding together and demanding reform and transformation of this mess we’re all paying for called nursing home care.

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America’s Shame: Trafficking Our Elderly

For most people, the term human trafficking conjures up images of ethnic young people controlled by sleazy handlers who buy and sell them for sex or labor.  We might hear about human trafficking ring leaders that have been arrested and sentenced to long prison terms for their heinous acts.

There’s another practice of human trafficking that goes largely ignored even though it happens daily, sometimes right under our noses.  The traffickers don’t hide from the law because the law is either on their side, as in the case of guardianship and conservatorship abuse, or because, even when these offenders are caught, the human trafficking component is ignored by authorities.  I’m talking about the use and abuse of our elderly who are sought out for their Medicare/Medicaid dollars.  Their predators are doctors, nursing home corporations, hospitals, and long-term care pharmacies.

The schemes are all fairly similar.  You need an unscrupulous doctor who is willing to admit patients into hospitals, order unnecessary tests, transfer them to a nursing home, and write prescriptions for as many pharmaceuticals as their poor bodies can manage.  Authorities uncovered one such scheme in Chicago.  The players were Dr. Roland Borrasi, Rabbi Morris and Philip Esformes, corrupt father/son nursing home corporation operators, an Illinois psychiatric hospital, and two acute care hospitals.  The Chicago Tribune covered this human brokering scheme which you can read here and here.

The Esformes, Dr. Borrasi, and hospital administrators colluded to shuttle patients among their facilities for the purpose of filling their beds and maximizing Medicare reimbursements. Hospital administrators paid Borrasi to admit elderly nursing home residents into hospitals for costly, unnecessary tests and treatments.  In turn, Borrasi paid Morris Esformes for the use of his nursing home residents. One of Borrasi’s associates alleged he was with Borrasi in March 2001 when Esformes called and told Borrasi to admit at least five nursing home patients to various hospitals. Borrasi did so without question.  Borrasi was recorded by federal agents as he spoke to a fellow doctor in his practice, “Basically, I have a commodity; my commodity is nursing home patients.”

In 2010, Borrasi was sentenced to 6 years in a Kentucky federal prison.  Today he resides in a RRM (Residential Reentry Management) facility in Chicago with a scheduled release date of June 7, 2014.  According to the Illinois Dept. of Financial &Professional Regulation, Borrasi’s physician and controlled substance licenses were suspended in May, 2010 “due to convictions of conspiracy and offering and receiving bribes, related to patient referrals.”  What happens if he applies for reinstatement?

The Esformes were named in the scheme, denied any involvement, and, as in the past, escaped without charges.  In 2005, Rabbi Esformes played the religion card when he was facing charges of abuse and neglect for abominable conditions in his Chicago nursing homes.  He said of city and state officials, “Beside the fact that they’re anti-mental health and anti-black, they’re probably anti-Jew because I’m an ordained rabbi.”  Oy vey.

Last August, facing a jury trial, the Esformes agreed to pay $5 million to the Justice Department to settle charges of a pharmacy sale kickback scheme with Omnicare.  Omnicare had already paid their fine.  Once again, the Esformes are free to move forward with nothing more than a wrist slap and a fine that, for them, is simply the cost of doing business. They continue full participation with our Medicare/Medicaid programs. Despicable.

The Esformes own EMI Enterprises which, according to Bloomberg Business, owns and operates nursing homes, retirement centers, and assisted living facilities in Illinois and Florida. The company is based in Lincolnwood, Illinois.  Their facilities have a long history of poor care and serious deficiencies.

We’ll never know how many nursing home residents were abused at the hands of these vile people.  We know about an elderly woman who was sent from one of their nursing homes to a psychiatric hospital because she refused to go to the facility dining room to eat her dinner.  I wonder how much Esformes got for her.  We know about the elderly man with dementia who Borrasi sent to a participating hospital to undergo inappropriate brain radiation treatments.  But what about all the ones who suffered that we don’t know about?  How many people were left with no quality of life because they were filled with antipsychotic drugs?  How many old people spent days confused and afraid as they were shifted from facility to facility, pawns in this shell game run by a group of health professionals who profited from these healthcare atrocities?  How many people died from this horrific arrangement of moving and drugging and gratuitous procedures?   This scheme went on for years and elderly patients were shuffled around like pieces on a chess board.

Understanding that what they did was wrong and feeling outraged is a cakewalk.  The more difficult task it accepting the lack of punishment for these crimes.  Why weren’t the perpetrators charged with human trafficking and elder abuse along with charges of fraud?   They all deserved harsh prison sentences, monetary penalties, and suspensions from any future dealings with our Medicare system to ensure they couldn’t repeat their crimes.  To this day, after years of providing shoddy care, Morris Esformes enjoys the fruits of his abuses.

This scheme wasn’t the first of its kind and it certainly will not be the last.  Until our public health officials ban providers who abuse our citizens or defraud our system, our elderly and vulnerable citizens can expect much more abuse in the future and we can expect to see our public health dollars funnel into the dirty pockets of the abusers.

Happy Thanksgiving – Grateful for Old People.

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In between fixing breakfast for my 10 year old daughter and searching the internet for anything newsworthy in the world of nursing home reform, I found myself feeling grateful for the blessing of loving old people. It’s not something I recall choosing. I’ve been like this since I was a kid.  Every so often, I’ll meet another person who shares this affinity.

“You love old people!  Me too!”  As we excitedly share our newfound commonality, we invariably learn that each of us has felt this way since we were kids.  So why and how did that happen?  I believe mine developed from close relationships I had with several old people when I was a child.

Uncle Matt lived next door to us, was the barber in our small town, and loved me unconditionally.  He was actually a great uncle, around the same age as my grandfather.   Uncle Matt’s barber shop was across the street from our house.  He didn’t give a second thought to stopping in the middle of a customer’s haircut to cross the street and walk me over so I could watch him from his second chair.  It was my job to sweep up after each cut.  My reward was a piece of Bazooka Joe bubble gum and a handful of warm shaving cream.

If you open a dictionary to find the definition of eccentric, you might find a photo of Uncle Matt’s wife, Alvina.  What a treasure.  She ran every minute of Uncle Matt’s free time and he followed her with a smile of content resignation.  “How ya perkin” with a slap to her hip was her typical greeting.  She needed little encouragement to take you in her arms to dance while she’d sing, “Enjoy yourself, it’s later than you think.”  I like to think I’ve adopted some of her eccentric ways.  At least that’s what I tell myself when people call me weird.

I recall our visits to a nursing home to see my great-grandmother, who had developed dementia.  During one visit, she clung to my mother’s arm and pleaded with us not to leave her.  She said they were taking her food away and hurting her.  I wouldn’t leave until my mother explained that “grape gramma” was confused and those things weren’t really happening.  I accepted that as fact but my experiences since that time leave me in a place of doubt.

I’m sure most kids have experiences with old people as they are growing up and don’t develop this affinity for them.  So why did I end up with this passion?   I don’t know.  What I do know is that I believe old people should be given the best of what we have to offer.  They should expect warmth, safety, and comfort.  They shouldn’t have to worry about where they’ll get their next meal.  They should be able to count on family, friends, and society’s conscience to help meet the needs they can no longer manage.  They should have a community that will rise up against anyone who hurts them and respond to any abuse with an iron fist.

We are far from where we need to be when it comes to caring for our old people.  Guardianship abuse, nursing home abuse, cuts to Meals on Wheels programs and threats to social security are just the tip of the iceberg. The needs are many.  We need to shore up our army of citizens who love old people and we need to make our voices heard.