California Elder Law Attorney Blog

Requiring more nurses to be on duty in nursing homes is key to improving care, according to a labor union and a watchdog group. Now, nursing homes are required to provide at least 3.2 hours of nurse staffing per patient per day. Some want the minimum raised to 3.5 hours.

Legislation that became law in 2008 mandated that an 18-member "workgroup" be formed to recommend how to improve care in nursing homes indicates California Elder Law Attorney Steven C. Peck.

The workgroup included members representing nursing home owners, the SEIU, the watchdog group California Advocates for Nursing Home Reform (CANHR), senior citizens groups and others.

The group was concerned with Assembly Bill 1629, which changed how nursing homes are paid and provided them with higher payments. The workgroup held a number of meetings. Its efforts were overseen by the state Department of Health Care Services, which was supposed to issue a report to the Legislature last March.

The report is still being finalized, said Lisa Gray, a spokeswoman for the department. She said she couldn't give a date when it's expected to be released.

Each member of the workgroup produced a list of recommendations for improving care at nursing homes. SEIU and CANHR both recommended raising the minimum nurse staffing level from 3.2 to 3.5 hours.

The union wrote that plans should be made, also, for how to reach the staffing level of 4.1 hours that some experts have recommended.

CANHR recommended that nursing home rate increases should depend on homes' meeting the 3.2-hour minimum. "We don't think they should be granting any rate increases to homes that don't meet 3.2," said Mike Connors, a CANHR advocate who served on the workgroup.

Last year, a bill was introduced in the Legislature that would have required nurse staffing levels to be at least 3.5 hours per day per patient, in place of the current 3.2 hours requirement.

Assemblyman Warren Furutani, D-Gardena, introduced the legislation, but he later withdrew it at the request of its sponsor, the SEIU, said Leilani Yee, Furutani's legislative director. Mary Gutierrez, a spokeswoman for the union, said the SEIU felt it couldn't do a good job of promoting the bill when it was so focused on the state budget. The measure might be introduced again next year, she said.

On another matter, both CANHR and the SEIU objected to nursing homes' being able to use money it received through Medi-Cal to buy liability insurance.

CANHR said the practice should be stopped altogether, while the SEIU called for controlling how much could be spent for that purpose. Owners of nursing homes who participated in the workgroup also made recommendations.

They called for making AB1629 a permanent law.

They also recommended measuring how satisfied residents, families and staff are and including that information in nursing-home ratings.

Continue reading "California Wants to Increase Nursing Home Staffing Ratio Per Patient Per Day" »

In 2007, Dr. David Graham, a drug safety expert with the FDA, testified before Congress and stated that approximately 15,000 people die each year in U.S. nursing homes from the off-label use of anti-psychotic drugs. Off-label use is the use of the drug for a condition it was not intended. In California, it has been estimated that up to 60% of all nursing home residents are given psychoactive drugs, which is an increase of 30% in only 10 years. It's no wonder that when we think about nursing homes, we think of isolated elderly people sitting hunched over in wheelchairs, or in bed, segregated from the world. That life is a sad realty for many.

To combat the misuse of psychoactive drugs, the California Advocates for Nursing Home Reform have released a publication called Toxic Medicine - What You Should Know to Fight the Misuse of Psychoactive Drugs in California Nursing Homes. The 20-page booklet provides an overview of what psychoactive drugs are, their purposes, the risks associated with them, and an overview of the resident's rights.

Primary among those rights is the requirement of consent. Before a psychoactive drug can be used, a physician must inform the resident (or his/her decision-maker) about the drug, why it is being recommended, and the risks associated with it, and then must obtain consent before prescribing it. The guide also provides a list of questions that should be asked of a doctor who is recommending a psychoactive drug, and what to do if it is suspected that the drugs are being used without proper authority.

Continue reading "The Misuse of Psychoactive Drugs: Elder Abuse In Nursing Homes" »

The 1987 Nursing Home Reform Act ("NHRA"), part of the Omnibus Budget Reconciliation Act of 1987("OBRA"), established quality standards for nursing homes nationwide and defined the state survey and certification process to enforce the standards (42 CFR 283.0). These regulations represent minimum standards for long term care facilities. They were promulgated to improve the quality of care of their residents. The general goals of OBRA are to:
(a) promote and enhance the quality of life of the resident;
(b) provide services and activities to attain or maintain the highest practicable, physical, mental and psycho social well being of each resident in accordance with a written plan of care;
(c) provide that resident and advocate participation is a criteria for assessing the facilities compliance with administrator requirements; and
(d) assure access to the State's Long Term Care Ombudsman (a 3rd party resident advocate) to the facilities residents, and assure that the Ombudsman has access to records, residents and care providers.
The goals are implemented by NHRA establishing the Resident's Bill of Rights:
The right to freedom from abuse, mistreatment, and neglect;
The right to freedom from physical restraints;
The right to privacy;
The right to accommodation of medical, physical, psychological, and social needs;
The right to participate in resident and family groups;
The right to be treated with dignity;
The right to exercise self-determination;
The right to communicate freely;
The right to participate in the review of one's care plan, and to be fully
informed in advance about any changes in care, treatment, or change of status in the facility; and
The right to voice grievances without the discrimination or reprisal.

Continue reading " The 1987 Nursing Home Reform Act Established Minimum Standards for Nursing Home Abuse and Neglect" »

A Fort Worth nursing home company left some residents' wounds untreated for so long that maggots infested them or amputations were required . At times, its staff didn't bathe, adequately feed or provide toileting for people. And it cheated Medicare, the U.S. attorney's office said.

Cathedral Rock, at 306 W. 7th Street, and its founder will pay the government more than $1.6 million in criminal and civil penalties, but otherwise won't be punished. Despite an admission of defrauding Medicare, the company will apparently continue to receive taxpayer healthcare payments.

The lawsuit and fraud concerned five homes in Missouri. Prosecutors said Thursday that company founder C. Kent Harrington, 60, of Fort Worth, also entered into a criminal deferred prosecution agreement for a two-year period.

Harrington, who earned an MBA from TCU in 1985, was charged with defrauding Medicare and Medicaid by submitting false statements and claims for the "the grossly deficient care" at nursing homes, according to the news release.

Cathedral, which says on its Web site that it puts "Integrity first, service above self and excellence in everything we do," also operates five facilities in Texas, one of which was found in July to have put residents in immediate jeopardy of harm. The problem was corrected, state officials said.

Michael S. Evans, Cathedral's executive vice president, spoke on behalf of Harrington and the company. He said he didn't know the source of the allegations of maggot-infested pressure sores and related amputated feet and legs says California Elder Abuse Attorney Steven C. Peck.

"On this issue with the maggots, that I think was something that was alleged against the building during a prior operator's tenure. ... I wasn't familiar with that piece of it," he said. Cathedral has leased the Missouri homes since July 2001. In a statement, the company said the case was based on allegations made by former employees 6½ years ago.

Evans also said the company was bound by an agreement with the government to remain silent. In plea agreements, the company admitted:

■ Staffing at nursing homes was, at times, insufficient to provide adequate care.

■ Wound care was sometimes not provided.

■ Residents often did not receive their medication.

■ Medical records were falsified, including during a "charting party" to make it appear all medications had been properly given by filling in records.

■ Fraudulent claims submitted to Medicare and Missouri Medicaid were for services that weren't provided or were worthless.

Cathedral and Harrington are not listed as being excluded from receiving Medicare funding, according to online U.S. Department of Health and Human Services records. Instead the company has a "corporate integrity agreement" that effectively gives it a second chance to play by the rules. The company must adhere to federal regulations for five years.

If Harrington abides by the conditions of his deferred prosecution agreement, the felony complaint against him will be dismissed.

"The government recognized it was in the best interest of justice that Cathedral Rock be allowed to continue to implement and maintain a rigorous compliance and ethics program," the company statement said, adding that it appreciates recognition "of the contribution that the company.

Continue reading " Nursing Home Severely Elderly Abuses its Patients" »

Illinois leads the nation with the most unsafe black nursing homes, according to a new analysis by The Chicago Reporter.

The Reporter analyzed data from the U.S. Government Accountability Office, which listed 580 of the nation's most unsafe facilities among roughly 16,000 nursing homes in the U.S. The office compiled the list by analyzing each homes' three most recent inspection survey results as of December 2008.

The Reporter was able to identify the racial composition of 531 of the list's 580 homes. Among these homes, 53 were facilities where a majority of the residents were black. Of those homes, Illinois had the most facilities with 12. Michigan came in second with seven.

The Reporter found that of Illinois' 51 majority-black nursing homes, 24 percent appeared on the federal list for having the worst safety records for elder abuse. By contrast, just 5 percent of the state's white nursing homes appeared on that same list, 31 of the 685 majority-white homes.

The Centers for Medicare & Medicaid Services oversees national nursing home abuse safety. Each state conducts its own inspections using the agency's federal guidelines. However, differences in state licensing standards and in state policies can affect the outcome of these surveys, said spokesman Peter Ashkenaz.

[R]anking facility scores within a state, rather than nationally, provides a more useful way of gauging the performance of nursing homes and elder abuse.

The Reporter found that the disparities also occurred at a national level. Black nursing homes represented 10 percent of homes on the government's list of unsafe homes, but just 5 percent of all nursing homes in the nation. No other racial or ethnic group was overrepresented in that way.

These disparities were even more acute in Chicago, where nearly one in four black nursing homes--seven of 30--and none of the 45 majority-white homes were listed as being among the most unsafe in the nation.

All seven of the majority-black nursing homes are located on the city's South Side: Alden Wentworth Rehab and Health Care Center, All Faith Pavilion, Avenue Care Center, Belhaven Nursing and Rehab Center, Rainbow Beach Care Center, Renaissance Park South, and South Shore Nursing and Rehab Center.

All of the majority-black homes in Illinois that appeared on the list are for-profit organizations. An established body of research, including the Government Accountability Office report, has found that for-profit homes tend to score lower on many indicators than nonprofit facilities.

Continue reading "Illinois leads Nation with Most Unsafe Black Nursing Homes" »

Placerville Pines Care Center has been fined $100,000 and received the most severe penalty under state law after an investigation found that inadequate care led to the death of a resident.

The Placerville facility got a AA citation from the state, according to Dr. Mark Horton, director of the California Department of Public Health.

The facility failed to adequately assess the patient and notify the physician when the patient's condition changed, the state said in a news release.

The state found that failure contributed to the death.

California has the statutory authority to impose fines against nursing facilities it licenses as part of enforcement remedies for poor care. State citations that require a civil monetary penalty be imposed are categorized as Class B, A or AA. The associated fines range from $100 to $1,000 for Class B, $2,000 to $20,000 for Class A and $25,000 to $100,000 for Class AA.

Continue reading "California Care Center fined $ 100,000.00 for Failure to Adequately Assess" »

Governor Schwarzenegger has signed AB 1457 into law, which is a measure to confront the failing quality of care in nursing homes created by the lack of transparency in the ownership and management structure of these facilities.

AB 1457 will require each licensee of a skilled nursing facility to disclose with each abbreviated contract of admission the name of the owner and licensee for the facility and the name and contact information of a single entity that is fully accountable for all aspects of patient care and the operation of the facility. In addition, to ensure that existing residents of such facilities are notified of this information when there is a change of ownership, the bill requires written notification to all current residents and to their primary contacts listed on the admission agreement. The California Department of Public Health indicates that from January 1, 2007 through December 31, 2008, it received 135 Skilled Nursing Facilities change of ownership applications, and it approved 115.

"Nursing home abuse and neglect continues to be a serious problem in the United States. According to a report conducted by the Inspector General of the Department of Health and Human Services, 94 percent of all for-profit nursing homes were cited in 2007 for violations of federal health and safety standards," said Assemblyman Mike Davis (D-Los Angeles), author of AB 1457.

According to the California Health Care Foundation, California has more Long Term Care (LTC) providers than any other state: some 1,200 nursing homes, 14,000 residential care settings with varying levels of care, and a vast array of community-based services.

"The California Legislature and the Governor understand the special attention to the needs and problems of elderly persons. AB 1457 provides California an opportunity to address a serious problem detailed in dozens of investigations by reports in the media. Each resident should know who is in charge of delivering services in every facility. This measure will require appropriate notification which will help ensure quality care in nursing homes," Assemblyman Davis concluded.

Continue reading "Schwarzenegger Signs Quality of Care Bill for California Skilled Nursing Facilities" »

The Governor has signed Assembly Bill 215, legislation that will help families seeking a nursing home for a loved one by requiring skilled nursing facilities prominently to post quality of care ratings. The bill, jointly authored by Assembly members Mike Feuer (D-Los Angeles) and Cameron Smyth (R-Santa Clarita) enjoyed strong bipartisan support throughout the legislative process.

"Families trying to choose a nursing home for their loved ones need more information so they can compare quality of care information and make the right decision," said Feuer. "Soon nursing homes will post their federal ratings, and families confronting this very difficult choice will be better informed. Most important, their loved ones will be better protected."

"I'm pleased that Governor Schwarzenegger recognizes the value of providing information on nursing home ratings to seniors and their families. AB 215 is important consumer protection legislation, and I'm proud to have joined Assemblyman Feuer in this bipartisan effort," said Smyth. "We were able to bring together members from both sides of the aisle, as well as stakeholders on all sides of the issue, in order to craft legislation that benefits all Californians."

AB 215 requires long-term health care facilities that accept Medicare or Medicaid to post the federal Center for Medicare and Medicaid (CMS) star rating in a visible, public location. Overall federal CMS ratings are based on health inspection results, staffing levels, and quality measures. The public can obtain this information through the CMS Nursing Care Compare website (www.medicare.gov/NHCompare/home.asp). A posted rating will provide more information to patients, residents, and visitors to nursing homes who are unaware of the ratings or who have limited internet access.

AB 215 is part of a three bill package by Feuer protecting vulnerable seniors from exploitation and abuse, all of which Governor Schwarzenegger signed into law this year. In August, the Governor signed AB 392, immediately restoring funding to local Long-Term Care Ombudsman programs to ensure nursing home abuse cases are investigated. He also signed AB 329, legislation that will give significant rights to seniors contemplating reverse mortgages.

AB 215 goes into effect on January 1, 2011.

Assembly member Feuer has fought for nursing home patient rights since serving as Executive Director of Bet Tzedek Legal Services, the House of Justice. During his tenure, Bet Tzedek provided free legal representation to more than 50,000 primarily aging or disabled clients on nursing home patients' rights, elder abuse, Holocaust restitution, slum housing conditions, access to medical care, consumer fraud and other critical issues.

Continue reading "Nursing Homes Will Now Have to Post Quality of Care Ratings in California" »

Illinois Attorney General Lisa Madigan has called on state public health officials to overhaul their approach to protecting seniors and disabled adults who live in nursing homes alongside mentally ill felons.

In a blistering letter to the director of the Illinois Department of Public Health, Madigan demanded beefed-up inspections and better data-keeping of criminal activity inside the homes. And she said the department must enlist the help of state police to immediately review the criminal history of every felon living in Illinois nursing homes.

In Illinois, law enforcement and the nursing home industry have failed to adequately manage the influx of younger, mentally ill offenders. The state's background checks, designed to identify dangerous residents so they can be properly monitored, often fell short by missing ex-convicts' violent crimes and downplaying their risks to others.

Countless audits and reprots have "exposed shocking and unconscionable gaps in (the public health department's) implementation of the law and a disregard for its role as chief regulator of Illinois' nursing homes," Madigan wrote in the letter to department director Damon T. Arnold.

Madigan's office has no direct authority to mandate changes in other state agencies. But her voice is crucial because as the state's top law enforcement official, she has investigated substandard nursing homes and pressed for the 2006 state law requiring criminal background screenings for all new admissions.

Madigan said health inspectors and state police should quickly launch a series of unannounced visits to troubled facilities, including those housing dangerous mentally ill offenders. The health department, which is principally responsible for inspecting nursing homes and ensuring resident safety, should halt the operations of facilities that fail to comply with patient protection laws, she said.

Separately, Gov. Pat Quinn's office announced that his new Nursing Home Safety Task Force will hold its first meeting Thursday at the downtown Thompson Center and simultaneously at the Capitol in Springfield.

The task force, which also was formed in response to a Chicago Tribune series, includes the health department and other state agencies responsible for nursing-home safety.

But Madigan said state health officials shouldn't wait to adopt reforms. "A task force should not be needed ... to require (the health department) to comply with and enforce the laws that are designed to protect nursing home residents," she wrote. "Until (the health department) fulfills its statutory responsibility to aggressively regulate these facilities, residents will remain at risk."

The health department defended its safety record, saying in a written statement that it "regulates long-term care facilities to the fullest extent permitted by current state law."

But department officials said they would support "stricter laws and resources to aid in better regulating the long-term care system and will continue to work with all state agencies and the Nursing Home Safety Task Force."

The Tribune series detailed cases in which elderly and disabled nursing home residents were allegedly assaulted, raped and even murdered by mentally ill criminals who also lived in the facilities.

More than any other state, Illinois relies on nursing homes to house mentally ill patients, including younger adults with criminal records who cycle into the facilities from jail cells, psychiatric wards and homeless shelters. Younger felons qualify for nursing homes if they have a mental illness or physical disability.

People with a primary diagnosis of mental illness now comprise more than 15 percent of the state's 92,225 nursing home population, the Tribune found. Those with felony convictions now total 3,000, including 82 convicted murderers, 179 sex offenders and 185 armed robbers.

The state's incomplete and often misleading criminal background checks have been performed under contracts worth $1 million a year by companies with ties to the health department, the Tribune reported.

Madigan's letter demanded that the health department perform a top-to-bottom audit of those assessment contracts. "The criminal history analysis and reports are untimely and incomplete and, as a result, are putting residents at risk," she wrote.

Continue reading "Illinois Seeks to Overhaul its Approach to Protecting Elders and Dependent Adults" »

Another person has been charged in a case of nursing home residents who were allegedly drugged against their will.

Kern Valley Hospital administrator Pamela Ott was charged Tuesday on eight felony counts of elder abuse for allowing staff to forcibly administer psychotropic medications to patients for their own convenience, rather than for their patients' therapeutic needs, according to a news release from the California Attorney General's office.

The druggings allegedly led to the deaths of three nursing home residents.

Three other people were charged in February for their alleged roles in the case. All of the defendants worked for Kern Valley Healthcare District's skilled nursing facility in Lake Isabella.

Former director of nursing Gwen Hughes, former pharmacist Debbi Hayes and staff physician Dr. Hoshang Pormir were arrested in February after a two-year investigation.

Medical complications, including lethargy and the inability to eat or drink properly, resulted from the forced medications, and three of the facility's residents may have died as a result, according to prosecutors. The patients who died were Mae Brinkley, 91; Joseph Shepter, 76; and Alexander Zaiko, 85.

Twenty-two patients were given high doses, and one surviving patient was greatly harmed, the investigation determined.

Hughes, starting in 2006, allegedly ordered staff to give high doses of psychotropic medications to Alzheimer's and other dementia patients to make them more tranquil and easier to control. Hughes allegedly ordered the medications be given to patients who argued with her, made noise or were otherwise disruptive.

In announcing the addition of charges against Ott, the attorney general's office said Ott hired and supervised Hughes and therefore is responsible, too.

"As hospital administrator, Pamela Ott was ultimately responsible for safeguarding the welfare of her patients," Attorney General Jerry Brown said in Tuesday's news release. "Instead, Ott abdicated her responsibility and allowed the staff of the Kern Valley Hospital to forcibly sedate patients who questioned their care."

Prosecutors said last month that former pharmacist Hayes was placed on probation and agreed to cooperate with the attorney general's office in its prosecution of the other defendants.

Contact Steven Peck's Premier Legal toll free at 866.999.9085 should you ever suspect the nursing home abuse and neglect of a loved one and visit us on line at www.premierlegal.org

Georgia Fitsos died in October 2007 of acute sepsis and other complications from what her family's lawyer calls "a bedsore the size of a turkey platter," a Stage 4 pressure wound that had eaten deeply into her flesh.

It was discovered almost by chance two months earlier, when Fitsos' son found her suffering unrelated shortness of breath. Paramedics rushed the 82-year-old woman to the hospital from a Folsom board-and-care home, the Broadstone Residential Facility.

Now Broadstone's owner and administrator, Adriana Catuna, and her husband, Viorel, are the focus of pending legal action on three fronts.

A felony elder abuse trial continues in mid-September, and the Fitsos family's civil suit, claiming negligence and wrongful death, goes to court a month later. The Department of Social Services' Community Care Licensing division began license revocation proceedings in late July.

Douglas Broomell, who represents Adriana Catuna in the civil litigation, declined to comment.

Lisa Franco, Adriana Catuna's criminal defense attorney, said: "I've had nothing but good reports from the other patients and families of patients who've stayed at the Broadstone. Mrs. Catuna is not guilty of the injuries that were caused.

"I hope things work out well for Mrs. Catuna," Franco added. "Her patients love her. She has a good case."

The Sacramento County Public Defenders Office, which represents Viorel Catuna in the criminal action, didn't return phone calls.

With a huge demographic wave of baby boomers sweeping into old age in the next two decades, the Broadstone litigation raises a number of issues.

Long-term care for the elderly isn't cheap: John and Peter Fitsos paid a monthly fee of $3,500, which rose to $4,500 in May 2007 after their mother suffered what the family said was a minor stroke.

State regulators monitor the industry, but patient advocates said enforcement can sometimes lag. Barring complaints, about one-third of California's 7,800 residential care facilities for the elderly are randomly inspected each year, said DSS Deputy Director Jeff Hiratsuka.

When families visit care homes, they see facilities that look clean and neat, and they assume this means elderly loved ones are well-tended, said Lesley Clement, an elder abuse attorney representing the Fitsos family in the civil matter.

"If you went into a day care center and found a child dehydrated with diaper rash penetrating to the bone and physically restrained because they're crying, you'd have the district attorney and attorney general's office lining up to take those cases," she said.

Too often, she said, care providers tell families their loved one would have died anyway - and families, who don't know where to turn for help, believe them.

Deputy Attorney General Steven Muni, who is prosecuting the criminal case, agrees.

"Working with law enforcement on elder abuse cases, we're where domestic violence was 20 years ago," he said. "We're still in the process of educating the public and the courts. The elderly are some of our most vulnerable people."

Georgia Fitsos emigrated from Greece to Sacramento in 1952 when she married a fellow native of the Peloponnese who was 30 years her senior. He died in the early 1960s, and she raised their two sons alone in east Sacramento.

She was diagnosed with Alzheimer's disease and dementia in 2006, and it quickly became clear to her sons that she couldn't continue living alone. That fall, she moved into a private room in the Broadstone, where, according to the facility's brochure, residents "can enjoy a lifestyle of Elegance!"

"I've been blaming myself for killing my mother for the past couple of years, because it was my decision for her to go to this facility," said retired attorney John Fitsos, 55, her older son.

He went by the Broadstone regularly to visit his mother, take her out to lunch and bring her to his house, he said.

In July 2007, he took pictures of her with a huge black eye. She told him someone hit her, he said, while Broadstone staff told him that she fell asleep sitting in her wheelchair at the dining table and hit her face on the table.

A month later, he found his mother suffering shortness of breath at the Broadstone and called 911 because, he said, the on-site attendant - who has since returned to her native Romania - didn't speak enough English to make the call.

Besides the bedsores, Mercy Hospital of Folsom personnel found that Georgia Fitsos, a diabetic, had high blood-sugar levels and extremely low blood pressure, according to medical reports. She died that October at the Bruceville Terrace skilled nursing center.

The initial investigation of Fitsos' complaints to Community Care Licensing resulted in Broadstone receiving a $600 fine in late 2007.

"I filed suit when I saw the system fall apart," said Fitsos, who wants to establish a nonprofit group to advocate for reform of the residential care industry.

"I'm not interested in blood money," he said. "I'm not interested in an adversarial situation. I'm interested in seeing legislation passed that really protects the public."

Please contact Steven Peck's Premier Legal to talk to an experienced elder abuse and neglect attorney toll free at 1-866-999-9085.

Tustin Care Center has been fined $50,000 by state health officials in the choking death of a nursing home resident.

The unidentified man died in March after choking on his lunch, according to an inspection report from the California Department of Public Health. The report says staff noticed the man had been growing weaker, but the facility still allowed him to eat regular meals on his own.

On the day of his death, the report says the man was eating soup with rice when he called for his wife, who was also a patient. The man struggled to breathe, and a nurse started the Heimlich maneuver but could not dislodge the food.

The man died later that day in a hospital. An autopsy found food completely blocking his trachea. The state report concludes that the nursing home failed to assess his ability to eat, which was a direct cause of his death.

In a call on Tuesday July 28, 2009, to the nursing home, staff said the administrator was out for the day and no one else could comment.

Immediately contact Steven Peck's Premier Legal toll free at 1-866-999-9085 to talk to an experienced nursing home abuse and neglect lawyer.

The California State Senate has approved Assembly Bill 392 (Feuer) with strong bipartisan support on a vote of 33-3. AB 392 would immediately provide $1.6 million for local Long-Term Care Ombudsman programs over the next year, ensuring protection from abuse and neglect for California´s vulnerable and elderly residents of nursing care and assisted living facilities.

"We need to take every step we can to protect seniors who may be at serious risk of abuse or exploitation," said Assembly member Mike Feuer (D-Los Angeles). "The funds provided to Ombudsman programs in AB 392 fill this important need during the next year. Isolated and vulnerable residents of nursing homes and assisted living facilities have nowhere else to turn, and their lives depend upon these programs being restored immediately."

Last year, Governor Schwarzenegger vetoed $3.8 million in funding for local Ombudsman programs, representing about half their funding. As a result of the cuts, the programs have been forced to lay off staff and drastically reduce services, compromising their abilities to investigate complaints and monitor facilities. Since these cuts have taken effect, residents have suffered the dire consequences of unchecked poor treatment.

In late June 2009, a Northern California facility owner and one care giver were arrested on suspicion of criminal abuse and neglect of a resident whose untreated pressure sores were so severe that they resulted in fatal sepsis. After the arrest, the two suspects posted bail and continued to collect payment to provide care for the six other facility residents. Unfortunately, without the funds provided by AB 392, the local Ombudsman cannot investigate how well the remaining patients are being cared for.

Local Ombudsman programs conduct frequent unannounced monitor visits to facilities, and they provide timely response to reports of suspected abuse and neglect. They investigate thousands of abuse cases each year. Without the scrutiny of the Ombudsman programs, the facilities are reviewed just once a year (or less) by government agency inspectors. Because no other program duplicates this critical advocacy service, the passage of AB 392 is especially important for residents´ quality of life and quality of care.
Contact Steven Peck's Premier Legal toll free at 1-866-999-9085 to talk to an experienced elder abuse and neglect attorney.

A live-in caregiver arrested in connection with the heat-related death of a 90-year-old man and the hospitalization of his wife in eastern Contra Costa County has been released, authorities said today.

Laarni Dime, 57, was arrested on suspicion of elder abuse after she failed to turn on the air conditioner in the Discovery Bay home of George Brim.

Brim was found dead in his bedroom and his 85-year-old wife was suffering from heat-related injuries at about 11:15 p.m. on Saturday July 18, 2009, Lee said. The high in Discovery Bay that day topped 100 degrees.

Dime was released late Monday while the investigation continues.

Should you ever suspect the elder abuse and neglect of a loved one, immediately contact Steven Peck's Premier Legal toll free at 1-866-999-9085 to talk to an experienced nursing home abuse and neglect attorney.

Physical, mental and sexual abuse are certainly forms of abuse encountered by nursing home residents across the country. Remember, you know your loved one better than anyone else. If you suspect mistreatment or elder abuse immediately report the situation to local police and/or ombudsmen. The reality is that most episodes of elder abuse go unreported.

The following situations certainly warrant further investigation:

Unexplained bruises, cuts, burns, sprains, or fractures. Bed sores. Frozen joints. Unexplained venereal disease or genital infections, vaginal or anal bleeding. Bloody clothing. Sudden changes in behavior. Staff refusing to allow visitors to see resident or delays in allowing visitors to see resident. Staff not allowing resident to be alone with visitor. Resident being kept in an over-medicated state. Loss of resident's possessions.
Sudden large withdrawals from bank accounts or changes in banking practices.
Sudden loss of appetite.

Q. Are bedsores an unavoidable part of living in a nursing home?

A. No! Bedsores, also called pressure sores or decubitus ulcers, are preventable -- with proper screening, early detection, and staff involvement. Bedsores are a widespread problem in nursing homes and hospitals. The development of bedsores in nursing home patients is really a reflection of poor nursing care than an inevitable part of of the aging process.

Bedsores likely will develop if the nursing home and its staff do not make bedsore prevention a top priority. Nursing homes must do a thorough assessment of residents on admission and on a regular basis during their stay. Following the assessment, the nursing home should develop a comprehensive care plan that specifies what precautionary measures should be in place.

The nursing home plan should include considerations to monitor each resident's hydration, nutrition, and hygiene. Early signs of bedsores should be identified by the nursing home staff and treatments should implemented. Unattended, bedsores can quickly become infected leading to sepsis, limb amputation and even death.

As part of nursing home's system of bedsore prevention, nursing home residents (particularly the bed-bound) should be repositioned every two hours and ensuring proper hygiene. Pressure relieving mattresses should be implemented as a preventative measure. While bedsore prevention plans are great in theory, the most important part of bedsore prevention and treatment ultimately relies on the skill and dedication of the staff. Do not let a nursing home or hospital tell you your loved one's bedsore was unpreventable!

Q: What should relatives do if they suspect their loved one in a nursing home has been abused?

A: Contact police, because police are the ones qualified to do criminal investigation. Listen closely to what loved ones say. Look for physical signs.Counseling should take place if needed. One of the worst things to do is to pretend nothing happened.

Q. What should families do to prove mistreatment?

A.When you become aware of mistreatment ... it is important to get your loved one the medical treatment they need and then get into "fact-collection mode." ... Collect information about the incident, acts of the nursing home staff and medical condition of your loved one.

Don"t assume you will remember all facts regarding the incident. As time goes on, your memory will begin to fade.The following information will prove to be valuable:
Photographs of the physical injuries themselves, the area where the incident took place and if possible, the people involved.
Write down as much information about the incident or events as you can remember. Write some more. Details can be particularly helpful ... Concentrate on: names, dates, room numbers, names of facilities and medication dosages (if relevant).
The medical chart from a nursing home and / or hospital is crucial to determining what a facility may have done or failed to do that resulted in injury or death.
Chronology: It is important get the correct names and general dates of admission at health-care facilities. The names of doctors who provided medical can be helpful as well.
Other Relevant documents: Health-care power of attorney, wills, death certificates, preinjury photographs, autopsy reports and nursing home inspection reports all can be helpful.
Q. Who regulates nursing homes?

A. In most states, nursing homes are regulated by a combination of state (Department of Health) and federal authorities (U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services). Each agency has its own regulations that control all aspects of the nursing home including: resident care, staffing, policies and procedures and medical equipment.

Because nursing homes are responsible for complying with state and federal regulations, agents from either agency conduct inspections of the facility to assure compliance with the regulations. These inspections are called 'surveys' and are generally done unannounced at least one time per year. Surveys may be conducted more frequently at facilities with a history of prior violations or in response to a complaint regarding resident care.

After each survey a report is completed regarding the facilities compliance with applicable regulations. If the findings do not immediately threaten patient safety, nursing home administrators will have an opportunity to review the survey findings and propose a 'plan of correction'. If however, surveyors find conditions that pose a threat to patient safety, they have the ability to impose a variety of penalties including: fines, appointed facility supervisors, suspension of new resident admissions or license suspension.
Steven Peck, an experienced California nursing home abuse and neglect attorney, may be contacted toll free at 1-866-999-9085 and at www.premierlegal.org