California Nursing Home Abuse Lawyer Blog

In their ongoing series on nursing oversight in the State of California, Tracy Weber and Charles Ornstein of ProPublica are out with another story about California's shortcomings in regulating healthcare professionals. Weber and Ornstein reveal that the national database that tracks dangerous or incompetent caregivers is missing serious disciplinary actions against "what are probably thousands" of health care providers. The revelations apparently surprised federal health officials, who just last month proclaimed that "no data is missing."

For almost twenty years the federal government has kept a database of disciplinary actions against doctors and dentist, and in 1999 individual state boards were required to include in the database reports on all other healthcare professional, including nurses, whose licenses were restricted or revoked. In California, however, not all penalized caregivers were included in the federal database. For example, California has formally disciplined 84 psychiatric technicians over the last two years, yet the federal database does not contain a single report of discipline against a psychiatric technician in the State of California.

The dangers of an incomplete database are obvious, as Dr. Sidney M. Wolfe of the Public Citizen's Health Research Group observed, prospective employers of health care professions could be given "a false sense of security that somebody who may be really dangerous isn't, because their name isn't there."

To read the entire ProPublica article click here.

The nursing home abuse and neglect lawyers at the Walton Law Firm represent seniors and dependent adults throughout California who have been abused or neglected in the skilled nursing facility, residential care facility for the elderly, and assisted living setting. Call (760) 571-5500 for a free and confidential consultation.

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.

The California Advocates for Nursing Home Reform is a San Francisco based nonprofit dedicated to improving the lives of long-term care patients since 1983.

A .pdf of the Toxic Medicine booklet can be found by clicking here.

The nursing home abuse and neglect lawyers at the Walton Law Firm represent seniors and dependent adults who have been abused or neglected in the nursing home and assisted living setting. Call (866) 607-1325 for a free and confidential consultation.

This story is flat-out disturbing, and started with a concern we have heard many times from the families of our nursing home abuse clients. It began with Phyllis Peters could not wake up her 97-year-old mother, who was residing in Kern Valley Nursing Home. When she complained to Gwen Hughes, the nursing home's director, Hughes would "chemically restrain" the patient by giving her powerful anti-psychotic drugs to shut her up. Hughes did this to other residents in the nursing home, and three of them died.

In a report from the California Attorney General, Hughes ordered one patient drugged because she "glared" at her. Another was given high doses of an anti-psychotic drug for throwing a carton of milk. Several residents became severely malnourished, and were left in bed drooling and emaciated.

"In a couple cases, elderly people were actually held down, restrained against their will, and given excessive amounts of medicine to keep them quiet," said AG Jerry Brown.

But here's the stunner. Hughes had been fired from a previous nursing home for over-drugging there. When the previous employer was called as a reference for the job at Kern Valley, they failed to explain why Hughes was terminated out of fear of lawsuits (ironically, since now they will become a part of a huge lawsuit). As a result of the deaths, Hughes, administrator Pamela Ott, and physician Hoshang Pormir have been charged with criminal elder abuse, all facing up to 11 years in jail. Lawsuits by the surviving family members, and probably others, are certain to follow. The FDA estimates that unnecessary anti-psychotics kill 15,000 nursing home patients each year.

Source: ABC News

The elder abuse and neglect lawyers at the Walton Law Firm represent seniors and dependent adults throughout California who have been abused or neglected in the nursing home and assisted living setting. Call (866) 607-1325 for a free and confidential consultation.

When a person has very serious concerns that a nursing home resident has been subject to abuse or neglect in the home, a complaint may be filed with the state. The California Department of Public Health (DPH) licenses and certifies all nursing homes in California, and maintains a process for investigating all complaints made against nursing homes.

The process of filing a complaint with the DPH is fairly straightforward, and the California Advocates for Nursing Home Reform have summarized it nicely:

1. Who Can File a Complaint? Any person, or even an organization, can file a complaint about nursing home neglect with the DPH. While it is usually a family member, it doesn't have to be.

2. When Should a Complaint be Made? Typically complaints are made after other measures to resolve the issue have failed. In cases of suspected abuse or neglect, it's best to file the complaint as soon as possible.

3. Where Do I File a Complaint? DPH complaints should be filed with the nearest DPH office, usually in your county. Click here for a list of DPH office numbers for all Southern California counties.

4. What Should I Say? Focus on the important issues. For example, if the resident has suffered numerous falls and been injured, but you also have been unhappy with room cleanliness, it's best to focus on the falls and injury. You can always discuss the room cleanliness issues later. The DPH gets many call of complaints against nursing homes, you want them to take yours seriously.

5. What Happens After I Make My Complaint? Under California Law, the DPH must commence an onsite investigation of the complaint with 10 working days from the date the complaint is made. After the visit, follow up investigation may be conducted, such as interviewing witnesses. The complaints are usually completed within 60 days, at which time you will receive written notice of the DPH findings.

6. Do I Need a Lawyer? It depends. If the complaint involves serious allegations of abuse or neglect, then contacting a nursing home abuse or neglect attorney might be a good idea. We frequently say that any unexpected injury, illness, or death could be a sign of neglect, and consulting an experienced attorney in California nursing home law might be a good idea.

Source: CANHR

The nursing home abuse and neglect attorneys at the Walton Law Firm LLP represent seniors and dependent adults who have been victims of physical or sexual abuse in the nursing home, and those who have been neglected or received substandard care. Call (866) 607-1325 for a free and confidential consultation.

A Ventura nursing home called Fillmore Convalescent Center, its owner, and one of its employees were hit with a $7.75 million verdict yesterday after a jury found them liable for elder abuse. It has to be one of the largest verdicts in California in a case involving nursing home abuse or neglect.

The facts are egregious. In 2006, the family of 71-year-old Maria Arellano, a stroke victim who was also non-verbal, began to notice suspicious bruising. They complained to the nursing home administration, but it failed to look into it. The family then placed a hidden camera in Ms. Arellano's room, which caught caregiver Monica Garcia slapping Arellano, pulling her hair, bending her fingers, and treating her violently. When the tape was revealed, Garcia was charged with criminal acts, and the family brought an elder abuse lawsuit against the nursing home.

The lawyer for Arellano, Greg Johnson, must have done an excellent job. He told the Ventura County Star that he offered to settle the case for $500,000, but was rebuffed. The nursing home, through its attorney Tom Beach, never offered a dime to resolve the case. "There was a lot of arrogance," said Johnson.

Ironically, Fillmore Convalescent received a five-star rating, the highest, from the Nursing Home Compare system, operated by the Centers for Medicare and Medicaid Services.

Source: Ventura County Star

The nursing home abuse and neglect attorneys at Walton Law Firm LLP provide free consultations to individuals and families who believe a loved one has been abuse or neglected in the nursing home or assisted living setting. Cases are accepted in all Southern California counties.

The Fallbrook Hospital District Skilled Nursing Facility was fined $90,000 by the California Department of Health in a case involving the fall and subsequent death of a resident. The citation was the most severe of its kind arising from inadequate care leading to the death of the resident. Although the resident was known to have a high risk for falling, the Fallbrook nursing home failed to take adequate measures to prevent the fall. The resident fell, broke his leg, and died four days later as a result of complications from the surgery to repair his leg.

The Walton Law Firm successfully prosecutes cases involving injuries caused by falls in the custodial care setting. If you have questions about falls, please submit your confidential question online, or call Walton Law Firm for a free consultation. We can be reached toll free at (866) 607-1325 or locally at (760) 607-1325

When police came to a San Bernardino board-and-care home looking for 23-year-old Trevor Castro, they found Castro and a whole lot more. Upon arrival they found a bucket of urine outside the door, and inside found outright squalor. The discovery led to the arrest of the home's owner, 61-year-old Pensri Sophar Dalton, who is currently being held on 16 counts of felony elder abuse.

According to reports, Dalton, who was called "Mama Sophar," ran a prison-like home - which was unlicensed - for 22 elderly and mentally ill residents in San Bernardino County. The home was surrounded by cinderblock walls with barbed wire atop. Several residents lived in converted chicken coops with no plumbing. A bucket was used for a toilet.

"None of [the chicken coop rooms] were up to code," said City Atty. James Penman. "They had some with padlocks on the outside and no emergency exits, which concerned us because it could be used to lock people in as well as lock people out. The smell of urine was horrific; it permeated the entire place."

Apparently this is not the only board-and-care home run by Dalton, who had another closed down a few years ago because of code violations. Public records show that there 13 other addresses under her name, with eight in San Bernardino, two in Redlands, two in Highlands, and one home in Los Angeles. Authorities are now looking into the care being provided at the other homes.

According to a neighbor, the city had been notified of the living conditions before, but no one bothered to investigate.

Source: Los Angles Times

The attorneys at Walton Law Firm LLP represent seniors and dependent adults who have suffered neglect or abuse nursing home, residential care, or board-and-care setting. Cases are taken in all Southern California counties, including Los Angeles, San Bernardino, Orange, Riverside, and San Diego. For a free and confidential consultation call (866) 607-1325.

Aggressive behavior by nursing home residents is on the rise, and is becoming a big problem in nursing homes and residential care facilities around the country.

"Resident-on-resident aggression is substantially more common than previously thought," said Dr. Karl Pillemer, a Cornell University gerontologist. "While they are mentally impaired, they are not physically impaired. They can do considerable damage."

It is estimated that roughly half of Americans over the age of 85 suffer from Alzheimer's disease or some other form of dementia. With the population of elderly set to explode in the next 20 years - those 65 or older will make up 20 percent of the U.S. population - most experts agree that the problem is only going to get worse.

A recent incident of peer-on-peer abuse that received substantial attention occurred in an assisted-living facility outside Minneapolis last January. Former wrestling champion Verne Gagne physically assaulted a 97-year-old fellow resident at the facility where they lived. The victim, a former concert violinist who had escaped Nazi Germany, later died.

Studies have show that men suffering from age-related mental disease are more likely to be aggressive than women.

Source: Baltimore Sun

The nursing home elder abuse and neglect lawyers at Walton Law Firm LLP represent seniors and dependent adults who have been victims of abuse or neglect in the nursing home and assisted living setting. Call (866) 607-1325 for a free and confidential consultation.

Police arrested a nursing home resident after he punched a fellow resident because he thought the man was stealing his food. According to new accounts, Ardyce Nauden was charged with aggravated battery after punching 72-year-old and wheelchair-bound Andres Cardona in the face, knocking him unconscious.

Nauden allegedly stated, “He was trying to steal my food and that is why I hit him. I held onto the bed with my right hand and hit him with my left hand."

Peer-on-peer resident abuse in the nursing home setting is not uncommon. A study by Cornell University found that aggression and violence between residents is more prevalent than abuse or neglect from nursing home employees. According to the Cornell study, peer abuse is nursing home is a problem that has received little attention.

To read the Cornell study click here.

Source: WBBM News Radio

The elder abuse and neglect attorneys at Walton Law Firm LLP represent elder and dependent adults who have been victims of abuse or neglect in the nursing home and assisted living setting. Call (866) 607-1325 for a free and confidential consultation.

The California State Assembly voted overwhelmingly to approve Assembly Bill 392, which would immediately restore $1.6 million to Long-Term Care Ombudsman programs throughout the state. Much of the funding to the programs was cut last year when Gov. Schwarzenegger vetoed the Ombudsman funding request.

In June 2009, a nursing home owner was arrested on allegations of criminal abuse and neglect, when a resident of his facility was so severely neglect that pressure sores went untreated and led to a fatal infection. Numerous nursing homes throughout the state have received citations for failing to provide adequate care of residents. Without an Ombudsman program, it is difficult to monitor the care the residents of these 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), who authored the bill. "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."

Source: California Chronicle

The California elder abuse and neglect attorneys at Walton Law Firm LLP represent individuals who have suffered abuse or neglect in the hospital, nursing home, or residential care setting. For a free and confidential consultation call (866) 607-1325.

Elder abuse cases are rarely reported, and even more rarely prosecuted. “Elder abuse cases, for whatever inappropriate reason, are not considered as severe,” said Riverside County District Attorney Rod Pacheco.

The reasons for the low reporting and prosecuting are varied. There is the embarrassment of being a victim, and in many cases - up to two-thirds - the elderly victim knows the abuser. But there is also the problem of ageism; the failure to take the matter seriously because the victim is elderly.

And it's not just the public that needs educating about elder abuse and neglect, but law enforcement as well. Riverside County has a special team dedicated to elder abuse cases, and it sees the ageism first hand. "They're old. They didn't have to live anyway," are the types of excuses heard by Tristan Svare, a San Bernardino deputy district attorney.

The problem is not expected to get better anytime soon. The California $26 billion budget shortfall may mean program cuts that would leave seniors more vulnerable. IHSS funding, which helps seniors avoid nursing homes, may be at risk.

Source: The Desert Sun

The Southern California elder abuse and neglect lawyers at Walton Law Firm LLP represent individuals who have suffered abuse or neglect in the hospital, nursing home, or residential care setting. For a free and confidential consultation call (866) 607-1325.

After a L.A.Times and ProPublica investigtion found that violent or negligent nurses were allowed to stay on the job for years because of slow responses from the California Board of Nursing, Gov. Arnold Schwarzenegger fired three of the seven appointees to the board. The Governor also named six new members to the nine-member panel, which oversees the work of approximately 350,000 registered nurses in California.

Schwarzenegger was forceful in his response to the report: "It is absolutely unacceptable that it takes years to investigate such outrageous allegations of misconduct against licensed health professionals whom the public rely on for their health and well-being."

The report from the LA Times (which was blogged about here) discovered nurses who continued to work years despite documented histories of incompetence, violence, criminal convictions and drug theft or abuse.

The Governor's office stated that the new board will move quickly and decisively to address the backlog of nursing discipline cases.

The elder abuse lawyers at Walton Law Firm LLP represent individuals who have suffered abuse or neglect in the hospital, nursing home, or residential care setting. For a free and confidential consultation call (866) 607-1325.

It's been almost six months since Nursing Home Compare was launched, and all of the nations 15,600 nursing homes were listed and rated by the U.S. government. The reviews are in, and it's no blockbuster, but it isn't a flop.

For consumers, it's been mostly a good thing. It is the most complete nursing home rating website, which provides information about nursing staffing, state inspections, allegations of neglect. But some consumer groups want more details included about inspection results, and how staffing hours is calculated. Just counting workers, they say, is no indicator of the quality of care.

The nursing home industry, which tried to delay the website's rollout, says the grading system used by the site is misleading. Just because an allegation of neglect or abuse is made, it doesn't mean it has been substantiated.

Larry Minnix, the chief executive of the American Association of Homes and Services for the Aging, a trade organization for nonprofit nursing homes, believes that some important categories are not addressed by the rating system, and that nursing homes may not get credit for the care they actually provide.

Even though it has been six months since its launching, and receives 50,000 hits a day, the impact of the new site is unclear. Both the nursing home industry and patient advocates believe that most people don't know about it.

"Right now, many people making decisions about homes are in a crisis and pressed to make an immediate decision, and some simply don't know that the ratings exist online." said Gerald Kasunic, a long-term-care ombudsman.

Source: Washington Post

Nursing home abuse and neglect lawyers at Walton Law Firm LLP represent seniors and dependent adults who are victims of neglect, abuse, mistreatment, and malpractice in the nursing home, assisted living, and residential care setting. Cases in all Southern California counties are accepted, including San Diego, Los Angeles, Orange, Riverside, San Bernardino, Ventura, and Imperial.

One nurse twisted a patient's jaw until he screamed. Another grabbed an elderly man by the shoulders and slammed him against a mattress. Our 70-year-old client was punched in the face by an angry nurse while giving our client a bath.

Charles Ornstein of the LA Times is out with an article today about problem nurses. He highlights a very troubling fact: It sometimes takes years for a formal complaint against a nurse to be addressed by the California Board of Registered Nursing. As Ornstein writes:

It's a high-stakes gamble that no one will be hurt as nurses with histories of drug abuse, negligence, violence and incompetence continue to provide care across the state. While the inquiries drag on, many nurses maintain spotless records. New employers and patients have no way of knowing the risks.

The LA Times investigation examined the case of every nurse who faced disciplinary action from 2002 to 2008, and made some troubling findings:

• It took more than three years on average to investigate and act on complaints;

• The Board gave probation to hundreds of nurses, the failed to crack down as many of the nurses landed in trouble again;

• The Board failed to use its authority to immediately stop dangerous nurses from practicing;

Most troubling, the Times investigation found more than 60 nurses who were disciplined for "serious misconduct" since 2002 had worked in three facilities before action was taken.

Here at Walton Law Firm, we have been told that the nurse who punched our elderly client in the face continues to work at a different facility. Something needs to be done.

The entire LA Times story can be found here.

The nursing home abuse and neglect lawyers at Walton Law Firm LLP provide free consultations to individuals and families who believe a loved one has suffered from abuse or neglect in a nursing home or residential care setting. Cases are accepted throughout Southern California.

The U.S. Court of Appeals, 3rd Circuit has ruled that the Federal Nursing Home Reform Amendments grants residents of county-operated nursing homes the right to bring civil rights claims for allegations of abuse, neglect, or other care-related complaints.

The ruling arose in a case involving the 80-year-old Melvinteen Daniels, who died in a county-run nursing home as a result of neglect, malnourishment, and pressure ulcers. The family brought a lawsuit against the nursing home alleging, among other things, civil rights claims under Section 1983. Challenges to the claims wound their way through the courts and leading to yesterday's ruling.

In a 23-page opinion, U.S. Circuit Judge Richard L. Nygaard held that, "the language used throughout the FNHRA is explicitly and unambiguously rights-creating. These provisions make clear that nursing homes must provide a basic level of service and care for residents and Medicaid patients."

Nygaard also went on to hold that the FNHRA "guarantees" nursing home residents the right to be free from physical abuse, corporal punishment, involuntary seclusion, or restraints imposed for the purposes of discipline or convenience. (Read the opinion here)

The FNHRA was passed in 1987 as amendments to the Medicare Act, and designed to address nationwide concerns over nursing home care.

The elder abuse lawyers at Walton Law Firm LLP provide free consultations to individuals and families who believe a loved one has been abuse or neglected in a Southern California nursing home or assisted living facility.

When Doris Weaver saw her mother's black eye at the local hospital emergency room where she had been taken from a nursing home, she was stunned.

"She had a bruise from her temple all the way down to her lower earlobe," said Weaver. "Her eye was black and was swollen."

Weaver demanded to know what caused her mother's injury, and even filed a police report, but to date she has gotten now answers...from anyone, even her mother, who cannot speak. [Read the entire story here]

Like elder abuse victims all over the county, Weaver's mother is unable to tell her story because of her advanced dementia. Because of memory impairment problems caused by dementia and Alzheimer's disease, many aging Americans under professional care are unable to communicate, and unable to tell family members when they are subjected to abuse or neglect. Our firm has one such case right now, involving a non-communicative Alzheimer's disease patient who was struck in the face by nursing caregivers, but unable to tell her horrible story.

Any unexplained incidents of bruising or dramatic changes in mental status should be reported to the resident's physician right away, and the local ombudsman office.

The elder abuse and neglect lawyers at Walton Law Firm LLP represent seniors and dependent adults who are victims of neglect, abuse, mistreatment, and malpractice in the nursing home, assisted living, and residential care setting. All case consultations are free and confidential.

There is a short but solid article in a New Jersey paper today addressing the signs of elder abuse. New Jersey attorney Victoria Dalton lays out the real world signs and symptoms of elder abuse, which she defines simply as taking advantage of the elderly.

Physical Abuse

Physical abuse is simply the use of physical force which causes bodily injury, pain or some other type of impairment. It can also include hitting, shaking, slapping, kicking, or pinching. The signs to be aware of include bruises, broken limbs, welts, cuts, burns or marks.

I would add neglect to this list. Neglect is the failure to provide case and often reveals itself in incidents of malnutrition and dehydration, pressure sores, untreated infections. In realty, any unexplained injury, infection, or death can be a sign of physical abuse or neglect.

Financial Abuse

Financial abuse is more subtle, and is essentially the improper use of the senior's funds, property or assets. A common indicator of financial abuse is when the elder's contribution to household services is disproportionately high when compared to an adult child living in the home. Another tell-tale sign is a change in banking habits. Be aware of any large withdrawals by a person accompanying the senior.

Emotional Abuse

Emotional abuse typically includes intimidation, humiliation and harassment. Degrading remarks, or treating the elder like an infant, giving the older person the silent treatment, are also examples of emotional elder abuse.

Elder abuse can be stopped, Dalton writes, if we are simply more vigilant.

The nursing home malpractice lawyers at Walton Law Firm LLP provide free consultations to individuals and families who believe a loved one has suffered from abuse or neglected in a nursing home or residential care setting.

The Walton Law Firm elder abuse and neglect lawsuit filed against Vista Hospital of Riverside was the subject of a front page story in the Press Enterprise newspaper today.

The lawsuit arises out of the improper care provided to 78-year-old Shirley Buffa, who died after the hospital failed to administer dialysis treatments necessary to treat her diabetes. According to her son, Marine Corp. veteran Robert Buffa, his mother became increasingly sick in the days after she was admitted to the hospital, but the hospital attributed the decline in her health to a reaction to antibiotics. When the mistake was realized, it was too late.

At that point, she couldn't even talk," Robert Buffa said. "I said, 'Mom, I love you. How come you can't open your eyes?'"

The Perris hospital has been under scrutiny by both the state and federal government. The Centers for Medicare & Medicaid Services, which regulates hospitals, investigated the hospital and found numerous violations, including:

● Delayed response or non-response to life-threatening emergencies
● Improper writing of a patient's "do not resuscitate" order
● Failure to track medical errors
● Failure to dispense and track medicines
● Inadequate infection control
● An inadequately staffed intensive-care unit
● More intensive-care patients than the hospital's license allowed
● Use of improperly serviced medical equipment
● Conversion of a trailer for medical use without state approval

Vista Hospital of Riverside was warned that it risked losing Medicare funding. It did not respond to the reporter's calls for comment.

To read the entire article click here.

The neglect and malpractice attorneys at Walton Law Firm LLP provide free consultations to individuals and families who believe a loved one has suffered medical negligence, abuse or neglect in the hospital, nursing home, or residential care setting. For a free and confidential consultation call (866) 607-1325.

In the news today is an article from the BBC about a nursing home nurse who was found guilty of assaulting an 80-year-old patient who suffers from dementia. According to the article (found here), the perpetrator "twisted the hand" of the resident, causing the resident to scream and cry. The assault was witnesses who reported the offense, leading to the prosecution and deportation of the caregiver.

But that was in Britain. Do we have such abuse in Southern California nursing homes? The answer is a resounding yes. Is it an epidemic? No, but there is enough of it to raise concerns. Our firm currently represents a San Diego nursing home resident who suffers from dementia, and who, while resisting care (something people with memory impairment diseases sometimes do), was punched in the face by a caregiver. Immediately after the battery, there was an attempt to cover up the abuse, but thankfully witnesses stepped forward just as they did in the case in Britain.

We advise family members and caregivers to be aware of sudden changes in condition of the patient, and to look for unusual marks or bruising that might indicate abuse. Sadly, many cases go unreported because either the resident cannot complain because of advanced disease, or will not, because of fear of retribution. If an assault and/or battery is suspected, the authorities must be contacted right away.

The elder abuse and neglect lawyers at Walton Law Firm LLP provide free consultations to individuals and families who believe a loved one has been abuse or neglected in the nursing home or assisted living setting.

A nursing home in suburban Chicago has been sued for failing to protect a 69-year-old resident from a sexual assault by a 21-year-old mentally ill man. According to the lawsuit, which alleges nursing home negligence and elder abuse, the skilled nursing facility tried to cover up the rape by telling authorities that it was consensual sex.

This case highlights the dangers in mixing elderly residents with younger patients who suffer from mental illness. The lawyer from the victim contends that a profit motive drives homes to mix residents.

"The only possible reason that you would be in this situation is a profit motive," said Pete Flowers, attorney for the woman. "You want more residents in your facility, but you're unwilling to pay for the necessary elements to protect all the residents."

According to the Chicago Tribune, the 21-year-old resident was missing at bed check, but no effort was made to find his whereabouts. Later in the evening, a night shift nurse heard the elderly woman moaning and entered her room to find the victim crying in her bed. Incredibly, the rapist was in the facility for bipolar disorder with aggression and told the staff shortly after his admission that he was sexually frustrated.

The nursing home abuse and neglect attorneys at Walton Law Firm LLP provide free consultations to individuals and families who believe a loved one has been abuse or neglected in the nursing home or assisted living setting.

An 89-year-old nursing home patient in Australia was bitten by mice, which shredded parts of his ears, head, and neck. According to reports, this victim of elder neglect was bedridden, and had the tops of ears severely chewed. A federal official, who has launched an investigation into the matter, said it was "extremely disturbing and traumatic" for the resident and his family. We couldn't agree more.

Here's a video report:

The San Diego elder abuse and neglect attorneys at Walton Law Firm LLP provide free consultations to individuals and families who believe a loved one has been abuse or neglected in the nursing home or assisted living setting.

Walton Law Firm LLP has filed an elder abuse lawsuit against Vista Hospital of Riverside, it’s owner Vista Healthcare, LLC and Dr. Joel Pengson. The complaint alleges that Shirley Buffa was admitted to Vista Hospital of Riverside on May 16, 2008 and died on May 27th, 11 days later. The complaint alleges that Mrs. Buffa's death was a direct result of the the Defendants' neglectful failure to provide her with the medical care which she required, including but not limited to, the failure to provide dialysis.

The Summons and Complaint can be viewed on the Riverside Superior Court's website HERE.

Elder Abuse and Neglect: On February 26, 2009 the Department of Health & Human Services, Center for Medicare & Medicaid Services released the results of the most recent survey of Vista Hospital of Riverside, located in Perris, California. The results reveal shocking examples of neglect.

The California Department of Public Health, the agency charged with surveying the facility for Medicare, reported "serious deficiencies." As a result, the Department of Health & Human Services determined that:

"the deficiencies, either individually or in combination, substantially limit the hospital's capacity to render adequate care to patients or are of such character as to adversely affect patient health and safety . . ."

Examples of some of the deficiencies found were:

- Vista Hospital of Riverside is only licensed to care for 8 ICU level patients, yet on the date of the survey, June 24, 2008, there were 10 ICU patients.

- Staffing reports for 20 random shifts indicated the facility failed to have at least two trained and experienced nurses present in the MSU (medical surgical unit) when ICU patients were present, "resulting in the potential for inadequate patient care due to insufficient numbers of specially trained personnel."

- A 78 year old woman was admitted with diagnoses that included end stage renal disease. Prior to admission she had been receiving dialysis three times per week and this was noted on admission. However, the patient did not receive dialysis until 5 days after her admission.

- The same patient was supposed to receive a medication, Procrit, for treatment anemia. The medication was not given due to "not available."

In fact, there are many, many deficiencies noted within the report for the failure to give medications as ordered by the physicians due to "not available." When the Pharmacist In Charge was interviewed by the surveyors, he stated that "he was not aware of the above issues regarding unavailability of medications and missed doses."

- On May 26, 2008 a "Code Blue" (emergency due to loss of heart beat or breathing) was called for a 78 year old female patient at 7:57 p.m. The on-call physician was called at that time. The nurses' notes indicate that the physician was called with an update at 8:30 p.m., 33 minutes later. There was no indication in the record that the physician ever responded to the "Code Blue."

- On May 15, 2008 a Code Blue was called at 8:11 p.m. for a 62 year old male patient. The physician responded. A second Code Blue was called for the same patient at 8:24 p.m. However, the Code Blue sheet indicated, "The Dr. did not return." When interviewed, the nurse stated that she did not know why the physician did not respond to the second Code Blue.

These are but a few of the numerous deficiencies outlined in the Department's 199 page report.

Walton Law Firm LLP has been retained by the family of one of the patients referred to in the report to investigate allegations of malpractice, abuse and neglect. The patient died 11 days after admission to Vista Hospital of Riverside and, it will be alleged, due to the neglect of Vista Hospital of Riverside.

To see the Department of Health & Human Services letter click HERE

The Ombudsman Services of Northern California, an organization dedicated to creating a corps of compassionate advocates for residents in long-term care facilities believes that state budget cuts to its ombudsman program will lead directly to an increase in cases of elder abuse and neglect.

This year the organization, which tracks approximately 1,600 nursing homes and assisted-living facilities, lost two-thirds of its staff due to shortfalls in the state budget. According to Joan Parks, nursing facilities are already taking advantage of the lack of oversight.

"Our monitoring in these homes was seen as a form of prevention," Parks said.

The nursing home abuse and neglect attorneys at Walton Law Firm LLP provide free consultations to individuals and families who believe a loved one has been abuse or neglected in the nursing home or assisted living setting.

U.S. News & World Report is out with an article on the common problems found in U.S. nursing homes in an interview with attorney Eric Carlson, author of 20 Common Nursing Home Problems. As a nursing home abuse lawyer, I found the article enormously helpful; particularly the answer to the first question, which I think is the most important:

What can consumers do to best protect themselves up front?

Be aggressive about questioning a prospective home about staffing and staff training. A nursing home generally receives $4,000 to $9,000 a month for the care of one resident, so it should be responsive to both residents and potential customers. Talk to residents and visitors without nursing home staff hovering nearby. Visit several times, at different hours and on different days. Make at least one visit at mealtime. Examine inspection reports. Each nursing home that accepts Medicare or Medicaid payment is inspected approximately once a year. And the National Citizens' Coalition for Nursing Home Reform offers a consumer guide to getting good care in a nursing home.

Other questions include Alzheimer's care, nursing home staffing, and nursing home rights. I encourage all who are investigating nursing home care, or currently have a loved one in a nursing home to read the complete article which can be found by clicking here.

The elder abuse attorneys at Walton Law Firm LLP represent individuals and families throughout Southern California who have suffered due to abuse or neglect in the nursing home and assisted living setting.

California ombudsman Nona Tolentino's job is to investigate cases of suspected elder abuse in nursing homes. Her conclusion after years as in the business: be afraid, be very afraid.

The biggest problem Tolentino faces is trying to prove the allegations. "I call it the conspiracy of silence," she said, because many nursing home residents and their family are reluctant to talk about, frequently out of concerns of retaliation or being evicted from the facility. Tolentino believes strongly that nursing home residents have fundamental rights to be free from physical and verbal abuse, unnecessary restraints, or involuntary seclusion.

Tolentino is mostly right. If one were to visit the local office of the California Department of Public Health and pull the file of any large nursing home in the region where they lived, they would be startled by the number of complaints made and investigated. More troubling, however, would be the realization that the vast majority of complaints are "unsubstantiated;" meaning the investigator could not prove the allegations are true.

This is a real problem. Not that every complaint is meritorious, but that the investigation and enforcement of these complaints is very inadequate. In our office, we have litigated numerous cases involving horrendous cases of neglect or abuse where a formal state investigation had previously found no wrongdoing. Sadly, because of California's budget woes, this probably will not change anytime soon.

Three California nursing home employees were arrested yesterday for allegedly injecting 22 residents with mood-altering drugs to keep them quiet and restrained. According to the criminal complaint, a nursing director, a pharmacist, and a physician drugged the residents in order to keep them compliant and easier to care for. Three of the patients died.

“These are powerful medications that were given, in some cases against people’s will, primarily for management, not health reasons,” said California Attorney General Jerry Brown. “It's unconscionable behavior and it’s certainly not what people expect when they entrust their parents or grandparents to a skilled nursing home.”

The allegations in the criminal complaint are appalling, including residents becoming "zombie-like" and unable to eat or drink for days, causing severe malnutrition and dehydration. The three residents who died were Fannie May Brinkley, Eddie Dolenc, and Joseph Shepter. At least one civil lawsuit has been filed as a result of the deaths, and more are expected.

The use of powerful narcotics as chemical restraints is an ongoing problem in nursing homes. Under California law, a resident, or his/her responsible party must be thoroughly informed about the risks associated with anti-psychotic medications, and must approve any request for us. These medications must also be administered only with a doctor's order.

Lemon Grove Care and Rehabilitation (San Diego County) has received the state's most severe citation after the burn-injury death of a 74-year-old resident. State investigators found that the facility failed to adequately supervise the resident, who caught fire while smoking at the facility. According the reports, the woman was sitting in the designated smoking area trying to light a cigarette when her jacket caught fire. She died 10 days after suffering her injury.

The nursing home has been issued an "AA" citation and a fine of $80,000.00, which it intends to challenge in Superior Court. Lemon Grove Nursing and Rehabilitation received two Class B citations last year (click here), and is currently under investigation for separate allegations of neglect in a case being handled by Walton Law Firm LLP.

Walton Law Firm LLP represents individuals and families throughout Southern California in cases involving nursing home abuse and neglect. All consultations about a case are free and confidential.

The Des Moines Register reviewed 81 bonus payment programs in over 30 states and found that numerous nursing homes with a below-average care giving rating were receiving quality-of-care bonuses. The newspaper looked at eight federal bonus programs in states where regulatory violations by a nursing home do not automatically disqualify a nursing facility from receiving a bonus. The eight programs analyzed are costing taxpayers $313 million per year.

By way of example, the Grace Living Center in Oklahoma earned approximately $96,000 in bonuses during the last year despite federal records that show the home has been cite for more violations than the state or national averages. Toby Edelman of the nonprofit Center for Medicaid Advocacy called the bonuses "preposterous," and pointed out the incongruity of the government taking money from bad facilities by issuing fines, then returning the money in the form of a bonus. "It just doesn't make any sense," Edelman said, "it's totally confusing to consumers."

Legislation approved earlier this year says the bonuses will continue at least through June 2009.

A study just released by the Inspector General of the Department of Health and Human Services reports that 94% of all nursing homes nationwide were cited for violations of federal health and safety standards during 2007. Approximately 17% received deficiencies or citations for issues which caused "actual harm or immediate jeopardy" to residents. These deficiencies were for such things as bedsores, medication errors, lack of nutrition/dehydration, abuse and neglect of residents.

In total, inspectors received 37,150 complaints nationwide. Surprsingly, only one-fifth of the verified complaints involved the abuse or neglect of patients. The remainder were for adminsitrative issues or those related to the physical premises.

Another telling statistic is that 94% of for-profit nursing homes were cited whereas only 88% of non-profit nursing homes were cited. For-profit also received an average of 7.6 deficiencies per home whereas non-profits averaged 5.7 per home.

The New York Times is reporting this morning that 90% of all nursing homes were cited for violations of federal health and safety standards. Approximately 17% of U.S. nursing homes had deficiencies that caused actual harm. As mentioned in this blog previously, nursing facilities that operate "for-profit" were more likely to have problems than non-profit homes.

Federal inspectors received 37,150 complaints in 2007 about nursing home conditions, the bulk of which involved bed sores, abuse and neglect of residents, medication errors, and nutritional issues. Failure to sufficiently staff was noted as a particular concern in the report, including the allegation that nursing homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.” Not surprisingly, researchers learned that elderly patients receive better care at homes with a higher ratio of nursing staff members to patients.

The U.S. has approximately 15,000 nursing homes, housing nearly 2 million people. Under the laws of most states, including California, these homes are inspected once a year.

The elder abuse lawyers at Walton Law Firm LLP, a Southern California law firm, represents individuals who have been impacted by the abuse of elders and dependent adults while under professional care. All consultations are free, and cases are accepted in all Southern California counties.

On Wednesday, the Senate Finance Committee approved two bills which will help prevent neglect and abuse of elderly persons.

A frequent source of abuse are caregivers who are repeat violent offenders. A bill (S 1577), sponsored by Sen. Herb Kohl (D-Wis.), would create a nationwide background check system to screen long-term care employees for a history of abuse or a violent criminal record prior to hiring.

A seven-state pilot program established under the 2003 Medicare law already exists and would be expanded by this bill. The bill would provide as much as $160 million in grants over three years to states which seek to participate in the program. This law would help keep violent offenders from working in nursing homes with particularly vulnerable elderly patients.

The secdon bill (S 1070), sponsored by Sen. Orrin Hatch (R-Utah), would create state and local training and assistance programs for long-term care employees. The legislation would also establish a database used to identify and track elder abuse cases.

Yesterday, the U.S. Census Bureau reported the number of citizens age 65 and older will more than double from their current number of 38.7 million to 88.5 million in 2050. The population of 85 and older is predicted to triple in number to 19 million from 5.4 million during the same period.

At the same time, the "working age" population, i.e. those aged 18 to 64 is expected to decrease to 57% of the popoluation from 63% currently. What this means is that there will be fewer people available to care for more elders. Will this cause an increase in nursing home abuse and/or neglect?

As any attorney who represents elders in elder abuse or elder neglect cases against nursing homes will tell you, the number one direct cause of elder abuse is a lack of staffing. Most elder abuse does not occur because the caregivers want to abuse/neglect their residents. It occurs because there aren't enough caregivers to perform all of the necessary tasks.

A University of Chicago study reveals that approximately 13 percent of elderly Americans experience some sort of mistreatment. The most common form of abuse was verbal, experienced by 9 percent of elderly Americans, then financial mistreatment, experienced by 3.5 percent, and then physical abuse, reported by .2 percent of the elderly.

“The population of the country is aging, and people now live with chronic diseases longer. So it’s important to understand, from a health perspective, how people are being treated as they age,” said lead author Edward Laumann, the George Herbert Mead Distinguished Service Professor in Sociology at the University of Chicago.

The complete study can be accessed here.

Despite having the same odds at recovery, elderly trauma patients are being steered away from top trauma hospitals while younger patients are getting the better care. A new study finds emergency medical personnel are systematically discriminating against seniors. The study examined 10 years of data from ambulance trips in the state of Maryland and found that nearly half of all patients over 65 were not sent to designated trauma centers for care compared to only 18% of younger trauma victims.

Here’s the video story:

Walton Law Firm LLP represents people who have been vicimized by elder abuse, elder neglect, mistreatment, and nursing malpractice. Cases are accepted in the counties of San Diego, Los Angeles, Orange, Riverside, San Bernardino, Ventura, and Imperial.

Elder abuse lawyers have all seen cases of residents being evicted from nursing homes, or refused readmission, for dubious reasons. We sometimes call it Medi-Cal prejudice; that is residents being refused admission to a nursing home for no other reasons than they are Medi-Cal recipients.

One former client of our firm called a nearby nursing home hoping to find a room for her mother, who was about to be discharged from the hospital. The first question from the nursing home was whether her mother was receiving Medi-Cal. Medicare, or private pay. When the daughter told the nursing facility her mother received Medi-Cal, she was promptly told there were no available beds, but that her mother could be put on a waiting list.

Being a nurse herself and believing there were available beds, the daughter called the same facility the following day to see if there was room for her mother. Using a different name, she again asked if there were available beds, and this time, after informing the nursing home her mother received Medicare, she was told there were several rooms available, and that the facility would be happy to provide a tour that afternoon.

The Wall Street Journal reported this week that nursing homes across the country are refusing to admit, or are forcing out, frail and ill patients who are on Medicaid (“Medi-Cal” in California), because the facilities can make more money caring for residents on Medicare or private pay. Over the last decade, the number of complaints over the discharge practices of nursing homes has doubled, and the true number of force evictions is unknown, as it is believed most go unreported.

We are frequently asked how nursing home neglect or abuse can be prevented. There is no magic answer, but there are things one can do to lessen the odds that a loved one will be subject to physical neglect, financial abuse, or suffer the decline in health caused by poor care. The California Advocates for Nursing Home Reform have published a guide for preventing abuse in long-term care facilities. How does one increase the odds there will be no abuse or neglect?

1. Be very supportive of the transfer to a nursing home. Under most circumstances, the initial entrance to a nursing facility will engender feelings of loss or abandonment. Visit frequently to help with the adjustment.

2. Make the most of visits. Visit frequently, and at different times. Also visit during meal time. This will give you a more complete picture of care and the performance of staff.

3. Get to know the staff. Building personal relationships with the caregivers can be an excellent way to ensure good care.

4. Participate in care planning meeting. No one knows your family member better than you. The care plan meeting will give you an opportunity to alter the course of treatment to meet the needs of your loved one.

5. Be an advocate! Do not be afraid to advocate for the rights of your loved one. All residents have basic rights (click here) and you need to fight for them without fear of retaliation.

Don’t try to do this all alone. Enlist other family members and friends to help, and communicate often. Most nursing homes can provide good care; it’s just a matter of making it happen.

The law firm of Walton Law Firm LLP is based in Southern California, and represents individuals impacted by neglect and abuse in the nursing home and residential care setting. Cases are accepted in all Southern California counties.

Elder abuse comes in a variety of forms. The abuse we hear about most frequently is physical abuse, which includes assault, battery, and sexual offenses, and financial abuse, which is usually a matter of fraud or undue influence upon a senior citizen. Both physical and financial abuse are very serous offenses that should be promptly reported to the police, and a private civil attorney.

Another, less discussed, form of abuse is abuse in the nursing home or assisted living setting. In California, there are approximately 100,000 nursing home beds, and probably an equal number of assisted living beds, and the health and well being inside these facilities usually depends on the quality of the care they are receiving. In truth, the word “abuse” is probably a bit misleading, as these occurrences are usually a matter of neglect of the elderly resident, not physical abuse.

Unfortunately, most instances of neglect or abuse are not reported. Elderly residents are often afraid to report an act of abuse or neglect for fear of retribution by staff, or simply because they cannot stand the thought of being transferred to a different facility. Or, more often, the decline in health caused by the neglect is attributed to some other cause, usually related to old age.

I typically tell people that if there is any unexpected injury, illness, or death, then it’s important to take a look at the records to determine the actual cause. Yes, people of advanced age usually have a variety of health problems, and most of the time illness or death is a naturally occurring event, and not the result of neglect or abuse. But if you, as the loved one, have a sense that something is not right, then I would suggest that an attorney with experience in nursing home abuse or neglect cases take a look at the person’s medical file.

The law firm of Walton Law Firm LLP represents seniors and dependent adults who are victims of neglect, abuse, mistreatment, and malpractice in the nursing home, assisted living, and residential care setting. Cases in all Southern California counties are accepted, including San Diego, Los Angeles, Orange, Riverside, San Bernardino, Ventura, and Imperial.

Nursing home abuse and neglect is not always perpetrated by staff members. New research from Cornell University suggests that aggression and violence between residents may be more prevalent than abuse or mistreatment from nursing home employees.

According to the study, peer-on-peer abuse is nursing home is a problem that has received little attention.

"Given that nursing homes are environments where people live close together, and many residents have lowered inhibitions because of dementia, such incidents are not surprising," said Karl Pillemer of Cornell. "Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem."

The Cornell research examined a large urban nursing home and found 35 different types of verbal and physical abuse between residents. The most commonly found aggressive behavior was screaming, followed by physical violence such as pushing, punching, or fighting. A related study found that 2.4 percent of the residents had personally experienced physically assault from another resident, and more than twice that had experienced verbal aggression.

The authors of the study hope that their findings will assist nursing home staff better manage aggressive behavior among residents.

This comic strip is from the LA Times. We've had this case. The angry caregiver who assaults the nursing home resident, usually over some frustration related to care. Not so funny when it really happens.

Class AA: The most serious violation, AA citations are issued when a resident death has occurred in such a way that it has been directly and officially attributed to the responsibility of the facility, and carry fines of $25,000 to $100,000.

Class A: Class A citations are issued when violations present imminent danger to patients or the substantial probability of death or serious harm, and carry fines from $2,000 to $20,000.

Class B: Class B citations carry fines from $100 to $1000 and are issued for violations which have a direct or immediate relationship to health, safety, or security, but do not qualify as A or AA citations.

The quality of care provided by California nursing homes has declined by almost every measure since the implementation of a new Medi-Cal rate system that increased funding the nursing facilities according to a new study by the University of California, San Francisco (UCSF). Meanwhile, nursing home complaints and the issuance of deficiencies have grown dramatically since the rate hike.

Critics contend that the nursing home industry crafted the rate hike on the basis that it was necessary to improve care. And while staffing levels improved under the new law, nursing home staff turnovers increased. The study reveals that 144 nursing homes in California failed to meet state minimum staffing requirements (.pdf).

According to the California Advocates for Nursing Home Reform:

The rate system's most controversial provision is a profit component that pays nursing homes 8 percent of their labor costs to spend or pocket as they wish. Estimated to cost Medi-Cal and taxpayers about $150 million per year, it is deceptively labeled as a "labor driven operating allocation." Every freestanding skilled nursing facility certified by Medi-Cal receives profit payments, no matter how poor its care. No other Medi-Cal providers are guaranteed a profit.

The entire UCSF study can be found here (.pdf). If you have any questions about nursing home quality of care, call Walton Law Firm LLP at (866) 607-1325.

Budget cuts proposed by Governor Schwarzenegger could cripple California's oversight of Residential Care Facilities for the Elderly. Further damage to the already struggling oversight program could put thousands of RCFE residents at risk.

According the California Advocates for Nursing Home Reform (CANHR), the proposed cuts come at a time when assisted living care is growing at a rapid rate. There are more than 7,000 assisted living facilities in the state, an increase of more than 25% over the last decade. Current law requires an inspection of RCFEs only once every five years, a dramatic decline from the 1980s when such facilities were subject to inspections twice a year.

Inspecting RCFEs once every five years or less is a recipe for neglect and abuse," said Patricia McGinnis, CANHR’s executive director. "Care standards and residents’ rights become virtually meaningless when inspections are so rare. Issuing a license under these conditions deceives consumers who assume the state is conducting regular inspections or offering oversight and protection to residents.

In my practice, I have seen more and more RCFEs retaining residents that should be moved to a higher level of care, but are retained in the assisted living facility for questionable reasons. This trend, combined with an unthreatening state oversight program is not good news for California seniors.

In an effort to save some taxpayer money and improve patient care at the same time, the Centers for Medicare and Medicaid Services (CMS) has made a list of health conditions that are preventable and should never occur in the nursing home or hospital setting.

According to the National Quality Forum, “never events” are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility.

The list of “never event” endorsed by CMS contains 28 negligent events ranging from a surgery performed on the wrong part of the body, to the discharge of an infant to the wrong person. Those listed events that frequently occur in nursing homes are:

● Stage 3 or 4 pressure ulcers or bedsores acquired after admission to a facility.

● Patient death associated with a fall while being cared for in a healthcare facility.

● Patient death or serious disability associated with patient elopement (disappearance) for more than four hours.

● Patient death or serious disability associated with a medication error.

● Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility.

● Sexual assault on a patient within or on the grounds of a healthcare facility.

So serious are these never events that starting October 1, 2008 CMS will not reimburse healthcare facilities for the occurrence of these conditions, unless the condition was present upon admission to the facility.

While the list contains many events that have no application to nursing facilities, I can say (sadly) that I have been involved in many lawsuits involving all the “never events” listed above, a few of them more than once.

Medicaid spends more money on antipsychotic drugs than any other prescription drug. Physicians are prescribing these powerful drugs in record numbers to nursing home residents in order to control their behavior, not for the treatment of psychotic illness.

It is reported that nearly 30% of the total nursing home population is receiving medication in a practice that is known as "off label use" of prescription drugs. It's no surprise to lawyers who practice this area that studies also reveal that nearly 21% of nursing facility residents being given these drugs do not have a psychosis diagnosis.

"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York's nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

Here at Walton Law Firm we frequently get calls from families angry at nursing providers for over-medicating loved ones. It's usually a similar story. The family stops by the facility for a visit, only to find their loved one non-communicative and listless, and sometimes incontinent.

The Centers for Medicare & Medicaid -- the federal agency that oversees the two huge tax-funded insurance programs that cover the elderly and the poor -- has "initiated a more rigorous process to oversee appropriate use of medicine," says Chief Medical Officer Barry Straube. He says the number of nursing home inspections that result in citations for violating drug-misuse rules has jumped by nearly 50% between 2004 and this year. Action is being taken and the increased vigilance is working, CMS says.

Dr. Straube says CMS -- which both funds and oversees nursing homes -- "is very concerned about the quality of care in nursing homes and has taken steps within its authority to discourage inappropriate use of all drugs, including psychotropic medications."

High use of antipsychotics in a nursing home can be an indicator of inadequate staffing or other negligent care, says Bruce Pollock, president-elect of the American Association of Geriatric Psychiatry. "We know the more staffing there is and the higher quality of care, the less the antipsychotic usage," he says.

If you have concerns that someone you know is being over-medicated contact the resident's primary physician immediately.

Nursing home owners have claimed for years that they are barely getting by, and the lawsuits against them for negligent care are going to drive them out of business, leaving no place to put seniors. We reject this argument as a time-honored trick by tortfeasors to become the victims after causing harm to others. A New York Times article substantiated that the nursing home business is plenty profitable.

According to the Times, private takeover of nursing homes leads to poorer care, and increases the likelihood of nursing home abuse or neglect. A survey of complaints against more than 16,000 U.S. nursing homes found that care often deteriorates significantly after homes are acquired by large private investment firms.

The Times compared the number of complaints received against 1,200 nursing homes acquired by these for-profit firms against those of 14,000 other nursing homes.

The report revealed that, on average, residents of these homes are now much worse off in terms of depression, loss of mobility, and loss of ability to dress and bathe themselves than before the takeover, according to data compiled by the U.S. Centers for Medicare and Medicaid Services. Much of that shortfall in care is linked to drastic cuts in nursing and other staff in the months after an investment firm takes over the home.

“The first thing owners do is lay off nurses and other staff that are essential to keeping patients safe,” said Charlene Harrington, a professor at the University of California in San Francisco who studies nursing homes. In her opinion, she added, “chains have made a lot of money by cutting nurses, but it’s at the cost of human lives.”

Advocates for nursing home reforms say anyone who profits from a facility should be held accountable for its care.

“Private equity is buying up this industry and then hiding the assets,” said Toby S. Edelman, a nursing home expert with the Center for Medicare Advocacy, a nonprofit group that counsels people on Medicare. “And now residents are dying, and there is little the courts or regulators can do.”

There is something you can do. Go after those who cause the harm, plain and simple.

The National Pressure Advisory Panel updated its definition of the four “stages” used to diagnose pressure ulcers or decubitus ulcers (often referred to as bed sores). It also added two new stages on deep-tissue injury and ulcers that cannot be staged. The updated stages of pressure ulcers were released at the conclusion of its 2007 annual conference held in San Antonio, Texas.

A pressure ulcer or bed sore is a localized injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure, or pressure in combination with shear and/or friction. In elderly or disabled patients, sores can begin on the skin of the tailbone, back, buttocks, heels, back of the head, or elbows. Poor nutrition or dehydration can weaken the skin and make it more vulnerable.

The new staging definitions are as follows:

Stage I. Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Stage II. Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

Stage III. Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

Stage IV. Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Unstageable. Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

There is rarely a legitimate explanation for a pressure ulcer to reach the level of a Stage IV in hospital, nursing home, or assisted living setting. Any skin wound progressing to Stages III or IV should be viewed with a critical eye, and a physician should be involved in the care immediately. The development of pressure ulcers in the custodial care setting is one of the leading causes of lawsuits against nursing homes in the United States, and have been the subject of several lawsuits brought by the attorneys at Walton Law Firm.

The Centers for Medicare and Medicaid Services announced last month that, it will no longer reimburse hospitals for treating eight "reasonably preventable" conditions as of October 2008 the Wall Street Journal reports. Pressure ulcers are among the most prevalent, costly and dangerous on the list. In addition to interfering with recovery, lengthening hospital stays and causing extreme pain and discomfort, pressure ulcers can increase the risk of infection, with nearly 60,000 deaths annually from hospital-acquired pressure ulcers.

Nursing homes and long-term-care facilities have made strides of their own in prevention, motivated in part by the costs of lawsuits for failure to prevent bed sores. Prevention methods can include using ultrasound to identify skin breakdown before a pressure sore forms, special pressure reducing mattresses and ensuring that residents are turned at least every two hours.

Despite the availability of these, and other, prevention techniques, nursing homes have long failed to do much to prevent pressure ulcers as they had no real incentive to do so (other than the fear of lawsuits). Most commonly, nursing homes save money by not having enough staff on hand to ensure that residents receive the treatments required. They are then “rewarded” for this behavior by Medicare paying them extra money per patient to treat the decubitus ulcers. As of October of 2008, nursing homes will instead have to “pay” to treat pressure ulcers which they cause. Hopefully this disincentive will result in better care for all nursing home residents.

The federal Older Americans Act provides funding to states to fulfill the goals of the Act, namely the protection of the vulnerable elderly population. To receive federal funds, states must comply with a variety of statutory requirements, including the formation of an office of the State Long-Term Care Ombudsman.

Under federal law, the designated state ombudsman may designate a local ombudsman office to provide services to protect the health, safety, and welfare of long-term care residents. It is the job of the local ombudsman to “identify, investigate, and resolve complaints made by or on behalf of residents that relate to action, inaction, or decisions, that may adversely affect the health, safety, welfare, or rights of the residents.” (42 U.S.C. §3058g(a)(5)(B)(iii).)

Generally, any concerns about resident rights issues, physical abuse or neglect, transfer and discharge issues, or any other unexpected injury, illness, infection or death should be reported to your local ombudsman office. Reports of elder abuse or neglect are confidential, and will not be revealed in any legal actions that might arise from the complaints.

Remember, residents have rights, including the right to be treated with respect and dignity, the right to be free from chemical and physical restraint, and the right to voice grievances without fear of retaliation.

People with questions about nursing home elder abuse or neglect, or who desire more information about the complaint process, should contact Walton Law Firm at (760) 607-1325. All consultations are free and confidential.

The Nursing Home Complaint Investigation Improvement Act (AB 399), authored was approved last week in the Assembly Health Committee by a vote of 10-0. The legislation would fight abuse and neglect by improving the quality and timeliness of nursing home complaint investigations. AB 399 has over 30 registered supporters including the AARP, Congress of California Seniors, Gray Panthers, and Bet Tzedek Legal Services. There is no registered opposition.

According to the California Chronicle, AB 399 would require the Department of Health Services (DHS) to complete investigations within 40 working days; send complainants a written summary of findings about their complaint; investigate facility-reported complaints of abuse and neglect within the same time frames as public complaints; and extend the number of days a complainant has to seek an informal conference from five business days to 15 days after receipt of the determination.

"Today's vote is an important step toward restoring public confidence in California's nursing home oversight system," said Michael Connors of California Advocates for Nursing Home Reform (CANHR). "Timely DHS investigations will help ensure that nursing home residents are protected from further neglect and abuse once it's been reported."

Supporters of the law are urged to write Governor Schwarzenegger as soon as possible and urge him to sign AB 399 into law.

The California Advocates for Nursing Home Reform (CANHR) in San Francisco has been fighting for the rights of long-term nursing home residents for more than 20 years. Through community education, legislation and litigation, it has been CANHR's goal to remind decision makers of what needs to be done about long-term care; that this "forgotten population" consists of our mothers and fathers, our husbands and wives, our brothers and sisters, and that their suffering is our shame. CANHR has received numerous awards for its work.

Walton Law Firm is proud to support the work of CANHR, and is now participating in its 2007 Campaign for Justice, an effort to continue the great work of this valuable organization. If you are interested in providing your support to the cause, and helping to give a voice to the voiceless, please visit our contribution site and contribute. Any contribution you can make will be appreciated.

Thank you.

Randy / Scott / Kim

A couple who operated a New Orleans area nursing home was acquitted of 35 negligent homicide charges and 24 counts of cruelty. Jurors believed the couple's mistake of staying in the nursing home during Hurricane Katrina should not be singled out and defense attorneys argued it was the government that did not do their job.

Providing nutritional support through feeding tubes to patients who are unable to eat enough orally to sustain themselves is an important component of supportive nursing care. Feeding tubes that enter the stomach through the abdominal wall, or percutaneous gastrostomy tubes (PEG tubes), can cause serious injury or death if misplaced or become dislodged. Nursing standards require that caregivers check the proper placement before using the tube for any purpose, whether it is for nutritional support, medication administration, or hydration. Failure to do so can expose the nurse and the nursing facility to legal liability.

Walton Law Firm currently represents two nursing home residents who were provided tube feedings after the tube was misplaced or became dislodged, causing tube feeding material to spill into the peritoneal space. Both patients became immediately septic, and one, a 73-year-old man, died.

Peer abuse in nursing homes is becoming more prevalent as the number of residents suffering from dementia or Alzheimer’s disease increases. Nursing facilities that accept individuals with dementia or Alzheimer's or any other psychological disorders have a duty to properly evaluate each resident and plan for the care of that resident in a manner that protects the resident, the staff, and all other residents of the facility. Failure to do so may expose the nursing home to legal liability. Walton Law Firm currently represents the family of a San Bernardino man who died shortly after being attacked in a nursing facility by a fellow resident.

Several recent news stories, including an article in Newsweek, highlight the growing problem of peer abuse in nursing homes. (Click link to see MSNBC's article: Nursing-Home Residents at risk For Peer Abuse)

An Alzheimer's patient was strangled by her bedrail while residing at an assisted living facility. She slid off her bed, became trapped between the mattress and the bed rail, and died from positional asphyxia. Bed rails, often used to prevent injuries, can be deadly if not used properly and under the right circumstances. Currently there are many defective bedrails on the market whose dimensions do not meet the current FDA recommendations. Walton Law Firm represents the family of the 90-year-old woman who is pursuing a claim against the residential care facility for the improper use of bed rails, and against the manufacturer and distributor for producing and supplying defective bedrails.

An elderly woman developed a large bed sore while residing in a residential care facility. Because of inadequate treatment, the skin wound worsened and the elderly resident died only 10 days after being sent to a hospital for proper wound care. Walton Law Firm represents the woman's family in prosecuting the assisted living facility for failure to provide adequate wound care and treatment.

A severe hip fracture suffered by a resident of an assisted living facility went undiagnosed by facility staff for two weeks. The resident, who was ambulatory before the hip fracture, died approximately three weeks after being hospitalized for her injury. Mr. Walton filed a lawsuit against the residential care facility for failure to recognize the fracture.

Attorneys Randy Walton and Scott Barber form Walton Law Firm LLP to join forces in the prosecution of nursing homes and residential facilities for the abuse or neglect of residents. Walton Law Firm LLP will represent individuals all over Southern California who have experienced nursing home elder abuse or neglect, including against San Diego nursing homes, Los Angeles nursing homes, Orange County nursing homes, Riverside nursing homes, and San Bernardino nursing homes.