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Family Wins $7.5 Million In Nursing Home Sexual Assault Lawsuit

The family of an elderly woman with dementia has been awarded $7.5 million by a jury who determined that the woman’s nursing home could have prevented her sexual assault.

After this article, check out our previous one on a Grant Awarded to Greenburgh Police Department for Training On Elder Abuse.

Jury Determines Nursing Home Negligence Resulted In Sexual Abuse

In January 2013, a 63-year-old male resident at a nursing home performed a sexual act with an 83-year-old female resident. While finding companionship is common in nursing homes, the issue with this relationship was that the woman has dementia and so couldn’t provide consent.

The nursing home was aware that the two were seeing one another and allowed the two to spend time together because they alleged that the female patient was eating better and responding better to her caretakers.elderly woman in nursing home

Her family, however, alleges that the nursing home knew that the male resident had not only been previously convicted of rape but that he had threatened to rape a staff member. In addition to this, the family claims that certain staff members also told supervisors about their concerns regarding sexually aggressive behavior that the male resident displayed while interacting with the female and their concerns about her ability to provide consent. However, despite several reports, no effort to separate the two and the man used the woman’s medical behavior to sexually abuse her.

The family filed a lawsuit against the nursing home and after a several week trial, the jury determined that the nursing home was 85% at fault and awarded the plaintiffs $7.5 million.

This isn’t the first time that a nursing home has been made to pay for their mistakes and it certainly won’t be the last because sadly, thousands of nursing home residents face numerous dangers on a regular basis.

Nursing Home Residents Are Regularly At Risk

Nursing home residents who live in these facilities because they require additional care frequently end up hurt through neglect and negligence. Common causes of injury in nursing homes include:

Prescription Errors

The elderly often require medications to treat various medical conditions and it’s incredibly important that those medications be administered per the doctor’s orders. Unfortunately, medication errors such as overmedication and failure to medicate happen frequently.

Slip & Fall Accidents

Safety bars should be installed on beds, in bathrooms, and hallways for residents to use. In addition to this, wheelchairs should be helping elderly walk in hallwayavailable and staff members should always be near to assist anyone who is unsteady on their feet.

When a nursing home resident slips and falls, they may sustain:

These injuries are not only painful but they can be quite expensive to treat. Depending on the resident’s health prior to falling, the injury may forever remove any ability to function on their own.


Statistics have shown that the majority of nursing homes are understaffed and that this results in residents not getting the care that they need. Signs of neglect typically include weight loss, confusion, bed sores, and infection.

If you or a loved one have been hurt because of a nursing home accident or neglect, you may be able to recover significant compensation.

Nursing Home Lawsuits

A nursing home lawsuit is a civil lawsuit that is filed so that those who have been hurt through neglect or abuse can recover compensation which will help them get the care that they need in order to heal. This lawsuit may be filed by the nursing home resident or, if the resident passed away from their injuries, the lawsuit may be filed by a family member.

If you believe that you or your loved one are eligible to file a nursing home lawsuit, call our law firm now. Our attorneys offer free consultations during which we will review your case and then present all legal options available to you. Call us now to learn more.

What Are Common Signs Of Nursing Home Abuse? Learn more.

Many elders around the globe are being physically or mentally abused; sometimes at the care centers they are living in and sometimes being abused by loved ones, including their own family. As elders begn to age, they may not see, hear or think as plainly as they used to. This can make them vulnerable and exploiters are given opportunities to abuse them. In the U.S. alone, millions of elder abuse and neglect cases are reported annually, however, a lot more go unreported.

If you have questions like, "How long does it take to settle a nursing home lawsuit?" See our next article. 

Elder abuse and neglect tends to occur where the senior resides; regularly in the home where abusers are frequently adult children, other relatives, grandchildren, or life partners. It can also happen in care facilities.elderly lady who is being abused

Physical & Emotional Abuse

The most common type of elder abuse is physical, where the victim is physically assaulted to the extent that it may result in physical impairment or injury. Similarly, emotional abuse is done by humiliating through yelling and threatening an elderly consistently. It may also include ignoring them or isolating them.

Sexual & Neglect Abuse

The elderly, like anyone else, can be sexually assaulted and this happens more frequently than anyone would care to admit. It is difficult for anyone to admit they have been the victim of sexual assault so it's hardly surprising that the elderly don't often come forward.

Financial Abuse

This abuse happens when all the financial assets of an elderly are used without their permission. This abuse involves misuse of elderly’s checks, credit cards, forged signatures, withdrawal of cash and personal checks.

Healthcare Scam and Abuse

This assault is done by some of the black sheep of the health care sector which includes insurance fraud, overcharging, and not providing sufficient care but charging for it.

It's important to be aware of the common signs that abuse may be occurring. Weight loss, sudden bruises or cuts, lack of self-care, and changes in mood are just a few examples.  If you suspect that elder abuse is happening to someone you love, the first thing you should do is contact an experienced attorney who can review the case and begin the steps towards protecting them.

Visit our next article on some information regarding elder abuse training: Grant Awarded to Greenburgh Police Department for Training On Elder Abuse

According to the Administration on Aging, about 28% of older Americans, those over the age of 65, live alone. But because life expectancy varies depending on sex (females born this year are expected to live 5 years longer than their male counterparts), these seniors living alone are disproportionately women. In fact, almost half of all elderly women over 75 live by themselves.

As we age, everyone experiences a minimum of physical and mental deterioration. But this decline is particularly troubling for seniors who live alone. For many elderly people, dementia, frailty, and the other effects of aging lead to a corresponding inability to adequately perform the activities of daily living (ADL). Left alone, these seniors can tragically fall into the faultless spiral of self-neglect.

Recent research has led a large contingent of the elder care population to conclude that self-neglect is the most common form of senior abuse. Continue reading to understand how our elder abuse lawyers can help you or your loved ones.

Signs Of Self-Neglect

Self-neglect refers to any situation in which an elder fails to maintain a healthy, safe lifestyle of their own accord. Obviously, when caregivers fail to provide adequate support, this is not self-neglect; it is simply neglect. In limited instances, self-neglect involves an active refusal to take care of oneself; more often, seniors are simply unable to care for themselves.

Because self-neglect implies a lack of necessary care, it's helpful to categorize its forms along the lines of basic human needs.

Water & food - seniors who self-neglect often fail to feed themselves, or drink too little water, becoming malnourished or dangerously dehydrated as a result.

Shelter & security - the elderly may neglect their clothing and homes, wearing filthy clothes, or ones that are unsuited to weather conditions. They may also ignore, or be unable to change, unsanitary conditions in their homes.

Basic health - elders who live alone are far less likely to seek medical care than those who live with others.

Seniors who self-neglect are more likely to:

If your loved one lives alone, check for the following signs:

Your loved one's home itself can be a source of symptoms, too. Check their residence for:

What Should I Do?

If you've noticed the signs of self-neglect, you can work to reduce your loved one's isolation. If you can, visit more frequently yourself, or set up a regular phone appointment to talk.

Many private companies offer "Friendly Visitors" programs, where seniors are matched with volunteer workers for a weekly home visit. Most of these companies match volunteers based on a common interest, so conversation should be easy. New York City's Department for the Aging runs a meal program that delivers fresh foods directly to seniors on a daily, or bi-weekly, basis. Sometimes even the simplest human contact can reduce an elder's risk of falling into self-neglect. You can find a list of "Friendly Visitor" programs in New York City here.

Confronting self-neglect is most difficult when a senior seems to make active choices in that direction. Refusing necessary medical care is particularly prevalent, but many senior citizens refuse to change their daily patterns in any way. As heartbreaking as it may be, you must always respect your loved one's wishes. Instead of forcing change upon them, use rational argument and sympathy. Try hard to understand their side of the story.

See a related article on the nursing home epidemic here:

As one of our society's most vulnerable populations, the elderly are at heightened risk of abuse. Whether disabled or not, many seniors are unable to resist an abuser's advances, and many fear retaliation if they reach out for support.

For many of us, this fact is hard to confront. And, while tragic, it would be oddly comforting to believe that most elder abuse and neglect occurs in nursing homes or assisted living facilities, at the hands of relative strangers. But the reality of elder mistreatment is more shocking.

Only one comprehensive study has ever been conducted on the extent of elder abuse in America. Completed in 2012, the US Administration on Aging found that a staggering 90% of reported cases of elder mistreatment involved abusive family members.

For more information on elder abuse, visit:

Can I Sue A Family Member For Elder Abuse, Neglect Or Exploitation?

Generally, most cases of elder abuse in which family members are the abuser fall within the purview of criminal courts. Criminal cases exist to enforce laws: the government brings a case a senior stressed by abuseagainst a person that it believes has broken the law. Several federal, as well as New York State, laws have been enacted to protect seniors from mistreatment and allow for the prosecution of abusers. If you suspect that a family member is abusing a senior in New York, call 1-800-342-3009 to file a complaint.

Civil cases that involve elder mistreatment are usually filed against nursing homes or assisted living facilities, facilities that failed to adequately protect their residents against abuse.

But the line between civil and criminal liability is often unclear. Speak with an experienced elder abuse lawyer in New York City to discuss your own situation and explore legal options.

Explaining Family Elder Abuse

Elder abuse that occurs between family members is a subset of domestic abuse. Broadly defined by the US Department of Justice, it involves "a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner." Domestic abuse relies on intimacy, usually the hallmark of loving relationships, to thrive. According to the Centers for Disease Control & Prevention, a narrower definition of elder abuse would look like:

"any abuse and neglect of persons age 60 and older by a caregiver or another person in a relationship involving an expectation of trust."

An abusive relationship, at least in the CDC's eyes, relies in part on trust. And who do we trust more than our family?

Care-giving relationships are intensely complex and can be fraught with emotional complications. While seniors may suffer at the hands of an abusive adult child or spouse, they may still rely on them for support. And remember, the past, a shared history, weighs on every consideration. Many abused seniors say that they still love their adult children, despite the abuse.

From the other side, most abusive adult children still live with the seniors who they abuse. They often rely on their parents for financial and emotional stability and feeling beholden, or dependent, on another can be the source of feelings as disparate as impotence and rage.

Many abuse victims live in denial of their situation or present a form of the famous "Stockholm Syndrome," in which captives develop a sense of empathy for or sympathy with their captors. And when the abuser is a family member, the very person meant to care for them, seniors may feel as if there is no one who can help.

Who Abuses The Elderly, And How?

The AOA's study found that:

In fact, only 1% of these cases involved an "out-of-home service provider," a category that includes the employees of nursing homes. Across all categories of mistreatment, adult children are the most likely to neglect, abuse, or exploit their aging parents. The most common forms were found to be:

Also see:

According to the United States Department of Housing and Urban Development, 88 percent of Americans over the age of 65 want to be able to live out their lives in their own homes. It is even more interesting to note that 92 percent of seniors said that they would want to stay in their own community, no matter what type of living arrangement they needed. The option to stay in one's own community is called aging in place.

What Is Aging In Place?

The idea of being able to remain in one place while you age is called aging in place, and it is becoming very popular throughout the country. If you intend to age in place instead of entering a senior living community, then you need to weigh the pros and cons of aging in place before you make your decision.

There is more to getting older than just worrying about medical care. There are several factors to consider that could make utilizing in-home care providers a practical solution. But, there are also situations where moving into a senior living facility is best for everyone involved.

Pros Of Aging In Place

The most significant positive aspect of aging in place is the ability to live out your golden years in the home you love. With the help of in-home care providers, you can do everything you need to do to live a relatively independent life at home for the rest of your life.

According to the Huffington Post, aging in place can reduce costs to the overall medical system by reducing the number of emergency room visits a senior may need, and reducing the number of people who live in nursing homes. When there is someone in a senior's home to provide care on a regular basis, that prevents seniors from falling and injuring themselves. It also prevents the need to put more of a burden on the already over-crowded nursing home industry.

Improved Quality Of Life

Seniors who age in place respond better to the care they are given because there is a general elderly woman with a loved oneimprovement in their quality of life. The United States Department of Health and Human Services mentions that advances in Internet technology have made it possible for doctors to do routine examinations on seniors living in rural areas, and it also allows doctors to offer valuable medical advice to seniors as well.

Aging at home takes a great deal of the financial strain off of public medical systems, and it gives seniors a quality of life they can appreciate. When seniors are allowed to age at home, they retain their independence and improve their overall emotional health.

Cons Of Aging In Place

The idea of aging in place sounds almost romantic, but there is still work to be done before it is possible for any senior to age in place. Unfortunately, the changes the body experiences as someone ages can make aging in place difficult. For example, a senior who lives alone may find that caring for themselves and maintaining their home is not as easy as it was. Those few hours a day where in-home care providers offer assistance are not enough to get everything done, and that causes problems.

Many seniors require regular monitoring of their medical conditions in order to be able to age in place, and that becomes expensive. There will come a point where the senior will have to admit that living in a certified senior living facility makes more financial and medical sense than aging in place.

Reduced Mobility While Living Alone

While the idea of aging in place sounds great on the surface, there are some realities that seniors must cope with if they are to live long lives. One of those realities is that a deterioration in the lack of mobility as a person ages means that they are not as able to get around as they used to. The result is a lack of companionship and contact with others that is essential to a healthy lifestyle.

In an assisted living community, seniors have the option of keeping to themselves or making new friends on a regular basis. The availability of scheduled activities in an assisted living facility means that seniors can get the exercise they might not get if they were aging in place, and it allows them the freedom to go shopping, visit friends, and go to doctor's appointments. Without an assisted living facility to arrange for all of that transportation, a senior who is aging in place can become cut off from the rest of the world.

Consider The Services & Price

There are a growing number of services and organizations that offer the services necessary for seniors to age in place, but the services become extremely expensive as the monitoring and medical needs increase. There are people who are trying to make aging in place a reality for everyone, but it may not be the best option for some seniors as they enter their golden years.

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It just got easier to sue nursing homes over resident abuse and neglect. On September 28, 2016, the Department of Health and Human Services announced a new rule that will prevent nursing homes from including forced arbitration clauses in their contracts. These clauses, which essentially surrender a patient's right to sue, will now be prohibited for any nursing home that receives federal funding. According to the New York Times, the agency's decision could come to strengthen the rights and legal protections of some 1.5 million nursing home residents.

info on forced arbitration

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CMS Prohibits Nursing Home Arbitration Clauses

On its surface, the rule change is simple. On page 12 of a 713-page document published by the Centers for Medicare and Medicaid Services (CMS), you'll read:

"Binding Arbitration Agreements: We are requiring that facilities must not enter into an agreement for binding arbitration with a resident or their representative until after a dispute arises between the parties. Thus, we are prohibiting pre-dispute binding arbitration agreements."

But this short paragraph is expected to have widespread ramifications throughout the nursing home industry, both for residents and the facilities obligated to care for them.

Why Arbitration Is Bad For Nursing Home Residents

Currently, standard practice within the industry, arbitration clauses in nursing home contracts force aggrieved residents and family members to enter arbitration sessions, rather than bringing their claims for compensation in court. The vast majority of nursing homes in operation push arbitration on prospective residents. In a recent survey, only 8% of long-term care companies were willing to accept a new patient without a signed agreement to use alternative dispute resolution.

Arbitration is an alternative to the traditional civil legal process, in which disputing parties hash out their differences before a supposedly neutral third party. An arbiter (or arbitrator) facilitates the dispute by supervising discussion, information exchange and - in many cases - brokering a final settlement.

Eliminating Constitutional Rights

The downsides of arbitration, however, are well-known.

Without formal rules, nursing home residents and their families lose out on many of the constitutional and procedural rights granted in a true court case. Although this lack of formality can be a benefit, it often comes at the expense of the party with fewer resources and less legal experience - almost always the plaintiff. As another drawback, arbitration provides no formal avenue allowing plaintiffs to demand evidence from a long-term care facility, which may hurt their ability to make a compelling case.

The clauses effectively push prospective residents into a no-win scenario, according to Vermont Senator Patrick Leahy, one in which they must "choose between forfeiting their legal rights and getting adequate medical care."

All too often, arbiters turn out to be "charlatans" according to the American Association for Justice. In many cases, arbitration clauses grant nursing homes the right to choose their own arbiter, creating the potential for kickbacks and long-term "working relationships" in which a business-friendly arbiter is given repeat business for resolving cases to the advantage of a defendant. Some arbitration sessions are even held in the offices of attorneys representing the company being accused of wrongdoing.

Arbitration Cuts Plaintiff Compensation

Nursing home residents secure less compensation in arbitration than they would by going to court. In 2009, a study commissioned by the American Health Care Association, a lobbying group for long-term care facilities, found that awards granted in arbitration agreements tend to be 35% lower than if the resident had pursued a nursing home lawsuit.a contract in a nursing home

Facilities, on the other hand, save a lot of money on arbitration. The method can cut the costs of resolving a dispute by nearly 40%. Arbitration is usually less expensive than taking a case to trial, but when alternative methods fail to resolve the dispute, the cost of this failure can severely limit a plaintiffs' ability to proceed.

Even successful arbitration proceedings can be a financial loss for injured nursing home residents and their families. NPR describes the case of Dean Cole, a resident in Minnesota who died after being taken to the hospital severely dehydrated and in a coma. Cole's wife had a solid nursing home neglect case, but she was not allowed to sue the facility due to a forced arbitration contract. While her arguments proved persuasive, and she was awarded over $60,000, the costs of arbitration itself cut that compensation to a mere $20,000.

Nursing Homes Sue Government Over New Rule

The nursing home industry isn't taking the government's new stance on arbitration clauses sitting down. On October 16, 2016, just 18 days after the new rule was announced, the American Health Care Association filed a lawsuit against two top health officials, challenging the government's decision as (ironically) "arbitrary and capricious." The lawsuit has been filed in the US District Court of Mississippi, Oxford Division.

In its complaint, the industry lobbying group points out that federal health regulators have banned all pre-dispute arbitration agreements, even ones that could be fair and beneficial to residents. The Department of Health and Human Services has exceeded its statutory authority, the group says, arguing that neither the Medicare nor the Medicaid acts give the agency power to regulate alternative dispute resolution requirements. Moreover, nursing homes will now be hampered by exorbitant litigation costs, siphoning money away from patient care. At least, that's how nursing homes feel.

Most notable, however, is the following line:

"Long-term care facilities and their residents and residents' families should not be deprived of the ability to choose arbitration, a valuable form of dispute resolution."

The value of arbitration is arguable. The irony of this statement is not. The Centers for Medicare and Medicaid Services has not prohibited arbitration in nursing home cases, and no one is being deprived of the right to choose arbitration of their own free will. On the contrary, CMS has prohibited the common practice of forcing residents to resolve their disputes through arbitration. Against the American Health Care Association's suggestion, CMS has actually given residents and their families the right to choose arbitration, a right they previously did not have because nursing homes gave them no other option.

Nursing Homes Hate The New Rule

It's easy to see why the nursing home industry has taken up arms against the new arbitration rule. For long-term care facilities, the benefits of arbitration go far beyond saving money and reducing settlement amounts.

Arbitration is a good way to keep past indiscretions out of the public's eye, since what goes on during negotiation sessions is often considered confidential information, unlike the proceedings of a civil court case. This was the argument raised by 16 states and the District of Columbia recently, which banded together to argue for an end to arbitration clauses at nursing homes and assisted living facilities. Their arguments, apparently, were enough to persuade the Centers for Medicare and Medicaid Services, an agency within the Health and Human Services Department that controls over $1 trillion in federal funding for long-term care facilities. According to the agency's newest regulations, any facility that continues to place pre-dispute arbitration clauses in its contracts risks losing federal funding.

The Centers for Medicare & Medicaid Services has yet to comment on the American Health Care Association's lawsuit, which asks the court to delay the ban on arbitration clauses until a judge can consider the case. At least for now, the agency's rule is set to go into effect in November.


Nursing home abuse has now entered the digital age. In increasing numbers, nursing home employees are sharing degrading and abusive photographs of residents on social media, according to reporting from independent journalism network ProPublica. State and federal regulators have scrambled to address the emerging issue, but many health officials have been shocked to learn that mental abuse committed online isn't yet illegal in some states.

Keep reading related information on What You & Your Loved Ones Need To Know About Elder Abuse.

Demeaning Social Media Posts & Mental Abuse

At least 47 instances of social media abuse have been reported since 2012, ProPublica reports, although the true incidence is likely higher. Convincing nursing home employees to report other workers for social media misconduct is difficult.

The details of these photos and videos, many posted to public social media accounts, are horrifying. Reviewing government citation reports and court records, ProPublica discovered numerous cases in which assisted living facilities had circulated images of elderly residents "naked, covered in feces or even deceased."

Online Elder Abuse

Some videos have depicted episodes of physical and verbal abuse. In one video shared on Facebook, a former nurse aide from St. Ann's Home for the Aged in Rochester, New York filmed facility employees tugging a resident's hair and verbally abusing her with racially-charged taunts. Snapchat conversations in Green Bay, Wisconsin have seen nursing home employees exchange photos of nude and vomiting residents, even sharing the images with friends.

Currently, Snapchat seems to be the most popular social media network for degrading posts involving elders:

Snapchat is not a surprising choice for this kind of dehumanizing activity. The application was designed to delete images shortly after they are shared.

State Laws Lag Behind Digital Elder Abuse

More shocking? In some cases, this form of abuse isn't even illegal. In March 2016, Iowa state health investigators learned that a certified nursing assistant had taken a humiliating picture of one of her patients, depicting the man with his "pants around his ankles, his legs and hands covered in feces." But Iowa's elder abuse law hasn't been updated since 2008, before the rise of Snapchat and Instagram and around a year before Facebook became profitable.

The photos and videos have been tricky for prosecutors to classify since many of the images don't technically qualify as "sexual." Only pictures or recordings depicting genitalia can be designated as "sexual exploitation" in Iowa, leaving the state with few options for formal disciplinary action. Today, the legislature in Iowa is attempting to revise the state's elder abuse laws to cover the new area of abuse.

Enforcing Criminal Penalties

Prosecutors in other jurisdictions have come up with creative ways to tackle the issue, using voyeurism and invasion of privacy charges to make up for the lack of specific laws addressing elders and demeaning social media posts.

New York is no exception. In the Rochester case, a nurse aide pleaded guilty to one misdemeanor, a count of willful violation of health laws. In a second New York case, a nurse's aide at Lancaster's Greenfield Health and Rehabilitation Center took photographs of an incontinent resident's phone with social media appsgenitalia, then shared the photos with another staff member over Snapchat. The aide was arrested on a charge of willful violation of health laws, a misdemeanor to which he pleaded guilty.

Felony charges have been sought in egregious cases, at the discretion of state prosecutors. A nursing assistant in Scottsburg, Indiana was charged with voyeurism after photographing a resident who was verbally abusing other residents at the time. In Michigan, a nursing assistant allegedly took a photograph of an elderly resident using the toilet, then drew a penis over the picture in Snapchat. The assistant, who was charged with a felony for using a computer to commit a crime, denies any wrongdoing.

Recruiting Social Media Companies

As legislatures struggle to draw up new online abuse laws, state officials have attempted to enlist social networks themselves in fighting online posting involving seniors.

For obvious reasons, elders are working at a distinct disadvantage in proactively eliminating online privacy abuses. Few seniors have even heard of Snapchat - let alone understand how to navigate the application's abuse reporting system. Family members and loved ones have also been stymied, by company policies that prevent third-parties from reporting abusive images or videos. Snapchat, for example, only allows the affected person to file complaints, particularly difficult for seniors with dementia.

In response to calls from members of Congress, both Snapchat and Facebook, which owns Instagram, say they are "doing what they can" to prevent abusive content from being published and shared on social media networks, according to recent reporting from ProPublica.

New Government Requirements

Degrading social media posts have been labeled a form of "mental abuse" by the Centers for Medicare & Medicaid Services, a category of intolerable acts that "includes, but is not limited to, humiliation, harassment, threats of punishment or deprivation." In August 2016, the federal agency instructed nursing homes to establish and implement written policies prohibiting all forms of mental abuse, including "taking or using photographs or recordings in any manner that would demean or humiliate a resident." These policies will be reviewed by government investigators during upcoming inspections.

Federal regulations require that nursing homes create "homelike" environments, in which all residents are treated with dignity and respect. Practices that demean, degrade or humiliate residents are strictly forbidden. Nursing home residents have "the right to be free from verbal, sexual, physical and mental abuse, corporal punishment and involuntary seclusion."

Responding To Social Media Abuse Of Elders

In response to the recent rise in social media abuse among nursing home employees, the US Centers for Medicare & Medicaid Services has announced concrete procedures for investigating allegations and disciplining non-compliant facilities.

When investigators receive a tip that nursing home employees have taken a potentially demeaning photograph, the inspectors will be required to investigate the incident as abuse, a potential violation of federal regulations. Notably, a resident's consent will not be sufficient to avoid government sanction over a degrading photo.

What Is An Abusive Photo Or Video?

Photos and videos that will constitute abuse automatically include:

Allegations of unauthorized photography or recording will trigger an onsite investigation, generally within two to ten days. Depending on the allegation's severity, law enforcement may be called in to assist in investigation and enforcement efforts.

See similar articles such as: Poor Dental Hygiene In Nursing Homes

The Town of Greenburgh is taking steps to ensure that the elderly living in the community are kept safe and are well taken care of. The Westchester Board of Legislators and County Executive Rob Astorino have fought to receive funding for law enforcement officials to provide them with additional training on elder abuse and neglect.

elderly man in nursing home

This new training will teach officers of the law techniques to handle elder abuse, neglect, sexual assault, stalking, or domestic violence affecting victims that are 50 years old, or older, as well as the regulations governing nursing homes and caregivers. The funding for this training comes from a grant awarded by the United States Justice Department’s Office on Violence Against Women. On August 10th, 2015, the Board of Legislators voted to approve an inter-municipal agreement between the County and Town of Greenburgh, which would give $15,880.00 to the Greenburgh Police Department to pay for the additional training.

Astorino commented on the funding, saying, "Elder abuse sadly does occur and it's often not reported. This Inter-municipal agreement broadens training among our local police to enable them to be better equipped to identify cases of elder abuse and intervene to stop it and protect our elderly seniors."

For more information about New York Nursing Home Abuse Lawsuits: What You Need To Know

Elder Abuse - A Sad Reality

Every day, new advances are made by medical professionals to treat and cure countless medical conditions. With these medical advances come an increase in the average life expectancy of both men and women, which naturally leads to an increase in the number of elderly in every community. Per data reported by AARP, there are 108.7 million Americans in the 50 years of age or older category.

Unfortunately, many of the elderly become victims of neglect and abuse. The National Center on Elder Abuse has noted that signs of elder abuse can even be missed by healthcare professionals because there is a lack of training on detecting the abuse. Often, the victim may not want to report the abuse because they don’t want to get the abuser into trouble. It is estimated that as much as 90% of elder abuse stems from a family member.

Greenburgh is one town that is clearly striving to address the lack of training so that law enforcement officers can recognize the signs of elder abuse and neglect. These signs can include bed sores, unexplained cuts or bruising, poor hygiene, malnutrition, and unexplained wandering by the elderly person.

If you'd like to continue reading related articles, see:

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Signing the paperwork to put a beloved parent into a nursing home is often heart-wrenching and stressful. It can be hard to admit that you don't have the resources to properly care for your loved one. But before you sign any papers, read them carefully and look for hidden clauses that might take your rights away should something happen.

What Is An Arbitration Clause?

The arbitration clause is an oft-missed part of the paperwork you fill out at a long term facility thatAn arbitration clause states that if something happens at the nursing home that results in the injury or death of your loved one, you agree to use a private arbitrator to settle for damages rather than take the nursing home to court.

Problems of Arbitration

While some may be quick to point out the benefits of an arbitration clause, such as the lower cost for care and the less chance that residents will be faced with an unmitigated lawsuit, there are many problems associated with using an arbitrator rather than taking a case to court. Some of these problems involve:

The Need For Lawsuits

Why does it matter so much that you do not sign an arbitration clause? What are the chances that you will even need to worry about lawsuits? According to statistics, the chances are quite high that at some point in your experience with a nursing home you will have to deal with your loved one being hurt or injured. In fact, between the years, 1999-2001, almost a third of the nursing homes in the United states were cited for violating regulations that might have led to serious injury or death of a resident.

How To Avoid The Dreaded Arbitration Clause

In an increasing number of cases, judges are throwing out the arbitration clause as part of a trend toward encouraging more honest business practices, since many people sign them without knowing what they are agreeing to. But there are many nursing homes who will still try to include an arbitration clause as part of their admission requirements.

The best way to avoid signing such a clause is to ask questions if you encounter something in the paperwork that you don't understand. You cannot be required by law to sign an arbitration clause for admittance to a nursing home.

If You Have Already Signed A Contract

If you have already signed an arbitration clause and it has been less than thirty days, you may revoke your signature. If it has been longer than thirty days you may still void arbitration should anything happen by arguing that without power of attorney over the resident in question you were not entitled to sign the agreement.

Some nursing homes will try to deny your loved one acceptance into the nursing home without a signed arbitration clause. This is illegal and generally frowned upon, but some facilities will still try it. If your choices are limited or you see a need to have your loved one in a particular facility, you may try to get the administrator to accept him with the understanding that you will sign papers upon moving in. Once the facility has accepted him, it cannot evict him for failure to sign the arbitration clause.


The topic of elderly care is an emotional one for residents and their families, but it can become a business conversation for the nursing home administrators. According to the National Center on Elder Abuse, 95 percent of residents who live in elderly care facilities indicated they had been the victim of abuse, or they had seen abuse take place. It is estimated that elderly people who scales of justice in law officeexperience abuse in a nursing home are 300 percent more likely to die because of that abuse.

Those numbers are frightening, especially for families who entrust their loved ones to skilled nursing facilities. Patient neglect is a huge problem in nursing homes around the country, and the only recourse families seem to have for getting things changed is to use neglect lawsuits. But even settlements of $500,000 can be written off by large nursing home corporations as a small loss. That is why one family decided to hit a negligent nursing home chain where it really hurt; in the bottom line.

Continue reading the details on this case provided by Banville Law.

The Doris Cote Lawsuit

Doris Cote was an elderly nursing home resident who had taken up residency at a Five Star Quality Care facility in Arizona. Six months after Ms. Cote checked into the nursing home, she died of a serious infection brought about by bed sores. The company claims that Ms. Cote had the bed sores when she checked in to the facility and that she died of natural causes. But when the facts were presented to a jury, the story was very different.

The lawyers for the Cote family presented evidence of patient neglect that included starvation and ignoring the development of bed sores. When those sores developed into a serious infection, the elderly care facility made almost no attempt to remedy the situation. After the Cote's presented their case, Five Star Quality Care offered a settlement of $500,000. But the Cote's knew that a settlement like that would not create real change. They decided to press forward, and the result was a $19 million dollar judgment in the family's favor.

The Impact Of The Verdict

If the Cote's had taken the settlement, then there may have been some surface changes made at Five Star Quality Care facilities to pacify the media. But the reality would have been that patient neglect would still occur, and more residents would die. By following through with their lawsuit and getting a large award, the Cote's forced Five Star Quality Care to make real changes to improve the level of elderly care in their facilities.

In some cases, neglect lawsuits need to have large awards attached to them if there is going to be real change. It is estimated that 20 percent of the American population will be thinking about residing in nursing homes by 2050. If those residents are going to be safe, then real changes have to take place now with the organizations known for patient neglect.

If you have an elderly loved one who is the victim of abuse in a nursing home, then it is time to take action. If you do nothing, then your loved one and all of the other residents in that elderly care facility face a significantly increased risk of death due to neglect. But if you can prove your case and get a substantial award, then you can create real change in a system that is growing rapidly but very badly broken.

Also see: Care Providers We Seek Justice From

New government statistics suggest that seniors deemed "difficult" are being evicted from nursing homes in record numbers, according to a recent analysis from the Associated Press. Since 2000, the number of complaints filed with ombudsmen over potentially illegal facility discharges has increased by around 57%, reaching 11,331 complaints on the subject in 2014 alone. That year, nursing home evictions were the most reported grievance among elder care residents.

Visit our previous article that covers: What Is Elderly Self-Neglect?


Complaints in general, however, have fallen over the last decade, the report found, as has the number of nursing homes in America and the total number of residents living in those nursing homes. But complaints centered on nursing home evictions have decreased only slightly in the same time period. Every year, reports of illegal evictions continue to account for a larger and larger share of all complaints, the Associated Press' Matt Sedensky writes.

When Is A Nursing Home Eviction Legal?

Of course, not every eviction is illegal. But elder rights advocates say that, at least in their own experience, most of these "involuntary discharges" are based on misrepresentations of existing laws. "The majority of the time," Tony Chicotel, attorney for the group California Advocates for Nursing Home Reform told the Associated Press, "it's because the resident is considered difficult."

Is "difficulty" a legitimate reason to evict a nursing home resident? No, not when "difficult" takes on its everyday meaning, as "disruptive" or hard to manage behaviorally. The federal Nursing Home Reform Act of 1987 allows evictions under the following six circumstances:

  1. a resident's need cannot be adequately by an elder care facility
  2. a resident's health has improved to the point at which the facility's services are no longer necessary
  3. a resident's behavior or condition has come to threaten others in the nursing home
  4. a resident's remaining in the facility would endanger the health of others in some way
  5. a resident has failed to pay or failed to apply for Medicare or Medicaid coverage
  6. the facility itself has gone out of business

It's the first justification when an elder care facility can no longer care for a resident adequately, that's usually cited in illegal evictions, according to Chicotel.

Enforcement Options Rarely Used

Sara Anderson's father, Bruce, sustained a traumatic brain injury over ten years ago. After the accident, he was shuttled between different facilities, ultimately ending up at Sacramento's Norwood Pines Alzheimer's Care Center.

While Norwood is certainly billed as a rehabilitation center for Alzheimer's patients, it's website clearly states that, "as a skilled nursing facility, we are also well qualified to care for and recover residents that have been hospitalized due to a variety of reasons." Some pages on the site specifically refer to "brain injury" as a condition targeted by Norwood's services.

But soon after Bruce landed in Sacramento, Sara says Norwood Pines began "insisting" that it wasn't an appropriate facility for her father. After he was hospitalized for pneumonia, the facility wouldn't allow him to return. Sara believes the discharge didn't come down to the adequacy or inadequacy of Norwood's services, but the frequent complaints she'd made about her father's level of care. Nursing homes are not allowed to evict residents in retaliation over complaints, and even though the family eventually won their appeal of Bruce's discharge, he's still in the hospital. Norwood Pines, according to Sara, continues to refuse Bruce's readmission. The facility would not return the Associated Press' calls for comment.

"The hearing," Anderson told reporter Sedensky, "was pointless."

Discharges Often Come Down To Economics

Of course, it's become common practice for nursing homes to evict residents for less-than-legal reasons. Chief among them is simple market economics. Nursing home beds are in short supply, says Eric Carlson, JD, an attorney at the National Senior Citizens Law Center, and that supply is frequently outstripped by the number of seniors looking to be admitted. Simply evicting unwanted residents, usually poor seniors with dementia, has become the easiest way to keep up with demand from other seniors, many of whom may not require the rigorous care and attention that people with Alzheimer's require.

Tony Chicotel agrees with Carlson's take on the subject. She says residents who are evicted are almost always beneficiaries of Medicaid. Medicaid usually reimburses facilities at much lower rates than private insurers or even Medicare, and most nursing homes, Chicotel says, would rather take a short-term rehab patient on Medicare than care for a long-term Medicaid patient.

Medicare doesn't cover long-term care, only short stints for rehabilitation. When it covers a nursing home stay, the coverage usually only kicks in after three days of hospitalization, and extends to no more than 100 days of care. That limitation works to the advantage of nursing homes, creating a "revolving door" dynamic in which beds are always open for new patients, as Medicare recipients are phased out of the system by the national insurer's own restrictions.

Economics certainly seemed to factor into the eviction of Vicki Becker's mother. Becker's mother, now 96, had been living in a Washington State assisted living facility for six years, paying over $5,000 a month, before the facility's management began hounding her family about having the woman transferred to a different center. Turns out the assisted living facility only began suggesting a transfer after Becker's mother had exhausted her savings and switched over to Medicaid.

Clearing House

Many of these cases appear to begin with threats of eviction, or strongly-worded "suggestions," like the ones leveled against Vicki Becker and her mother. Threats aren't a violation of federal law, however. Under the Nursing Home Reform Act, a facility has to give written notice of the scheduled eviction, within 30 days of the potential discharge, and provide facts to support the decision. Here's where potential legal violations come in, when those "facts" are either untrue, insufficiently provided or can't reasonably be interpreted to satisfy one of the six conditions we covered earlier.

Residents have every right to appeal a nursing home eviction, but it has to be done quickly. Residents have only ten days within receiving a written notice of discharge to request an appeal hearing. This is when seniors who believe their rights are being violated should consider contacting an experienced attorney. Ten days isn't very long, and you'll want to give an attorney ample time to prepare for the hearing.

Once Hospitalized, Some Residents Never Return

Time is another big issue when it comes to hospitalizations, which the Associated Press says have become a common opportunity for facilities to deny their residents' rights. After a resident is brought to the hospital, nursing homes have to hold their bed for no less than seven days under federal law. Some elder care facilities just "refuse to let the person back in," says Eric Carlon, an attorney who works on eviction cases for the non-profit Justice in Aging.

Others have found even more under-handed tactics, taking out restraining orders against hospitalized patients so they're unable to return legally. It's not as hard as you'd think, California Advocates for Nursing Home Reform reports. Just claim that the resident was assaultive or combative to a "reasonable probability," a low legal standard, and find a judge who is unfamiliar with nursing home residents' rights.

Long-term care ombudsmen are appointed officials tasked with resolving problems in nursing homes, assisted living facilities and other elder care facilities. Most are volunteers, appointed by state-run agencies that ultimately answer to the federal Administration on Aging.

Ombudsmen act as the interface between three key stakeholders in the elder care world: the government, which subsidizes most nursing homes through Medicare and Medicaid, elder care facilities and, of course, residents, prospective residents, and their families.

Continue reading more elderly abuse articles such as Abusive Relationships: Family Elder Abuse.

Before 1987, nursing homes were poorly regulated. Each State had its own set of rules, but these were rarely enforced and largely ineffective. Residents suffered across the board, subjected to unsafe facilities and sub-standard care. Congress tried and tried, and tried again, to create binding regulations, but State governments battled federal authority at every turn.

Then, the Institute of Medicine published its influential study, Improving the Quality of Care in Nursing Homes. The report changed everything. In its pages, Federal and State regulators could clearly see the perilous position in which most nursing home residents lived as a matter of course.

And worse, the problem was the government's fault, the result of fifty years of inaction and misguided failure.

At Banville Law, our goal is to provide our readers with useful informative articles that can help families make decisions for their loved ones. Continue reading more articles provided by our law firm here.

The Nursing Home Reform Act Of 1987

Congress was spurred to change.

The "Nursing Home Reform Act" was quickly drafted and passed into law in 1987. This law presented the rights of nursing home residents in clear, legally-binding terms for the first time.

Nursing homes were now required, by federal law, to ensure that their residents were provided all the foundations of a high quality of life: physically, psychologically and socially.

Maintaining Quality Of Life

In order to maintain this quality of life, nursing homes must:

The Residents' Bill Of Rights

Every nursing home resident has the right to:

How Did Congress Enforce The New Nursing Home Rules?

Money, of course. Congress made it explicit: if you fail to follow the rules, you won't receive payments from Medicaid and Medicare. According to the American Association of Retired Persons (AARP), nursing homes can only receive federal funds if they are certified by their state "to be in compliance with the requirements of the Nursing Home Reform Act." Nursing homes are inspected, without advance notice, at least once every 15 months.

That's a really big deal, and it's worth taking a closer look.

In 1998, the year the Nursing Home Reform Act was passed, nursing homes received 58% of their copies of nursing home regulationstotal income through federal programs. Obviously, cutting off such a huge source of revenue would have forced any elder-care facility to shut its doors.

We wanted to know if it would still be such a huge loss, so we checked the data sets at the Centers for Medicare & Medicaid Services. Turns out it would probably be an even bigger hardship.

The past two decades have seen state governments take a more active role in subsidizing nursing homes. But Medicaid and Medicare still cover roughly 52% of all the income that flows to elder-care facilities.

After factoring in State and local resources, only 12.5% of nursing home income comes from private health insurance policies or out of resident's pockets. If a nursing home loses its certification, it stands to lose almost 88% of its revenue as well.

How Did We Get Here?

Forty years before the Nursing Home Reform Act, around 1950, Congress ordered State governments to create licensing programs that would ensure a certain standard of care. But in an odd move, the legislative body failed to specify any standards. Not one.

Increased Federal Funding, No Federal Oversight

At the same time, federal funding began to pour into nursing homes nationwide.

Studies conducted in the 50s found that almost 60% of nursing home residents received public assistance from the federal government.

With this increase in financial involvement, the government turned its eye to ensuring the quality of care in these homes.

Congress To The Rescue?

The States had all cobbled together their own sets of nursing home regulations, but none were very good.

Congress created multiple review boards to inspect facilities from State to State, and the results were troubling. Wide disparities in quality and outcome needed to be addressed:

With these results, Congress was ready to act. The Public Health Service went to work, studying each State's licensing program and slowly developing a comprehensive set of guidelines.

"Guidelines" Won't Cut It

In 1963, the Nursing Home Standards Guide was released. But Congress didn't yet have the legal authority to make their rules legally binding, and problems persisted. Most crucially, States were still unwilling to enforce their various regulations:

  1. To enforce the rules would be to close nursing homes. Where would the residents go?
  2. Revoking a home's license would entail complicated legal proceedings that could stretch on for years.
  3. Judges balked at the idea of closing nursing homes, because most owners said they were addressing the problems.
  4. State-run inspections were looking at the wrong problem. Instead of focusing on the quality of care, they examined its physical plant.

New Money & A New Opportunity

In 1965, Medicaid and Medicare were passed into law, and a new flow of revenue became available to nursing homes. But in order to sign on, Congress forced skilled nursing facilities to accept a new set of regulations. These rules were far more rigorous, and a little unrealistic.

Out of 6,000 nursing homes that applied for federal funds in 1965, only 740 were fully approved. In other words, an overwhelming 88% failed to meet the health and safety standards set out by Congress.

Federal regulators let some slide-by, 3,000 actually. These homes were said to be in "substantial compliance," which is the equivalent of saying, "you get the point. We'll work on those messy details later."

For the rest, those 2,260 facilities that failed altogether? Congress simply turned regulatory authority back over to the States.

Over the next 5 years, Congress tried several new tactics to increase nursing home compliance, including creating a new type of facility with limited responsibilities. Existing homes could re-designate themselves as "intermediate care facilities," and offer residents a narrower range of services. This made it easier to meet the government's standards.

But most of the time, legislators were wrapped up in hearings, arguing over the how far their influence could legally extend.

Can Tragedy Lead To Change?

In 1970, two high-profile tragedies focused the nation's attention on the state of nursing homes. In Ohio, a fire killed 32 residents. In Maryland, an outbreak of food poisoning killed 36.

New reports from the Senate Finance Committee found widespread corruption. Many states were reclassifying their nursing homes as intermediate care facilities, without ensuring that the homes reduced their offered services to federally-mandated levels. Others had simply disregarded Congress' new regulations, and continued to approve nursing homes based solely on their own State-level rules.

After investigating facilities in three states, the US General Accounting Office concluded that half violated standards for staffing, physician visit and fire safety. Even so, they were receiving Medicaid funding.

Nixon's Pledge

President Nixon made an impassioned speech, condemning the substandard conditions of nursing homes throughout America. He committed himself to stopping the flow of federal dollars to facilities that could not follow the rules.

Nixon raised the bar. In 1972, he eliminated the distinction between "intermediate care facilities" and "skilled nursing facilities." Now, all nursing homes would be held to the same standards. Of course, these standards had yet to be written.

It was only in 1974 that the new nursing home regulations were released. Many were critical - these new laws seemed more general, less stringent than before. And while intermediate care facilities were subject to the same licensing procedures as skilled nursing facilities, they were not held to the same standards.

All in all, Nixon's attempts to reform nursing homes looked very much like a failure.

Focused On The Wrong Thing

In 1974, a newly-created federal agency, the Office of Nursing Home Affairs (ONHA), began (another) large-scale investigation. Instead of focusing on a nursing home's physical plant, its employees' qualifications or institutional framework, the ONHA looked simply at its residents and their quality of care.

Shocking as it may sound, this was revolutionary. No one had thought to look at the patients who live in a nursing home, rather than at the nursing home itself.

ONHA found a similar problem in the way States were licensing and certifying elder-care facilities:

States had been evaluating nursing homes on whether or not they could provide quality services. They never looked at whether or not nursing homes did provide these services.

The ONHA devised a fix, a new way of assessing quality of care called the "Patient Appraisal and Care Evaluation" (PACE). The ONHA wanted to use this new measuring stick to evaluate every nursing home. If the results were good, a facility was eligible to receive federal reimbursement. If not, they couldn't get funds from Medicaid or Medicare.

In the end, PACE became "too complex" to use. It was published only as a voluntary guideline. Nursing homes could use it to evaluate their own level of patient care, but didn't need to. And while PACE was a failure, the change in perspective that had brought it into being was just what the nursing home industry needed.

A Matter Of People

Over the next decade, federal and state regulators made numerous attempts to change the now complex set of rules and guidelines overseeing nursing home standards and compliance.a capitol building

Each new initiative failed in its own way, but each also contained the seeds of a solution. Regulators had finally realized that nursing homes are about people, not institutions.

In 1983, Congress stopped working on nursing home regulation. They realized that, instead of leading clearly with foresight, they were stumbling in the dark. They tasked the Institute of Medicine (IOM) with a simple, overwhelming project: tell us what's wrong with nursing homes and how we can fix it.

The IOM study would only be finished three years later, in 1986. Its recommendations provided the foundation for the Nursing Home Reform Act, passed the next year.

This history drew substantially from the Institute of Medicine's "History of Federal Nursing Home Regulation," published initially in Improving the Quality of Care in Nursing Homes.

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While the results haven’t been published yet, a new study out of Cornell University suggests that up to 20% of elderly nursing home residents experience verbal or physical abuse at the hands of other residents.

Resident-To-Resident Abuse Common In New York

Spending a full month in ten different New York nursing homes, doctors led by Karl Pillemer and Mark Lachs used accident reports, medical charts, staff and resident interviews and in-person observation to determine the prevalence of resident-to-resident mistreatment. In all, 2,011 residents were assessed. Nearly 1 out of every 5 residents were involved in an incident of resident-to-resident abuse over the course of only four weeks.

The researchers chose skilled nursing facilities that were comparable in quality of care, staffing levels and inspection history to the average home nationally.

What Does Mistreatment Look Like?

Known collectively as "resident-to-resident elder mistreatment," these aggressive, unwarranted behaviors include:elderly woman who is being bullied

In essence, resident-to-resident elder mistreatment includes "any unwelcome behavior that had the potential to lead to physical or psychological distress in the person on the receiving end," CBS News writes.

Breaking Down The Numbers

A full set of data from the paper hasn't been released yet, but preliminary findings are available. Verbal abuse was most common, affecting 16% of the residents:

Invasions of privacy, like entering another resident's room without permission or consent and rifling through another person's possessions, impacted 10.5% of the residents who were mistreated. A handful of other inappropriate behaviors, including offering unwanted help and making threatening gestures, are also included in that 10.5%. Physical incidents, which the doctors characterized as instances of:

occurred in 5.7% of cases, while sexual forms of abuse, from exposing one's genitals to touch other residents inappropriately, affected 1.3% of the residents involved.

The study concluded that "nearly one in five nursing home residents were involved in at least one negative and aggressive encounter with one or more fellow residents over the previous four weeks," according to a Cornell press release. The team's full results will be presented November 8 at the Gerontological Society of America's annual symposium.

An "Under-Recognized Problem"

Lachs says his study is the first of its kind. Prior to its publication, no other researchers had attempted to look at the problem of resident-to-resident abuse in a systematic way.

Previous studies have tended to focus on the abuse committed by nursing home staff members, but Lachs believes resident-to-resident mistreatment may be an even "more frequent threat to residents." It is, however, chronically under-reported, the researcher says, both by residents and nursing homes. Staff members, for one thing, can actively avoid residents who exhibit aggressive behaviors or become the victims of abuse themselves. In the opposite direction, nurses can become desensitized to resident-to-resident mistreatment, just as they become desensitized to shouting and yelling.

Identifying resident-to-resident mistreatment can be difficult, however, even for well-trained nursing home staff members. Not every outburst is targeted, for example. Shouts can often be heard in the halls of assisted living facilities and nursing homes, and while profanities or abusive language aren't uncommon, these eruptions of apparent aggression aren't always directed toward other residents. Even when they are, and an outburst is clearly meant to target another person in the room, that other person may not respond to the insulting language.

Dementia & Aggression

Although Lachs and Pillemer didn't differentiate between instigators and victims of resident-to-resident mistreatment, the study has insights on which elders are most likely to be involved in this type of abuse.

As one would expect, dementia and mood disorders, common among elderly patients, are implicated in the problem. Residents involved in resident-to-resident abuse were more likely to live in dementia-centered special care units. But it's not severe cases of these conditions that are at the root of resident-to-resident mistreatment. In fact, the residents most likely to be involved are actually "less cognitively and physically impaired" than their co-residents. They're also younger and tend to be white.

Even so, "people who typically engage in resident-on-resident abuse are somewhat cognitively disabled but physically capable of moving around the facility. Often, their underlying dementia or mood disorder can manifest as verbally or physically aggressive behavior. It's no surprise that these individuals are more likely to partake in arguments and shouting matches, and pushing and shoving, particularly in such close, crowded quarters," study co-author Karl Pillemer MD says.

While aggression can be a consequence of worsening dementia, most dementia patients don't become physically or verbally abusive. In 2012, German researchers found that around 29% of dementia patients engage in either physically or non-physically aggressive behavior, much of which could be due to increasing depression. Opening the scope of our inquiry to behavioral disorders generally, we find a far higher prevalence. Studies suggest that between 30% and 90% of dementia patients experience some degree of psychological or behavioral change, from anxiety and agitation to psychosis and disinhibition.

Protecting Elders From Other Elders

This isn't a criminal issue, Lachs says. While abusive staff members "should be arrested, fired and prosecuted," a stern punitive approach isn't likely to solve the problem of resident-to-resident mistreatment. Dementia patients, after all, are just as much the victims of their condition as the people harmed by abusive behavior.

Unfortunately, we just don't have the research to devise adequate strategies for combatting resident-to-resident abuse. Not yet, at least. But Lachs has a few ideas based on his own time in nursing homes.

Environmental Design

Noise and poor lighting can aggravate residents, especially ones with dementia, so one possibility is to create bright, calming spaces for residents. Designing spaces to be easily-navigable, rather than frustratingly cluttered, may help, too. Using materials that dampen sound in communal rooms is a potential improvement, but we'll also have to ensure that nurses can still hear residents down the hall.

Lessons From The Classroom

Help may also come from a surprising source. Lachs thinks that high schools, and specifically the way educational institutions have tackled bullying in recent years, may provide valuable lessons for nursing homes.

In a recent review of school-based anti-bullying programs, criminologists at Cambridge University found that, on balance, these programs work. Anti-bullying initiatives reduce both bullying behavior, by an average of 20% to 23%, and victimization (being bullied) by around 17% to 20%.


While resident-to-resident mistreatment is understudied, Lachs and Pillemer have been on the case for a while. Along with some colleagues, the two doctors have even developed a training program, called SEARCH, to help nursing home staff members intervene effectively after abusive behavior is spotted.

Here are the core principles:

While most of these steps seem self-explanatory, if not obvious, they're obviously time-consuming, and nursing home staff members have many duties to attend to. But they also work. At least that's the conclusion of one pilot study conducted at five New York City nursing homes between July 2008 and December 2011. As you might expect, training staff members in the SEARCH principles resulted in more reports of resident-to-resident mistreatment. After a 6-month-period, nursing home units trained in SEARCH had reported 580 incidents of resident-to-resident abuse. Units who hadn't received the training reported only 79 incidents.

Elder to Elder Mistreatment

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Nursing professions are among the highest demand fields available for new college graduates.justice scales There is always a need for qualified, professional LPNs and RNs in hospitals and other medical care facilities like nursing homes. The nurse to patient ratio in these long-care facilities is often so high that it's unsafe and sometimes leads to neglect.

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Quality care comes from time spent with the patient, and many nursing homes just don't have the staffing to allow nurses the time to visit patients for more than a few minutes at a time. A new bill, known as the Safe Staffing for Quality Care Act, or NYA08580, passed by the State Assembly of New York attempts to change that.

Proposal Of The New York Staffing Bill

With a new bill being proposed to the Senate of New York, nursing homes and hospitals in the state would have to implement a minimum nurse-to-patient ratio. Centers would be required to submit a plan for their staffing to the Health Department. In addition, nurses will be allowed to refuse to work in facilities where the minimum staffing hasn't been fulfilled. Supporters of the bill believe that the quality of care would improve with a lower staff to patient ratio.

The bill is not expected to pass the senate. This is partly due to the opposition of the Coalition for Safe & Affordable Care and the opposition of a group of nursing home administrators, insurers, and hospital administrators. All the opposers say that imposing regulations will disrupt teamwork and deny flexibility in nursing homes and hospitals, thereby undermining care decisions.

Looking At The California Model

California was the first state in the country to implement a required nurse-to-patient care ratio in 2004. It was done to keep nurses on the job and improve mortality rates among patients requiring complex care. The bill required a nurse for every five patients in surgical units and oncology, one for every three patients in labor/delivery and one nurse for every two patients in ICU.

In 2006, Florida passed similar legislation requiring a registered nurse to be in the operating room during every surgical procedure. The legislature also created a minimum staffing requirement for nursing homes. However, this model does not require a nurse to be linked with a certain number of patients, only that the nursing home should have a certain number of nurses on staff.

Comparing The Ratio Solution: Does it Work?

The Department for Professional Employees (DPE) recently conducted a study that compared a nurse reading to an elderly patientCalifornia with two other states that don't have minimum nursing requirements (as of 2006), New Jersey and Pennsylvania, to determine whether the minimum nurse-to-patient ratio implemented in California is working.

The results of the study were impressive, particularly in the area of nurse satisfaction. In California, 73% of nurses felt that their workload was manageable, compared to 61% in Pennsylvania, and 59% in New Jersey. During surgical procedures, California experienced a mortality rate that was almost 14% lower than New Jersey and 10% lower than Pennsylvania. These statistics alone indicate that California is doing something right by implementing a required ratio of nurses to patients.

New York Statistics

To determine if passing a bill requiring a minimum nurse-to-patient ratio would benefit the patients and nurses of New York, it is helpful to know where the nursing homes currently stand regarding the quality of care.

In 2006 the Attorney General of New York published a report on the staffing levels of New York nursing homes. The purpose of the report was so that families could make an informed decision when considering nursing homes for their loved ones. The research revealed that 98% of the homes in the state would not meet the standards required by a comprehensive federal (CMS) study for the quality of care. Seventy percent of the homes would not meet staffing standards set in Florida, and 38% wouldn't meet California standards.

The passage of the Safe Staffing for Quality Care Act would vastly improve patient care by increasing the number of nurses available to assist patients during critical periods of the day when injuries are likely to occur (getting up to use the restroom, bath time). Statistics have shown that passing the bill would be in the best interest of the patients if not nursing home administrators or insurance agents.

Did you know New York Group Homes Aren’t Always A Safe Environment? Continue reading.

There were more than 20,000 new nursing licenses issued in New York in 2015. This includes nurse's aides, LPNs, and RNs. With such a large pool of nursing professionals, there is no room fornursing assisting a patient faulty hiring procedures. Yet, New York nursing homes regularly employ nurses who have been in legal trouble (or worse).

The problem in New York isn't an employee problem; it is a result of bad management. In most states, nurses are held to standards that meet stringent requirements of independent nursing boards or the state health department. However, in New York, the Office of the Professions, which is the oversight agency responsible for the nursing profession, is led by the Board of Regents, a child agency of the Department of Education for the state. Besides being responsible for all nurses in the state, they also oversee the state's public education system.

For more articles on nursing homes, visit: Malnutrition And Dehydration In Nursing Home Residents

Hiring Nurses In New York

In other states, the process of screening nursing applicants is strictly regulated. New applicants must go through a background check before being hired. Unfortunately, New York bypasses most regulations, requiring little more than the applicant's word that she is qualified for the job and hasn't been in any trouble. In fact, nursing home applicants in New York don't even have to submit fingerprints or submit to a background check.

One of the biggest problems with New York policies is the self-reporting requirements. In New York State, licensed nurses only have to report criminal or legal convictions to the Office of the Professions every three years, when they are preparing to renew their license. Many nurses fail to report such changes, and nothing stops them from continuing to interact with vulnerable patients.

What Are The Dangers Of Not Having Background Checks?

In any position where medical professionals must interact with patients on a regular basis, particularly when those patients are unable to physically care for themselves, their very lives can depend on the moral compass of the nurse in charge of their care. Without a background check, anyone can call themselves a nurse and become employed in a position of power. Not only does chaos in the form of ineptitude and negligence ensue, patients are exposed to the potential for:

Changes Can Be Made

In order to avoid the potential problems, nursing homes can experience after hiring an unethical nurse, New York state legislation can change the rules that currently govern the nursing profession and encourage more stringent hiring laws and disciplinary procedures.magnifying glass

Punishing nurses who commit a crime or conduct themselves inappropriately is one way to reduce the dangers involved with living in a nursing home. In 2014, New York disciplined approximately 1 in 1,190 nurses for errors in judgment and negligent care. Compare this to Texas, who disciplined 1 in 167 nurses. Or California, who disciplined 1 in 325 nurses.

Another way to reduce the dangers of nursing home existence is shortening the time period between the acknowledgment of misconduct and the disciplinary action taken to correct the wrong. Because the units within New York's Office of Professions are separated, renewals and investigations are often filed by two different departments, which can lead to a lag extending more than a year from charges to punishment.

Finally, the Office of Professions could enact its emergency suspension privileges, a process designed to remove
dangerous caregivers from their position immediately and save seniors from potential abuse. In ten years, New York's Office of the Professions used their emergency suspension power only twice.

Future Potential

Governor Andrew Cuomo has recently promised to investigate the hiring gaps in New York's Office of Professions and shift the oversight responsibilities to the state Health Department if necessary. Others in the position of power within the Department of Education say the same thing, promising to make background checks and fingerprinting a requirement for new hires if state legislators proposed such a measure.

New York Nursing Home Residents Are Suffering. Continue reading to learn more.

The state of New York is the third largest in terms of housing the elderly population of the country, but it unfortunately severely lags behind in both quality care and laws to protect senior citizens worried elderly manfrom financial and physical abuse. Abuse of senior citizens is considerably ignored with experts estimating that only 1 out of 14 elder abuse cases is reported to authorities.

According to a report released by the inspector general of Medicare's skilled nursing facilities, one in three skilled nursing home patients suffers from medication errors, infections or other dangers. Injuries caused because of negligence are rarely reported and patients don't get the care they deserve - often causing long-term ailments and even death in some cases. This is worrying when you consider the number of elders living in New York nursing homes today.

Change Needed To Protect The Vulnerable

The elderly and disabled members of the community face the most risk of being abused and exploited because of
their inability to fight for their rights. This is why they need additional protection under the law.

According to Robin Schimminger, Assemblyman of District 140, the financial loss to elderly victims is estimated at approximately $2.9 billion, which is up by 12 percent from 2006. Experts believe that abusers can be caregivers, strangers or even family members.

Elder abuse in nursing homes is a serious problem. Injuries have been caused because of neglect, improper care, and deliberate physical abuse. Like most domestic violence and sexual assault cases, it may be challenging to identify signs of elder abuse because it is typically well hidden. For example, in some cases, if there is no documentation evidence then the abuse goes unknown.

The need to create proper laws for these vulnerable community members is vital, but the state continues to lag behind in providing sufficient legal assistance to victims. While 29 other states have created laws specifically designed to help senior citizens, New York has been sluggish in following suit. For instance, effectively supervising and monitoring nursing home aids through cameras and other monitoring systems doesn't exist in the state's elder care facilities - and without any legal necessity, nursing homes are unlikely to install them either.

Filing Complaints In New York

The laws and regulations governing New York nursing homes are nowhere near where they should be, but senior citizens and family members must be aware of the existing laws in place to protect themselves from abuse. If you are filing a claim against a particular nursing home or health care aid, you should know the different methods available to you when reporting complaints:

What Happens With The Complaints?

Every complaint is sent to a centralized complaint unit and action is expected to be taken as appropriate. The unit typically conducts interviews with patients, loved ones and staff from the nursing home. The unit also reviews documents and records to ascertain whether abuse has taken place or not.

According to existing laws governing New York nursing homes, all facilities must meet federal and state statutes or they risk being fined or completely shut down. While some laws for New York nursing homes are in place to protect elderly patients, the fact remains that they aren't enough when you consider the number of patients abused and the number of cases actually reported. Stricter laws and regulations are vital for improving the quality of nursing homes and elder care in the state of New York.

According to the New York Times, obesity rates in the United States jumped from 14.7 percent in 2000, to almost 25 percent in 2010. In only 10 years, the obesity rate in the United States jumped seven percent, and that is not good news for a population that is aging. As the Baby Boomer generation prepares to celebrate their golden years of retirement, the nursing home care system finds itself under increasing financial strain. The end result is that the nursing home system within the United States is finding it difficult to place obese patients into long-term care facilities, and the problem is getting worse.

See our next article on Urinary Tract Infections Frequently Untreated In Nursing Homes

Obesity Costs Are A Big Issue

At the heart of the obesity problem in an aging American population are the costs of caring for woman suffering from poor healthlarger patients. Many obese patients cannot move on their own, which means they require special equipment to get out of bed and move around. The reinforced beds and wider wheelchairs that facilities need to accommodate patients are extremely expensive, and the costs are not getting absorbed by the government.

While almost 60 percent of all nursing home care patients are covered by Medicaid, the Medicaid system does not reimburse facilities for this special equipment. If a facility is going to give personal care to obese patients, it either does so at a loss or finds a way to charge obese patients more for their services. While that sounds like a logical approach, there are legal problems to deal with.

A Growing Disability

The Americans with Disabilities Act outlines several specific conditions that cannot be discriminated against in any way. The problem is that obesity has been left as a gray area that allows nursing homes to reject obese patients for any reason at all. There are a handful of instances where obese patients have used the ADA successfully to be admitted to long-term care facilities, but those instances are few and far between.

Even if the courts rule that a nursing home must accept an obese patient, there is no consideration for the costs associated with taking care of that patient. Obese patients require more medication, food, and nursing assistants for their personal care. It is a cost that could, at some point, cause facilities to have to make difficult decisions.

The Push From The Younger Generations

According to the Rand Corporation, one in three Americans are obese, and that number is rising. Younger people who are too obese
to take care of themselves are starting to take up beds in long-term care facilities that used to be reserved for the aging. Not only does the system have to worry about a growing number of obese seniors that are difficult to place in long-term care facilities, there is also the growing problem of younger people who need care as well.

This problem is only going to get worse as the obesity rate in the United States continues to rise. As more obese seniors turn to the ADA for legal help in finding a place to get care, the financial costs being assumed by these facilities are causing severe financial strain. With more younger people in need of long-term care in nursing facilities, the issue of what to do with obese seniors is headed towards being a significant problem in the near future.

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The Henry J. Kaiser Family Foundation put out a report in May 2015 that offered an interesting fact about nursing home care in the United States. According to the report, smaller nursing homes score higher than larger nursing homes when it comes to independent measures of patient care by a margin of nearly two to one. That means that according to health inspection records and personal nursing homes can be a cash makerfamily reviews, smaller nursing homes do a better job of taking care of patients than larger for-profit ones.

This little fact may seem obvious to many people, but it points out a problem that has been on the rise in nursing homes for some time. Smaller facilities are able to afford the staff needed to care for their patients, and that tends to be the contributing factor to the higher level of care. But as facilities get larger, staffing issues emerge that degrade the quality of care. Families with elderly loved ones in nursing homes are wondering why care seems to diminish as the facility gets larger.

Continue reading about Wrongful Death In Nursing Homes: The Facts

For-Profit Facilities Could Be To Blame

The University of California San Francisco released a report in 2011 that bluntly asserted that for-profit nursing homes offer a lower quality of care than non-profits or facilities run by the government. The study indicated that large
for-profit nursing home chains control 13 percent of the nursing home populations in approximately 2,000 facilities. When you do the math, it gets easy to see where the problem lies.

There are approximately 15,500 nursing homes in the United States that are currently approved to accept funds from Medicaid and Medicare. This number represents nearly all of the nursing homes in the United States. There are approximately 1,400,000 patients in long-term care situations in these nursing homes. This means that 2,000 for-profit facilities are caring for 182,000 patients, or an average of 91 patients per facility. Since a small facility is considered one with 60 beds or less, the average for-profit nursing home is a large facility.

Could Profit Be A Priority Over Care?

The for-profit facilities received 41 percent more serious violations than the better public facilities in 2011. With these facilities having to answer to shareholders and turn a profit, there seems to be a correlation between poor care and the quest for higher profits. For-profit facilities are not hiring enough RNs, and they are short-staffing themselves on qualified personnel to care for their patients.

Without evidence, much of this could be dismissed as coincidence. That is why the UCSF report also indicated that between 2003 and 2008, the largest for-profit chains saw drastic drops in service quality immediately after being purchased by private equity and investment firms. It can now be established that for-profit nursing homes that are Medicare-certified are making profits a priority over care.

What Can You Do?

In recent years, lawsuits from families have caused most of the states to start doing more regular inspections of for-profit, non-profit, and government nursing homes. Long-term care facilities are now being held accountable for their actions, and there is also a comprehensive rating network in place to help warn families about the facilities that offer poor care.

Despite the advances, nearly 40 percent of all nursing homes in the United States only achieve a maximum rating of one or two out of five. There is still work to be done, but the spotlight is on nursing homes to offer quality care. Before you decide which facility will care for your loved one, do your research and find out if it is a facility that offers quality care, or if it is a facility that tends to put profit before patients.

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There is a rapid increase of people who are developing drug-resistant bacterial infections. This is happening mostly in nursing homes. A study conducted in many different nursing homes showed that most residents were getting treated for urinary tract infections that they do not have in the first place. Most of the residents often get misdiagnosed or do not get diagnosed at all as doctors will prescribe antibiotics before even doing any tests.

See our last article on medication errors in nursing homes here:

Adverse Reactions

The use of antibiotics unnecessarily leads to different reactions and even allergic reactions. This is very dangerous and can even be deadly for those people who are over the age of 65. The abuse of antibiotics used to treat infectionsantibiotics leads to the person becoming resistant to the drugs and, as a result, it becomes even more difficult to treat them. It is even more common among those people who are suffering from dementia, as they cannot express and explain their symptoms clearly.

For one to be diagnosed with a urinary tract infection, they have to show the symptoms of the infection. They should also test positive for the presence of the bacteria in their urine. However, those suffering from dementia are often not able to express themselves. This is also common for those who have mental conditions. Thus you will find that for this group of people, they are often given antibiotics for suspected infections without doing proper tests.This results in the residents taking more antibiotics that they do not need.

In nursing homes, as a result of the overuse of antibiotics, you will find that the residents develop drug-resistant infections. Drug-resistant infections lead to the following negative effects.

Increase In Recurring Infections

Whenever a person takes antibiotics, it destroys all bacteria present in the body. The drugs get rid of the good bacteria that is needed in the body. The drug resistant bacteria that is in the body does not get destroyed. Instead, they multiply and can spread to other parts of the body. They can be spread to other people. You will end up getting the same infection over and over again as it was never cleared from your body.

Advanced Illness

Misusing antibiotics also leads to the person getting advanced infections. This is because now the bacteria will not respond to the antibiotics as they are resistant to them. This leads to the infection turning into a superbug that refuses treatment.

More Invasive Treatment That Is Expensive

When the bacterial infection a person has does not respond to antibiotics, doctors will have no other option but to prescribe probiotics. These drugs are stronger than antibiotics. They are also more expensive than antibiotics. Most people are not able to afford them due to their cost.

Prolonged Recovery For Patients

People who have drug-resistant infections take longer to recover compared to those who do not have drug-resistant infections. This is because those who have the resistant strains will need to have higher doses of the drug taken over a longer period. This delays recovery.

More Deaths Due To Antibiotic Resistance

There are more infection-related deaths among those who have been overusing antibiotics. This is because they get resistance to the infection and do not respond to treatment that leads to death. Also, those who cannot afford the expensive treatment prescribed by the doctor will end up dying from the infection.

To prevent this from happening, nursing home providers can carry out the following measures:

This will reduce the number of people misusing antibiotics in nursing homes, and also reduce the chances of people developing resistance.

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Senior citizens are the most rapidly growing demographic in the US today. By the year 2050, people who are 65 years or older will comprise over 20 percent of the US population. These staggering numbers prompted The New York State Senate to pass a package of 10 bills designed to protect senior citizens from various types of abuse. The legislation, which was passed in June, 2015, includes the creation of a statewide senior abuse reporting system and a comprehensive campaign to raise awareness.

Visit our last article about MRSA: America’s New Nursing Home Epidemic

What Are The Numbers In New York?

As the elderly population increases, elder abuse and other crimes against aging persons also increase. A study published by New York City Department of the Aging revealed that for everyelderly man who is concerned reported case of elder abuse, at least 24 more incidents go unreported. The most recent comprehensive report cites that of every 1000 seniors in New York, 76 have reported abuse.

Nursing homes and care facilities have an obligation, under the law, to protect and care for our loved ones. A form of abuse that is prevalent in nursing homes, but is discussed less frequently is abuse between the residents of the nursing home. A study conducted by Cornell University in 2014, used multiple data sources from over 2,000 New York nursing homes and reported that one in five nursing home residents had been involved in an altercation with another resident within the previous four weeks that could constitute abuse. Nursing homes are responsible for maintaining the safety of senior residents in their care and the failure to protect residents from other residents may constitute neglect.

New York State maintains an ongoing database, open to the public, containing findings of all nursing home inspections and investigations. The New York State Nursing Home Quality Initiative (NHQI) operates the database and conducts an annual evaluation and ranking of eligible Medicaid-certified nursing homes in New York State. The nursing homes are evaluated based on their performance in three key components:

  1. Quality
  2. Compliance
  3. Efficiency

The data collected implies that New York is experiencing a significant rise in nursing home abuse.

Types of Nursing Home Abuse

Nursing home abuse may come in many forms, including the following most prominent forms:

Nursing Home Abuse Prevention Strategies

The first step to ensuring that your loved one is being cared for by quality caregivers in a safe and comfortable nursing home is to conduct extensive research. Resources like provide reviews and detailed information about nursing home options. When visiting the nursing care facility, pay attention to other residents and use a checklist as a guide for asking questions.

Once you have selected a nursing home and your loved one is settled in, check back frequently with the management. Even frequent phone calls will raise awareness with management and staff to the fact that you are paying attention to the care of your loved one.

Should you suspect that your loved one is experiencing nursing home abuse, it is best to contact a professional who will assist you with the process of reporting abuse and protecting your loved on.

Continue reading: What You Need To Know About Nursing Home Abuse

When your elderly loved one requires nursing home care, you expect and trust that your family member will be cared for by dedicated professionals who create a comfortable environment for them and treat them with kindness, respect, and dignity. While many senior care facilities are diligent in offering high standards of care, there are, unfortunately, numerous cases within the state of New York where nursing home residents have found to be subjected to neglect, poor medical care, and even sexual abuse.

Check out our previous article for more relevant information:

Prominent New York Elderly Sexual Abuse Cases

In 2013, a janitor, who was employed by Riverdale Nursing Home for twelve years, was arrested Understanding Elderly Sexual Abuse and Taking Actionand convicted of sexually assaulting an 81 year old resident of the facility. Another employee of the nursing home witnessed Jorge Sarmiento sexually assaulting the elderly, female victim, who suffers from advanced Alzheimer's disease. When Sarmiento was arrested and the family was notified, the incident prompted family members to recall other incidents when the victim was experiencing unusual symptoms, now linked to ongoing sexual abuse.

More recently, in 2014, John Tamba, an employee of a nursing home facility, was arrested and charged with nine counts of sexually abusing a female patient at a local nursing home facility. It was alleged that Tamba engaged in forcible sexual contact with the physically disabled female victim while she was in his care at the nursing home. Tamba was charged by the Medicaid Fraud Unit, part of the Attorney General's office that is responsible for protecting elderly and disabled citizens from fraud and abuse perpetrated by nursing homes. The Attorney General has repeatedly indicated how seriously they feel about protecting nursing and long-term care patients in vulnerable situations.

 Sexual Victimization

Although neglect and poor medical care may result in significant physical and emotional problems for residents of
nursing homes, sexual abuse is the most damaging and most reprehensible type of abuse that can take place in a nursing home setting. The primary concern with sexual abuse within a nursing home setting is that it takes on a variety of facets, and may cause a victim to suffer in silence.

In many instances, victims of sexual abuse in nursing homes are typically singled out due to their medical conditions, which make it difficult for them to communicate with others and report the abuse. Dementia and Alzheimer's patients are commonly victimized due to their difficulty with recalling events and their inability to effectively communicate what happens to them behind the closed doors of the nursing home environment.

Sexual abuse of patients in long-term care facilities and nursing homes, where there is an expectation of trust, is a serious problem and while not all problems can be avoided with due diligence, be sure to research a facility using the Department of Health prior to moving your family member to a nursing home facility.

Suspicion Of Sexual Abuse

We understand that there will be many questions if you suspect that your loved one is the victim of sexual abuse within a nursing home and you will experience many emotions. It is always best to contact a professional who can guide you through the reporting process and who will help to navigate the legal journey.

Also see: Did The Nursing Home Reform Act Work?

The sub-standard oral care provided to vulnerable patients in long-term care facilities can have a number of serious consequences. Some of these include increased risk of heart disease, pneumonia,elderly woman who needs dental care and stroke. There are steps that can be taken to reduce these issues; however, facility management and nurses have to first recognize there is a problem.

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This epidemic of poor oral hygiene in these facilities is seen all over the U.S. With seniors keeping their teeth longer than ever before, they require more dental care; however, the workers at nursing homes may not be prepared to offer that care. Also, there are many residents who decline this care from the staff.

When thinking about challenges facing long-term care residents, the first thing that comes to mind is usually not poor oral hygiene. However, evidence has now linked poor oral health to a number of serious systemic illnesses. Even though many residents need assistance in taking care of their oral care needs, many residents do not get much, if any, oral hygiene care assistance.

Oral Care Issues

While there are no current assessments of oral health care in nursing home facilities, since 2011 there have been at least seven different states that have evaluated their residents based upon oral care. One of these states was Kansas, where there were 540 older residents evaluated by dental hygienists in 20 different facilities. The results showed that about 30 percent of the residents had significant oral debris affecting about two-thirds of their teeth. Also, more than a third of the residents had untreated issues of decay.

While those who screened the patients saw plenty of crowns and fillings, it was concluded that these individuals had not received regular dental care for quite some time.

Barriers For Oral Care In LTC Facilities

The issue of poor oral health for nursing home residents is actually multifactorial. One of the biggest ways to ensure good oral health is to ensure daily oral care; however, this seemingly easy task can post a real challenge in a number of long-term care (LTC) facilities. There are a number of residents in LTCs that have a hard time brushing their own teeth because of cognitive impairment, vision problems, limited mobility, or manual dexterity issues. In fact, a study performed by Frenkel and colleagues discovered that between 72 and 94 percent of residents in LTCs have preventive issues when trying to take care of their own oral health needs. In a number of cases, these individuals also did not receive any assistance for caring for their teeth or dentures. Read more about the consequences of poor dental hygiene for the elderly here.

Only about five percent of residents in LTC facilities received help when they needed it. Also, when help was given, the average time spent on the senior's teeth was only 16.2 seconds, rather than the recommended two minutes.

There is more and more evidence emerging that shows the relationship between systemic illness and poor oral health for residents in LTC environments. For a number of years, oral health was considered independent to overall health. However, with contemporary healthcare culture, views are changing to reflect this growing concern. Making changes in long-term health care facilities is essential. This will ensure the long-term health of residents and prevent any unnecessary pain or discomfort.

Read more on nursing home abuse lawsuits here: Family Wins $7.5 Million In Nursing Home Sexual Assault Lawsuit

Methicillin-resistant Staphylococcus aureus, MRSA for short, is an infection that you may have never heard of. But in 2011, this little-known condition affected more than 80,400 people, almost 61% more than contracted HIV.

Shockingly, over 60% of MRSA cases are spread in healthcare facilities. And according to the Centers for Disease Control & Prevention (CDC), almost one-third of all patients who enter hospitals to be treated for the infection come from long-term care facilities. Clearly, nursing homes and assisted living facilities are breeding grounds for this virulent illness.

Continue reading helpful articles provided by our elder abuse attorneys here.

What Is MRSA?

Staphylococcus bacteria, a germ found on the skin and nose, causes what is frequently referred to as "Staph infection." More often than not, Staph bacteria is benign, resulting in no problems but a germs in a nursing homemild rash. When the bacteria penetrates deep into the body, usually through open cuts or sores, it can cause severe damage. Spreading through blood, and infecting bones, joints and organs, Staph can end in life-threatening complications like Toxic Shock Syndrome. But again, these complications are rare.

Staph infections are treated simply, through the use of antibiotics. But one strain, MRSA, has evolved and become resistant to treatment.

After infection, symptoms begin quickly, first presenting as small red bumps. In the absence of treatment, these bumps can develop into excruciating abscesses, pus-filled sores that must be drained surgically. In severe cases, the bacteria can burrow beneath the skin, infecting bones, organs or the bloodstream.

MRSA is a significant cause of pneumonia, a lung infection that kills more than 10% of the elderly people who get it.

How Does The Disease Spread?

Staphylococcus bacteria is common; the CDC reports that "one in three people carry staph in their nose, usually without any illness."

And while only 1 out of every 50 people carry the particular strain responsible for MRSA, it can be easily spread through physical contact. Hands become quickly contaminated through direct contact with carriers, and the bacteria spreads further.

Why Is It So Common In Nursing Homes?

1. MRSA relies on openings in the skin to infect the body. This is particularly problematic in elder care facilities, where bed sores and surgical wounds are common. Any invasive procedure, including IV tubing and artificial implants, can create a dangerous entry point for the bacteria.

2. Elderly nursing home residents generally live with weakened immune systems. Unable to stave off infection, their bodies succumb to the bacteria's negative effects far more easily than that of a younger person.

3. Nursing homes can be crowded. Living in close proximity to others, especially when the environment is frequently left unsanitary, increases the risk of the disease's spread.

Can MRSA Be Treated?

Yes, but first it must be recognized. Unfortunately, many cases of MRSA are diagnosed as normal Staph infection first. Others are misdiagnosed initially as spider bites. The primary treatment measure for either condition, antibiotics, will have little effect in fighting MRSA and often causes more severe complications:

Doctors can properly diagnose the infection only by taking a sample of nasal secretions. In a lab, this material will be stored in a petri dish, along with special nutrients that promote the growth of bacteria. After testing the results, you'll be able to know whether or not the bacteria is resistant to antibiotics.

Thankfully, MRSA is only resistant to the most regularly used antibiotics. Other types of antibacterial medications still work, although recent studies suggest that the bacteria is evolving beyond those as well.

In limited cases, the illness can be effectively treated without the use of drugs. Doctors may be able to drain abscesses, and the infection will clear of its own accord.

What Should Nursing Homes Do?

The CDC has outlined a number of guidelines to help nursing homes prevent the spread of MRSA within their facilities.

Many involve easy, routine hygienic practices. Cleaning surfaces with antibacterial disinfectants and regularly washing bed sheets are simple ways to reduce risks. Nursing home employees should carefully clean their hands before and after coming into contact with any patients, and wear gloves whenever possible.

Experts agree that infected patients should be isolated, or share rooms only with other residents who have also been infected.

But the CDC's guidelines are just that: recommendations. They're not laws, and failure to comply is not a violation of any legally-binding sanction.

Misdiagnosis Of MRSA

Misdiagnosis, on the other hand, may be cause for legal action. As we've seen, MRSA can be mistaken for other diseases. When improperly treated, a mild infection often becomes a major concern.

With the industry's newly increased awareness, medical professionals should now actively screen for MRSA, by testing cultures for the presence of the deadly bacteria. If doctors fail to rule MRSA out as a possibility, and their misdiagnosis leads to the worsening of a patient's health, loved ones may be able to file a medical malpractice lawsuit.

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Beginning to consider in-patient long term care for your elderly loved one? According to the Henry J. Kaiser Family Foundation, there were 631 assisted living facilities and nursing homes in New York State alone as of 2011.

Our New York bed sore lawyers want to provide you with the information you need when choosing a care facility for your loved one.

Finding The Right Elder Care Facility

How can you possibly choose the right one for your loved one, the one that blends their needed services, a high standard of care and the atmosphere that they'll best respond to?

Keep our tips in mind as you begin your search:

1. How Close Is Close Enough?

Most Americans want their loved ones close, so they can visit regularly and check in on the facility's conditions. One way to whittle down the list is by considering only the nursing home's in your immediate vicinity.

This is easy to do. Just visit the New York State Department of Health (DOH) website, click your county on the map, scroll down and "refine your search" by zip code. We'll discuss other ways you can use the DOH's database later in this article.

2. Speak With Your Healthcare Provider, Friends & Family

Does your loved one have a trusted doctor? They're probably the best place to start in seeking recommendations.

For one, they'll be intimately acquainted with your loved one's medical needs, and know which types of care will help the most. And it's very likely that they will also know the area, and be familiar with the facilities around you.

Ask friends and family in the area if they have any recommendations, too.

3. Visit, Visit, Visit

Call each facility that you're considering and set up a meeting with their general director and director of nursing. When you're there, try to get a feel for the interactions between residents and staff, the overall conditions, like cleanliness, and whether or not the patients themselves seem content.

Also note whether or not staff members are attentive to your questions or concerns.

After your initial visit, visit again without making an appointment ahead of time. Try going on a different day, so you can meet new staff members.

4. Compare Nursing Homes Based On Complaints

This step is actually pretty easy. Head over to the DOH website that we linked above and search for one of the nursing homes you're considering.

Overall Standards

Under the "Quality" tab, you'll find a statistical review of common continuing care issues and a 5-star ranking system that compares each nursing home to others in the state.

For example, Beacon Rehabilitation and Nursing Center in Queens reports that 0.6% of its residents  "have pressure (bed) sores that are new or worsened." Compared to the State average of 1.2%, Beacon looks pretty good. A 4 out of 5-star rating under bed sore management places Beacon near the top.

Annual Inspection Results

You can also find examination records under the "Inspection" tab. During the year, inspectors from the DOH review a nursing home's facilities and investigate complaints. This section is extremely well-reported. Taking a look at the records from Riverdale Nursing Home in the Bronx, we can see that they've been cited for "Standard Health Deficiencies" 31 times between 2010 and 2014, 35% more than the state average.

And below that, we can find detailed descriptions of each citation. Just click on the magnifying glass beside an entry, and you can read a lengthy discussion of the home's deficiencies. On April 28, 2014, Riverdale was cited for failing to "ensure that necessary housekeeping and maintenance services were provided to maintain a sanitary, orderly, and comfortable interior." We can even learn how many residents were affected by the problem. In the previous example, the unsanitary conditions impacted the lives of two patients.

Abuse & Neglect Complaints

Under the "Complaints" tab, we can find exact numbers on how many times a nursing home has violated state or federal regulations. Although this section isn't as detailed as the others, we can assume that many of the violations involved reports of nursing home abuse or neglect.

Brooklyn's Hamilton Park Nursing and Rehabilitation Center was cited for 37 violations from 2010 to 2014. The DOH puts this number in perspective in terms of beds. So for every 100 beds in the facility, Hamilton Park received 24.4 citations. That sounds really high, the Statewide average is actually 35.9.

Notably, the DOH also tells us how many complaints were reported by the nursing home itself, versus patients and their loved ones. Hamilton Park's staff only reported 24% of all their violations. This could go some way in indicating that they lack the transparency and thorough oversight we would expect from people who have taken our loved ones under their care.

How Do I Use This Information?

Every nursing home in New York State is registered in the Department of Health's database, and all the available info can be overwhelming. We suggest narrowing your list first and then investigating their record of complaints and violations.

Continuing learning about: Bill Being Considered To Establish Better Patient To Nurse Ratio

Medical science is progressing at an astonishing pace. Every year, there are new medications to treat serious conditions and prevent others entirely. As a result, we're living longer than ever before. But because many ailments only develop over time, our longer lives have an odd side effect.

Medications extend our lifespan, but the older we get, the more medications we need. It's understandable then that prescription drugs are central to the work done in nursing homes.

Medication Errors Happen Every Day In Nursing Homes, read more on this subject here.

Reducing Independence: The Dangers Of Chemical Restraint

In a recent article, we wrote about the misuse of bed rails, which is still common in many elder care facilities. If bed rails are not strictly necessary to prevent falls, they're banned outright. Why? Because they reduce a resident's independence, making it difficult or impossible to get out of bed and walk around. Nursing homes can even be held legally accountable for using restraints when they are not necessary.what is chemical restraint

Nursing homes have a duty to treat patients properly, according to their needs. This isn't surprising; it's common sense. But one of their other duties isn't as self-evident. In addition to treating medical conditions appropriately, a nursing home's staff has a duty to maintain patients' independence as much as possible.

As we noted earlier, effective prescriptions are one of the greatest achievements of modern society. But every drug comes with its own set of risks and dangers, which we usually think of as "side effects."

What Is Chemical Restraint?

Chemical restraint, the deliberate use of a drug to limit a patient's freedom and movement, is another less-familiar danger implicit in prescription medication. Essentially, doctors or nursing home staff may actively "drug" a patient that they deem troublesome.

According to federal law, drugs can only be used for two reasons:

  1. to treat diagnosed medical conditions
  2. to prevent a patient from physically harming someone else or themselves

If nursing home staff use a medication to discipline patients or make their own lives easier, it's illegal.

New York has its own specific set of regulations on chemical restraint:

What Drugs Are Used To Restrain Residents?

Psychotropic drugs, used to treat psychological illnesses, are the most common type used to restrain patients. These medications usually act on neurotransmitters in the brain, altering behavior, perception, sensation, mood, and awareness.

According to the FDA, around 15,000 elder care facility residents die annually due to the unnecessary administration of anti-psychotics alone.

Is It Always Banned?

In limited cases, chemical restraints are legal, but this is still controversial. Doctors may be allowed to restrain patients if their actions pose a danger to other residents, nursing home staff, or themselves. But crucially, the resident must consent to the chemical restraint first.

Contact A Nursing Home Lawyer In NYC

Chemical restraint is almost always a grave violation of rights, and your loved one deserves better. If you believe that someone is being unnecessarily restrained in any way, contact the nursing home lawyers at Banville Law. Discuss your case with our experienced attorneys in a free consultation, and learn whether you can pursue compensation in a personal injury lawsuit.

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According to the Centers for Disease Control & Prevention, "one out of three older adults falls each year, but less than half talk to their healthcare providers about it." Of those seniors who do seek medical attention, some begin looking for long-term care, places outside the home that offer accommodation, medical services and, most importantly safety.

It's a logical course of action: fall, realize that home may not be the healthiest option anymore, and start looking into nursing homes. The numbers bear this logic out: 40% of all nursing home residents cite a serious fall as their main motivator, the primary reason for seeking long-term care.

Bed Rails In Nursing Homes: When Are They The Right Choice?

As loved ones, we expect a nursing home staff to take every precaution, surround our elderly family members with multiple layers of support and protection. But when our expectations aren't met, when we find that certain safety measures haven't been taken, it can be jarring.a bed without bed rails

In general, bed rails are used far less than most of us imagine, even for those patients who present a serious fall risk. Bed rails, of course, run along the side of a hospital bed, preventing seniors from falling onto the floor at night. And for most of us, that's all we know. Based on that definition, it's perfectly reasonable for us to insist on these 'interventions.' Bed rails are 'safety equipment,' and therefore 'safe,' right?

What we don't know is that bed rails present their own risks, which in some cases, outweigh their potential benefits.

Bed Rails: Why Not?

In a report released in 2006, the Food & Drug Administration (FDA) highlighted a newly-recognized danger threatening seniors: "entrapment." " 'Entrapment' describes an event in which a patient / resident is caught, trapped, or entangled in the space in or about the bed rail, mattress, or hospital bed frame." Between 1985 and 2006, the FDA received 691 reports of entrapment. In almost 60% of these reports, patients died because they had been trapped between a bed rail and mattress. In another 17%, residents were seriously injured.

Obviously, bed rails can present an immediate safety risk to some elderly patients. The dangers are particularly high for those residents who have become frail, confused, or restless. Elderly patients with seizure disorders, or those extremely likely to flail during the night, are often placed in beds without rails for good reason.

Bed rails can also have a less-visible adverse effect on nursing home patients. And while they may be able to prevent falls, health regulators recognize that bed rails can increase a patient's sense of isolation. For those seniors who would otherwise be able to leave their beds safely, the FDA considers bed rails an "unnecessary restraint." And legally, nursing homes can actually be held accountable for unnecessarily reducing a senior's independence.

Bed Rails: Why?

Nursing homes are required by federal regulation to perform risk evaluations for each patient. So what happens when they identify a patient who is at risk of falling?

Because of their inherent safety risks, it's actually a big deal for a nursing home to allow the use of bed rails. First, nursing homes generally try alternative fall-prevention methods. Beds that can be lowered directly to the floor are a good option. They can be left down most of the time, and only raised when a caregiver needs to work. Motion detectors, "bed alarms," can be installed to alert caregivers when a resident nears the edge of their bed. In rare instances, patients may even be legally restrained, in effect "tied to the bed."

When none of these other prevention methods work, the use of bed rails may be warranted.

What Is Being Done To Protect My Loved One From Entrapment?

In 2006, the FDA set up its Hospital Bed Safety Workgroup (HBSW) to study entrapment events and supply industry guidelines. But the HBSW's guidelines are only recommendations; they don't create legally-binding rules. So hospital bed manufacturers are not required to create safer beds, and nursing homes aren't required to purchase beds that follow the Workgroup's guidelines. Still, most do, and many have even upgraded their existing, "legacy," beds to meet the new recommendations.

But dangers still remain. In 2012, the New York Times found that another 550 patients died in entrapment events after the FDA's voluntary guidelines were released in 1996. Several high-profile lawsuits, at least one filed against a nursing home for negligence, have spurred renewed interest in studying the effects, and possible regulation, of bed rails.


Along with considerable expansions in health care policy, astounding advances in medical technology have had big results: Americans are living longer lives. But as more citizens reach the age of 65, providing adequate supervision and proper care has become absolutely essential. Many of us turn to residential facilities, nursing homes and assisted living facilities, to watch over our loved ones when we cannot. This transition, although often necessary, requires a lot of trust. We need to be able to depend on the qualifications and compassion of strangers.

Tragically, it's become increasingly apparent that this trust is not deserved. Elder abuse and neglect are rampant, both nationwide and in New York State. The personal injury lawyers at Banville Law created this free infographic to help you understand how big this problem really is, how to spot elder mistreatment when it happens, and what to do afterward.

For more information on elderly abuse, visit our next article:

What You Need To Know About Nursing Home Abuse

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What does negligence look like in a nursing home or assisted living facility? It can be hard to tell the difference between the natural stages of aging, in which some physical and mental deteriorationman who is sad about poor care is to be expected, and the effects of irresponsible care. We hope that the following examples of alleged neglect, gleaned from elder care lawsuits and investigative reports, will serve as some example.

While their circumstances are impossibly tragic, the cases of Doris Cote and Joan Boice should be a wake-up call to every family with a loved one in a long-term care facility. From the outset, it's particularly crucial to note that in both cases, family members began to suspect something was wrong well before their loved ones paid the ultimate price of nursing home neglect. For Joan Boice's daughter-in-law Karen, it was just a feeling at first; something was "weird," she would later tell reporters.

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CA Assisted Living Facility Lets Bed Sores Progress

Joan Boice moved into Emerald Hills, an assisted living facility in Northern California, on September 12, 2008. Assigned to the facility's Memory Care Unit, according to ProPublica, Boice received a cursory examination from a nurse, Peggy Stevenson, who even noted that Boice should be monitored closely to prevent a fall. But Stevenson, who today says she remembers neither Boice nor her own time working at Emerald Hills, didn't work up any sort of plan to actually care for the resident.

It shouldn't be surprising, then, that Boice fell only 10 days later, in the television lounge. When emergency responders arrived, Boice was splayed face-down on the floor, bruises beginning to develop on her face. It was the night Boice's son, Eric, and his wife, Kathleen, had planned to hold a birthday party for their daughter.

State Regulations Disregarded, Boice Family Claims

Not one employee at the facility, however, could tell the ambulance crew how Boice had fallen, or for how long she'd been lying on the floor. Nor did any employees accompany Boice to the hospital. They also delayed notifying her husband, Myron, who also lived at Emerald Hills.

Boice recovered, to a degree, although she couldn't walk, feed herself or speak clearly, according to Jenny Hitt, who worked as a medication technician at the assisted living facility. But Emerald Hills was woefully understaffed, report ProPublica's A.C. Thompson and Jonathan Jones, and couldn't hope to care for Boice, or any patients, adequately. Alicia Parga, another nurse, oversaw the memory care unit in which Boice lived, intended for residents with dementia and Alzheimer's. It took Emeritus around 18 months to give Parga any training on either condition, even though only 6 hours of training were required by state law.

Lack Of Communication, Adequate Staff, Led To Death

Nineteen days after entering Emerald Hills, Joan Boice developed a pressure sore on her foot. In her medical records, an employee noted the severity of her condition, writing that a "skilled professional" would attend to Boice's wound.

But no one from the assisted living facility contacted Boice's doctor. In fact, they didn't contact a doctor at all. Nurses were in short supply; time sheets obtained by ProPublica suggest that Emerald Hills left Boice's memory care unit unattended at least five nights during her stay. It was only two weeks after a nurse had first noticed the festering wound on Boice's foot that her physician was finally called. The doctor sent back a short memo, advising the facility to bring Boice in for X-rays. Three weeks later, Emerald Hills notified Boice's family of the sore.

Eric, Joan Boice's son, would ultimately become the person who took her to the doctor. Tayyiba Awan, Boice's physician, inspected her sore, which seemed to be healing - an ulcerated bunion, the doctor thought. But had Boice been left to lie on her side for extended periods of time? It was possible, Awan said.

Back at Emerald Hills, Boice's condition was quickly deteriorating. Bed sores were multiplying across her body, and the assisted living facility's employees were scrambling to "improvise" a solution, according to ProPublica. Under California law, assisted living facilities aren't allowed to keep residents with serious bed sores, which require expert medical care. But Emerald Hills did, Boice's family claims, and the facility has a history of doing so, receiving multiple citations from state inspectors over the years.

"We Knew We Weren't Supposed To Do It"

Executives from Emerald Hills deny that any improper medical care occurred in Boice's case. But speaking to Jenny Hitt, a worker who spent time at Emerald Hills while Boice lived there, ProPublica heard a very different story. Hitt says that she and her coworkers tried desperately to deal with Boice's pressure sores:

"We knew we weren't supposed to do it. We knew we weren't licensed or medically trained to do it."

Hitt, who has no medical training, had been put in charge of doling out medications at Emerald Hills. Boice's bed sores turned from bad to worse, deepening and turning black as her skin died. But even then, Emerald Hills didn't inform her family members of the condition, they say.

In December, only two months after Boice was admitted to the assisted living facility, Peggy Stevenson, the nurse who had first examined her, e-mailed Boice's daughter-in-law. Boice's condition, Stevenson wrote, required transfer to a nursing home, a facility with the qualified medical staff necessary to treat her. Kathleen, ProPublica writes, "was stunned." It was "the very first time [Boice's family] had ever heard anything like that."

After her transfer, Boice was inspected by a nurse at the nursing home, who found at least eight sores, in various states of decay, on her body. Kathleen sat through the inspection, horrified. Two months later, on Valentine's Day, 2009, Boice died. Her death certificate, the Sacramento Bee found, listed bed sores as a "substantial factor in her death."

Family Heads To Court, Hoping "To Share Mom's Story"

More troubling facts would come out in the course of the lawsuit eventually filed by Boice's family. While California state law requires that assisted living facilities conduct a "pre-admission appraisal" of residential applicants, in order to identify potential health concerns, Emerald Hills had never performed one for Boice.

In fact, a state investigator found in 2008 that the assisted living facility had been admitting residents illegally, without the doctor's evaluations required prior to move-in. Assisted living facilities, Thompson and Jones write, have a "powerful business incentive to boost occupancy rates and to take in sicker residents, who can be charged more."

Emeritus offered the Boice family a settlement, $3 million, but the terms of that settlement, Eric Boice says, were unacceptable. With a trial date quickly approaching, Emeritus wanted the family to return every internal document obtained by their attorneys. Deposition records would be kept under seal forever. And Emeritus would accept no wrongdoing, or liability in the death of Joan Boice. The family rejected Emeritus' offer because, as Eric later said, "we would not have been able to share my mom's story."

The Boice family would spend the next two months in a California courtroom. Two, long difficult months at the end of which a jury awarded the estate of Joan Boice $3.875 million in damages, an award quickly cut to $250,000 by California's "cap" on pain and suffering damages, and $22.9 million in punitive damages.

On Appeal, Judge Adds Over $4 Million To Verdict

But in a turn of events common after such large jury verdicts, Emeritus appealed the case to the Sacramento County Superior Court. Karen Lucas, an Emeritus spokesperson, said "we believe that the verdict was tainted by the admission of improper testimony and evidence and does not reflect the care that we provided Ms. Join Boice." The company's attorneys argued that $23 million was far out of line with the punitive damages normally awarded in such cases, and requested a reduction or retrial.

Not only did Judge Judy Holzer Hersher disagree with Emeritus' arguments, she tacked on another $4.3 million to cover the legal and court fees accumulated by Boice's family during the appeal. In Emeritus' actions, Judge Hersher saw a "high degree of reprehensibility."

Emeritus has since changed hands. The company's assets, including Emerald Hills, were acquired by Brookdale Senior Living Solutions in 2014.

Vital Care Plans "Ignored" In Arizona

In 2015, an Arizona jury awarded the Estate of Doris Cote $19.2 million, handing down the whopping decision against Five Star Quality Care, Inc., a national chain of skilled nursing facilities based out of Newton, Massachusetts. Before trial, Five Star Quality Care had offered Cole's estate a settlement of $500,000.

Five Star, a public company valued at $200 million according to Courtroom Connect, operated the nursing facility in Peoria, Arizona where Cote, 86 at the time of her death, was sent to recover from an infected shoulder.

While Cote did not die in The Forum at Desert Harbor, her estate's attorneys argued that the nursing home's "willful disregard" of safety procedures had contributed significantly to her passing. During her stay at The Forum, Cote was over-medicated with potent painkillers, fell multiple times, suffered severe malnourishment and ultimately developed a pressure sore that became infected with MRSA, or methicillin-resistant Staphylococcus aureus, her family claimed.

Employees of The Forum, Cote's attorneys argued at trial, chose to ignore procedures put in place to minimize the development of bed sores. In fact, a 2011 inspection conducted by federal investigators had previously found evidence that The Forum's pressure sore management policies were woefully inadequate.

In "six of seven sample residents," randomly chosen, "the facility failed to initiate care and provide services to prevent pressure ulcers and promote healing," according to a report filed in conjunction with the inspection. The facility knew about the problem but did nothing, the estate's lawyers argued, promising to implement immediate improvements in an attempt to "get the government surveyors off their back." Those improvements never came, Cote's family members claimed, and their loved one paid the price.

In order to check that nursing homes are in compliance with federal regulations, the Centers for Medicare and Medicaid Services (CMS) will have a state employee conduct an unannounced survey of the facility, noting any deficiencies in the environment, staffing or quality of care in an official report.

In the event of a lawsuit, these surveys can become crucial evidence. How? Being cited for a elderly man in a nursing homeviolation is a formal warning. The nursing home is now aware of a serious problem, one that only threatens the facility's continued certification, but could mean higher penalties down the road, including punitive damages in a nursing home neglect lawsuit.

After receiving a citation, the nursing home should do everything in its power to fix the problem. In fact, experts suggest that nursing homes should reevaluate their internal policies, and make improvements as necessary, to prevent future injuries. But if a facility makes no effort to improve the living conditions of its residents, and another patient gets hurt as a result, that can mean increased liability in a personal injury case.

Just as troubling, The Forum attempted to conceal Cote's degenerating condition, attorneys said, lying on forms required by Medicare and Medicaid about Cote's weight loss. The jury agreed and found the defense's argument that Cote's decline in health was caused by common, unavoidable consequences of the aging process, rather than negligence, unconvincing. While the jury ultimately said The Forum was not responsible for Cote's death, the nursing home was responsible for her pain and suffering. Her estate was awarded $2.5 million in compensatory damages and $16.7 million in punitive damages.

The case was Estate of Doris L. Cote, et al. v. Five Star Quality Care Inc., et al., case number CV2012-094285, filed in the Maricopa County Superior Court.

5 Lessons Learned

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Not many New Yorkers are aware of the Nursing Home Reform Act, a sweeping piece of legislation passed in 1987.

The Act was meant to broaden federal authority, tying nursing homes in each state together under a single, rigorous code of standards.

But our Banville Law article didn't tackle the most obvious question:

Did Federal Reform Actually Fix Nursing Homes?

A study published in 2002, 15 years after the Act's passage, was less than promising. On the question of nursing home quality, Federal nursing home reform seemed to have had little effect.nursing home employee assisting a resident

Nursing homes were still plagued by systemic problems.

According to the New York Times, the study found that over 90% of America's nursing homes were "woefully understaffed." To complete the research, surveyors spent over 8 years in elder-care facilities across the nation. They concluded that under-staffing had led to an increased incidence of "severe" bed sores, malnutrition and troubling weight loss among patients.

New Suggestions, Old Problems

After reviewing the report, the US Department of Health & Human Services (HHS) amended its suggested guidelines.

HHS recommended that residents should receive at least two hours of attention from nurse's aides every day, and at least 12 minutes from registered nurses. At the time, HHS reported that the majority of nursing homes were under-equipped to meet either standard.

With funding tight and little movement among Congress, it looked like nursing home's were poised to fall back into their old ways. Under-staffed, crowded, and unsanitary, elder-care facilities had been largely unchanged by the Nursing Home Reform Act.

Nursing Home Deficiencies Still Rampant

Of course, 2002 is old news. Unfortunately, the intervening years saw few improvements.

A decade later, in 2011, researchers from the University of California San Francisco (UCSF) led an exhaustive, national study of America's 10 largest for-profit nursing home chains:

Together, these nursing home companies oversaw an astounding 13% of all nursing home beds in the country. All but one, Sun Health Care, are still in business. Notably, none of them, not one, have locations in New York State. Several are active in New Jersey and Pennsylvania.

For-Profit Elder Care Facilities Chronically Understaffed

The study found that for-profit nursing homes "have fewer staff nurses than non-profit and government-owned nursing homes." As a result, patients living in the for-profit homes received 30% fewer total nursing hours, and were the "sickest" people living in elder-care facilities nationwide.

Compared to the best facilities in America, the large chains had been cited for 36% more minor deficiencies and 41% more serious deficiencies.

What Went Wrong?

After the study was released, officials in California cited two overarching problems that were actively threatening the lives of nursing home residents:

In short, regulators were lax in their inspections, missing deficiencies entirely.  And even when violations were spotted, the enforcement protocols instituted by the Nursing Home Reform Act failed to adequately address them.

This claim was confirmed in 2008, when a study conducted by the US General Accountability Office found that 70% of the surveys conducted by State regulators missed at least one deficiency. 1 out of 7 surveys missed a violation that had caused patient's actual harm.

Here's another huge point to remember:

When Medicaid and Medicare were changed to offer substantial amounts of money to privately-owned nursing homes, the market expanded at a rapid pace. New players entered the game at an alarming rate.

But these places are businesses, and their focus is on cutting costs and increasing profits. One of the easiest ways to slash expenses is to decrease worker hours. All of which comes at the expense of residents' safety and health.

Did The Nursing Home Reform Act Make Things Worse?

The team at UCSF also tracked the average number of deficiencies caught by State regulators at nursing homes across the country. Their statistics run from 1994 to 2006, a period in which the Nursing Home Reform Act's changes should have been taking firm hold on the industry.

But what they found was the opposite.

As Nursing Home Citations Increase...

In 1994, the average certified nursing facility was cited for 7.2 violations. By 1997, that number had dropped substantially, to 4.9 annual deficiencies.

True progress seemed within reach.

But by 2004, the average had peaked, at an unacceptable 9.2 violations. While the number fell again, dropping to 7.5 violations in 2006, it never again reached the low it had achieved 12 years earlier.

Fewer Homes Are Citation Free.

On the other hand, you can look at the amount of nursing homes that were never cited for deficiencies and see some real hope. But it would be short-lived.

In 1994, 12.6% of facilities had not been cited for a violation that year. By 1997, that number rose to 21.7%. But there was a staggering change from 1997 to 2006, a year in which only 7.7% of homes had completely clean records.

Are Nursing Home Residents In More Danger Than Before?

There was improvement, though, in the most important category.

Any time we mention "deficiencies," that word says nothing about whether or not residents were harmed by a violation. It only means that regulators found some broken standard, which may have occurred far from patients. For all we know, the deficiencies may be record-keeping errors.

In mid-July of 2005, regulators began to differentiate between simple "deficiencies" and violations that cause "actual harm" to residents or place them in "jeopardy." It finally became possible to tell if a nursing home's patients were being hurt by the facility's negligence.

In 1996, 25.7% of America's certified nursing facilities were cited for a life-threatening violation. The percentage peaked at 30.6% in 1999, but then gradually fell to 15.5% in 2004. By 2006, the number had creeped back up to 18.1%.

And while the numbers clearly reflect an overall improvement, it's still 1 out of every 5 nursing homes, violating standards and causing actual harm to residents.

How Are Residents Being Threatened?

It's very hard to tell.

This is one of the biggest problems with the way we track nursing homes. Facilities can be wildly negligent in one area of service, and fine in another.

When we lump everything together into an aggregate rating, as Medicare's Nursing Home Compare website does (nursing homes are given a "grand total" ranking out of five stars), we often miss the real ways in which they threaten patients.

Here's another problem: State regulators seem to minimize many life-threatening violations, by classifying them as "simple" deficiencies rather than ones that cause "actual harm."

While only 18.1% of nursing homes were cited for "actual harm" deficiencies in 2006, almost 20% were cited for violations in relation to pressure sores. You can read about the dangers of bed sores yourself, but there is no doubt that they can become life-threatening if left untreated.

Another example: a shocking 37.9% of nursing homes were cited for "food sanitation" violations. If you read our last article, you'll know Congress was spurred to investigate the problem of care in nursing homes because of an outbreak of food poisoning that killed 36 patients in Maryland.

If you'd like more information, you can find a concise survey of the study's results on the Kaiser Family Foundation website.

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The family of a 16-year-old boy pursued legal action against his school nurse, alleging that her failure to inform his family of a potential concussion resulted in serious brain damage.

Continue reading more articles provided to you by our nursing home wrongful death lawyers at Banville Law.

His Football Injury

The plaintiff, who had recently joined his high school football team, was sitting on the sidelines without his helmet when a few teammates began to throw footballs at him. A few of the footballs hit him in the player who suffered head injury

Shortly after this incident he went to see the school nurse. He informed her that he had been hit in the head with more than one football and that he now had a headache and double vision. He mentioned to her that he was worried that he had a concussion. She made one attempt to reach his grandmother, the family member with whom he lives, but was unable to contact her.

After this first visit to the nurse, he continued to go to practice over the next two weeks. He also returned to the nurse on multiple occasions, complaining once again that he was suffering from headaches and double vision. She apparently did contact his grandmother but only discussed the fact that he had pinkeye.

Several days after the phone call, the boy was at home with his grandmother and began to complain of head pain, neck pain, and issues with his vision and balance. She rushed him to the emergency room where doctors saw a large mass on the images that they took of his head.

His Diagnosis

The ER doctors transferred him immediately to another hospital where doctors found what is known as a cavernous malformation.

A cavernous malformation is a type of vascular malformation. Blood vessels end up with large “caverns” due to dilated vessels that fill with blood slowly. These lesions have a tendency to leak because of the malformation. In this case, a blood clot formed near the boy’s brain stem.

His doctors were forced to perform brain surgery to remove the clot. Due to a combination of the bleeding and the surgery, he suffered from brain damage which required extensive rehabilitation therapy and impacted his ability to walk. He currently needs to use a wheelchair or a walker, although his physical therapists and doctors are hopeful that with time he may be able to walk with just a cane.

The Pursuit Of Justice

The boy and his family filed a lawsuit against the school nurse, alleging that if she had informed his grandmother of the symptoms that he was experiencing and the possibility of a concussion, he would have seen a doctor at an earlier date. They believe that if he had been evaluated immediately, doctors would have food the bleeding, preventing the clot and the brain damage. They further alleged that she had also failed to inform his football coaches of his condition which allowed him to experienced additional blows to the head.

After presenting their arguments at trial, a jury found that the nurse's failure to inform the family and football coaches resulted in the bleeding and damage to the boy’s brain. They awarded him $991,800 in compensation for his losses.

Medical Malpractice

Medical malpractice is when a medical professional either fails to do something or does something which results in harm to a patient. It isn’t just doctors who can perform medical malpractice, any medical professional with a licenses such as a nurse, physical therapist, EMT, or technician can be held liable for the choices they make.

The most common forms of medical malpractice include:


If a doctor fails to determine what is really causing the patient’s symptoms, they may recommend a treatment that can do more harm than good and delay the proper treatment.

A Failure To Diagnose

Time and time again patients report going to their physician with a set of symptoms only to be told that there is nothing wrong. Failing to diagnose a condition in time can be a deadly mistake. Cancer is one of the most common conditions which physicians fail to diagnosis.

Prescription Medication Errors

Giving the wrong combination of medications or the incorrect dose can cause lasting damage to a patient’s body.

Anesthesia Errors

Anesthesia doesn’t apply to just the act of putting a patient to sleep during surgery. Anesthesiologists also perform nerve blocks and epidurals. These procedures are delicate and a simple mistake can leave a patient with lifelong nerve pain or paralysis.

Surgical Errors

Surgical errors include performing surgery on the incorrect body part, leaving an inanimate object inside of the body cavity, or performing an incorrect where a mistake was made by a nurse

In order for the plaintiff to show that medical malpractice actually occurred, they must prove:

  1. That a medical-professional - patient relationship did, in fact, exist.
  2. The medical professional behaved in a negligent manner.
  3. The doctor’s negligence resulted in some harm to the patient.
  4. The injury or harm resulted in a loss.

What Is Informed Consent?

The term informed consent basically means that a medical professional must inform their patients of all of the potential risks, side effects, and benefits of a procedure, medication, or treatment. They must also inform the patient of any alternative treatments. If they fail to do so, they may be held liable for any injury to the patient.

If I Signed A Consent Form Do I Still Have a Case?

It is possible that you may still have a case even if you did sign a consent form. This form does not release the medical professional from any negligent decisions or acts that they make.

How Do I Know If My Doctor Was Negligent?

If you aren’t sure if your doctor was negligent, the first thing you should do is contact a medical malpractice attorney. They can review your case and help you determine if you are eligible to pursue legal action.

In many cases, an attorney will recommend that you seek a consultation with another doctor, an expert. This expert will examine the patient and review prior medical records to determine if they can provide a “certificate of merit”. This certificate certifies that the expert has reviewed the available information and has determined that the medical professional who treated them did, in fact, deviate from the generally accepted standard of care.

How Long Do I Have To File A Claim?

In New York, plaintiffs have two and a half years to determine if they want to pursue legal action. There is an exception to this rule - if a foreign body is found years after surgery, the plaintiff has one year from the date that the object was found to file a lawsuit.

It is important to note these dates because once the statute of limitations has passed, your chance to obtain compensation will be lost.

How Much Is My Case Worth?

Every case is different and there is no accurate way to determine exactly how much a case may be worth.

The majority of medical malpractice cases settle before they go to trial. An attorney can help you negotiate a settlement that is appropriate, or, if the case goes to trial, represent you and fight on your behalf. Any damages awarded by the jury will take into consideration the past and future medical expenses of the plaintiff, any lost wages, the physical pain and suffering they may have endured, and any emotional trauma.

See more about: For-Profit Nursing Homes Putting Profit Before Care

According to researchers at the University of Oregon, the average age of death in 1850 was just under 40 years old. In 1910, after the transformative changes of the Industrial Revolution had taken hold, life expectancy had reached 51. By 1950, it had sky-rocketed, to 68 years of age. And for the past fifteen years, since 2000, life expectancy has hovered around 79. senior home abuse

The aging revolution is here. The Administration for Community Living reports that around one in every eight Americans currently living is over the age of 65. And with so many of our loved ones reaching ripe old ages, we've turned as a society to the care of third-party professionals: nursing homes and assisted living facilities.

See a related article on grants given for training on elder abuse:

The Most Common Warning Signs Of Elder Abuse

But the facts of aging have not changed. Seniors are still vulnerable members of the community. Many of our elderly loved ones cannot perform essential tasks on their own, which makes finding compassionate care professionals that you can trust a huge priority.

Tragically, this trust can be broken. Elder mistreatment has reached epidemic proportions throughout America. A large research study that focused solely on New York State uncovered a startling reality. Almost 10% of all elder NY residents had experienced abuse in a given year, but that study did not include financial forms of exploitation. The mistreatment rate was highest in New York City.

It may not be hyperbole to say that nursing home abuse is common. Which means that we all need to be vigilant. As friends, family and neighbors - we need to know the signs of elder abuse, and report mistreatment immediately when necessary. Here's what to watch for:

Physical Signs Of Elder Abuse

In long-term care facilites, elder mistreatment involves physical abuse more often than any other form of wrongdoing. According to the National Center on Elder Abuse (NCEA), 29% of all reported complaints involved direct, physical harm. Common warning signs include:

Emotional Signs Of Nursing Home Abuse

While physical signs of bodily harm may be most apparent, many forms of abuse leave deep, psychological scars, as well. Unfortunately, emotional warning signs often overlap with normal aspects of the aging process.

Healthy seniors may appear withdrawn, or emotionally distanced, for reasons that have nothing to do with abuse. But these normal changes are often protracted; they occur gradually, over long periods of time. Watch for sudden changes in affect, including:

Signs Of Financial Exploitation

Defined by the NCEA as "the illegal or improper use of an elder's funds, property, or assets," financial elder exploitation is surprisingly common. And while it's most often committed by adult children or at-home caregivers, it is possible for nursing home staff to steal valuable items or gain access to a senior's bank account.

Self-Reported Instances Of Elder Abuse

Elder abuse is severely under-reported. The New York State Elder Abuse Prevalence Study found that for every case of elder abuse that was properly reported to governmental authorities, 24 went unreported.

This may be a tragic consequence of elder abuse's very nature. Seniors often rely on their abusers for necessary services, making many elderly victims unwilling to report their mistreatment. Moreover, seniors often feel intimidated into silence, fearing further abuse if they speak out.

One thing is clear: if your loved one complains of mistreatment, report it immediately.

Contact A Nursing Home Abuse Lawyer In New York City

Between 1991 and 2001, one in every three US nursing homes were cited for violating federal regulations. All of these infractions had the potential to cause elderly residents direct harm. And, according to the US House of Representatives, one out of ten did. 10% of all nursing homes violated standards and caused patients serious injury.

If you've noticed any signs of abuse, it's important to act immediately. Contact the experienced nursing home abuse lawyers at Banville Law today. In a free consultation, we'll review your case and explain your legal options in clear terms. Our services are free until we win your case. Call (917) 551-6690 or fill out our contact form. You'll speak with a dedicated elder mistreatment attorney within 24 hours.

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Laurence P. Banville
Date Published: September 4, 2018
Laurence P. Banville is the managing partner of Banville Law. As an experienced personal injury attorney, Mr. Banville helps clients recover compensation from those responsible for his clients' injuries. Our firm is located in New York City, serving clients from the five boroughs: Manhattan, Brooklyn, Queens, The Bronx, and Staten Island.
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