California should take heed. Illinois has been housing mentally ill felons with the elderly in state nursing homes and the results have not been pretty. An elderly woman was raped by an ex-convict, a frail man had his throat slashed, and in one home a wheelchair-bound man died of massive head injuries that a doctor said it looked like he was hit with a baseball bat.

According to one report, mentally ill patients make up over 15% of Illinois’ nursing home patient population, and among them are approximately 3,000 ex-felons with histories of serious crimes. Nursing home owners downplay that numbers of violent attacks, arguing they are miniscule in context to the whole, but there is a growing concern. The states largest nursing home owner’s association has advocated an end to the practice, asking state officials to create separate facilities for those residents who may pose a danger to others.

While the population of U.S. residents is aging, those who can afford to do so are opting from home health or assisted living care over traditional nursing home or convalescent hospitals.

A report being released today by the Government Accountability Office finds that the federal program designed to identify and scrutinize the country’s worse nursing homes is missing many of the poor performers. The Centers for Medical and Medicaid Services has identified about 136 nursing homes nationwide that are considered “special focus facilities” for their history of problems related to patient care, but many more questionable facilities are not making the list.

Herb Kohl, the chairman of the Senate Aging Committee wants more information about all of the poorest performing facilities on the government website Nursing Home Compare. The current report does not identify the homes.

“If far more than 136 nursing homes boast the bleakest conditions, then perhaps we should consider expanding” the program, said Kohl.

In the 10 years since I took my first case against a nursing home for elder abuse, I have seen a growing number of homes going without liability insurance. While the uninsured problem used to be confined to the small mom-and-pop assisted living facilities with 6 to 12 beds, now I am seeing in large, institutional-type skilled nursing facilities. On Friday, the Oakland Tribune did an excellent article on this problem.

The article profiles the story of 39-year-old Grover Brown, a multiple sclerosis and Parkinson’s patient with paraplegia. Brown was a resident of High Street Care Center in East Oakland. High Street is owned by Trinity Health Systems, whose president, Randal Kleis, has operated about a dozen facilities all over California under several corporate names.

While in the care of High Street, Brown developed a pressure ulcer on his coccyx, which, due to neglect, worsened to the point that doctors were required to remove his tailbone to curtail the deep infection. Brown and his family hired an elder abuse attorney, who sued High Street for abuse and neglect under California’s elder abuse laws, which also protect “dependent adults” like Brown.

Tri-City Hospital in Oceanside was fined $25,000 by the California Department of Public Health for “failure to ensure the health and safety of a patient” who fell out of bed and fractured her hip. The hospital has modified its policies as a result.

According to reports, a 91-year-old woman who was admitted to Tri-City on December 7, 2008 because of a stroke, and paralysis on her right side, fell out of bed two days later and fractured her hip. She was taken to surgery for repair of the hip, and died the following day in the ICU.

The state investigation revealed that upon admission to the hospital the woman was rated as a high risk for falls; a rating that would require a series of interventions such as bed alarms, padding on the floor around the bed, etc. The investigation revealed that “there was no evidence in the medical record to support that these interventions were in place at the time (the patient) fell.

After 15 years of bouncing from nursing home to nursing home, and living with the indignities, the mother of a quadriplegic and brain injured daughter had had enough. On Sunday, September 13, Diana Harden wrote a note to a television news station exposing the problems she encountered trying to care for her daughter, then went to the nursing and shot her daughter to death, before turning the gun on herself.

In her letter to ABC news in the San Francisco Bay area, Harden spoke of the years of abuse and neglect her daughter endured in her nursing home. Yvette Harden, suffered a major brain injury and quadriplegia in a car accident 15 years earlier, and spent the last six years at the Oakland Springs Care Center. Oakland Springs is a nursing facility that had 54 complaints lodged against it in 2008 (which is an astonishing amount), and hundreds of deficiencies.

The letter attempts to explain, “the deaths of my daughter and myself.” In it, Harden says that that nurses called her daughter a “big fat pig,” and that they would “wash her like a car” in the shower. To punish the daughter, Harden claims, the water would be turned cold until she screamed. As a result, Harden wrote that her daughter has been “begging” her to end her life for over two years. The stress was too much.

There is a growing movement to ban the common practice of requiring nursing home residents to waive their right to file a lawsuit in claims of negligence, abuse, or neglect in favor of arbitration. Last week, several consumer advocates testified before congress and criticized the practice of “forced arbitration.”

Public Citizen released a report alleging that the practice of forced arbitration, essentially requiring a consumer to sign an arbitration agreement as a condition of being provided the service, has become pervasive. The report, “Forced Arbitration: Unfair and Everywhere” found that many industries, including nursing homes, banks, contractors, cable companies and auto sales, will require consumes to waive their right to file a lawsuit before the services will be provided.

For years, attorneys and consumer advocates have questioned the impartiality of arbitration, which usually has a lawyer or retired judge, or a panel of them, sitting as the trier of fact. The Public Citizen report reveals that arbitrators for the National Arbitration Forum (NAF), the largest arbitration firm in the country (but one of many), ruled against consumers 94 percent of the time.

We write enough here about nursing homes that commit acts of abuse or neglect, so we thought we’d mention one that is being recognized for providing good care. A California Filipino-American owned nursing facility received a five-star rating from the US Department of Health and Human Services and the US Centers for Medicare and Medicaid Services.

Good Samaritan Rehabilitation and Care Center, in Stockton, was one of only a handful of nursing homes in the country to receive 5-stars in every measurement of quality of care. The Medicare Nursing Home Compare website provides categorical quality ratings for each of the 16,000 U.S. nursing homes. Good Samaritan received five starts in the areas of health inspections, quality measures, and staffing levels.

The owner of Good Samaritan said that the facility takes the ratings seriously, and continually looking for ways to improve care.

The administrator of Kern Valley Hospital was charged eight counts of felony elder abuse this week after permitting caregivers to forcibly administer psychotropic drugs to residents out of convenience and not medical necessity. One resident died because of the practice.

Since 2006 the director of nursing at Lake Isabella nursing home has allegedly ordered caregivers to administer high doses of psychotropic medications to Alzheimer’s and dementia patients to control their behavior and make them easier to care for. This use of medications as a “chemical restraint” is illegal, and will likely expose the nursing home to civil lawsuits in addition to the criminal charges that have been filed.

According to news reports, three residents may have died as a result of the practice. The residents who died were Mae Brinkley, 91, Joseph Shepter, 76, and Alexander Zaiko, 85.

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

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

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

It’s not uncommon to hear nursing home residents to complain about the quality of the food being served. The Nevada state health officials decided to do something about it.

A routine survey last Tuesday by the health department of a North Las Vegas nursing home found some very serious food safety violations. Upon inspection, officials found a 16-foot hole in the ceiling of the kitchen that was leaking, it found perishable foods like chicken and beef being stored at unsafe temperatures, soiled and contaminated countertops, and an “overall inability of the staff to safely prepare food.”

So what did the health department do? It didn’t force the 240-bed facility to close down. Instead, it suspended the food permits, and required the nursing home to order food from local restaurants. The suspension only lasted for a day. The problems were addressed and the food permit reinstated.

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