How to Identify Nursing Home Abuse, Prevent Negligence, and Evaluate Care Facilities [PODCAST]

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How to Identify Nursing Home Abuse, Prevent Negligence, and Evaluate Care Facilities

In this episode, James Morgan, Founding Partner of Lanzone Morgan LLP, discusses how to identify nursing home abuse, prevent negligence, and evaluate care facilities.

Highlights of this episode include:

• What is nursing home abuse and neglect?
• Most common types of nursing home abuse and neglect.
• Why are nursing home residents getting neglected?
• How are nursing homes usually paid for caring for its residents?
• The difference between nursing homes and assisted living facilities.
• What family members can do to prevent abuse from happening in a nursing home.
• How do people know if a nursing home is good or bad?
• If someone suspects that a family member is being abused in a nursing home, what should they do?

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome James Morgan. Jim is a highly respected nursing home abuse attorney, an elder abuse lawyer in California, and the founding partner of Lanzone Morgan LLP. For more than 25 years, Jim has dedicated his legal career to representing victims of elder abuse, nursing home neglect, and assisted living facility misconduct, helping families hold negligent care providers accountable. He has helped secure millions of dollars in settlements and verdicts for elderly victims and their families while pushing the long-term care industry to improve safety and accountability. He graduated cum laude from Jacksonville State University in 1991 and went on to graduate Magna cum laude from Washburn University School of Law in 1997. Jim is currently licensed to practice law in Arizona, California, and Nevada. He’s also licensed with the United States District Court, Southern District Court of California, the United States Ninth Circuit Court of Appeals, and the United States Supreme Court. Jim has also served as president of a national organization of attorneys dedicated to suing nursing homes for elder abuse.

In this episode, we’re discussing how to identify nursing home abuse, prevent negligence, and evaluate care facilities. Welcome, and thank you for joining us, Jim.

James Morgan: Thanks for having me.

Kelly: All right, well, let’s go ahead and jump in. So, let’s just start off with a pretty basic question. Jim, what is nursing home abuse and neglect?

James: Well, that’s a good starting point. Nursing home abuse and neglect can be anything from as minor– I shouldn’t say minor, but anything that doesn’t necessarily cause major injuries but is certainly concerned about somebody’s dignity, which is maybe not being showered timely, not getting changed in a timely manner if you’re sitting in your urine and feces and you can’t change yourself and make it to the restroom. Those are dignity issues, and that’s the result of neglect. If somebody is sitting in their urine and feces for hours not being changed, it may not lead to long-term problems, but it could. And then neglect can also lead to very serious injuries, such as infections from what I just described. Also, falls, fractures, falls with subdural hematomas or brain bleeds that may lead to death. And of course, probably the number one type of case we get, which is terrible bed sores from somebody sitting in the same position in bed for hours upon hours and not getting turned and repositioned. So, neglect ranges from everything from dignity issues to very serious injuries and death. But the bottom line is nursing home neglect is when nursing home residents are not getting proper care to meet their needs.

Kelly: Okay. Thank you for explaining that for us. So, what are the most common types of nursing home abuse and neglect that you see?

James: The two top cases that we take are the falls fractures or falls leading to other serious injuries and bed sores. Those are by far the most common types of injuries that lead to lawsuits. And when I say bed sores, what I’m talking about are wounds that happen at pressure points in the body when somebody’s sitting in bed. So, the most common type of pressure sore that we see is on the coccyx area where your tailbone is pushing down you’re not being turned and getting any pressure relief.

So, you get a terrible pressure sore on your coccyx or on your heels because those are also bony prominences where people can get bed sores if they’re laying in bed all the time. But other types of nursing home abuse and neglect cases are dehydration, malnutrition, especially if somebody’s on a feeding tube. Elopement cases. Elopement cases are when somebody wanders out of a facility. They might have Alzheimer’s or dementia, and they should be in a locked facility or somewhere where they’re kept safe, but they wander out of the facility and, unfortunately, can get injured. And then there’s probably fewer cases of, but certainly problematic, are the actual physical abuse of the residents, either just physical assaults or some type of sexual assault. So those are probably the most common types of neglect that we see here in our law firm.

Kelly: Wow. That’s very sad, but thank you for giving that information to us. So why are nursing home residents getting neglected?

James: Most of the neglect that we see in our cases stems from understaffing issues. Understaffing occurs when the nursing home tightens its budget to save costs and make more profit. Most nursing homes are privately owned. They’re for-profit enterprises, so people are trying to make money. And the way to make money in a nursing home is to fill every bed because that’s where you’re getting your revenue and to cut costs. And labor is by far the highest cost of running a nursing home.

So very simply put, the way to make money by owning a nursing home is to fill every bed so that you can make as much revenue as possible and to take care of those residents with as little labor as possible. When that happens, it could be a recipe for making money. But unfortunately, it’s also a recipe for neglect of the residents when there’s not enough staff to meet their needs.

Kelly: Yeah, labor does make sense to be the highest cost there. So how are nursing homes usually paid for caring for its residents?

James: Okay, so skilled nursing facilities are primarily paid by Medicare, Medicaid, private pay, or insurance. Private insurance, or maybe somebody has long-term care insurance. But the private pay and the private insurance are the lowest number of residents getting paid paying for the nursing home care that way. By far, most of the revenue in nursing homes comes from Medicare and Medicaid. Now, Medicare pays the highest amount of money to the nursing home to care for the residents. So nursing homes want Medicare patients. So, here’s what happens. An elderly person is living at home and they have a stroke or a heart attack or a fall with an injury, and they go to the hospital.

And they’re in the hospital for a few days, recovering from whatever happened. And the doctor says, “We really don’t want to send you directly home. You need some physical therapy to gain some strength. You might need to be on an IV antibiotic for a little while. We want to send you to a nursing home for some rehab.” Okay? If that person has Medicare, Medicare is going to pay for that nursing home stay. Nursing homes love this because Medicare pays the highest rate of reimbursement. So if a nursing home had its way, every bed would be filled by a Medicare patient because that’s how they’re going to make money.

That’s how they’re going to make the most money. Now, the problem is that Medicare will only pay the nursing home for about 100 days of physical therapy. After that, the resident is going to have to go either on Medicaid or private pay or insurance. And so the nursing home will want to get rid of a resident right at that 100-day mark after they’ve gotten all the money they could possibly get out of Medicare. And then all of a sudden, they might tell the family, “Hey, you got to go. They’ve reached their peak. We need to discharge them by tomorrow.” They a lot of times will give you short notice. And the nursing home doesn’t– and even if the family says, “Hey, they’re not quite ready to go home. They need some more physical therapy. They need some more care.” The nursing home’s not going to want to keep them because if they end up being a Medicaid patient, then Medicaid reimbursement is quite a bit lower than the Medicare reimbursement. So, what the nursing home wants to do is get rid of that person who ran out of Medicare days, get them out of the facility, and fill that bed with another resident who’s on Medicare. So, they can keep getting the maximum reimbursement for that bed.

So, what you’ll see in nursing homes sometimes are called Medicare wings, so where everybody on a certain hallway is a Medicare patient. And those hallways are typically staffed well because the reimbursement is good on that wing. And then you’ll see other wings that are what’s called long-term wings for long-term care residents whose stay is being paid by Medicaid or private insurance or private pay. There is a drastic difference between the Medicare wing and the long-term care wing. And when I say drastic difference, what I’m talking about is staffing and care. So when somebody comes to me with a case, it’s typically somebody who is in that long-term care wing because that wing is staffed less than the Medicare wing. We do not get a lot of cases from people who are on the Medicare wing because those wings are typically staffed better because the reimbursement is higher. So that was a long answer to tell you that most of the nursing homes pay comes from Medicare, Medicaid, private pay, and private insurance.

Kelly: That makes a lot of sense. Thank you for sharing all that with us. So are nursing homes and assisted living facilities the same thing?

James: No, no, they are not. Skilled nursing facilities– or when I say nursing home, I’m talking about a skilled nursing facility. And that’s basically a step down from an acute hospital, okay? So, when somebody leaves an acute hospital, a lot of times they will go to a nursing home, also called a skilled nursing facility, for rehab because they need more care, right, coming right out of the hospital. And the skilled nursing facilities have just what that’s described as: the skilled nursing. So, they’re going to have nurses on staff, and they’re going to have people with more medical experience at the nursing home. An assisted living facility is a step down from that. It’s somebody who doesn’t need quite as much medical care and is fairly independent, can get up themselves, can wash themselves, take a shower themselves, usually, can dress themselves, feed themselves. Assisted living facility residents simply don’t need 24-hour nursing care. But one of the big differences also is that all of those ways I described how nursing homes get paid is completely different at an assisted living facility. Assisted living facilities are primarily reimbursed by private pay. Okay? That means the families pay for the stay at the assisted living facility or long-term care insurance. Medicare does not pay for care at assisted living facilities because they don’t pay for– they only pay for the skilled nursing care, not assisted living care. So primarily private pay and primarily people who are less in need of services are the ones who are living in assisted living facilities.

Kelly: Okay. Thanks for describing those differences for us. And so, what can family members do to prevent abuse from happening in a nursing home?

James: The best thing a family can do to prevent abuse and neglect in a nursing home is to be present and to visit as frequently as possible. And not only that, but to visit at different times of the day. So, for example, I’ve had clients say, “I come every day after work, so I get there at 5:30 every day, and they’re dressed, and they’re ready for dinner. And everything looks good. So, I had no idea anything bad was happening until one day I went at lunch, and I saw that their breakfast was still sitting there. Nobody helped them eat breakfast. They’re not dressed. They’re sitting in a soiled diaper.” And so, what happens is that the nursing home staff will learn the routine of the family. If the family comes at the same time every day, that’s when the patient’s going to look like they’ve been taken care of. So, the family is going to think, “Oh, this is what’s happening 24 hours a day. Everything is great,” but that’s not necessarily the case. So, the family, if at all possible, needs to visit frequently and at different times of the day to see what’s happening morning, afternoon, and evening. Not only that, but you have to be a squeaky wheel. When something’s not right, you got to speak up and you got to say something. And when I say, “You got to say something,” I’m not talking about just to the CNA or the certified nurse assistant who’s providing direct care, who’s maybe changing the sheets or changing the diapers. You’ve got to make complaints to the head nurse or the charge nurse or the director of nurses or even the administrator because a lot of times these CNAs are overworked, they’re working a shift or maybe a double, and they’re going to be out of there. They’re not going to make any changes to the care of a resident systematically. They may change what they do on a particular shift. But when you need a change made, like you need your mom or your grandma’s medication given on time every day and that’s not happening, you need a systemic change there not just a change with one CNA. So you’ve got to make those complaints to the director of nurses or the administrator in order to hope that any systemic change is made with respect to the care of your loved one. And if that doesn’t work, then you make a complaint to the state and you tell the state what’s– your complaint is, and you call the state and you ask for a formal complaint investigation. And the state will go in there and they will investigate what your complaint is, and they’ll either substantiate it or they won’t. But that’s a good way to get the attention of the nursing home.

Kelly: That’s really good advice. Thanks, Jim. So how do people know if a nursing home is good or bad?

James: Well, I tell people my two favorite online resources for finding information out about nursing homes. And these resources will give you information on what the patient’s rights are, what the state and federal regulations are that govern the care that’s supposed to be given in a nursing home. And they’ll give you some history on the nursing homes. So, you can look up what complaints have been made against nursing homes. What complaints have been substantiated against nursing homes? How many complaints does this nursing home get compared to other complaints? I’m going to give you three total things to look for, but I’m going to tell you two websites that are super helpful to me and that I always recommend people look at. One is a California website, but it’s useful for people all over the country because a lot of the information on there refers to federal regulations, and federal regulations will govern all nursing homes, not just the ones in the state of California. But that nursing home is– I’m going to say it, and then I’m going to describe it. It’s canhr.org. C-A-N-H-R, dot org, and that stands for California Advocates for Nursing Home Reform. That website is great for all kinds of information, not just California-specific information.

But the other website that’s fantastic, believe it or not, is medicare.gov. And if you go to Google and you just type– in Google, type in Nursing Home Compare or Medicare Nursing Home Compare, either one, and the first thing that’s going to pop up is Medicare’s website that talks about nursing homes. And you’re going to be able to look for nursing homes by zip code or city. When you find nursing homes, you’re going to be able to click on them, and you’re going to be able to find out who owns that nursing home, what complaints have been made against that nursing home, what the staffing is. Medicare has a star rating, one to five stars. I don’t always look at the star rating because the star rating is based on information that the nursing home provides to Medicare. But it’s helpful more for me to look at the complaints against the nursing home and see what complaints have been substantiated against the nursing home. But let me give you one more thing to look up because you asked, “How do you know if it’s a good or bad nursing home?” I’m going to tell you something to look up that’s going to tell you if a nursing home is bad, okay?

And what I mean by that is they have been put on notice by Medicare that they may lose their federal funding unless they straighten up their act. So, I always tell people to go to Google and type in, “Special focus facility.” The special focus facility list will come up, and that will be a list of nursing homes that are of special focus to Medicare because Medicare has warned them they’ve got to straighten up their act, they’ve got to take better care of residents, or they’re going to lose their federal funding. They’re going to lose their Medicare funding. If you see a facility on that special focus facility list, I would absolutely not let a loved one go to that facility. That is the best advice I can give as far as knowing whether a nursing home is good or bad. You can’t tell by the outside of the nursing home. If it looks nice, to me, that just means they’re spending all their money on gardening and making it look pretty. You got to go in there. You got to see, “Does this place smell? Does it smell bad because they’re not changing the residents timely? Is it hot because they don’t have air conditioning?” Because believe it or not, not all nursing homes have air conditioning. So, other than just walking in and using your best judgment, those are the websites that I would go to to get information on nursing homes.

Kelly: Wow. Thanks for providing those great resources, Jim. We appreciate that. And lastly, if someone suspects that a family member is being abused in a nursing home, what should they do?

James: So back to what I said earlier, make a complaint to the director of nurses and the administrator at the nursing home, not just a verbal complaint, put it in writing. Make sure you have a letter or an email that you send to them. Or sometimes they’ll give you their cell numbers. You can put it in a text. But I always ask clients who call me, “Did you complain to the director of nurses or the administrator? And when and what did you say?” Because you need a trail of documentation showing that you put them on notice that certain things weren’t being done and certain changes needed to be made. So, I always say, “Make a complaint and be able to trace that complaint.” If that’s not sufficient for taking care of the problem, then you go to the state, and you make a complaint to the state, and you ask the state to do a complaint investigation. In California, it’s called the Department of Public Health. It’s something similar in every state, but you can go online. And you can go to that Medicare website that I told you about, Nursing Home Compare at Medicare.gov. And there will be a link to how to make a complaint against a nursing home to the state.

And so, looking at those websites and getting that information and making complaints, and if the abuse is bad enough or not being addressed still or somebody’s been injured, then you can always look for an attorney and consult with an attorney to say, “Hey, is this right? Am I wrong? What can I do? Does this rise to the level of a lawsuit? Should we do something more?” But if you type in, “Nursing home abuse and neglect lawyer,” wherever you are, I’m sure you’re going to get a lot of attorneys’ offices popping up. And talk to a law firm that specializes in that type of litigation. My advice is don’t talk to just somebody who does all kinds of personal injury, auto accidents, and falls. Talk to some law firm that specializes in suing nursing homes and assisted living facilities.

Kelly: Thank you so much for providing that for us, Jim. And thank you for sharing your insights with us on how to identify nursing home abuse, prevent negligence, and evaluate care facilities. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

James: They can go to our website, number one, which is lanzonemorgan.com, L-A-N-Z-O-N-E M-O-R-G-A-N, Lanzone Morgan. Or they can call us 888-887-9777. But if you look up Lanzone Morgan in Google, you will certainly find us pretty easily. I think we’re the only firm in the country named Lanzone Morgan.

Kelly: All right. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

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