Twelve years of media exposè and federal and state investigations of the Los Angeles County Department of Public Health, and nursing homes are worse than ever – Medicare continues to rate the offending facilities as 5 star!
Meet Helen, the Elderly Poster Girl For Victims of Nursing Home Neglect and Abuse Cases:
ENOUGH IS ENOUGH!
Like the photo above, abuse and neglect documentation is buried in oversight Agencies’ findings of “unsubstantiated,” illegally unavailable to the public through the California Public Records Act requests.
While federal and state government investigations, and the media, have exposed that these problems have existed for over 12 years, and that nursing homes know how to game the system, this 2024 investigative report adds:
New information –
- Oversight agencies game the system by finding “unsubstantiated” for consumer complaints with lax, cursory investigations. If a death occurs it will be “substantiated” with no state or federal violations. Cases closed – but now in a “timely manner.”
Note: My complaint about Helen’s abusive and neglectful treatment was investigated – documented with photos, a video, dates and times. A few weeks later it was determined to be unsubstantiated. At the same time as Helen’s complaint was being investigated, LACDPH chief Barbara Ferrer was quoted by LA Times columnist Steve Lopez as saying, “….the majority of the improvements have been implemented or are in the final stages of implementation”
Lopez also quotes Mollie Davis, whose nonprofit runs L.A. County’s Long-term Care Ombudsman program: “Whatever’s been happening has been happening behind the scenes, and there’s not any accountability for it.” Helen’s case is living proof that there is no accountability for the changes being publicly touted by LACDPH leadership – they are just empty words.
- Nursing facilities staff know and understand the lax agency oversight and incomplete investigations with falsified findings. The facilities game the system by “explaining away” consumer complaints, and oversight agencies collude with the facilities by using their facility interviews/narratives, to quickly find the complaints are “unsubstantiated” and close the cases.
- The facilities also game the system by limiting what they record in their patients’ medical record.
AND
- In the case of Helen’s ’s retirement community, after Los Angeles County Department of Public Health stamped her case “unsubstantiated,” the 450 residents were told, by the Gardens in a new set of rules, that:
- They had a right to file a complaint
- Unsubstantiated allegations are prohibited (by the Gardens Administration)
AND
- The CEO and her attorney, who is known as the “godfather of senior living operators,” attempted to coerce me into signing the following agreement:
I strongly suspect that the above “agreement” is used for nursing facility staff who bring concerns to the Administration’s attention.
I also strongly suspect that the above agreement that the Gardens CEO and her attorney tried to coerce me to sign, is also used in their nursing home arbitration agreements. What families do not realize is that their agreement to arbitration is buried in the print of admission documents. Note: Families have 30 days to withdraw their agreement to arbitration. Click here for more information.
Draconian NDAs/non-disparagement agreements are yet another way for nursing facilities to protect their brand. They bury the truth which egregiously misleads the public about the truth of what goes on in nursing homes. In my case there was no discussion, much less mutual agreement. I was completely blindsided by the agreement and stymied by the contingency agreement requiring me “to agree” to exchange my constitutional right to free speech for my civil right to an assistance dog housing accommodations.
“Enough. Is. Enough!”
2013
2013 UNDER FIRE…..CA Department of Public Health and the Federal Medicare Rating System for U.S. Nursing Homes
On October 30, 2013, the Foundation Aiding the Elderly (FATE) filed a public interest civil suit against the California Department of Health Services (CDPH) for its failure to investigate complaints filed by FATE, as well as other consumers, in a timely manner. Some are critical of law suits; however, after 32 years of watching CDPH continue to fail its mandated duties to protect our most vulnerable citizens, it was time that CDPH’s negligent behavior come to a stop.” For more information click here.
But it hasn’t stopped. Sometime since 2013, CDPH and the Los Angeles County Department of Public Health have made one major, but worthless, change:
In 2013 the issue was that consumers complaints were not investigated for years – including complaints about elderly patients in imminent harm and danger.
But now in 2024, the CDPH and LACDPH staffs are quickly conducting cursory overviews of consumer nursing home complaints, stamping them “unsubstantiated” and moving on to the next complaint, repeating its cursory overview with more findings of “Unsubstantiated.” Technically cases are now closed in a timely manner, but the results are falsified. No reasonable person reviewing the documentation submitted with Helen’s case, would find her case unsubstantiated:
More Abuse Deficiencies Were Cited in Nursing Homes from 2013 through 2017:
Physical and Mental/Verbal Abuse and Staff Perpetrators Were Most Common:
Further, the report states:
“Definition of substantiated abuse. We found confusion among some state survey agencies about CMS’s definition of what it means to substantiate an allegation of abuse—a challenge because substantiation is a trigger in the investigation process, and CMS requires state survey agencies to make referrals to law enforcement and staff registries when abuse is substantiated by evidence. As a result, there is a potential for substantiated abuse to not be reported and, subsequently, not referred to law enforcement or MFCUs for criminal investigation. Two of the five state survey agencies in our review told us they believed they could not substantiate an allegation unless they could also cite a federal deficiency.”
“This is inconsistent with CMS’s guidance, which says that state survey agencies can substantiate that an allegation occurred without citing a federal deficiency and that, subsequently, these substantiated allegations must be referred to law enforcement and staff registries. For example, according to CMS guidance, if the state survey agency investigated and found evidence that a resident was abused, but the nursing home had taken preventive actions against the deficient practice, the state survey agency would then substantiate that the abuse occurred, but not cite a deficiency. However, state survey agencies may decide not to substantiate an abuse allegation verified by evidence if they believe no deficiency should be cited, such as if the nursing home had taken preventive action against the deficient practice, which could result in that abuse going unreported and not referred to law enforcement, MFCUs, or staff registries. Because substantiation of abuse is a critical trigger in abuse investigations, confusion around its interpretation could prevent these important next steps. CMS officials told us they are aware that the state survey agencies have varying interpretations of what it means to substantiate abuse. According to federal standards for internal control, management should internally communicate quality information to achieve the entity’s objectives.”
Exactly what do the above paragraphs even mean? What are the entity’s objectives? Is Medicare’s facility rating, using one to five stars to assist consumers in making informed decisions, an entity objective? LACDPH track record strongly suggests it is not.
Personally, I would not knowingly chose a facility that had treated Helen the way she was treated! But how would I know? There is no record available to the public. Medicare rates it 5 stars! I did not know, and chose this retirement community! As a Life Plan Community, if I were to move, I would forfeit hundreds of thousands of dollars that I have paid for future medical care.
2014
Department of Health and Human Services
OFFICE OF INSPECTOR GENERAL
“CMS’S RELIANCE ON CALIFORNIA’S LICENSING SURVEYS OF NURSING HOMES COULD NOT ENSURE THE QUALITY OF CARE PROVIDED TO MEDICARE AND MEDICAID BENEFICIARIES.”
Daniel R. Levinson
Inspector General
June 2014
A-09-12-02037
“CMS’s reliance on these surveys could not ensure quality of care and that adequate protection was provided to Medicare and Medicaid beneficiaries.”
CALIFORNIA AUDITOR REPORT:
California Department of Public Health
It Has Not Effectively Managed Investigations of
Complaints Related to Long-Term Health Care Facilities
Report 2014-111
Medicare Star Ratings Allow Nursing Homes to Game the System
New York Times
By Katie Thomas
Aug. 24, 2014
“But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes.”
L.A. County Officials Allegedly Reduced Penalties In 3 Nursing Home Deaths in 2010:
L.A. County Officials Told Inspectors to Cut Short Nursing Home Probes:
Review Finds Flawed Management Of Nursing Home Inspections In Los Angeles County:
Officials propose new rules for nursing home care
Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy was quoted in the above article by Susan Jaffe, Kaiser Health News:
“The biggest problem is that the rules we have now are not enforced,” said Edelman. “We have a very weak and timid enforcement system that does everything it can to cajole facilities into compliance instead of imposing penalties for noncompliance.”
What? Cajole facilities into compliance? Hmmm. If you promise to correct this problem and not to do this anymore, we’ll write it up as unsubstantiated? In next week’s post I will write about how the records are not retained by the public health agencies. If another mobility dependent elder was left, unattended, sleeping in her wheelchair for several hours, waiting for rest room assistance and assistance to go to bed for the night, the facility could promise not to do it again – perhaps also promising to provide some staff training – and once again there is an unsubstantiated complaint and 5 star rating? Just empty promises – no matter how many different families report the same complaint.
2017
The government failure allowing nursing home nightmares to happen
CBS News
by Lynda Figueredo
Fri, November 10th 2017 at 11:32 PM
“We found that CMS, the Centers for Medicare and Medicaid Services didn’t have adequate controls in place to detect these potential instances of abuse or neglect,” said Curtis Roy, Assistant Regional Inspector General for Audit Services, OIG.
Roy said the federal agency is required to identify cases of neglect – and they didn’t.
2019
June 2019
NURSING HOMES
Improved Oversight Needed to Better Protect Residents from Abuse
HIGHLIGHTS:
What GAO Found:
The Centers for Medicare & Medicaid Services (CMS) is responsible for ensuring nursing homes meet federal quality standards, including that residents are free from abuse. CMS enters into agreements with state survey agencies to conduct surveys of the state’s homes and to investigate complaints and incidents. GAO analysis of CMS data found that, while relatively rare, abuse deficiencies cited in nursing homes more than doubled, increasing from 430 in 2013 to 875 in 2017, with the largest increase in severe cases. GAO also reviewed a representative sample of abuse deficiency narratives from 2016 through 2017. Physical and mental/verbal abuse occurred most often in nursing homes, followed by sexual abuse, and staff were more often the perpetrators of the abuse deficiencies cited. CMS cannot readily access information on abuse or perpetrator type in its data and, therefore, lacks key information critical to taking appropriate actions.
On August 10, 2019 Prominent Los Angeles Times columnist Steve Lopez, wrote about his personal experience with California Department of Public Health which also oversees Hospice care:
Steve Lopez: After my mother’s disastrous hospice experience, we filed a state complaint. It came to nothing [Los Angeles Times]
Incensed by (my mother’s) poor treatment, I filed a complaint against the hospice agency with the Licensing and Certification Program of the California Department of Public Health. I‘ve now received a letter detailing the agency ‘s findings.
“L & C was not able to validate the complaint allegation through direct observation, interviews, and /or review of documents.”
“I had spoken to the investigator several times. She told me she believed the accounts given to her by my sister and me, but the hospice agency presented a different story.”
Well, yes of course they presented a different story. If they admitted to what had transpired they could be cited and fined. Instead they presented a story where Steve and his family had been responsible ensuring that his mother’s pain medication followed his mother when she transferred to another facility. In my opinion, the discharge plan should include these types of details and be signed by the patient/family, who would also received a copy. Then there would be the same story. Complaints and responses to complaints should be signed under penalty of perjury. Those working in the industry know how to game the system and do so with impunity.
2023
Steve Lopez: Increased staffing for nursing homes? Sure, but the lack of oversight is deplorable
Steve Lopez, Los Angeles Times
Sept. 2, 2023
“ …. Another glaring deficiency is the deplorable lack of federal and state oversight.” ….“Tony Chicotel, senior staff attorney for California Advocates for Nursing Home Reform, …. has been working on an article for his agency’s fall newsletter, in which he tells the story of Sam Rios, an 87-year-old former college professor who died after developing bed sores during a two-week stay in a Roseville nursing home in 2017. Chicotel writes that a nurse at the facility testified that care there “was barbaric.”
“Earlier this year, a jury in a civil case alleging elder abuse, negligence, understaffing and wrongful death awarded $30.9 million to the Rios family. But the state Department of Public Health investigation found it unsubstantiated!“
“The contradiction is stunning,” Chicotel writes in his newsletter account, which carries an ominous headline:
“Has California nursing home oversight ever been worse?”
One way to for this insidious process to stop is to:
Understand Institutional Betrayal
Identify the Institutional betrayal of our most vulnerable elderly of our families; the betrayal by nursing facility staff and oversight agencies.
Practice Institutional Courage
What is Institutional Courage? It is an institution’s commitment to seek the truth and engage in moral action, despite unpleasantness, risk, and short-term cost. It is a pledge to protect and care for those who depend on the institution. It is a compass oriented to the common good of individuals, the institution, and the world. It is a force that transforms institutions into more accountable, equitable, healthy places for everyone.
And it gets worse…..
Next week: Nursing Home Complaint Public Records Gone Missing!