March 21, 2010

Newspaper: The Sun Chronicle
By: Rick Foster:  link to article

March 21, 2010

ATTLEBORO — When 88-year-old Myrtis White was ready to retire to a nursing home several years ago, she helped her granddaughter pick out Life Care Center of Attleboro — a modern, sparkling facility with airy rooms and a home-like decor.

“ When you walk through the door it’s very impressive,” said Kim Cavalieri of North Attleboro, one of White’s five adult grandchildren. “ She seemed to be very happy.”

Life Care’s advertising, which touted the home’s high standards and fall-prevention program, assured family members that the 100-pound, legally blind woman would be well cared for.

Yet less than four years later, Myrtis White lie on the floor of her room dying of a skull fracture and related injuries. Shockingly, statements by Attleboro Fire Department rescuers accused the nursing home staff of doing little to aid the stricken woman.

Legal documents filed in connection with the 1997 case said it was the 30th fall suffered by the 92-year-old great grandmother while at Life Care — nine involving broken bones. An arbitrator said the accidents occurred despite recommendations that White be closely watched and assurances Life Care gave the family that it was working on the problem.

White’s family sued and last December was awarded $409,000 by an independent arbitrator who found that Life Care was negligent, violated reporting requirements and engaged in unfair and deceptive acts by doing so. A wrongful death claim was denied.

A Life Care spokesman called the White case “ unfortunate” and said the facility strives to maintain to the highest standards of care.

For the state’s 500 nursing homes, stories like White’s symbolize the latest crisis to strike an industry already beset by bankruptcies, inadequate Medicaid compensation and a shortage of qualified health care workers. Lawsuits against extended-care facilities, once rare, are being brought in increasing numbers by families charging negligence, mistreatment and inadequate staffing.

Nationwide, suits against nursing homes are “ mushrooming” said Janet Wells, director of public policy for the National Citizens’ Coalition for Nursing Home Reform.

Four of the top 50 U.S. jury verdicts in 2001 were against nursing homes and their owners, according to the National Lawyers’ Weekly. One was a $312 million judgment against a Texas facility.

In Massachusetts only a handful of nursing home cases reached juries throughout the 1990s, according to David Hoey, a Reading attorney whose firm specializes in health care cases. Dozens of cases are now pending, although a majority will probably end up in pre-trial settlements or before arbitrators.

Industry advocates link the upsurge in consumer complaints and lawsuits to increased economic pressures on nursing homes and “ opportunistic” lawyers. Families and litigators say the industry has only itself to blame.

Nursing homes face increasing hurdles to maintain care standards, says Ernie Corrigan, a spokesman for the Massachusetts Extended Care Federation. Declining Medicare and Medicaid reimbursements cover as little as 70 percent of patient costs, and dwindling revenues make it harder for homes to offer competitive salaries to qualified health care workers.

But critics say many homes are poorly run, often by bottom-line-oriented administrators short on medical knowledge. “ Nursing homes can say they lack adequate reimbursement and have trouble getting qualified staff and both are true,” Hoey said, “ but the core reason for the problems they’re facing is mismanagement.”

Recent cases of nursing home injuries and deaths have cited illiterate care workers unable to read patients’ orders, a woman whose spine was damaged when unqualified employees moved her and untreated bed sores that were allowed to grow into life-threatening skin ulcers.

Corrigan said such criticism is overblown.

“ The idea that nursing home workers can’t make a mistake is an ideal that can never be reached,” he said. “ The vast majority of owners, administrators and direct care workers work harder for less money than they could get in other professions and they do it because they care about the welfare of patients.”

Cavalieri said her family still isn’t over the 1997 tragedy in which her grandmother lie semi-conscious and alone for up to three hours before being discovered by a laundry worker. She died in a hospital 12 hours later.

White, who suffered from short-term memory loss, apparently fell while trying to climb over the side rails on her bed. She was not strapped in, in keeping with Life Care’s “ restraint-free” policy.

Arbitrator John T. Murray determined that other falls occurred when White was allowed to walk about unattended — in spite of orders that she be accompanied and supervised closely.

“ It still leaves a bad taste,” Cavalieri said. “ I wish like anything we’d gotten her out of there.”

Particularly disturbing was testimony by three Attleboro Fire Department rescue crewmen that no one from the nursing home seemed to be trying to help White when they arrived.

“ No staff member from LCC was assisting or was any care given to the patient prior to Engine Four’s arrival,” Attleboro EMT Timothy Poirier said in a deposition. “ Nurses had no idea how long she had been down or if she was unconscious when they found her.”

Michael McGahan, the lawyer who handled the case for White’s grandchildren, said Life Care failed in its obligation both to White, its patient, and the family who placed the 92-year-old in its care.

“ Anyone who places a family member in a nursing home relies on the operator’s experience and skill in caring for that loved one,” he said. “ They’re entitled to rely on what they’re being told.”

Nursing home Administrator Patrick O’Connor, who did not work at the facility in 1997, said confidentiality restrictions bar him from commenting directly on White’s death. But he said there have been no similar incidents in the home’s 10-year history.

“ We’re human,” he said. “ We’re people who care for other people. We’d like to be as perfect as it’s possible to be.”

Despite the arbitrator’s findings, O’Connor noted that the Massachusetts Department of Public Health thoroughly investigated Myrtis White’s death and never imposed any sanctions against the nursing home for violating any laws or regulations.

Life Care recently received an upgrade in its accreditation from the Joint Commission on Accreditation of Healthcare Organizations and improved its score on a key indicator of nursing home performance.

The joint commission, which reviews credentials of more than 18,000 U.S. nursing homes, hospitals and health care providers, advanced Life Care’s accreditation status last May to “ full compliance.” Since 1999, the nursing home had been accredited with “ requirements for improvement.”

Life Care also reduced the number of health deficiencies reported by the state Department of Public Health from 11 in 2000 to six — none serious — during the most recent inspection. The average number of deficiencies for Massachusetts nursing homes, in categories ranging from nutrition to administration, is four.

Cavalieri said she would like to have seen an improvement sooner. She’s still haunted, she says, by images of her grandmother’s funeral.

“ Some of the great-grandchildren asked us adults if we didn’t want to get up and say something,” she said. “ But none of us could speak.”

As the adults mourned, the oldest of the children took turns telling how they would miss Grandma White.

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