Category Archives: Nursing Home Negligence

Elder Law Office Maryland. Estate Planning. Nursing Home Negligence. Asset Protection. Guardianship. Elder abuse

The Scary Truth Behind Netflix’s “I Care a Lot”

I Care a Lot is a recently released Netflix film that follows the fictional account of a nursing home administrator who systematically exploits the elderly for financial gain. There are dramatic scenes of Marla Grayson (the nursing home administrator) with her wall of mugshots of her elderly residents. It shows a dramatic insensitivity that the residents are nothing more than cash cows to the nursing home system.

More chilling is the twisted use of the court process to declare these individuals as incapacitated, as a way to strip them of their rights to make decisions on their own. In essence, they become victims of a system that is supposed to protect them, robbing them of all decision-making power and their assets.

How Real Is Elder Abuse?

Can this happen in real life? The unfortunate answer is, “Yes”.

While the wall of elderly mugshots and a corrupt physician may be overly dramatic, there is an uncomfortable reality of nursing homes denying their residents basic rights and abusing the court guardianship system and the medical assistance process in order to get paid.

According to the National Council on Aging, up to five million older Americans are abused every year, and the annual loss by victims of financial abuse is estimated to be at least $36.5 billion.

Certainly, there are many well-run and well-meaning nursing homes, but there are also some nursing homes that are neither. For these nursing homes, their operating process is to cut off the resident’s family, deny them access, or grant access to only those who will align with their goal of keeping the resident at the nursing home and facilitate the nursing home’s wish to be paid.

How Can This Kind of Elder Abuse Happen?

A little background explanation is in order here. Let’s look at the typical process that an older adult might go through to end up at a nursing home.

For example, if your mom is over 65 years of age and has more than a 3-night stay at an area hospital, then she will generally be eligible to receive Medicare benefits. These benefits will pay for her hospital stay and then her nursing home rehabilitation stay—for the first 20 days in full, and then typically up to 100 days, with a co-pay expected from days 21–100. (A 100-day period is not guaranteed though.)

The key here is that the decision to move your mom from the hospital to the nursing home for rehabilitation would be made quickly. It is often the discharge planner at the hospital who makes the recommendation for rehabilitation at an area nursing home of their choice. As such, this is a guaranteed, temporary payment source for area nursing homes.

So, let’s say that your mom goes to nursing home rehabilitation for the 100 days that are covered by Medicare. Then, it’s time for your family to meet and make a big decision. What’s next? Should mom come back home, go to an assisted living facility, or stay at a nursing home?

The Nightmare Nursing Home Situation

At this point, a problem could arise between the nursing home and your family. What if your family and your mom’s health care agent want to take her home, but the nursing home recommends that she stay there? That is when the nightmare could begin.

If the nursing home wants to keep your mom, then they might say something like, “Your mother is better off staying here. She gets agitated when your family talks about taking her home.” Thus, the nursing home views your family as “agitators” who are upsetting their resident. Of course, this ignores the fact that your mom might want to come home, and she becomes complacent only when she is not reminded of the option to come home (i.e., she gives up).

Then the nursing home will demand payment. If your mom’s power of attorney holder does not use your mom’s money to pay the nursing home, then the nursing home will file for guardianship. This will strip your right, as your mother’s child, to be her agent.

The nursing home will have the court appoint a random attorney to control your mom’s money, and they will appoint the local Department of Social Services to make health care decisions for your mom. The goal of the random attorney will be to sell all of your mom’s assets and apply for medical assistance (i.e., Medicaid) to continue to pay for her nursing home stay. The goal of the Department of Social Services representative will be to just keep your mom at the nursing home where “she is safe.”

It is not unheard of that the nursing home will cut off access to your mom’s medical information or cut off your contact with mom all together. This issue has become even more pronounced during COVID-19.

It is not unheard of that the nursing home, when it files for guardianship, “conveniently”:

  • does not list you and your family members as interested persons
  • fails to mention that your mom has a power of attorney holder or health care agent (when they know of both)
  • tells you not to worry about your mom’s guardianship hearing and that you don’t have to attend
  • blindly files your mom’s medical assistance applications without knowing her assets, in order to have Medicaid pay the nursing home. (Please keep in mind that the medical assistance reimbursement, while it is not as high as the private pay rate, is substantial.)

The nursing home will often characterize this new guardianship filing as an “emergency” guardianship filing, not because there is any emergency with your mom, but because they want to get paid as soon as possible. The nursing home does not want a non-payment situation that could result in your mom’s discharge. (Although, from your family’s perspective, a non-payment situation leading to discharge would be just fine, if you wanted to take your mother home anyways.)

Adult Guardianship Issues in Maryland

In order to have a successful filing for a guardianship petition, in Maryland you need two physician certificates to prove that your mom is unable to make financial or health care decisions on her own.

Here are some questions about guardianship that you might have, along with my responses:

  • Is it possible that there could be corrupt physicians gaming the system to fraudulently declare your mom as incapacitated, as shown in I Care a Lot? That I have not seen.
  • Is there a lot of grey area when it comes to meeting the guardianship standard? Yes.
  • Are there cases when such a certificate is completed by a physician in 5 minutes, based solely on the first certificate? Yes.
  • Have there been circumstances of a physician completing certificates for guardianship in full, before even meeting the individuals or never meeting them? Yes (but that is rare, from my point of view).

The more common issue is not whether your mom needs help or not, but whose decision is that to make and what right does the nursing home have to make that decision.

Local Elder Law Firm Expertise

I’ve been in practice for over 19 years, and I don’t think there has been a single incident of a parent saying that they want to go to a nursing home. Nursing home placements are contemplated as a last resort when nothing else works.

The issue in many cases is that the nursing home becomes a third party in a battle over where mom is going to reside in her final days. Oftentimes, mom’s voice becomes irrelevant. But make no mistake, at the heart of this process, the nursing home’s concern is how it’s going to be paid.

The nursing home will frame the context to say that mom is “safer” there than at home. This argument will be used by the nursing home to convince the court that she should continue to stay there. The nursing home will have access to her medical records and the financial resources to hire a physician to articulate this position.

At our elder law firm, we are often involved in fighting these decisions. That means that we fight to get access to your mom’s medical records (which may lead to a separate battle of their release) and fight to maintain your right to make decisions for mom.

If the court appoints a random attorney as guardian of the property, as stated before, their sole role is to sell mom’s assets. If there are jointly held assets, an attempt will be made to sell them. If there are gifts of assets or transfers within the last 5 years, they will come under scrutiny, and depending on if there are assets to fund this random attorney in litigation, there will be an effort to have these gifts undone or otherwise transferred back.

The next thing you know, you are being cast as the “bad guy” for not returning these gifts, and now litigation begins with your mother’s guardian of the property and you to get these assets back. The reason why the guardian of the property may go after these transfers is that these transfers may be barriers for the nursing home to be paid by Medicaid. Gifts within 5 years are penalized transfers and will be barriers for the nursing home to be paid. As such, they will likely be pursued.

At the heart of these transactions is the court process, which will be used to try to keep mom at the nursing home, sell all of her assets, have strangers appointed as her guardian, and have this third-party attorney go after you, if you are involved in transactions that prevent the nursing home from being paid.

This is not the storyline of I Care a Lot. But the core issue of the nursing home being paid and abusing the judicial system to meet their needs is very real. And the nightmare, while not as dramatic as the plot of I Care a Lot … is very real.

We Care a Lot

At the Law Office of Adam J. Roa, we understand how scary and overwhelming these issues can feel for your family. As an experienced elder law firm in Maryland, we are here to guide you and fight for you. Please call us for a consultation at 410-296-8166 x292.

Elder Law Office Maryland. Estate Planning. Nursing Home Negligence. Asset Protection. Probate.

COVID-19 Maryland Nursing Homes

We understand that there is a lot of anxiety regarding nursing homes during this COVID-19 pandemic.

But, just as before COVID-19, seniors are still failing in their health. Many of them will need 24-hour care that can be provided through a live-in aide (very expensive) or through placement at a nursing home.

If Your Loved One Needs Nursing Home Care During COVID-19

However, as of now, many nursing homes in Maryland are not accepting new residents. While nursing homes are taking precautions by separating the COVID-19 residents from those who do not have COVID-19, many facilities are still not admitting any new residents.

As a result, some hospitals are keeping their patients longer than normal because they can’t locate an available nursing home. If a patient has a delayed discharge from the hospital for this reason, then issues can arise with Medicaid and with who is paying for that extended stay.

If Your Loved One Starts Nursing Home Care During COVID-19

For those nursing homes accepting new residents, they will be asking for information relating to your family’s level of assets and income. Be prepared to provide that financial information, as well as providing a copy of the financial power of attorney and advance directive.

If the nursing home wants you to sign the nursing home contract, no matter how nice the director of admissions is, tell them that you need your elder law attorney to review the contract first before it is signed. This is a normal request, and it will help you avoid potential problems in the future, such as having your loved one get involuntarily discharged from the nursing home, or having the nursing home seeking immediate payment from you if the Medicaid application is denied.

If Your Loved One Stays in a Nursing Home During COVID-19

For existing residents of nursing homes, there is a very real issue of staff shortage to address current needs. Staff shortage can often lead to nursing home negligence issues.

Because most nursing homes are not open for family visitations, there is a very real concern of family members not being in a position to determine if the nursing home is still properly caring for their loved one.

One possible solution to this is that many nursing homes will allow for private duty aides/attendants to visit your loved one to provide their care. This is normally a welcome solution for a nursing home that is dealing with a shortage of staff. This can also provide a direct link of information that normally would not exist. This could include not only insight for medication and care, but also open up the possibility for telephone or video calls. Some nursing homes only extend the visiting privileges to certain nurses/aid agencies, while others have less stringent requirements.

We’re Here to Help During COVID-19

We understand that these are uncertain times. Now, more than ever, is when your loved ones need you to be their advocate in planning for the future.

As an experienced elder law firm in Maryland, we’re happy to guide you through the issues of nursing home cases. Please call us at 410-296-8166 x292.

Elder Law Office Maryland. Estate Planning. Nursing Home Negligence. Asset Protection. Probate.

An Advance Directive for Nursing Home Negligence Cases

Having a properly executed advance directive is absolutely critical in nursing home negligence cases.

What is an advance directive?
An advance directive is a legal document that allows you to explain your decisions about medical care. If you are unable to make decisions or communicate in the future, this makes it easier for your loved ones and health care providers to understand your wishes.

What is the difference between an advance directive and guardianship?
Both of these legal tools help others make decisions regarding your medical care if you are unable to make them. However, an advance directive is appointed by you while you are still fully capable. Guardianship, on the other hand, is appointed by the court, after you have already become incapable of making decisions.

Please know that the medical facility has a right to charge you for accessing the medical records.

Why is it important to have an advance directive in a case of nursing home neglect?
In a nursing home negligence case, you need medical records to show the harm that the negligence caused. You have a right to the medical records; but you need legal authority in order to access them. The advance directive gives you this legal authority.

How do I get a properly executed advance directive?
The term “advance directive” is often used synonymously with the term “living will” or “durable power of attorney for health care.” In Maryland, the advance directive normally contains both the health care agent powers and the living will (i.e. end of life decisions). However, it is also not unusual for there to be a separate durable power of attorney for health care and a living will.

To make things more confusing, sometimes the financial power of attorney will have health care agent rights in it as well. There are strict requirements regarding execution of an advance directive in Maryland. It’s important to know the specific requirements of these legal documents. It is also important to know if the documents you already have will be sufficient to get the necessary legal documents.

Our Attorneys Help with Advance Directives
If you don’t have an advance directive, we can help. As elder law specialists in Maryland, we can navigate your family through whatever crisis you might be experiencing. If you think your family member isn’t being treated well at the nursing home, then let’s sit down and talk about it. Give us a call at (410) 296-8166 x292.

Elder Law Office Maryland. Estate Planning. Nursing Home Negligence. Asset Protection. Probate.

Documenting Nursing Home Neglect

Nursing Home Neglect

At some nursing homes and assisted living facilities, the staff and aides are underpaid, untrained, and overworked. In these situations, there is usually a high turnover rate. Therefore, mistakes might often be repeated and not corrected. The mistakes only come to light when disaster strikes, and a family member is willing to fight back.

Nursing home neglect occurs when the facility fails to properly care for their residents. Neglect can be caused by inaction (such as not assisting a resident who is at risk of falling), or it can be caused by improper action (such as physical abuse). Nursing home negligence can lead to serious medical problems, such as needless falls or bed sores.

If You Suspect Nursing Home Negligence

Suppose your mother has a fall at her nursing home. You suspect it’s the nursing home’s fault. She’s currently recovering, so you don’t know the full extent of the harm yet. What should you do?

You might not be ready to take legal action yet. But here’s what you need to do: document the incident.

Document Nursing Home Neglect Now

If you observe potential negligent behavior, or if any incidents occur, it’s best to document them as they are happening. If you need to take legal action, even if it’s one or two years later, then you will already have these important details recorded. Keep a journal of diligent notes specifically for this purpose.

Document Everything for Your Attorney

Make sure you record:

  • Dates
  • Time of day
  • Names and positions of facility staff who are involved
  • Names of witnesses
  • What happened (negligent behavior could be action or inaction)
  • Any harm that may have ensued

You could also take pictures, if appropriate.

An Example Journal Entry

For example, you could write down:

On September 8, 2019, Mrs. Hannah Jones, an aide at the Happy Days nursing home, told me that my mother had a fall. On that day, around 3:00 pm, my mother wanted to take a walk. Mrs. Jones said she assisted her during the 20-minute walk and then took her back to her room to rest.

About 10 minutes later, my mother apparently tried to leave the room on her own but was too weak and fell. She broke her wrist and was treated at Clarksville County Hospital by Dr. Robert Lam. It was unclear why my mother tried to leave the room without an aide. I talked with my mother’s next-door roommate, Mrs. Kathy Albertson. Mrs. Albertson said she heard my mother calling for an aide a few minutes before her fall, but no aides appeared until after her fall.

Win the Nursing Home Negligence Case

Why should you take the effort to document everything now?

If a judge gets involved, the documentation:

  • Helps establish your case and key witnesses (especially if the facility staff involved with the incident is no longer employed there)
  • Makes it easier for the elder law attorney to help you win
  • Relieves you from the pressure of trying to remember all the pertinent details

Having proper documentation can make the difference between winning and losing a case when legal action is required.

Assisted Living Negligence

There are two key issues to consider for facility negligence:

  1. What is the harm that was caused?
  2. Did the facility breach their standard of care?

A Typical Example

Let’s suppose your mother lives in an assisted living facility. She needs an aide attending to her every time she walks because she’s considered at risk for falling. You’ve had no issues with the facility so far.

One day your mother wants to take a walk and is assisted by an aide. Afterwards, she rests by watching television in the main hall. When she wants to go back to her room, however, the aide that assisted her is not around. The aide’s shift had ended, and instead of waiting for the tardy night shift aide, she simply left.

So your mother decides to walk back to her room on her own. In this attempt, she falls and breaks her leg. She’s admitted to the hospital, suffers complications, and passes.

Key Issues in Negligence Cases

In this case, the facility clearly breached their standard of care. There wasn’t an aide to assist her in moving when she needed it. There was also harm as a result of that breach (assuming the hospital was not at fault).

In other cases, the extent of the damages might not be clear. For example, your parent might still be going through rehabilitation or have an extended hospital stay.

Don’t Be Fooled by Assisted Living Negligence

Don’t let the assisted living facility convince you it’s not their fault. Falling is not to be accepted as just part of the risk of living in that kind of facility.

Take Prompt Action

Assisted living and nursing home negligence matters are complex and time-sensitive. While the example above seems relatively straightforward, there are a number of factors to consider. It’s important to document the possible negligence now, including the issues, events, and names of interested persons.

Give our office a call to discuss your situation. The first half hour of the consultation is free. Our firm can help you hold the facility accountable for their wrongdoing.

Nursing Home Negligence

In many instances of nursing home or assisted living negligence, medication mismanagement is the direct cause of other issues, such as a resident falling down.

It All Starts Well

Consider this example. Your mother is a resident in an assisted living facility. She needs 9 different medications given to her on a daily basis. She can independently move from room to room and is not considered at high risk for falling.

Problematic Signs

However, you eventually notice that your mother’s pill supplies are being exhausted faster than anticipated. So you remind the assisted living facility of the physician’s prescriptions, including the proper dosages and reasons for medication management.

Signs of Nursing Home Negligence: The Fall

One day, a staff member from the assisted living facility calls to inform you that your mother “unexpectedly” fell. She sustained various injuries and is now at the local hospital suffering from a broken hip and a concussion.

The Untold Cause

What they didn’t tell you was that the nurse in charge of medication management over-medicated your mother. Normally your mother would have no difficulty walking, but due to the side effects, she became drowsy and weak. This led to her stumbling, falling, and injuring herself.

Proving the Assisted Living Negligence

It will be up to you to prove the negligence in this matter. The assisted living facility is being paid to take care of your parent. Don’t let them get away with their negligence.

Call our office, and let us fight for you.

Signs of Nursing Home Negligence

The Facility’s Responsibility

When your parent transitions to a nursing home or assisted living facility, a significant agreement is made. The facility agrees to provide care as your parent needs, in exchange for a hefty monthly fee.

Nursing homes and assisted living facilities often categorize their care into 3 levels. Level 1 is a step up from independent living; the resident needs little supervision. Level 3, on the other hand, indicates a resident that needs regular supervision, similar to a nursing home level of care.

Whatever level of care your parent is in, it is the responsibility of the facility to ensure your parent’s safety. Perhaps that means having a rail on the side of the bed to prevent falls. Or maybe it’s putting an alarm under the bed to alert nurses when a resident moves off the bed. Or perhaps there is the need to have constant assistance moving from place to place.

Signs of Negligence

Here are signs that a nursing home or assisted living facility may be liable for negligence:

  1. The facility is aware of a resident’s unique need.
  2. The facility fails to address that unique need.
  3. As a result, the resident is hurt.

Case in Point

Let’s suppose your mother was recently admitted to an assisted living facility under Level 3 care. Weighing about 160 pounds, she needs the assistance of two aides to move her from any location, such as from the bed to the bathroom.

One morning, one of the nurse aides is running late. Your mother pushes the alert button near her bed, signaling that she wishes to use the bathroom. However, only one aide comes to her assistance. He attempts to get her out of bed, and things are fine—until she puts more weight on the unassisted side and suddenly stumbles. They both fall down hard on the cold, unrelenting floor. Your mother’s thigh bone, already in brittle condition, snaps. She is immediately rushed to the hospital, where she undergoes surgery to set her broken hip.

You are told about this incident immediately by the facility director, who assures you they did everything possible and that accidents sometimes happen. Unfortunately for your mother, the broken hip leads to invasive surgery that leaves her in a weakened condition. She never fully recovers, and her health rapidly worsens. Her surgical wound constantly hurts, and moving her leg also causes her pain. She eventually passes in a nursing home three months later.

This is a case of actionable negligence against the assisted living facility. If they hadn’t violated the standard of care of two nurse aides, your mother would not have fallen to the floor. But because of their negligence, your mother had to endure constant pain over the last remaining months of her life, which was dramatically shortened as a direct result of the injury.

Getting Compensation

If you think your family member has been the victim of negligence in a nursing home or assisted living facility, our law office can help. Sometimes it takes assistance from a lawyer to get the assisted living facility to pay for their negligence. Your family deserves to be compensated for the pain and suffering the negligence caused.

Call our office, and let us fight for you.

Bed Sores

Paying Attention: Nursing Home Staff

Bed sores are often the result of nursing home staff not paying a resident any or very little attention. A parent is left on their bed, unable to care for themselves, fecal matter accumulates, and there is a rapid break down of their skin. Serious infection follows. This is negligence at its most avoidable because the cause is simply lack of attention. Nursing homes are paid lots of money to take care of your loved one. Under no circumstances should a bed sore develop.

Awareness of Bed Sore Issues

In many cases, the family only becomes aware of the bed sore issue upon admission from the nursing home to a hospital after a loved one’s health seriously deteriorates.

Taking Legal Action

No one wants to have a bed sore that leads to more complications. How do you know if it is severe enough to warrant legal action? There is no bright line test for the severity of the bed sore to make it actionable. But the general rule is this: the worse the bed sore is and the more complications that result, the stronger the case.

The unfortunate issue with bed sores is that yours will probably not be an isolated occurrence. If your parent or loved one suffers from a bed sore at this nursing home, there is almost a guarantee that this is a chronic issue at this facility. Make sure it does not happen again to your loved one or anyone else at this facility.

Taking Responsibility for Nursing Home Negligence

Very rarely will a nursing home freely admit they are at fault. Often the nursing home will blame a previous nursing home, assisted living facility or hospital. Do not let them get away with it.

Action against a nursing home for this violation of trust can force them to hire the right staff, and your action may protect not only your loved one but also future residents. You are also holding the nursing home accountable for the trust you have given them for the privilege of taking care of your parent or loved one.

The Grand Bargain

Bed sores are often the result of a severe breakdown in the grand bargain—that in return for significant payment, a loved one is guaranteed a safe and secure environment. Please note that even if a loved one is on Medical Assistance, the nursing home is still being paid a very large sum for their care.

Once that bargain is violated and the bed sore issues are severe, you may have a case against that nursing home. Do not let them get away with it.

The Importance of Documentation

Always document the action or inaction by the nursing home staff (i.e. names, witnesses, pictures, dates, times, etc.). This is often the difference between a winning and losing case when legal action is required.

Feel free to give our office a call for a consultation.

Falls at a Nursing Home

Standard of Care to Prevent Falls

Nursing homes and assisted living facilities are under a duty to care for their residents.

This includes a standard of care when it comes to their residents who are at risk of falling. When a nursing home or assisted living facility breaches that standard of care and a resident is harmed, there may be a legal case against that facility.

Often the fall was completely avoidable and should have been prevented. Nursing homes and assisted living facilities are being paid lots of money to take care of loved ones. It is their responsibility to mitigate falls. It is their job. A single fall can be a life altering event, affecting a person’s quality of life for the rest of his or her life.

The Grand Bargain

Nursing homes and assisted living facilities are supposed to be safe havens for our parents and loved ones when living in the community is no longer viable. In essence you are trusting the facility to take care of your parent at a time when you cannot take care of them yourself. It is a grand bargain: the facility is paid handsomely for their care in return for taking every precaution to make the living arrangements safe. In some case, unfortunately, that trust is blatantly violated.

Nursing Staff Negligence

At some nursing homes and assisted living facilities, the nursing staff and aides are underpaid, untrained, overworked, and have high turnover. Mistakes are often repeated and not corrected. Their mistakes only comes to light when disaster strikes and a family member is willing to fight back and say that is not right.

Nursing homes and assisted living facilities want to limit their exposure to “accidents” and will want the resident to sign an arbitration clause to avoid a court trial. Do not sign the arbitration agreement. Signing an arbitration clause is akin to insuring less of a recovery and less accountability for the facility. Often times the facility will ignore the problem, pretend the issue does not exist, or blame the resident. Nursing homes and assisted living facilities know that their residents often suffer from dementia, are weak or physically unstable. These are not unknowns to nursing home or assisted living management, and they are obligated to take measures to address these risks.

Taking Legal Action for Nursing Home Neglect

How do you know when it is time to get an attorney involved?  The nursing home or assisted living facility has to have breached their standard of care to the resident (i.e., it was their fault, their staff was negligent in their action or inaction, etc.). Next, the resident has to be harmed to a significant extent. How much harm is enough? The harm at issue does not have to be permanent but must be significant.

Nursing home and assisted living facilities are big business in Maryland with the average cost of assisted living facilities at $4,000–$6,000 per month and nursing home costs at $8,000–$11,000 per month on average. Sometimes the facility does not hold up their end of the deal. Do not let the nursing home or assisted living facility get away with their behavior. For the sake of your loved one and countless others at their facility, someone needs to take a stand.

Recommendation #1: Document Everything

Take diligent notes of the negligent behavior (dates, names of those involved, witnesses, etc.). Unfortunately, not everyone has a photographic memory. Always document the issue. This helps establish your case when a judge gets involved.

Feel free to give our office a call for a consultation.