Grandma’s Nursing Home Nightmare

Shady legal maneuvering is rendering government oversight useless.

Assisted living facilities that don't want to bring their practices up to code, become regular housing where residents just happen to receive nursing services—and operate at-will with no license.(Photo: Gary Cameron/Reuters)
Matt Fleischer is a TakePart contributor who was awarded a Fund for Investigative Journalism grant for his series “Dangerous Jails.”

When 71-year-old Grenada, California, widow Diana Medal fractured her spine, she knew she was in for a painful road to recovery. What she didn’t realize was that recovery would include being ignored by nursing attendants for upward of a half-hour as she called for help to use the bathroom, or to get a bedpan before she went to sleep at night.

Across the country, big business nursing home conglomerates...are creating a maze of convoluted corporate structures to avoid legal settlements. 

Nursing homes in California are legally obligated to provide a bare minimum of 3.2 hours of daily personal care per resident. Medal says the nursing home conglomerate Skilled Healthcare, owner of the facility she stayed at for three weeks in 2010, didn’t even come close.

“I wouldn’t send my worst enemy there. It was hell,” she told the Eureka Times-Standard of her ordeal.

In 2010, Medal was one of nearly 42,000 Skilled residents who filed a class action lawsuit against the company for negligent care. A jury found Skilled liable for $677 million. The company eventually negotiated that payment down to $50 million in a settlement, under the condition that it would submit to regular inspections by a special auditor, who would help ensure the kind of negligence Medal faced would never happen again.

So what did Skilled do? According to an investigative report in the North Coast Journal, Skilled farmed out management of several of its facilities to a subcontractor—while still making money on the facility by “renting” beds to the new company. Under the provisions of the lawsuit, a new owner wouldn’t be subject to inspection by the new auditor. Skilled pulled a fast one. Its stock jumped 25 percent overnight.

Skilled certainly isn’t the only elderly care facility in California using legal maneuvers to duck state supervision. Just last month, the Ventura County Star reported that legal advisors for assisted care facilities for the elderly in California have started telling their clients to refuse to turn over patient information to the state ombudsman—inexplicably citing privacy concerns.

“Privacy issues [in this case] are baloney,” Patricia McGuiness, executive director of California Advocates for Nursing Home Reform, tells TakePart. “The ombudsman is funded to assist residents and has been doing so for 30 years. This is about providers ducking oversight.”

The problem of elderly care providers abusing patients and getting away with it isn’t isolated to California, says Eric Carlson of the National Senior Citizens Law Center. He tells TakePart that big business nursing home conglomerates across the country, like Skilled Healthcare, are “creating a maze of convoluted corporate structures to avoid legal settlements. The operation that holds the nursing license likely doesn’t hold many assets.”

Attempts to crack down on this practice have met with little success, says Carlson, because “the people [in state governments] handling licensing are not corporate ownership experts. This is way over their heads.”

Parts of President Obama’s Affordable Care Act were intended to provide a fix, forcing nursing home companies to publicly disclose their corporate structure. So far, however, transparency under the new law hasn’t gone so well. When Florida’s long-term-care ombudsman Brian Lee attempted to force local nursing home companies to outline their business structure, they fought back. The Sarasota, Florida, Herald-Tribune reported that friends of the nursing home industry in Florida’s government pushed incoming Governor Rick Scott to force Lee’s resignation.

If that sounds bad, national trends in assisted living facilities for the elderly—where seniors require 24-hour supervision, but not full-time healthcare—are even worse. Eric Carlson says that many companies, particularly in Iowa, that don’t want to spend the resources to bring their facilities up to code simply stop calling themselves assisted living facilities. They transform into regular housing where residents just happen to receive nursing services—and operate at-will with no license.

“Let’s face it, nursing homes are all about money,” says Patricia McGuiness. “You can’t touch their hearts on this stuff, you have to touch their wallets. Right now, it’s worth it to violate the law.”

The fines for practices like these are nonexistent or minimal. Until that changes, says McGuiness, our parents, grandparents and loved ones are all at risk of negligent or abusive care.

Do you have any scary nursing home stories to share? Tell us in comments.

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