Life and Death in Assisted Living: "A Sinking Ship"

On Sept. 30, 2008, an employee at the Emerald Hills assisted living facility in Auburn, Calif., made an entry in a company computer log: “pressure ulcer/wound.”

Joan, who had spent just 19 days in the facility, had developed the wound on her foot. The fall eight days earlier had hospitalized her and left her with bruises and an abrasion on her right temple. This, though, could be much, much worse.

Pressure ulcers — also known as bed sores — can form when a person loses the ability to move about freely. Lying in bed or sitting in a chair for long stretches of time diminishes the blood flow to the skin, causing it to break down and die. A hole grows. If bacteria creep into the wound, the bugs can devour flesh or invade the blood and bones. Pressure ulcers can turn fatal, particularly in older people.

Because of the lethal potential of pressure ulcers, the federal government monitors them closely in the nursing home business. In the eyes of experts, the sores are often an indicator of poor care. Attentive caregivers can prevent many pressure sores by making sure that people don’t spend too much time in the same position.

“We know that most bed sores are avoidable,” said Kathryn Locatell, a forensic geriatrician who investigates allegations of elder abuse for California Department of Justice. “That is the consensus of experts in the field.”

Emerald Hills was supposed to contact Joan’s doctor when she developed the ulcer. But nobody from Emerald Hills called a doctor. No nurse came to salve Joan’s wound. And nobody told Joan’s relatives — her husband, Myron, who lived in the same facility, or her son who lived nearby — about the development.

Joan’s short, painful stay at Emerald Hills seemed to be accelerating her decline.

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Life and Death in Assisted Living:  “A Sinking Ship”

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Life and Death in Assisted Living:  “They’re Not Treating Mom Well”

Life and Death in Assisted Living:  “The Emerald City”

"I Made a Small Change"

Tara Wilson

Attorney Tara Wilson of Andover, MA, had many of her own estate planning documents in order. But after her grandmother fell ill at 84 and her relatives disagreed on her care, the court appointed a stranger as guardian, overruling her grandmother’s wishes.

“The guardian kept her from her loved ones, put a reverse mortgage on her house, moved her to a nursing home and squandered her savings. From all this I learned that I needed to name a second and third choice for healthcare proxy and power of attorney, and add a provision to my will that the court is not to appoint anyone else to represent the interests of my children. And I keep my will up to date.”

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“I Made a Small Change”

Man’s Death After Confrontation With Police Ruled a Homicide

The Victory Centre of Park Forest

 

Saturday’s death of a 95-year-old nursing home resident who was shocked by a Taser and struck with bean bag rounds during a confrontation with police has been ruled a homicide by officials in the Cook County Medical Examiner’s Office.

An autopsy showed John Warna died of blunt force trauma to the abdomen from being hit with the bean bags.

Officials at the Victory Centre of Park Forest, the south suburban home where Warna lived, said the man was displaying “unusually aggressive behavior” on Friday evening. When police arrived, they said Warna was threatening paramedics and staff with a cane and a metal shoehorn.

Police said they struck him with a Taser and bean bag rounds after he threatened officers with a 12-inch butcher knife.

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Man’s Death After Confrontation With Police Ruled a Homicide

Woman wounded by Pacific Palisades man was caregiver, neighbors say

A Pacific Palisades man shot and wounded his caretaker before fatally turning the gun on himself early Tuesday, neighbors told a local television station. Police confirmed that the man had shot the woman, then himself.

Residents near the 1400 block of Paseo de Oro, where the shooting occurred, told NBC 4 the man had suffered a stroke in recent months and the victim was his caregiver.

The Los Angeles Police Department has not confirmed the relationship between the woman and the dead man.

Officer Wendy Reyes said there was no search for a suspect because the shooting was considered “an isolated incident.”

Police found the two after responding to a report of shots fired shortly before 8:30 a.m., LAPD Sgt. Albert Gonzalez said.

The man, shot once, was pronounced dead at the scene, Reyes said. The woman, shot multiple times, was taken to a hospital. Her condition was not known.

LAPD Officer Bruce Borihanh confirmed that the man shot the woman, then himself.

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Woman wounded by Pacific Palisades man was caregiver, neighbors say

Life and Death in Assisted Living: They’re Not Treating Mom Well

When the ambulance crew arrived, about 8:20 p.m., Joan Boice was in the TV lounge, face-down on the carpet. Her head had struck the floor with some velocity; bruises were forming on her forehead and both cheeks. It appeared she’d lost her balance and fallen out of a chair.

But no one at the assisted living facility could say precisely how the accident had occurred. No one knew how long Joan had been splayed out on the floor. She had defecated and urinated on herself.
Worried that Joan might have injured her spine, the emergency medical personnel gently rolled her over and placed her on a back board. They pumped oxygen into her nostrils.

It was Sept. 22, 2008 — just 10 days after Joan had first moved into Emerald Hills.

No Emeritus employees accompanied Joan to the hospital. And even though Joan’s husband, Myron, was living in the facility, the Emeritus workers didn’t immediately alert him that Joan had fallen and hurt herself. Joan, confused, injured, and nearly mute, ended up in the local hospital by herself, surrounded by strangers.

California law requires assisted living companies to conduct a “pre-admission appraisal” of prospective residents, to ensure they are appropriate candidates for assisted living.

But Emerald Hills took Joan in without performing an appraisal. It wasn’t for lack of time. The Boices had signed the contract to live at Emerald Hills more than two weeks before Joan moved in.

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Life and Death in Assisted Living:  They’re Not Treating Mom Well

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Life and Death in Assisted Living: The Emerald City

Criminal probe requested in conservatorship case

John E. Clemmons

Citing “incomplete accountings and other misrepresentations,” a court-appointed conservator is recommending that the district attorney general and the TBI open criminal investigations into a Nashville attorney’s handling of a conservatorship.

In a 26-page report filed Thursday in Davidson County Probate Court, Paul Gontarek found that attorney John E. Clemmons paid himself over $370,000 while acting as the conservator of Nannie P. Malone. Court records show that most of those payments were made without court approval.

Malone passed away last year at the age of 81, but her family has filed a civil suit against Clemmons, who is facing criminal charges in a separate case in Rutherford County.

Gontarek was named to replace Clemmons in the Malone case on April 10 after the Tennessee Supreme Court suspended Clemmon’s license to practice law. Probate Judge David “Randy” Kennedy also named Gontarek to take over three other of Clemmons’ cases.

Gontarek said that his review of the four cases showed Clemmons routinely submitted accounting reports that omitted the payments he made to himself. He said some of those reports were “totally fraudulent.”

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Criminal probe requested in conservatorship case

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Nashville Attorney John E. Clemmons Charged With Theft in Conservatorship Case

Tennessee Attorney John E. Clemmons, Court Appointed as Conservator, Sued for Breach of Fiduciary Duty, Conversion, and More

Feds Sue Over Kids In Nursing Homes

Federal officials are suing alleging that hundreds of children with disabilities are being unnecessarily segregated in nursing homes in violation of the Americans with Disabilities Act.

The U.S. Department of Justice filed suit Monday accusing the state of Florida of relegating nearly 200 children with significant disabilities to nursing homes who could be served at home or in other community-based settings.

Last September, the Justice Department warned Florida officials of ADA violations after an investigation found that state policies and practices limited access to in-home care for kids with significant medical needs leaving many families with little choice but to send their children to nursing homes. What’s more, the probe identified children who spent years at the facilities before receiving federally-mandated screening to assess whether or not the environment was the most appropriate for them.

Though the state made some changes since being notified of the investigation’s findings, federal officials said that after several months of negotiating, violations remain making legal action necessary.

“Children have a right to grow up with their families, among their friends and in their own communities,” said Eve Hill, deputy assistant attorney general for the Justice Department’s Civil Rights Division. “The violations the department has identified are serious, systemic and ongoing and require comprehensive relief for these children and their families.”

Kids living in nursing homes have limited interaction with individuals without disabilities and are often located hundreds of miles away from their families, according to the federal complaint.

In addition, the suit alleges that the state’s policies and practices put other children with significant medical needs who are currently living in the community at risk of similar institutionalization.

For their part, Florida officials said they have taken steps in the last year to improve an “already strong program” providing services for children with complex medical needs, indicating that more than 1,000 children are now receiving enhanced care services to help them return to or remain in the community.

“Today’s Obama administration action shows that Washington is not interested in helping families improve but instead is determined to file disruptive lawsuits with the goal of taking over control and operation of Florida’s Medicaid and disability programs,” said Elizabeth Dudek, secretary of Florida’s Agency for Health Care Administration, in a statement.

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Feds Sue Over Kids In Nursing Homes

Disability Spending Drops For First Time In Years

For the first time in decades, a new report finds that total government spending on individuals with developmental disabilities has declined.

When adjusted for inflation, government funding fell 0.2 percent in 2011 as compared to the year prior, according to findings in the 2013 State of the States in Developmental Disabilities, a report produced by the University of Colorado.

That’s the slowest growth rate documented in at least 35 years, researchers said.

Overall government spending on people with intellectual and developmental disabilities for 2011 — the most recent year for which data is available — was $56.65 billion, the report found.

Of the funding distributed nationwide that year, about 20 percent went toward programs providing family supports, employment services, personal assistance and similar aid.

Almost 60 percent went toward residential settings for six or fewer people while 5 percent funded living environments with seven to 15 residents. State-run institutions with 16 or more residents received 11.5 percent of total spending and 3 percent went to institutions that were privately run.

Nearly 80 percent of government spending on people with intellectual and developmental disabilities was funneled through the Medicaid program in 2011, the report found. Other funding came from the states and federal programs like Social Security.

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Disability Spending Drops For First Time In Years

Life and Death in Assisted Living: "The Emerald City"

Joan Boice needed help. Lots of it. Her physician had tallied the damage: Alzheimer’s disease, high blood pressure, osteoporosis, pain from a compression fracture of the spine. For Joan, an 81-year-old former schoolteacher, simply getting from her couch to the bathroom required the aid of a walker or wheelchair.

The Alzheimer’s, of course, was the worst. The disease had gradually left Joan unable to dress, eat or bathe without assistance. It had destroyed much of the complex cerebral circuitry necessary for forming words. It was stealing her voice.

Joan’s family was forced to do the kind of hard reckoning that so many American families must do these days. It was clear that Joan could no longer live at home. Her husband, Myron, simply didn’t have the stamina to provide the constant care and supervision she needed. And moving in with any of their three children wasn’t an option.

These were the circumstances that eventually led the Boice family to Emeritus at Emerald Hills, a sprawling, three-story assisted living facility off Highway 49 in Auburn, Calif. The handsome 110-bed complex was painted in shades of deep green and cream, reflecting its location on the western fringe of the craggy, coniferous Sierra Nevada mountain range. It was owned by the Emeritus Corp., a Seattle-based chain that was on its way to becoming the nation’s largest assisted living company, with some 500 facilities stretching across 45 states.

Emeritus at Emerald Hills promised state-of-the art care for Joan’s advancing dementia. Specially trained members of the staff would create an individual plan for Joan based on her life history. They would monitor her health, engage her in an array of physically and mentally stimulating activities, and pass out her 11 prescription medications, which included morphine (for pain) and the anti-psychotic drug Seroquel (given in hopes of curbing some of the symptoms of her Alzheimer’s). She would live in the “memory care” unit, a space designed specifically to keep people with Alzheimer’s and other forms of dementia safe.

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Life and Death in Assisted Living:  The Emerald City

Lawyer barred from practicing for mental health issues

Minneapolis lawyer Jill Eleanor Clark has been forbidden from practicing law for being “unable to competently represent clients because of mental health issues.”

Clark, 56, of Golden Valley has been placed on “disability inactive” status by the state Supreme Court, which rules on attorney discipline cases.

“There is overwhelming evidence in the record that Clark has a serious mental health condition,” the Supreme Court order, made public Wednesday, said.

Details of her condition were placed under seal, but some specifics emerged.

Her medical records show that “she suffered from extreme stress and anxiety during long stretches of 2012, and that this stress and anxiety severely affected her cognitive abilities and judgment.”

On two occasions, she went “on the run” because of emotional crises, once leaving town for 10 days and once for three weeks, the order said. She was hospitalized three times during those crises.

Clark did not dispute that she had mental issues, the order said. She was temporarily suspended in January.

In July 2012, Clark filed a motion to disqualify the entire Supreme Court from ruling on her case. The court denied the motion.

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Lawyer barred from practicing for mental health issues