Chicago Nursing Home Abuse Attorney Blog

Many people think nursing homes are spooky places. Some think they're downright scary and don't ever want to be sent to one.

But one nursing home situation led to an even spookier situation at the Lake County, Ill., coroner's office -- or so it seems. The Chicago Tribune tells the story.

The eerie things that have startled people in the coroner's office started in the late 1990s when the body of a woman was inadvertently left in the cooler at the morgue for several months, the Tribune said in its Oct. 30 editions. Workers at the office suggest strange knocking sounds, sudden movements and glimpses of people walking around what should be an empty autopsy room are because of a spirit angry at being forgotten.

She was a woman named Anna who died in a nursing home. Whether she was a lonely person there isn't clear, though you can infer that she was. She became truly lost after a deputy coroner picked up her body but forgot about her in a rush of other cases. Several months went by before someone got around to caring for her body. Then, when another deputy took her to a funeral home, weirdness began. The doors of the car locked and unlocked, windows went up and down by themselves, and when the deputy reached the home and went to take her out of the car, all the doors locked and the engine turned off.

Ever since, employees have reported odd noises in the morgue, things that one senior deputy, who thinks of himself as a scientist immune to ghost stories and a skeptic when it comes to the supernatural, says he can't explain. Employees say they have heard knocking from inside the cooler where bodies are kept. They say a body's hand will fall and that they've seen persons walking in the autopsy room when a worker is the only ones around. They report doors staying open that are supposed to close automatically when they walk through them. They have heard loud whistling, sounding like a woman screaming, and attributed it to the wind.

Deputies have also reported receiving shocks from touching bodies when there were no electrical connections around, and seeing people at accident scenes walking around who were later found to have already been killed.

The deputies admit it's spooky, but say they don't feel it's dangerous.

True or not? These men of science say it happens and they can't explain it. Still, after all, it is the season for ghost stories.

It's just interesting that this one starts with a nursing home.

Michael Kosner, President
The Kosner Firm Chtd.

A public meeting earlier this week took a hard look at the practice of putting younger adults with mental illnesses in Illinois nursing homes. Members of Gov. Pat Quinn's Nursing Home Task Force spent four hours listening to social workers, nursing home residents and advocates demanding that the practice stop. These undesirable residents allegedly include felons who police say assaulted, raped and even killed elderly and disabled housemates.

"A nursing home is not the place to test the rehabilitation of violent offenders. It is not the place to see if the fox can live peacefully in the henhouse," said Jamie Jimenez, an advocate with the Community Counseling Centers of Chicago, quoted in an article in the Chicago Tribune.
As well they should be, the governor's representatives were also upset by the violence in the state's facilities. "We have a situation that is not acceptable to us," said task force chairman Michael Gelder, Quinn's senior health policy adviser. He described the hearing as "a call for action," that call coming in the form of questions about, and criticism of, Illinois' long-term pattern of putting criminals with mental illness with the elderly and disabled. The shuffling of younger residents into nursing homes from jails, shelters and psychiatric facilities has put a definite strain on that industry and fails both the psychaitric patients and other nursing home patients.

"We are in crisis now," said Phyllis Mitzen, co-director of the Center for Long-Term Care Reform. "We find ourselves ... with a need to change the entire long-term care system."

Mark Heyrman, a board member of Mental Health America of Illinois, noted that psychiatric patients often receive substandard treatment in nursing homes and could be more cheaply and effectively housed in community mental health centers and assisted living arrangements. "Our long-term plan has to be to stop institutionalizing people in nursing homes who are only there because of a mental illness," he said.

The Tribune says Illinois nursing homes currently house about 15,000 people whose primary diagnosis is a mental illness, and one speaker estimated two-thirds of them could be in less institutional settings within five years if the state budgets for community rather than institutional care. Anthony Zipple of Thresholds mental health centers said Illinois has two pilot programs, though small ones "relative to need," that seek to move hundreds of mentally ill people out of nursing homes.

State law requires criminal background checks (and assessments of risk to other residents if felonies are found) of all incoming nursing home residents. However, a Tribune investigation said those screenings were inaccurate and often took longer than a year.

Other speakers called the current process farcical, and noted that nursing homes don't always report crimes that take place to the police. Moreover, police reports are generally not shared with state inspectors. They called for closer cooperation between the state and local law enforcement and prompt removal of licenses from homes with continuing patient-safety issues.

The task force will hold its next meeting next week (Oct. 29) in Springfield. We can only hope the state moves quickly to correct the kinds of conditions that led another speaker at last week's meeting to report he had been stabbed by the same person in two different nursing homes. In the meantime, be ready to question a home's policies in this area (Who do you let in?). It can keep your loved ones safer.

And if you have comments or recommendations, check out the task force's web site.

Michael Kosner, President
The Kosner Firm Chtd.

Can you expect your loved ones to get better care when you put them in a for-profit nursing home or in a not-for profit home? Intuitively, given the competitive market place, you'd expect for-profits to do a better job for your money, but a recent study of homes in the United States and Canada, done by a group of mostly Canadian doctors and published in the British Medical Journal, suggests the not-for-profits provide higher quality of care.

The study cautions, however, that it is an overview and many factors may influence quality in the case of individual institutions.

The paper's 11 authors reviewed 8827 studies that had been done of the quality of care in for-profit versus not-for-profit nursing homes between 1965 and 2003. Of these, they decided 956 should be reviewed fully and they selected 82 articles to be included in their results.

The authors looked most closely at results for the four most frequently reported quality measures and found that in 40 of the articles, all significant comparisons favored not-for-profit facilities. In three, all comparisons favored for-profits, and the rest were less consistent.

Analyzing the combined results for the articles suggested not-for-profits delivered higher quality care in the categories of more or higher quality staffing and lower incidence of bed sores. The other two quality measures - physical restraint use and problems with government inspections - tended to favor not-for-profits but not by statistically significant amounts.

The study's authors noted that nursing homes, whether for-profit or not-for-profit, vary substantially in their management styles, motivations and organizational behavior, and their study, they said, is not a blanket judgment of all institutions. "Some for-profit institutions may provide excellent quality care, whereas some not-for-profit institutions may provide inferior quality care," they wrote.

Of course, such an analysis is only a broad background factor when we're looking for a home for our loved ones. However, the findings do remind us that the amount a home costs is not a guarantee of quality, and we do have to look closely at a lot of factors if we want a good result.

Michael Kosner, President
The Kosner Firm Chtd.

Nearly one in ten births worldwide is premature, and one million deaths - more than one quarter of all neonatal deaths annually - are the result of preterm birth. These are interesting numbers, but surely that's in poor nations, isn't it? Well, yes and no.

"A White Paper on Preterm Birth - the Global and Regional Toll, recently released by the March of Dimes Foundation, says "the regional toll of preterm births," defined as before 37 weeks (full term is about 40 weeks), "is particularly heavy for Africa and Asia, where over 85 percent of all preterm births occur."

But, it notes, the rate of such births has been rising wherever information on trends is available. And while the highest rate of preterm birth is in Africa, second is, surprisingly, North America (Canada and the United States combined). Then come Asia; Latin America and the Caribbean; Oceania (Australia and New Zealand); and Europe.

In the U.S., the rate of preterm birth has increased 36 percent in the past 25 years, with most of this coming in late preterm births (between 34 and 36 weeks gestation).

These numbers are based on data from the United World Health Organization and the Paper is also supported by Save the Children, USA and the Partnership for Maternal, Newborn and Child Health.

The Paper says prematurity in rich countries is caused by different things than prematurity in poor countries. It notes that wealthy countries - like ours - have sophisticated neonatal intensive care units for the earliest babies. Because of this technology, babies that once would not have survived now do. But these children often have birth injuries - lifelong problems including blindness, cerebral palsy and learning problems.

One of the next steps planned by the White Paper's participating organizations is to study the care women, both in rich and poor areas, receive. If they can figure out the causes of preterm labor, many of which are still obscure, then they can develop strategies that lead to improved care for women with high-risk pregnancies and for premature babies.

If they can strengthen the care pregnant women receive, this will likely lead to fewer preterm deliveries and, as a consequence, fewer birth injuries.

The Paper is part of an increasing focus on preterm birth; there's a lot still to be learned,

Michael Kosner, President
The Kosner Firm Chtd.

Each state inspects its nursing homes to make sure they comply with state and local laws. In Illinois, each home is inspected, on average, once a year. But once the inspection is made, what happens to the results? One thing we know, they are not sent automatically to the residents or the families of residents at a home.

MemberoftheFamily.net puts it this way: "Federal Regulations do not require State inspectors or the nursing home to notify patients and their families that a particular patient's care has been the subject of a survey violation. Even a finding of substandard care or actual harm does not require notification."

Illinois law doesn't require such notification, either.

Here's part of what the Illinois Department of Public Health says about the inspection process: "The Illinois Department of Public Health is responsible for ensuring nursing homes comply fully with mandatory state regulations. (U)nder a cooperative agreement with U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS), (IDPH) is also responsible for ensuring that facilities accepting Medicare and Medicaid payment for services rendered to program beneficiaries meet federal regulations and certification rules. Each year, (IDPH) conducts approximately 1,300 full, on-site licensure inspections of nursing homes and responds to approximately 6,000 complaints."

By the way, if you want to file a complaint about an Illinois nursing home, you can call the IDPH toll-free hotline at 1-800-252-4343.

IDPH notes that licensure inspections evaluate the fitness and adequacy of a nursing home, its equipment, staff, policies, procedures and finances. Illinois has some 200 surveyors employed in teams that each consist of a registered nurse, a nutritionist and an environmental health practitioner. These experts may be joined by life safety code experts and other professionals.

Complaint surveys are conducted by experts in the areas involved in charges lodged.

IDPH notes, "Illinois' licensure surveys are generally conducted on-site over a three- to four-day period during which the ... teams evaluate all aspects of resident care and nursing home procedures and practices, assessing facility compliance with more than 1,500 specific state and federal standards. (Some areas of care reviewed include resident rights, access to care, activities, assessment and care plans, health care and dietary services, housekeeping, staffing, quality of care and quality assurance.)

"The Department's evaluation may include an inspection of medical records, observation of resident care, inspection of all areas of the nursing home and interviews of residents, family members, staff or other individuals. (IDPH) also may (analyze) statistical data reported by nursing homes or (review) reportable event information or other notices filed with IDPH. Reportable events include administrator or director of nursing personnel changes; interruptions of three or more hours of services essential to the health and safety of residents; alleged or suspected crimes investigated at the facility by police; and all fires, disasters, deaths or other risks to resident life or health resulting form accidents or incidents at the facility. ...

"Nursing homes are inspected at least once every six to 15 months. The state average is once every 12 months."

Facilities are not told in advance about inspections.

IDPH shares its findings with nursing home administrative staff in an exit interview at the end of each inspection. The findings are also included in a survey report sent to the facility. If IDPH finds the nursing home failed to comply with licensure standards, it is cited for deficiencies, which it has to correct.

So, information is available but, since the home where our loved one may be staying isn't required to let you or the patient know about inspection results, we have to act to keep up with what's going on. Find out the home's policy on releasing reports. Talk to your loved one's doctor and to the person in charge of the home. If you don't get a satisfactory answer, an attorney can help.

Information on reports and a home's status are important. You have to know what you're dealing with to make sure a nursing home is giving proper care. You should be able to get inspection reports and the nursing home's response from the home or IDPH. You can ask IDPH for an inspection file by writing the Illinois Department of Public Health Freedom of Information Officer at 535 W. Jefferson St. Springfield, IL 62761 (Attn: Division of Communications)

In addition, federal inspection surveys are at www.medicare.gov/NHCompare/home.asp.

Michael Kosner, President
The Kosner Firm Chtd.

Nursing homes are rated by both the state and by the Centers for Medicare and Medicaid Services of the U.S. Department of Health & Human Services - CMS for short. CMS uses a five star system to rate nursing homes, basing its results on Inspections done by the states, the nursing home's staffing and designated quality measures.

There's a web site - MemberoftheFamily.net - that has compiled the CMS ratings into easy to look at tables. The site was started about ten years ago by a doctor who was appalled by the attitude of a nursing home toward one of his patients - an attitude that ignored his orders for treatment because they might cause problems for the home. It now keeps records for about 16,000 homes nationally, based on the CMS ratings. While it doesn't cover every nursing home, it's a useful tool.

The tables list numbers of violations reported with four summary ratings ranging from actual harm or immediate jeopardy, to potential for more than minimal harm, to potential for minimal harm, to no violations reported. Then it gives and overall rating based on the CMS stars, ranging from much above average to much below average.

We took a look at the statistics for Illinois nursing homes and we were shocked.

Of 784 homes listed, more than 80 percent - four of five - ranked either below average (221) or much below average (434!!!!)! Of the rest, 82 were average, 38 were above average and only nine were ranked much above average.

Now you can be shocked, too.

Michael Kosner, President
The Kosner Firm Chtd.

I've written about negligence as someone doing something unreasonable. While neglect may be planned, in practice it is often a failure to do something. Abuse, on the other hand, generally involves someone acting to hurt someone else. It's a broader area than neglect and some kinds of neglect fall within its definition.

Abuse is when someone harms someone else. This damage can be physical or emotional. Nursing homes have become centers of abuse because the people entrusted to them cannot defend themselves and the homes may not be able to control underpaid and uncaring employees.

How many of us can relate stories like that of the man, suffering early Alzheimer's, whose wife resolves that, though he is in a nursing home, she will do everything she can to preserve his dignity. She provides him with nice clothes and makes sure he has pictures of his kids and a few dollars in his pocket, only to find that everything with any potential value disappears within days, if not hours. Theft is rampant and, in the end, all she can do is bring him clothes from the Salvation Army Thrift Store and try to control her frustration and indignation.

Then there are stories of sympathetic nurses or aides who warn relatives of persons entering a nursing home or a hospital to take home anything they have of value because otherwise it will surely disappear.

We even know of a computer whiz who, after finding that his mother's belongings were gone from her nursing home room, rigged hidden cameras and caught the culprits - or at least some of them.

Illinois, as well as the other 49 states, have enacted laws that make elder abuse felonies; they make physical abuse and financial exploitation crimes.

Physical abuse may include beatings, sexual attacks and being forced to swallow food or medicine. Here is where neglect can fall in, when a caretaker who doesn't care fails to feed or dress patients, or to keep them clean.

Mental abuse may occur when someone humiliates, insults or threatens patients, or denies them the dignity of making even simple personal choices, such as whether to get out of bed or when and what to eat.

Financial abuse can be theft of belongings or forcing patients to turn over funds or include someone in their wills.

Why is there nursing home abuse? Understaffing and using under-qualified and poorly paid employees, high-pressure work environments and a lack of proper training have all been blamed. Provisions in the federal Nursing Home Reform Act lay out expectations and requirements for every home that receives federal funds; these facilities are monitored by Medicare as well as state agencies.

Regulators, however, can only do so much, as evidenced by nursing home ratings that drop from above average to dangerously below average from one annual inspection to the next. Inspectors need the support of family members who are looking after a loved one, and family members may have to turn to an attorney to sort through the complications and make sure the law is enforced.

Staying alert may be difficult, but successfully fighting nursing home abuse can at least provide some satisfaction in caring for a loved one - which is, at best, difficult.

Michael Kosner, President
The Kosner Firm Chtd.