Who is “ Assisting” at Assisted Living Facilities and…… Is It Enough?




Assisting living facilities are a popular alternative to the traditional nursing home and the number of facilities  opening here in Ohio and around the country are growing fast. But is this tread good for our seniors?  The biggest danger is, are they staffed with enough well-trained personnel? A recent article highlighted this concern.

Hina Shah of the Coalition for a Fair and Equitable Caregiving Industry released a new report that shows the changes needed including

  • mandated staffing ratios,
  • inspections and enforcement, and
  • licensing, including mandatory wage and hour compliance training.

All of this would improve the quality of care for residents and the working conditions of the caregivers.

According to Shah’s report, 53% of the state’s (California) Residential Care Facilities for the Elderly, residents are aged 85 or more years, 40% have Alzheimer’s disease or dementia and 39% have cardiovascular disease.  Nationally, those numbers indicate 40% have Alzheimer’s disease or dementia, and 46% have cardiovascular disease.  I have no doubt Ohio’s numbers are comparable. So these residents need well trained caregivers and enough caregivers to keep the residents safe and cared for.

What working conditions need changed for caregivers?  Ms. Shah’s report highlights some their challenges:

  • Caregivers are understaffed and overworked. Live-in caregivers do not get sufficient sleep because many work in 24-hour shifts;
  • There is a lack of dignity and care. The work is physically demanding and many caregivers succumb to chronic stress, anxiety, loneliness and/or other mental health problems.  Grief counseling when dealing with the death of the resident is rarely provided, if at all;
  • Wage theft. When caregivers are required to work around the clock for a flat rate, many times the hours worked calculates to less than minimum wage; and
  • Miscalculation as independent contractors.

What About Ohio?

The challenge, and in some cultures the privilege, of caring for seniors is something most everyone will face in their lifetime.  So how safe are Ohio’s assisted living and skilled care centers?  Take a look at the Ohio Attorney General’s 2016 Ohio Medicaid Fraud Control Unit report covering the period between July 1, 2015 and June 30, 2016.  As of June 30, 2016, there were a total of 1,333 open investigations.  The highest number of investigations were opened in the categories of Nursing Facilities with 104 open investigations and 97 completed; Personal Care Services Attendant with 153 open investigations and 173 completed; and Home Health Agency with 116 open investigations and 85 completed compared to Assisted Living Facilities with 12 open investigations and 22 completed.  It has been my experience that most cases of neglect happen as a result of not enough staff or inadequately trained staff, so these proposed changes can only improve care for our seniors. The real issue will be can these necessary changes be enacted in the face of a resistant long-term care industry?

Reports like these are scary, for seniors and their  families trying to make difficult placement decisions. But being aware of the fact that good , safe care in assisted living facilities is dependent on well-trained  and sufficient numbers of staff, will give you questions to ask when investigating assisted living facilities

Don’t Look Now, There Goes Your Rights! Seniors Beware!

While we have all been glued to the news lately on the repeal and replacement of the Affordable Care Act, we should really be watching the dangerous roll back of regulations affecting our seniors. It could be your parent or even you someday that suffers as a result of changes the government has signaled it intends to enact.
Specifically, the Trump administration has indicated it wants to eliminate a recent ruling which banned the use of pre-dispute arbitration agreements that residents can be asked to sign upon entry into a nursing home facility. In other words, the government wants nursing homes to be able to eliminate a resident and his/her family’s ability to sue a nursing home for neglect, abuse and mistreatment, any of which can lead to death. Holding wrongdoers accountable is a cornerstone of our court’s system and a right to trial by jury is guaranteed by the 7th Amendment to the Constitution.
By residents waiving rights to due process and everything that the judicial system offers, they are at an extreme disadvantage, and nursing homes know this. It opens the door to something close to impunity, or at least, severely mitigated risk and damages, should the nursing homes neglect their residents.
Typical nursing home claims involve injuries caused by the carelessness of caregivers, and inadequate staffing and resources. These injuries can involve bed sores that can lead to lethal infections, choking, sexual assault, renal failure and other conditions caused by dehydration, malnutrition, burns, gangrene, painful and immobilizing muscle and joint problems resulting from long-term inactivity, among many other potential forms of harm. These avoidable conditions can be the result of negligence or willful misconduct by long-term care facilities.
Presenting these binding arbitration agreements is a step nursing homes take during the admission process, which is a very difficult and stressful time in families’ lives. Individuals usually feel compelled to sign the agreement because they are under pressure to be admitted, and the implied message is that they will be refused care if they don’t agree to sign the document. Requiring residents to give up their rights in order to receive care is unfair by anyone’s standards.

Arbitration is unfair because it stacks the deck against residents by usually allowing the nursing home to select both the arbitrator and the rules for the arbitration process. Arbitrators have a strong incentive to find favor with the facility since this will ensure their continued employment. Ultimately, residents will lack the ability to hold a nursing home accountable for mistreatment and harm. This also enormously limits any penalties imposed for wrongdoing. Additionally, the proceedings are confidential, so the public will never know of a nursing homes’ true track record. We all lose when wrongdoers are not held accountable and bad nursing homes stay in business undeterred by the court system.
Full disclosure is the best deterrent for substandard care, along with the elimination of pressured consent to signing arbitration agreements.

Since we all have skin in this game, it should stay on your radar.

Today is World Elder Abuse Awareness Day

Today, June 15, 2017 is World Elder Abuse Awareness Day as declared by the United Nations. I hadn’t thought of elder abuses as a world-wide issue but the United Nations committee  cite to an expected increase in such abuse due to the numbers of elderly growing. Financial exploitation and material abuse is one of their focuses this year. And the statistics are troubling, between 5- 10 percent of older people world-wide may suffer from this kind of elder abuse. This kind of abuse is often not reported as the victims are often ashamed or embarrassed. Common forms of financial abuse may vary based on the country; in developing countries there is theft, forgery, misuse of property and denying access to monies and in less developed countries this abuse can be ejection of the elder from their home, denial of inheritance or theft of property. Regardless of country , elderly are at risk because of cognitive problems or health problems that leave them frail. So what can be done to prevent financial abuse begins with first education and encouraging specific measures to monitor financial abuse and then legislation and programs to detect this abuse, report it and protect.
Throughout the world our daily lives maybe look different but i am certain we can all agree that our parents, grandparents and elders are worthy of our protection . Our elders, all over the world , deserve to live in peace and dignity and free from financial abuse and this issue  is certainly a worth a day of awareness.

What Does Climate Change Have To Do With Our Seniors?


There are a lot of reasons to care about climate change. But unbeknownst to many people, one of those reasons should be the health of your grandma or mom. A recent report issued by the Medical Society Consortium on Climate and Health makes the case that climate change is harming our health, and the Medical Society has a Report entitled just that. What is the connection? Our planet is experiencing more very hot days, along with more frequent stretches of these sizzlers accompanied by much greater humidity. And seniors, children, and pregnant women are the most vulnerable citizens affected by these temperature extremes. Seniors in particular are more affected because many suffer from chronic heart and lung conditions and their therapeutic medications tend to make them less able to regulate their body temperatures. If seniors do not have home air conditioning they are not able to get relief from these hot humid days, thereby subjecting them to sundry difficulties. As a result, health professionals, doctors and nurses see their patients affected by a variety of heat-related illnesses, including a worsening of chronic illnesses, injuries and deaths resulting directly from dangerous weather events, an increase in infectious diseases spread by mosquitoes and ticks, along with illnesses from contaminated food and water. Additionally, a marked increase in climate related mental health problems are noted.
So what can we do to improve the lives of our families? There are many groups that are already making a difference. One such example is the Regional Greenhouse Case Initiative which is a consortium of 9 States which came together in 2007 to reduce CO2 emissions from fossil fuel power. Their efforts in reducing air pollution have already documented a positive effect in preventing:
• 300-830 early adult deaths
• 40,000 lost work days
• 35-390 non-fatal heart attacks
• 8,000 asthma flare-ups
• 200 hospital admissions
• 200 asthma ER visits

That is some real and significant health benefits from combating climate change! So if you don’t already have a reason to care about the health of our planet, I have just given you one– reducing climate change will keep your loved one healthier! And don’t forget this Saturday April 22, 2017 is Earth Day! Honor our Planet and Celebrate!



It was disappointing and disturbing to see that Ohio’s nursing homes ranked as some of the lowest in the country. How could that be ? We are the land of buckeyes, the birthplace of eight  US Presidents and a great lake- so why our state’s nursing homes treat our seniors so poorly? The Cleveland Plain Dealer reporters have spent the last few months analyzing data and recent published a scathing report of Ohio nursing homes  According to the numbers set forth in the national nursing home rating system known as Nursing Home Compare.  See my April 2, 2015 blog post on this national rating system.  Let’s take a quick review of this government system here.The Center for Medicare and Medicaid who pay the greatest bulk of the bill for residents, set up a national rating system to grade nursing homes on a 1- 5 star rating system :1 star is a lowest rating and 5 star the highest or best rating. The rating system is based on 3 issues which are important to assessing good resident care :

1. Health inspections rating:
The health inspection ratings on the 3 most recent comprehensive (annual) inspections, and inspections due to complaints in the last 3 years. Though more emphasis on recent inspections.
2. Quality measures (QM) rating:

There are 16 QMs conditions that affect the residents in the facility; like how many residents have fallen recently, have pressure ulcers, have had a loss of mobility , have lost control over bowel and bladder function or have lost significant amount of weight . These condition are obtained from clinical data reported by the nursing home. These may indicators quality of care .
3. Staffing rating:

These rating are based on two factors a) Registered Nurse (RN) hours per resident per day; and 2) total staffing hours per resident per day which RNs; Licensed Practical Nurses (LPNs) and Certified Nurse Aids (CNAs). Once again these numbers are submitted by the nursing home and take into account the needs of the residents;

So this investigation looked at Ohio’s nursing homes and their ratings as compared with the nation and found that Ohio has 184 nursing homes that are rated with only one star. And nearly 200 Ohio nursing homes received a two star rating . So that tally stands at nearly 41% of Ohio’s nursing homes only earned a one or two star rating. Charlene Harrington , a distinguished Professor of Nursing and member of the Nursing Home Compare advisory committee said “ One-star nursing homes tend to have a lot of deficiencies and low staff.” Of course that makes sense, that if there is not enough nursing staff to care for the residents, the residents suffer” . Why would a nursing home not hire enough nurses and nurse aides? Yep you guessed it money – staffing is the major expense in a nursing home, so short on staffing and save some money and increase those profits. Shameful but often true.
I believe the rating system in Nursing Home Compare is an important tool for families when researching the right nursing home for their family member. One of the best ways to prevent nursing home negligence is picking a home with a high rating which usually means a well- trained nurses and enough nursing staff to care for all the residents.

Who Is Stealing From Grandma?

pursethiefWho is Stealing from Grandma?

Well, I was surprised to learn there is a lot of stealing going on! It is reported that nearly 1 in 5 of our seniors (65 years and older), are the victims of financial abuse. This is according to a recent report by Public Policy Polling.As a result, there is a renewed effort by many different groups such as doctors, nurses, family members, and financial advisors to alert and educate seniors and their families to this growing problem. When seniors lose money they may no longer be able to pay for much needed care, assistance, equipment or life-saving medications. You can easily imagine how a senior’s inability to afford care and assistance can lead directly to declining physical and emotional health. Moreover, aging people often become more dependent, both physically and financially, on family members so the effect of stealing trickles down to many more than just the elderly. So well recognized is this burgeoning concern that even the government is now prioritizing concerns to protect seniors by placing them at the top of their 2017 list. Similarly, the Securities and Exchange Commission’s Office of Compliance Inspections and Examinations plans to protect seniors by focusing on deals negotiated between investment firms and the seniors they represent. These firms will now be subject far more than previously to comprehensive reviews and audits. So while the SEC is monitoring financial advisors and their dealings with seniors, is there something we can do today to protect seniors? Yes. One of the most widespread and easiest means of ripping off the elderly comes in the form of the scam. Many seniors are victims of scammers who use the telephone to harass and steal. Remembering that sage advice that ‘forewarned is forearmed,’ here is a list of the top ten scams:
1. IRS impersonation scams
2. Sweepstakes scams
3. Robocall/Unwanted phone call scams
4. Computer tech support scheme scams
5. Identity theft scams
6. Grandparent scams
7. Elder financial abuse scams
8. Grant scams
9. Romance scams/Confidence fraud scams
10. Home improvement scams
This list was compiled by the Special Committee on Aging, and the details of these scams may be found by checking their website. Importantly, this Special Committee also has a fraud hotline (855-303-9470). This hotline is a wealth of great information and a terrific resource as they match victims with the appropriate authorities to investigate fraud cases. It is important to remember that we all have an important role to play in protecting our beloved seniors from financial fraud and abuse. They have worked all their lives for their savings, which is not only a source of pride and independence, but which may also make the life and death difference between getting the care and services they sorely need and going without. So be aware that abuse can also be financial. We are always ready to take action on elder abuse whether it is financial or physical.

Dog Bites: Are there “Bad” or “Dangerous Dog Breeds,” or is this just a Myth?


Are there really specific breeds of dogs that are vicious by nature? There seems to be alot of information that indicates a certain breeds of dog (usually the “pit bull class of dogs”), is more likely to bite than other breeds.  However, is there really any truth to this?  The “pit bull class” includes American Pit Bull Terriers, American Staffordshire Terriers, Staffordshire Bull Terriers and English Bull Terriers.  Some of the other breeds that are listed as “more aggressive” include, but are not limited to:  the American Bulldogs, Rottweilers, Mastiffs, Dalmatians, Chow Chows, German Shepherds, Doberman Pincers or any mix of these breeds, or dogs who simply resemble these breeds.

What did nature intend? While it may be true that some breeds are known to be more aggressive, we need to be reminded that all dog breeds were once known to serve a specific function for us such as their guarding & protecting skills and/or hunting & gathering skills.  Although pets of these certain breeds most likely do not fulfill these original purposes, they do still carry the DNA from their ancestors that can predispose them to certain types of aggression.  So will targeting certain breeds and banning them from your community make you safer?

Some cities are passing “Breed-Specific” laws in an effort to make their cities safer. But does a town with less pit bulls mean less dog attacks or bites? There is no evidence that breed specific laws make neighborhoods safer, (see https://www.aspca.org/animal-cruelty/dog-fighting/what-breed-specific-legislation).

Although these breed-specific restrictions are meant to make the communities safer, they can also cause negative consequences such as:

  •  Families could be forced to move
  •  Dog owners with a “dangerous breed”  may try to stay under the radar may not seek routine veterinary care, including avoiding spaying/neutering and important vaccinations
  • Less community resources for dog licensing laws, leash laws and other laws that encourage responsible dog ownership

What doesn’t seem to be a myth is to always be cautious and careful around any dog! If you find yourself bitten by a dog, regardless of breed, you may want to determine if the owner is legally responsible, and we can help with that analysis.

Do You Know the Early Signs of Alzheimer’s Disease? You Might Be Surprised!



Have you ever had the experience when visiting with a family member that their responses and behavior seems different and a little “off.”  Are they having a bad day or is there something more serious affecting their health? Alzheimer’s disease is a progressive, degenerative brain disease which destroys memory and many other mental functions. This disease affects some 5 million people and is the sixth leading cause of death, though it actually is the third leading cause of death for the elderly. Though there are many types of and causes of Alzheimer’s there seems to be a some common features. Plagues and tangles in the brain are the main feature of this disease, along with the loss of connections between nerve cells in the brain. (https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet)

But how can you tell if someone is affected by this serious disease? A leading Alzheimer’s expert, Dr. George Perry, the editor of Journal of Alzheimer’s Disease recently discussed 7 signs of early Alzheimer’s disease and some might surprise you:
• Stealing or Significant Behavior Change
• Falling
• Forgetting the use of Objects
• Eating Strange items (such as paper or non-food items)
• Losing their Sense of Humor or Sarcasm (not being able to recognize sarcasm)
• Depression (new onset)
• Staring into Space

This is not an exact list. But what is important is identifying significant behavioral changes which may be indicative of brain changes consistent with Alzheimer’s. So if you notice these signs in a family member it is best to have them evaluated by a doctor.

Falls Can Kill — Stay STEADI

Falls can kill — keep seniors STEADIFalling can be deadly for any of us, but especially for people over 65 years of age. The CDC (Centers for Disease Control and Prevention) just issued a report outlining the danger and prevalence of falls in nursing homes and at home.

The numbers are scary: In 2014, falls caused 27,000 deaths and 7 million injuries. About 25 percent of older adults reported falling at least once in the last year.

So, falls are happening to many elderly. But are they just an inevitable part of aging? Not according to this report and a new program the CDC has recently launched.

The new program is called STEADI: Stopping Elderly Accidents, Deaths and Injuries. The program identifies fall risks and interventions to lower the risk of falls for both individuals and practitioners. It also offers education, practice guidelines and materials for practitioners.

For example, the CDC suggests three questions for health practitioners to ask their patients:

  • Have you fallen in the past year?
  • Do you feel unsteady when standing or walking?
  • Do you worry about falling?

People who answer yes to any of these questions face an increased risk for falling, and the CDC recommends further assessment.

Some of the interventions include a review of all the medications a person is taking. Practitioners should eliminate unneeded medications and reduce those that affect balance and cognition. If a vitamin D deficiency exists, adding this vitamin will improve bone, muscle and nerve health.

Falls can be the beginning of the loss of independence — especially for our seniors. So I appreciate these simple efforts to reduce the risk of falls.




Bitten by a Dog? What Should You Do?


Millions of people suffer dog bites or attacks every year. Unfortunately, most do not know what to do in the event that they’re bitten by a dog.

First, immediately seek medical treatment by going to the emergency room, urgent care center or your doctor. Bite wounds need to be treated as soon as possible.

Second, prepare a detailed written statement of what happened, including a description of the dog and location of incident. You think you will not ever forget all the details, but you will — so write them down. Take clear photos of all injuries, and include any article of clothing or personal item that might have been ripped or damaged during the attack.

Be sure to obtain information of the dog owner(s) and any witnesses. This information is important should you seek to make a claim (medical expense reimbursement, lost wages, damaged clothing or personal items, pain and suffering).

Contact the local health department to report the incident and find out about the dog’s vaccinations. You may need to get a tetanus or rabies shot(s) as soon after the bite as possible. Ohio law requires a dog bite be reported within 24 hours of the incident so the dog can be quarantined for rabies observation. Reporting to the local police and dog warden is also helpful with the investigation and prevention of future incidents from this same dog.

Finally you may want to consider making a legal claim for costs of medical treatment, lost time from work and for pain of the bite and required treatment and maybe a disfiguring scar. Such a claim would be against the dog owner’s insurance company and you can be sure they have any attorney. So you should consider working with an attorney such as my firm which has experience with these claims. Give us a call; there is no cost to you for a consultation.


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