Nursing homes are supposed to exist to care for the aging members of our society who are no longer able to care for themselves. They are supposed to be places of safety and security where our elderly loved ones can get the often extensive care that they need and the love and support of the staff that they desire. Unfortunately, these nursing homes have become less and less about the patient and more and more about turning a decent profit – or a more than decent profit.

One of the biggest drains on the finances of any business can be the employees, and the more highly trained and well educated these employees are, the more expensive they are to keep in employ.

A nurse is a highly trained medical professional, and are essential to the safe and proper running of a good nursing home. Unfortunately, the more focused these nursing homes get on money and on profit, the fewer nurses each shift seems to have until the remaining nurses are trying to do the work of twice their number.

These skeleton crews of nurses are simply unable to keep up with the demands of caring for our elderly relatives and for their invalid patients. They might find themselves taking shortcuts due to the nursing home’s negligence, desperately trying to keep up with the endless work of caring for people too old or too sick to care for themselves.

These nurses quickly become burned out, with many of them quitting or transferring into new fields to escape the physical and emotional stresses of working under these conditions.

The more nurses leave the nursing homes, the more the homes try to make do with fewer and fewer capable hands to do the work. These nursing homes become hotbeds of neglect and abuse, all in the name of turning a profit at the expense of the health and well being of the patients that the system was created to care for.

Nursing home patients are frequent victims of this terrible nursing home negligence, and little is done about the dangers that they face until truly horrible harm is done or patients die because of the negligence of the nursing home owners. Not only do exhausted and overworked nurses become more prone to aggressive or angry behaviors like neglect and abuse, but they also become prone to human error.

Incorrect medications or incorrect doses might be given by nurses who are working too many hours and doing too much work for their bodies to handle, causing painful complications and even death to the patients.

For too long, we have stood aside and hoped that the system would improve on its own, and the system has continued to get worse. As nursing homes realize that there are few to no consequences for behaving in a negligent fashion, they realize that they can get away with their terrible behavior without modification for the better. Occasionally one of them will get tagged with a lawsuit, however the huge profits that they have been turning help them to take care of settlements without any problems. The lack of consequences might even make them more bold in their negligent activities.

The time for letting these nursing homes get away with their neglectful behavior is over. It is up to us to stand up for the victims of these crimes of neglect and abuse and help the victims find their voices in the legal system. Anyone who has had to watch a loved one suffer from the aftermath of nursing home neglect or abuse knows the pain that they are going through.

It is time for these families to band together to stand up to the greedy nursing home owners and managers and make them stand accountable for their actions. The abuse will not stop until we stop it, and nursing home abuse lawyers can help us make this stand against the corporate profiteering mentality.

With the aid of a nursing home abuse lawyer, families of the victims of this terrible crime can make the nursing home owners pay for the suffering that they cause their patients through their negligence. They will be forced to deal with the consequences of their actions, and a big enough hit to their purses might even cause them to reconsider their impersonal and impractical approach to heal care for the elderly.

It is in our power to end nursing home negligence if only the families of the victims stand up and fight together for the justice that should be theirs.

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No one wants to live or place someone they love in a nursing home. But what if there was an alternative the the traditional hospital like nursing home. The Green House Model hopes to revolutionize how we care for our elders. Develped by Dr. William Thomas. Documentary short Produced by Wiland-Bell Productions Directed by Dale Bell Edited by Beverly Baroff

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About Author

Nick Johnson is lead counsel with Johnson Law Group. Johnson represents plaintiffs in many states and focuses on injury cases involving Nursing Home Abuse, Nursing Home Neglect and Negligence. Visit http://www.topnursinghomelawyers.com or call 1-888-311-5522

Let me give you a dose of reality when it comes to nursing homes. You may be shocked by whats revealed here. Few people really understand much about nursing homes. You’ll have a much better understanding about how nursing homes work and the experience to expect after your loved one is admitted.

Truth #1: Some nursing homes provide better care than others.

Nursing homes, like people, have their own strengths, weaknesses and skill levels. While each nursing home offers the same basic services like nursing care, food service, activities, laundry and round the clock care some facilities will emphasize one type of care over another.

For example, some facilities cater to Alzheimer patients. Some offer on-site dialysis services. Others focus on rehabilitating stoke victims. If your loved one has special needs, find a facility that meets those needs. You get the most effective care that way.

Truth #2: Some people get better in a nursing home. Some can’t .

If your mom is in the nursing home rehabilitating from a broken hip, you can realistically expect her to return home once the hip mends. But if she also has Alzheimer’s disease, that same expectation may be unreal.

Alzheimer’s sufferers have a difficult time understanding a therapist’s instructions. If they can’t duplicate instructions they can’t participate in their rehab.

If they can’t participate in rehab, the hip will not heal enough for her to regain its use. If she unable to regain her ability to walk, it’s not because a shortcoming of the nursing home.

Truth #3: Mistakes happen.
Nursing homes are like every other business. Mistakes will happen. Don’t expect perfection. You’ll be disappointed. Even in the best-run nursing homes, errors are a fact of life.

Some will be minor like clothing getting lost or an aide being rude. Some can be serious like medication errors or inadequate hydration.

The key is how management responds. Nursing home
management wants to do a good job. The good ones
take full responsibility for the errors and take steps immediately to correct it so it doesn’t happen again.

Management wants nursing home care to go smoothly. When it does you are happier with the care, the home is more profitable and the facility stays full.

Truth #4: Nursing homes are expensive.
The average cost of nursing home care across the USA is $55,000 per year. Some areas cost more, some less. Like any other service business, nursing homes expect to get paid.

The average nursing home stay is 29 months. Few families have an extra $132,917 hanging around (the average cost of care over 29 months. Paying nursing home costs produces a major stress for spouses both spouses and their adult children.

Truth #5:Medicare pays very little toward nursing home care.

The maximum Medicare will pay is for 100 days, but that’s not guaranteed. Without long term care insurance in place, most families start out liquidating their savings, spending it down on
nursing home costs until they qualify for
Medicaid.

Medicaid is the only public program that pays nursing home costs. To qualify you must meet tight income and asset limits.

Truth #6: Ugly nursing homes can give great care.
Don’t judge the quality of care by the nursing home’s decor . We all have a tendency to prejudge a company’s quality of service by how new the
place looks.

While it’s nice to have pretty surroundings, it’s not what counts. What matter are the people inside. Find out how conscientious and dedicated the people are inside the facility and you’ll know the care quality you can expect.

Truth #7: People working in a nursing home want to do a good job.

Your attitude toward them directly impacts the quality of care. It also regulates your stress and anxiety level. People naturally respond better to those who treat them with respect and kindness. Think negatively towards the staff of the nursing home you select and you’ll get negative results.

Truth #8: To get better care, shift your thinking.

One way to improve the overall nursing home experience is to make a slight shift in how you view your role there. Look at yourself as the individual responsible for selecting and managing a team to provides the care for your loved one.

It’s your job to find, interview and hire the best staff to handle the job. By viewing yourself as an involved and caring manager of the care team, you’ll feel more at cause over the activities of the staff.

In return they will be more receptive to you. You’ll receive daily reports on your loved one’s condition and how they have fared through out the day. Because the staff knows you care, they will gladly give you a heads up on health and social issues they see.

You’ll be able to head off problems before they become serious. More importantly, you’ll be more satisfied with the level of care provided.

Truth #9: To get the best care, visit frequently.
The quality of care rises directly with the amount of family involvement. The more family and friends visit a nursing home and the more involved you are with nursing home activities the better you’ll understand how the nursing home functions.

The better you understand how a nursing home works, the easier it is for you to ensure your loved one gets quality care.

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Almost everyone will deal with the possibility of putting a loved one in a nursing home. I have worked in the nursing home business for 44 years and I have seen the pain and suffering nursing home patients and their families deal with everyday. Nobody plans to live in a nursing home, but an accident or a health crisis can cause a nursing home admission. If you are 40 or older I urge you to make a physical retirement plan for yourself and your loved ones, so you will never have to live in a …

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Martin Sabel, has developed a toolkit called “How To Find The Right Nursing Home”. If you are worried about the safety and care of your loved one, this toolkit is a must. See for yourself at

There are a lot of different circumstances that must be taken into consideration when it comes to activities within nursing homes and <a title=Assisted living facilities at Great Places! Href=http://www.greatplacesinc.com/features/AssistedLivingFacilities.aspx>assisted living facilities</a>.Meaning, your activity must be able to appeal to almost every person within a nursing home- meaning, people with disabilities, age level and religious, ethical and political preferences. Here are six great ways to get everyone involved this Easter while making sure that most everyone in the assisted living facility is able to participate.

Spring Time Easter Tea Party
Nothing says Easter like a big Easter hat and white gloves. The other thing that a big white hat and gloves scream is a traditional English tea party, especially one in a spring garden, just in time for Easter. Since an English style spring time Easter party offers a brief escape for every age, mobility and even mental ability to enjoy it, it makes it a perfect activity for an assisted living facility. All you need are tablecloths, a couple tea pots, some tea sandwiches and small cookies and you are set. 

Easter Basket Decorating
It’s likely that many residents living in your <a title=Assisted living facilities at Great Places! Href=http://www.greatplacesinc.com/features/AssistedLivingFacilities.aspx>assisted living facilities</a> grew up with Easter baskets. Offer an open class on Easter basket decorating for residents to either give away to their grandchildren, donate or keep for themselves. Ask if a local craft store would host a basket decorating class, charging only for supplies or ask if an art student wouldn’t mind donating their time to offer friendly help and suggestions.

Egg Decorating
The ultimate classic Easter activity that is open to everyone! Boil several dozen eggs, create a food grade dye from several Easter egg dying kits and make an announcement one week that there will be an Easter egg dying activity in the main activity area. Lay newspaper over several circular tables and invite everyone who wishes to color and dye eggs. The best part about this is making deviled eggs for lunch the next day!

“Easter Parade” Movie Night
This fun musical for Baby Boomers is an Irving Berlin classic. Seniors who appreciate old black and white romance will love this movie. Serve lemonade and popcorn and project it onto a big screen. Charge a nickel admission for some added nostalgia.

Spring Cleaning For Charity
Active seniors like to be kept busy. What better way to appreciate their skills than to help raise money for a local charity. Invite every active assisted living senior to help organize a local fundraising “yard sale.” Hang flyers in local neighborhoods suggesting community-wide “spring closet cleaning” and offering to collect items for a sale benefiting a local charity. Send church members or other volunteers with trucks to gather the goods and hold the sale in the assisted living parking lot. To offer a thank you to the local church volunteers, offer to place a card with Easter service times in each bag of goods you sell.

If you work in an assisted living facility, don’t let Easter or spring for that matter come whipping through without paying any attention to it. What ever your religion, make it a celebration!

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WEDNESDAY – APRIL 22 – SPECIAL FEATURE: Incredibly gifted and independent thinker SOFIA SMALLSTORM has connected all the dots from chemtrails (the delivery system) – to Morgellon’s (the wiring system) – to the control of human consciousness (polymer triggers). Sofia explains how we are currently in the set-up (hardware) stage; the extension of Eugenics where technology will override our bio-systems; with this ultimate goal: “The entire biological world is being eradicated, to be replaced …

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About the author: Melissa Peterman is a web content specialist for Innuity. For more information regarding assisted living facilities go to Great Places.

It’s something most of us don’t want to talk about, but the problem of nursing home abuse is surprisingly widespread. Neglect, rather than actual abuse is more common, but the numbers speak for themselves – around a million residents in nursing homes are abused or neglected every year.

Although the problem has existed for years, it has only recently been seriously addressed. The first comprehensive report on nursing home abuse which actually analyzed reports from across the country was undertaken in 2001 at the instigation of Senator Henry Waxman, (Democrat-California).

The report studied a two year period from 1999 to 2000 and found that around 30% of the 17,000 or so nursing homes in the United States were cited for some kind of abuse. The report also found that on occasion, residents were actually attacked by other residents and staff members.

Abuse in nursing homes is often described as “institutional abuse” and there are several different types. Abuse can be physical, emotional, psychological, and even sexual. And many examples of abuse only come to light when residents or families actually complain.

So if your loved one is in a nursing home, what can you look for to make sure this isn’t happening? Ascertaining nursing home abuse can be difficult, as often residents have limited means to communicate. Identifying abuse can require frequent visits and observant monitoring.

Physical abuse is perhaps the easiest kind of abuse to identify. Signs include any kind of unexplained injuries such as cuts, wounds or bruising. Also, look for unreasonable physical restraint or forcing a resident to stay in his or her room for a long time.

Medication is an area where neglect or abuse can occur. Residents can be abused by either being given too much or not enough medication. Staff in nursing homes that have the job of administering medication to residents are required to be trained and experienced in this area.

Nursing home abuse can also be emotional or verbal. Residents who have been abused in this way may seem upset, agitated or withdrawn. They may also exhibit aggressive, insulting or humiliating behavior towards friends and family.

And be watchful for any unusual or obsessive behavior such as rocking, hugging oneself or nail biting. Also, try to observe a resident interact with a caregiver – they both should be comfortable in each other’s company. If a resident is withdrawn or fearful, it may be a warning sign of emotional abuse.

Sexual abuse is a terrible thing, but it occurs more often than is believed. Many seniors with dementia are particularly vulnerable, and sadly, many staff have not been adequately vetted before being employed. Some things to look for would be torn or bloody clothing, unexplained genital infections or venereal disease.

There are other warning signs. Any injury that occurs inside a nursing home that necessitates the need for a hospital visit or emergency treatment should raise a red flag. And you should be suspicious if a resident’s injuries or illness are not immediately reported to a family member or doctor.

One type of abuse which is particularly difficult to spot is financial exploitation. Some examples of this might include stealing or misusing resident’s possessions; cashing checks or forging signatures. Many elderly residents have little or no knowledge of how much money they have and when bills are due.

There are certain things you can do if you are trying to choose a nursing home for a loved one. Apart from talking to the residents and the administrator, try talking to some of the staff and the residents’ families. And according to Medicare regulations, you also have the right to see a copy of the most up to date state survey.

Try to visit a nursing home at different times of day or night, nursing homes are routinely not as well staffed at weekends or late evenings. Try to visit during meal times and ascertain the quality of the food, and whether residents are being assisted with their meals. Some facilities will allow you to eat with the residents.

Nursing home abuse is a terrible thing, and not always easy to identify. Having made the decision to put your loved one in a nursing home, it’s partly up to you to make sure they are getting the care they need, they may not be able to do it themselves.

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About Author

Nick Johnson is lead counsel with Johnson Law Group. Johnson represents plaintiffs in many states and focuses on injury cases involving Nursing Home Abuse, Nursing Home Neglect and Negligence. Visit http://www.topnursinghomelawyers.com or call 1-888-311-5522

Getting efficient exercise, both physically and mentally can be a challenge for some seniors who have disabilities, lack of physical assistance, or financial difficulties. Nintendo’s Wii Sports brings mental and physical exercising to seniors instead of seniors having to seek it outside their homes. It’s not just the kids playing video games these days. Retirement and com/features/NursingHomes.aspx”>nursing homes
and other senior assisted living facilities
, have opened their social hours to include Nintendo’s Wii for mental as well as physical activities.

Wii Makes Exercising Fun and Stimulating for Seniors
Now seniors can bowl, box, play tennis and golf right in their living room, what’s more is that they have to physically get involved. Seniors will find themselves standing up and swinging the virtual golf club, using the controller to wave their arms as they play tennis or sweep the air to bowl. It may not be overly straining, or cardiovascular, but the low-physical exertion and mental processes all help keep them and their brains active. Seniors can even participate in Wii Fit- purposely created to provide indoor-exercise.

Some Wii Fit “Games” For More Active Seniors

•    Aerobics
•    Balance Board
•    Strength Training
•    Yoga

Some of Wii Fit’s games may not be appropriate for all seniors but for more active seniors, some of the more cardiovascular games will prove great results. The more oxygen the brain receives, the better their mental health. That’s another reason why exercise is so important for physical and mental health. When people exercise, they take in more oxygen.

Some retirement homes are making the Wii apart of daily living because of its popularity and exercise/ stimulation benefits. One retirement home in Chicago has a daily Wii bowling tournament where they have set up a fan for seniors to dry their hands on before they have a turn. The social benefits of Wii are almost as important as the physical and mental stimulus. Isolation and loneliness can be a problem for many seniors, but a friendly game of tennis or golf can encourage a wealth of comments and friendly competition. 

Instead of grandparents not being able to relate to their children’s video games, now grandchildren can teach them how to play! It may not be the same thing as taking grandchildren to the Zoo or outside to play catch, but at least grandparents can interact with their grandchildren on a new and fun level of this generation’s game playing, while keeping physically and mentally fit.

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Rain Man” in one critical way, he is fully capable of living a fully independent life which makes him unique among people who have sever autistic disorders. He had emerged from the “other side” of autism with the ability to function successfully. He is even able to explain what is happening inside his head, an amazing feat in its own. Rain Man is a 1988 film drama written by Barry Morrow and Ronald Bass and directed by Barry Levinson. It tells the story of an abrasive, selfish yuppie, …

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About the author: Melissa Peterman is a web content specialist for Innuity. For more information about assisted living facilities , or nursing homes. go to Great Places.

Assisted living facilities are rapidly becoming the nursing homes of the future. According to the National Center for Assisted Living, there are over 36,000 licensed assisted living facilities nationwide with an estimated 1 million residents.[1] However, because there is no common definition for assisted living facilities, this number may not adequately reflect the prevalence of these facilities. In fact, in 2002 the National Conference of State Legislatures hailed the assisted living market as one of the fastest growing long-term care options for senior citizens; the number of seniors in assisted living facilities receiving Medicaid benefits has grown nearly 50% over the past few years.[2]

These facilities tend to aggressively market and recruit residents, many times promising staffing levels or services that, in reality, are not available.[3] In an attempt to compete with nursing homes, assisted living facilities are accepting patients with higher acuity. Most major chains promote special Alzheimer’s Disease Units, and are accepting patients with significant cognitive impairment. The reality is that many of these facilities have staffing that is inferior to the staffing levels present in nursing homes and simply cannot meet the needs of the higher acuity residents. The end result is that residents throughout the county are suffering from serious injuries due to the neglect and abuse that is taking place in these facilities.

A. Assisted Living v. Nursing Home Care

Assist living abuse and neglect cases and nursing home abuse and neglect cases are similar in some respects, i.e., both involve supervision and care of the elderly, but evaluating the assisted living case involves a greater perception of the differences in the two types of facilities.

1. Standards of Care. The litigation of assisted living abuse and neglect cases, like the litigation of nursing home abuse and neglect cases, can be an effective tool in forcing the industry to comply with proper standards. However, since most states have weak regulations, it often becomes difficult to establish the legal standard of care for a particular facility. Many times a plaintiff may have to fall back on basic community practice nursing standards that will apply when an assisted living facility contracts to provide more than just room and board.

Nursing homes are highly regulated and must comply with the regulations set forth in the Omnibus Budget Reconciliation Act (“OBRA”) of 1987[4] (otherwise known as the federal Nursing Home Reform Act) which set minimum standards of care for long term care facilities that receive federal funding. Unlike nursing homes, assisted living facilities are not regulated by the federal government, and the state regulations that do exist are inconsistent and, for the most part, not aggressively enforced.

When considering the basis for liability, one must consider whether the assisted living facility breached regulatory or community practice standards in admitting the resident whose needs may have been too great to be met by the assisted living facility. Many assisted living facilities, especially those with “Specialized Alzheimer’s Units” are accepting residents with advanced dementia who would normally be admitted to a nursing home, and possibly even a skilled wing of the nursing home. In such cases, it would be advisable to obtain an expert who will evaluate the resident’s condition and the relevant admission criteria. Such an evaluation will likely be beyond the abilities of a lay person, although many admissions decisions in assisted living facilities are being made by non-medical personnel.

Almost all states prescribe some limitation on who can be admitted into an assisted living facility. For example, Virginia regulations prohibit adult care facilities from admitting or retaining patients with a variety of conditions, including ventilator dependency, dermal ulcers stages III and IV, those requiring intravenous therapy or injections directly into the vein, nasogastric tubes, and those who require continuous licensed nursing care. 22 VA. ADMIN. CODE § 40-71-150 (West 2003). Other states contain similar limitations with prohibitions aimed at excluding patients with a demonstrated need for skilled or specialized care.[5] Assisted living facilities do not provide skilled care; consequently, they are uniformly required to screen patients to determine the level of care needed and reject patients whose needs exceed their capacity. State regulation of assisted living facilities is lax and, for the most part, ineffective. Only a few facilities in the Commonwealth of Virginia have been denied a license for regulatory noncompliance. It is the opinion of this author that weak regulatory enforcement is in part due to inadequate regulations that do not adequately specify industry standards.

2. Experts. To litigate a nursing home abuse and neglect case it almost always requires the use of medical experts who will define the standard of care and address breaches in the standards. As assisted living facilities are generally not considered health care providers, one may question whether an expert is necessary. This will obviously depend on the facts of your case. But in almost every case, at the very least, you will require an expert to establish causation and damages. Since many times injuries in assisted living facilities result in the patient requiring long term care in a nursing home, you may also want to consider obtaining a life care plan from a qualified expert.

Once you have obtained records, you should have the case reviewed by a nursing expert you can rely upon. Unlike nursing homes where there DON and Administrators are RNs, many of the nurses who work in the assisted living arena are LPNs and lack the background that you may be looking for in an expert. Finding talented nurse experts who are actively involved in assisted living care is a challenging task. This author has used the ATLA list serve, and random calling of facilities to locate qualified experts.

B. Evaluating the Assisted Living Case

1. Facility Records. The first step in assessing liability against an assisted living facility will be to obtain the records from the facility and the contract that was signed. The contract will likely define the duties undertaken by the facility. Most assisted living facilities have various levels of service. Level one might be the basic service which would include only room, board, meals and activities. Level four, or the highest level of service, might include resident assessment, care or service planning, medication administration, and dementia and nursing care. The standards applied by these facilities could be analogized to standards of care applied by a nursing home that was not providing skilled care.

2. Freedom of Information Act. In addition to obtaining the records, you will need to do a Freedom of Information Act request. This will help you identify the corporate entity that actually owns and operates the facility and may also allow you to see surveys or inspections that were done on this facility. The license should always be available, and may include information about the scope of services that the defendant facility is authorized to provide. Do not expect the surveys or inspection reports to contain the wealth of information that are available for nursing homes. Many times surveys are performed by the local Department of Social Services and do not include assessments of whether or not these facilities are complying with regulatory standards of care.

3. Case Review. The following are some factors to consider early on in deciding whether or not to prosecute an assisted living facility for negligence or abuse:

a. The nature of the resident’s condition upon admission. If she was mentally competent and independent with acts of daily living, you will confront significant problems with contributory negligence and comparative fault defenses.

b. The nature of the contract and duties assumed by the facility. If they only agreed to provide room, board, and meals, the defense will argue their duties are analogous to that of a landlord in an apartment building.

c. The quality of the relationship between the personal representative and the victim. If the victim is deceased, this may take on a greater importance as the nature of that relationship may define your damages under the applicable wrongful death act.

d. Whether the family members make good fact witnesses, appear genuinely outraged by the facility’s conduct, and complained and/or removed their loved one from the facility.

e. Whether the facility had serious staffing shortages or a pattern of neglecting their residents.

f. Did the victim suffer a significant injury in the facility that adversely affected the quality of her life for the future, or caused her death?

g. Do you have strong witnesses and powerful exhibits? Do you have an insider who is willing to blow the whistle on rampant staffing shortages? Do you have color photos of that pressure?

h. Do you have significant economic specials that are not encumbered by a Medicare or Medicaid lien?

i. Is the defendant a charitable organization, religious affiliate, or part of a large assisted living chain?

C. Theories of Liability

With weaker regulation, variety in industry standards, and market competition, it is not surprising that the U.S. General Accounting Administration, in 1999, identified problems in assisted living facilities that included inadequate or insufficient resident care, insufficient trained staff, improper medication administration, and not following admission and discharge policies required by state regulation. A 2000 study by the U.S. Department of Health and Human services found that a high percentage of the staff at assisted living facilities were not knowledgeable about the normal aging process and at least 60% of the staff did not know how to properly manage difficult behavior among assisted living residents.

Liability: Improper Admission. Many times, liability based upon an improper admission results when someone is admitted into a facility that is not locked down or enclosed. Many residents with dementia have a tendency to wander and they should simply not be admitted into facilities that are not locked down or do not have appropriate wander guard systems and/or alarms on the doors.

In Selvin v. DMC Regency Residence, Ltd., 807 So. 2d 676 (Fla. Dist. Ct. App. 4th Dist. 2001) a resident of an assisted living facility wandered off and was found dead in a nearby canal. Plaintiff’s complaint alleged two different theories of liability: the first was a statutory wrongful death action and the second was based on alleged violations of statutes relating to assisted living facilities. Plaintiff alleged that the facility had a common law and statutory duty to supply at least the level of services and care that all licensed assisted living facilities generally furnish elderly patients of the plaintiff’s decedent’s classification and condition. At the time of trial, plaintiff sought to introduce expert testimony about specific safety precautions that were the industry standard and further sought to show that the facility should have built a fence to prevent elders from wandering near the dangerous area of the canal. The trial court precluded this testimony, finding that the facility had no legal duty to fence off the canal to the general public. The Appellate Court reversed, finding that the facility undertook to furnish certain services of care and security which created such a duty of protection. The Appellate Court also held it was an error to exclude testimony regarding industry standards of what could have been done to protect these impaired residents from falling into the canal.

1. Liability: Falls. Another common area of liability in assisted living facilities involves falls. Expert testimony may not be required in such cases. See, Walker v. Southeast Alabama Med. Ctr., 545 So. 2d 769 (Ala. 1989).[6] However, fall assessment and fall prevention planning is usually done by a nurse or other medical provider and it may be advisable to have an expert address this issue. In large part, the need for an expert will be determined by the facts of your particular fall. If the staff simply dropped the resident during a transfer, an expert may not be necessary. However, if the resident came in to the facility with multiple risk factors for falling[7] which were never assessed or care planned and he fell one day while wandering the hallway, you should retain an expert to discuss how the standard of care for fall prevention was breached. To establish causation, she will have to testify that if appropriate standards were followed, it would have, more likely than not, prevented the particular fall which caused injury to plaintiff. As this is an area of first impression in many jurisdictions, it is advisable to educate the court with a trial memorandum addressing experts and other issues prior to trial.

D. Other Theories of Liability

Attorneys who prosecute assisted living facilities have an opportunity to be far more creative in the prosecution of these claims, given the broad range of theories that are available. Below are some typical theories that can be advanced against an assisted living facility.

1. Common Law Negligence. This is probably the most common theory of liability advanced in assisted living cases. Make sure you do not plead breaches in medical or nursing standards of care, or you may face the argument that you have pled a traditional malpractice case. You can plead the breach of regulatory standards and/or industry standards which proximately caused injury to your client. As assisted living facilities are not health care providers, they should not be subject to caps or other discovery limitations (i.e., quality assurance privileges) that apply to traditional health care providers.

2. Violations of the Consumer Protection Act. Make sure to inquire of your client what representations were made as an inducement to enter the facility. Obtain the brochures that were handed out by the marketing representative. Most consumer protection statutes provide relief for misrepresentations which were made as an inducement to enter into the consumer transaction. Case law has allowed such theories to be advanced even against health care providers, so there should be no reason that this theory could not be advanced against an assisted living facility.[8] The advantage is that many states’ consumer statutes allow for the recovery of costs and attorney’s fees.

3. Adult Protection Act. Most states have statutes that have been specifically enacted to protect the rights of elder Americans.[9] Some states, like Tennessee, specifically exempt health care providers from the application of such statutes.[10] As assisted living facilities are not health care providers, these exemptions should not apply.

4. Breach of Contract. Almost all assisted living facilities will make their residents sign a contract as a condition of admission. Scrutinize the contract carefully, as it may contain waivers of liability or waivers of the resident’s right to a jury trial. Such waivers can be asserted irrespective of whether one pleads a separate breach of contract claim. Under the laws of most states, contract damages will be limited to foreseeable economic damages, so it would be disadvantageous to plead this as your only theory of liability. However, the contract may have required that certain services be delivered to the resident (i.e., activities, assistance with acts of daily living, 24 hour supervision) which were not, in fact, provided. The resident may have suffered no physical injury from the failure to deliver such services and the defense will argue that such evidence should be excluded at the time of trial. With the contract theory properly pled, plaintiff can argue that such evidence is admissible to prove contract damages and recover monies for services which were not provided.

Be wary that the defense may argue that since plaintiff failed to quantify the extent of services that were not provided, any award of contract damages would be based on speculation. As such, you should make an attempt to have your client provide a good faith estimate in percentage terms as to what services were not provided. However, if you have a strong negligence claim based on a discreet event (i.e., a fall causing a hip fracture) you may not want to confuse the jury with a lot of collateral facts and issues that may not have a strong bearing on your damages.

5. Negligent Hiring and/or Retention. Consider this claim where you have intentional torts committed by an employee and some evidence that the defendants knew or should have known that this was a troubled employee. Many assisted living facilities don’t adequately screen their employees. This evidence may not be revealed until the discovery process begins and it is essential that you obtain the employee’s personnel file early on in litigation so you can amend your complaint if necessary. Depending on the tolling provisions of your individual claim, the cause of action may still relate back because it arguably arises out of the same set of operative facts. It is also a good idea to sue the employee individually. The same defense firm may represent both the employee and corporation, making it impossible to argue that the employee was not operating within the scope of his employment.

6. Wrongful Death. In any case where there is evidence that the facility’s negligence caused or contributed to the resident’s death, a separate wrongful death claim should be asserted. If there is any good faith basis to conclude that the negligence contributed to plaintiff’s death, you should plead both survivorship and wrongful death claims. Any long term care case has greater value if you can argue that defendant’s neglect caused plaintiff’s death. You may also have separate claims for injury that in no way contributed to the resident’s death. Such claims should be pled with your survivorship claims. Research the law in your jurisdiction to determine what forms of damages are recoverable under a wrongful death statute. If you’re in one of those unfortunate jurisdictions that allow only economic damages, you may not want to plead a wrongful death claim.

7. Punitive Damages. As the nature of economic damages in an assisted living case may not be impressive, and as your client will likely have suffered from several preexisting conditions that may weaken your compensatory damage claim, you should, whenever possible, plead punitive damages. Successfully pleading a punitive damage claim will also provide you with the basis for exploring defendant’s conduct with respect to other residents who were neglected in substantially similar ways to that of your client. Cases from around the country have upheld such punitive damage claims against nursing homes, and there is no reason that such precedent would not apply equally to assisted living facilities. [11]

8. Americans with Disabilities Act/Fair Housing Act. The Fair Housing Amendments Act of 1988 (FAA)[12] prohibits discrimination in virtually all housing and related activities, whether such conduct takes place in the private or public sector. This law is complemented by the Americans with Disabilities Act,[13] which, while it specifically does not include entities covered by the FAA, applies to non-housing functions of a facility, such as common areas, meeting rooms, cafeterias, adult day care, or long term care under Title II (state and local) and Title III (public accommodations) programs.

E. Selected Case Results

A survey of reported cases reveals very few published cases throughout the country. This author has litigated fall cases, negligent admission resulting in pressure sores cases, and one case involving an unfortunate resident who caught fire in the recreation room. The manner in which he was ignited was never explained by the facility.

In one assisted living case taken to verdict in Virginia, plaintiff had fallen during the evening and was placed back in bed (with a hip fracture) by a nurse aid who denied the fall ever happened. Plaintiff was alive at the time the case went to verdict and required ongoing nursing care because of her injuries. The jury rendered a verdict of $1.5 million in compensatory damages.

A brief survey of published assisted living cases results and verdicts across the U.S., reveals the following:

1. Dick v. Bixby Knowles Towers; No. NC 021 371, verdict date 04/15/1998. Plaintiff was walking through the dining room when she felt hot coffee spill onto her neck, back and shoulder. She turned away from the coffee and stumbled and fell. One employee acknowledged holding two pots of coffee at the time of injury, but denied spilling coffee on the Plaintiff. Plaintiff suffered a fractured distal femur and first and second degree burns. Verdict was $378,990, with medical expenses totaling $128,000.

2. Wiggins v. St. John’s Terrace Homes, Inc. Docket No. 96-2705-CA; FJVR reference No. 98:7-55 (July 1998) Plaintiff, an assisted living resident, was seated at a dining table when a coffee pot burst open, pouring scalding coffee down Plaintiff’s leg. Verdict of $223,893.

3. Weiland, as Personal Representative of Louise Debenack, v. Alexandra & Co. of Boca Raton, Inc., d/b/a/ The Colonnade at Haverhill, Docket NO. CL 99-00066 AE; FJVR reference No. 01:6-54 Pub.(June 2001). Plaintiff found dead after she developed a UTI that became septic. Upon admission to hospital, plaintiff had a large hematoma which was not explained by the defendant. Settlement for plaintiff for $1 million.

4. Estate of John Doe v. Anonymous Assisted Living Facility. (Reported from the Michigan Trial Reporter, JAS Publication) Settlement of $1,350,000 for an elderly assisted living resident who died from burn injuries sustained while showering. Plaintiff’s theory of negligence alleged that defendant was negligent in not having proper temperature controlling devices for their residents.

5. Davis v. Premium Health Care, Inc. Docket No. 98-20263, Reference No. 01:8-12 (August 2001). Settlement of $300,000 for decedent who developed multiple pressures sores (including a stage IV) while in the facility.

6. Casaletto v. Helen Homes Corp., d/b/a The Palace Gardens, Docket NO.: 01-12468 BA 20; FJVR Ference No. 02:9-44 (Miami, September 2002) Defense verdict involving an 86 year old male who was admitted to an assisted living facility in May and suffered a fall in August of the same year. Plaintiff alleged improper admission and failure to properly supervise. Defendant contended that the decedent was a proper admission and that the level of supervision was appropriate in he ambulated independently. Both parties relied on experts in the area of assisted living administration.

7. Pollock v. CCC Investments I. LLC d/b/a Tiffany House by Marriot, Docket No. 01-16746, Ref. No. 05:3-9 (Florida 2005). Defense verdict involving a resident who was murdered by another resident. Defendant’s argued they had no notice of the other resident’s potential violent conduct. The jury found there was no negligence on the part of defendants that caused plaintiff’s death. They also found there was no violation of the assisted living facility’s resident’s rights under Florida statutory law. Defendant’s highest offer was $750,000 with lowest demand at $9,900,000.

II. Conclusion

As this is a new and evolving area of the law, attorneys who litigate these cases should strive to establish favorable precedents for those who follow. If the recent explosion in nursing home litigation is any indication, assisted living facilities could be the nursing homes of the future. As with nursing home litigation, the civil prosecution of these cases provides an important safeguard in protecting the rights of our elderly and assuring that proper standards are followed in the industry.

[1] Mollica, Robert L. State Assisted Living Policy: 2000. Portland: National Academy for State Health Policy, 2000, Executive Summary.

[2] Issue Brief, Health Policy Tracking Service, National Conference of State Legislatures, October 1, 2002.

[3] Based on a study done by AARP that randomly shopped some 80 assisted living facilities, a pattern of discrepancies was found between what representations were made in the marketing materials versus promises made in the admission’s contract. Two previous surveys that compared marketing materials and assisted living contracts, one by the American Bar Association’s Commission on Legal Problems of the Elderly Consumer Reports, and the other by the U.S. General Accounting Office, revealed similar problems. Adrienne Oleck & Bruce Vignery, Nurture or Neglect? Challenging Deceptive Practices in Assisted Living Facilities, CONSUMER ADVOC., Jan. 2001, 7(1).

[4] See, 42 C.F.R. 483.10 et seq.

[5] Montana law prohibits assisted living facilities from admitting patients who, inter alia, are non-ambulatory, in need of physical/chemical restraints, or unable to self-medicate. MONT. CODE ANN. § 50-5-226 (2002); Florida law prohibits admission of residents who are bedridden, those who have stage III or stage IV pressure sores and those residents who may require 24 hour nursing care. FLA. STAT. Ch. 400.407 (2005).

[6] In Walker, there was evidence that a patient had a history of falls and further that the patient’s doctor had instructed the nurse to leave the bed rails up at all times. A nurse lowered the bed rails and the patient fell. The court held that the plaintiffs were not required to present expert testimony because the breach of care alleged by the plaintiffs, leaving the bed rail down contrary to doctor’s orders, was so apparent as to be understood by a layman.

[7] Risk factors for falling could include dementia, confusion, unstable gait, prior stroke, arthritis, medications usage, history of falls, history of agitated behaviors, vision problems, and weakness or muscle atrophy.

[8] Dorn v. McTigue, 157 F. Supp. 2d 37 (D.D.C. 2001) (holding that District of Columbia Consumer Protection Act applied to the medical profession); Chalfin v. Beverly Enters., Inc., 741 F.Supp. 1162 (E.D. Pa. 1989), reconsideration den., 745 F.Supp. 1117 (E.D. Pa. 1990) (health care services provided by a nursing home were within the scope of “trade or commerce” provisions of Pennsylvania consumer protection laws); Winkler v. Interim Servs., Inc., 36 F. Supp. 2d 1026 (M.D. Tenn. 1999) (Disabled Medicare beneficiaries’ claims against home health care provider for violation of Tennessee Consumer Protection Act were not exempt on the grounds that the provider’s termination of services was regulated by the Medicare Act, given the alleged claims did not arise under the Medicare Act).

[9] According to the National Center of Elder Abuse, www.Elderabusecenter.org/laws, all fifty states and the District of Columbia have enacted legislation authorizing the provision of adult protection services in cases of elder abuse. The statutes vary widely on definitions of abuse, investigation responsibility, and remedies for such abuse.

[10] The Tennessee Adult Protection Act, TENN. CODE ANN. § 71-6-101 et. seq. (2002) does not apply to actions against “health care providers,” as defined in the TENN. CODE ANN. § 63-6-228 et. seq. Alternatively, Tennessee’s Medical Malpractice Act provides the statutory authority to suits against health care providers.

[11] See, Texas Health Enters. V. Geisler, 9 S.W.3d 163 (Tex. App. Fort Worth 1999) (repeated shortages of staffing and other acts of negligence supported punitive damage award against defendant); Estate of McIntyer by & Through Ex’r v. Transitional Health Servs., 1998 U.S. Dist. LEXIS 13965 (M.D.N.C. May 1998) (holding that defendant’s knowledge that it was operating in serious violation of several health codes and that it took very little, if any, action to remedy those violations might reasonably be found to constitute reckless indifference to the rights of their elderly residents with varying medical and non-medical needs); Beverly Enters. – Florida v. Spilman, 661 So. 2d 867 (Fla. Dist. Ct. App. 5th Dist. 1995) (testimony that expert was “outraged” at poor level of care of resident who developed and died from an infected decubitus ulcer supported punitive damage award against corporation and management company). See also, Christopher Vaeth, Allowance of Punitive Damages in Medical Malpractice Action, 35 A.L.R. 5th 145 (1996).

[12] Fair Housing Amendments Act, 42 U.S.C. § 3601 et. seq. (2000).

[13] Americans with Disabilities Act, 42 U.S.C. § 12101 et. seq. (2000).

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Jeffrey J. Downey – an attorney who has written extensively on the long term care industry and trial practice. Mr. Downey practices in Washington D.C., Maryland and Virginia representing victims of elder neglect and other torts.

For more information on how to select a nursing home / assisted living facility, or if you need someone to talk to about your legal rights, call the Law Office of Jeffrey J. Downey at (202) 789-1110 or visit us on the web at www.jeffdowney.com

Making the decision to put ourselves or a loved one into a nursing home is one of the hardest we face. Placing somebody in one of these facilities is rarely the ideal situation and can be emotionally draining. It is important to us that we take care of our families as they have taken care of us, and negative media coverage, as well as social stigma regarding nursing homes make facing this dilemma even more troublesome.

In addition to considering all of the negative news coverage, one must also take into account several other factors, such as nursing home staff, quality, environment, and life. There are so many options from which to choose that, at first, making an informed decision may seem impossible. Just knowing whether to choose a nonprofit nursing home, private nursing homes or a chain can be a daunting task. Fortunately, there are tools available to us that can help us ensure that we are making the best choice.

When beginning your search you should also consider and special needs you or your loved one may have and find the facilities that are best equipped to handle those needs. Does your loved one need skilled care which allows them access to Medicaid which is accepted by most nursing home chains? Or would you prefer a private-pay or nonprofit facility? Figuring out the answer to this question can help you narrow the field of possibilities.

Once you’ve figured out which type of facility you prefer you can begin contacting these types of nursing homes near you. Before scheduling visits, you should narrow your search even further by conducting phone interviews. When calling get the answers to important questions like: "What’s your staff turnover rate?", "Do you offer skilled care?", "How much can I expect to spend with your facility?" Asking these questions will help you to figure out which facilities you would like to tour.

While touring a facility it is important to remember that cleanliness is more important than newness. Although a nursing home may be brand new or may have recently been renovated, the cost the entity has incurred is normally passed on to you. A long standing facility that is clean is more likely the best choice.

Long standing homes are also more likely to have staff that have been with the facility for many years. A nursing care home with staff members that have worked there for a long time points to job satisfaction; satisfied employees usually enjoy working with the residents and are likely to administer higher quality care. Perhaps the most important thing to us when we look into an assisted living facility is making sure that our loved one is well taken care of.

You can ensure that your loved one is getting the fairest treatment by becoming familiar with the rights of residents. Nursing homes across the United States must honor the Resident’s Bill of Right according to federal law. This bill includes but is not limited to the right to: information about one’s medical condition, choose one’s own physician, manage one’s own personal finances, privacy, dignity and respect, be free from abuse and unnecessary restraint, voice grievance without retaliation, no unfounded discharge or transfer, be allowed visitors and to control visits, and legal counsel. All nursing homes in the United States are required to make the Resident’s Bill of Right available at all times to residents and their families. For a complete list of these rights you should be sure to ask for a copy at any of the nursing care homes you visit.

Making the decision to place yourself or a loved on into a nursing home does not have to be a bad experience. There are many options available and with a little bit of research it is easy to become educated enough to make the best choice possible. Nursing home life can be fulfilling, so long as we or our loved ones are properly cared for. Be sure to check into your options thoroughly, doing this will to ensure that you have chosen a clean facility with a low staff turnover rate; a facility that regularly schedules activities for the residents outside of the campus, and which adheres to the Resident’s Bill of Rights, easy. 

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Jennifer Carnduff Narrates beautifully the complete picture of the nursing home and pain is unavoidable yet can be constructive if treated on time in Nursing homes.

Assisted living communities accommodate a large percentage of the elderly population. Similar to individual residences, these communities provide various accommodations for those who need specialized assistance when it comes to Activities of Daily Living.  There are six basic activities generally classified as Activities of Daily Living, also known as ADL’s.  These activities may include bathing, dressing, eating, transferring (e.g.: from bed to wheelchair) walking and medication management.

When seeking information on assisted living communities in your area, the Internet can be a valuable, multifaceted resource. Using specialized comparison services, those who are looking for different options can find a community that provides both specialized personal care and general assistance with ADL’s. When the complications of aging begin to take their toll, the elderly will surely benefit from the many services offered in assisted living. 

Considered as somewhere in-between nursing homes and independent living, assisted living communities provide an entire range of services. Trained nurses and other specialized personnel make sure that their residents enjoy the quality of life that they are entitled to.  In addition to offering personalized assistance, assisted living communities aim at creating a caring environment that go a long way in lessening feelings of isolation and depression. Many residents benefit from new found friendships and depending on the community and the accommodations offered, they are even allowed to bring their pets.

In relation to ADL’s, assisted living communities also provide delicious meals, weekly housekeeping and linen services. The personnel are also instructed to offer assistance when it comes to taking medication and managing personal finances. When individuals find it increasingly difficult to live on their own and a nursing home is not a present need, an assisted living community may be the next best thing to living independently. With this in mind, and the sometimes difficult process of locating individual communities online, a single source reference website can be an excellent tool in finding an assisted living community in your area.

Unlike nursing homes, assisted living facilities provide health care and personal assistance for those who are not 100% independent. The best candidates for assisted living are not the individuals that require constant health care and assistance with everything they do. The best candidates just need a little bit of help with one or several ADL’s, and other regular activities. As senior sometimes require medical attention, assisted living communities may have medical care centers attached to their community, this way a seniors are given an alternative to stand alone nursing homes.

Creating an individual plan for each resident, assisted living communities provide great care and personalized services. With all this in mind, it is best to consider all senior care possibilities. Despite the great service offered by assisted living and retirement communities, many people prefer to remain in their home.  If this is the case, Home Care may be an option, offering a superior level of independence then that of a senior community.

If you are wondering what home care actually means, you should know that the Internet is a great source of information in that area as well. Apart from searching for home care providers, you can also read about the types of home care options offered by specialists in the field.  In addition to assisting with personal ADL’s, home care aids are prepared to take care of housekeeping, provide assistance with shopping and running errands. Making the right choice can be easier when you are equipped with the appropriate information and understand the many different options now available through the Internet.

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No matter if you are searching for assisted living facilities or home care providers, we believe our website to be a valuable resource. Feel free to browse and discover an entire array of health care options at your finger tips!

Nursing homes are designed to serve patients who require preventive, therapeutic, and rehabilitative nursing care services for non-acute, long-term conditions. Usually residents are elderly and frail, but not bedridden, although many will require canes, walkers, or wheelchairs to help them get around.

Patient stays are on the whole relatively long, with the majority of residents staying for the remaining months or years of their life. Most UK Nursing homes will also care for a number of convalescent patients who are in recovery from acute illnesses, but no longer require hospitalisation.

Nursing homes present special design challenges in that for most residents the nursing home is not just a facility, but indeed their home. The reality is that in most cases the residents will live there for the rest of their lives and, moreover, rarely leave the premises at all. The nursing home therefore becomes their entire world. The challenge is to design an environment that is sensitive and responsive to long-term human needs and well-being, both physical and emotional. Thankfully there are a growing number of companies who specialize in the manufacture and supply of stylish yet practical Nursing Home furniture, which means designers are no longer limited in terms of interior décor.

Building Attributes

Nursing homes are primarily patient care focused rather than medically focused, and consequently its more important attributes are those focusing on the general happiness of its residents rather than high-tech considerations. Features of a well designed nursing home are as follows:

Homely environment

The impact of surroundings and environment on the recovery of Nursing Home patients cannot be underestimated. Both the building’s architect and interior designer needs to gain a thorough understanding of the function of the venue and the profile of its patients. Attention must be paid to ensuring that the exterior and interior design cater for physical and mental disabilities along with loss of sight. This should all be packaged in such as way as to suggest a home away from home as opposed to a medical institute.

Efficiency

In order to create the most efficient space possible for both staff and patients, the nursing home’s design should promote efficiency by minimizing the distance it is necessary to travel between spaces that are most frequently used such as recreational rooms, dining areas and toilets.

Ease of supervision is another essential feature, as allowing supervision of patients by minimal members of staff can reduce the total number of employees required by the nursing home, and can free up nursing staff to perform other tasks at any one time.

Cleanliness and Sanitation

Odour control is a priority for all nursing homes, since many patients are likely to experience occasional incontinence. The resulting odour can give the impression of poor hyginene and uncleanliness to family and other visitors. In addition to operational practices and careful choice of nursing home furniture, facility design can help odor control in the following ways:

Highly visible toilet rooms in key locations near spaces where residents congregate

The use of appropriate, durable finishes for each space used by residents

Proper detailing of such features as doorframes, casework, and finish transitions to avoid dirt-catching and hard-to-clean crevices and joints

Adequate and appropriately located housekeeping spaces

Effective ventilation, which may need to exceed nominal design levels

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Cliff Arnold worked in the Nursing Home industry until very recently. He is a big fan of Knightbridge Furniture.