Articles Posted in Nursing Home Abuse

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Private nursing homes deserve to make a profit – a fair profit.  Nursing home operators, like those managing any other type of business, take steps necessary to maximize profit.  However, far too often, the methods used to do so run afoul of nursing homes’ statutory and moral obligation to “attain or maintain the highest practicable physical, mental and psycho-social well-being” for their residents.

Many of the expenses in operating a nursing home are fixed – meaning there is nothing the operators can do to decrease them.  Expenses such as rent, food, supplies, and electricity are not easily decreased. On the other hand, staffing is an area where money can be saved; however, often at the expense of the residents.

In the clinical setting, nursing homes typically have registered nurses, licensed professional nurses and certified nursing assistants.  They may also have physical therapists, occupational therapists and speech therapists. The highest expense for a nursing home is staffing and the most expensive employees are registered nurses.

Our Jacksonville nursing home abuse and neglect lawyers see the effects of understaffing in nearly every case we handle.  Most commonly, we see the number of registered nurses cut to the bare minimum. Why does this matter?  It takes at least two years of college to become a registered nurse and many have a four year bachelor’s degree.  In contrast, it takes about one year of schooling to become an LPN.

Florida’s Nurse Practice Act spells out the resulting difference: RNs are able to make assessments of patients’ conditions; while LPNs are not.  This means that an RN has the training and experience to consider what is going on with a nursing home resident and make, or suggest, changes to his or her care plan, medication or treatments.  LPNs, on the other hand, are not trained to make such assessments.

Many people think that the resident’s doctor will make rounds and perform global assessments on a frequent basis.  This is not accurate.  After an initial visit, it is common that doctors only see residents when a concern is brought to their attention.  Without registered nurses performing assessments, a patient’s decline, whether it be from infection, malnutrition or dehydration, often goes unnoticed until it is too late.

We have seen many examples of this here in Jacksonville.  In 2016, we resolved a wrongful death case against a large chain nursing home operator whose employees apparently did not notice its resident had an infection until it had gotten so bad that he was rendered unconscious by sepsis.  He died within a day of being transferred to Memorial Hospital Jacksonville.   Notably, the nursing home could not produce a single nurse’s note for the last week of his life.  Had a registered nurse seen him, his infection may have been caught and treated before he became terminally ill.  That nursing home was severely understaffed, and was found to be especially lacking in registered nurses.  The man was only 61 years old.

Attending doctors will not take up the slack.  It is important to understand that the doctors that make rounds at nursing homes are typically not employees of the nursing homes.  Most residents are assigned a doctor by the nursing home.  The nursing home chooses among several that it has contracts with; however, the doctor is not an employee of the nursing home.  Further, any neglect on the part of the doctor is not attributable to the nursing home.

Florida has standards that require a minimum number of LPNs and CNAs.  A nursing home’s failure to meet these standards can result in a moratorium on new admissions.  In just about every nursing home case we litigate, we find that the nursing home staffed only to the level of these minimums regardless of  how serious the needs of their residents are.  We have also found examples where a nursing home inflated the number of staff performing direct care to the residents in order to make it appear that the standards were met.  Continue reading

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As Florida’s largest,  and the country’s sixth largest, nursing home operator, Consulate Health Care operates approximately 77 nursing homes in Florida and approximately 210 nationwide.  Statewide, Consulate has had a spate of regulatory and judicial troubles as outlined by the this article in the Naples Daily News: https://www.naplesnews.com/story/news/special-reports/2018/05/31/neglected-fraud-and-abuse-nursing-homes-florida/542609002/.

Highlighting those troubles is a judgment entered against Consulate in February of this year for $347.8 million arising out of allegations of Medicare and Medicaid fraud.  While that judgment was set aside by the Federal trial Court, an appeal is pending.

In the Jacksonville area, Consulate operates five nursing homes: Consulate Health Care of Jacksonville; San Jose Health and Rehabilitation; Harts Harbor Health Care Center; Consulate Health Care of Orange Park; and Governors Creek Health and Rehabilitation.   None of these nursing homes has received more than 2 stars on a one to five star scale set by the Centers for Medicare and Medicaid Services.  Governors Creek Health and Rehabilitation Center in Green Cove Springs, Florida, has a one star ranking.  The remaining four nursing homes each have a two star ranking.

Medicare ranks every nursing home in the country that receives payment from Medicare on the one to five star scale.  Rankings are based on  criteria including: health inspections; staffing levels; and 16 different quality measures.

Health inspections are conducted by Florida’s Agency for Healthcare Administration.  Approximately once a year, each nursing home is subjected to an unannounced survey.  In addition, AHCA may also survey a nursing home in response to a complaint.  During a survey, the inspectors review random resident records, staffing reports and the nursing home’s policies and procedures.  Inspectors also interview residents and family members.  In addition, building issues, such as cleanliness and fire protection equipment are evaluated.

Staffing levels are assessed based on “per patient day” averaging.  The number of registered nurse, licensed practical nurse and certified nurse assistants employed are broken down on a per patient day average.

The quality measures include: the percent of residents who report moderate to severe pain; the percent of residents with new or worsened pressure ulcers (bedsores); the percent of residents who were given the flu vaccine; the percent of residents given anti-psychotic medication; the percent of residents experiencing falls causing major injuries; the percent of residents with urinary tract infections; the percent of residents who develop bowel or bladder incontinence; the percent of residents requiring an indwelling urinary catheter; the percent of residents who were physically restrained; the percent of residents whose need for assistance with activities of daily living has increased; the percent of residents losing an excessive amount of weight; and the percent of residents suffering from depression.

Here in Jacksonville, our nursing home abuse lawyers have handled three wrongful death cases against Consulate’s Jacksonville area nursing homes.  In comparison, we have never accepted a case against any of the five star facilities in the Jacksonville area.  Continue reading

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A licensed practical nurse working at Life Care Center of Orange Park nursing home was arrested this week for grand theft of a controlled substance.  The arrest came following an investigation into missing prescription painkillers.  Over one hundred hydrocodone and oxycodone pills were reported missing.

Life Care Centers operates hundreds of nursing homes in twenty-eight states.  In the Jacksonville area, it operates three nursing homes: Life Care Center of Jacksonville; Life Care Center at Wells Crossing (located in Orange Park); and Life Care Center of Orange Park.  These three nursing homes have received high rankings from the Centers for Medicare and Medicaid Services, respectively earning five stars, three stars and five stars on CMS’ one to five star rating system.  While certainly not an infallible measure of quality, our lawyers have noticed a strong correlation between the ranking system and the level of care provided.

Theft of prescription painkillers, or “drug diversion” as it is commonly called, at nursing homes is a nationwide problem.  The Controlled Substances Act of 1970 regulates narcotic pain medication. Nursing homes must maintain a Controlled Substances Log pursuant to  21 U.S.C. 827(a).  A Controlled Substances Log is used to track every dose of pain medication by recording the date and time the pill was obtained by a nurse, the name of the resident receiving the medication, the name of the nurse receiving the medication, and the name of the subscriber.  Pain medication must be kept in a separately locked cabinet in a secure area of the nursing home.

This level of documentation does not however, ensure that the nurse actually gives the pain medication to the resident.  Many residents of nursing homes suffer from a degree of confusion or dementia.  It is a simple enough task for a nurse to provide the resident an over the counter pain reliever while pocketing the actual narcotic.  Of course, such a practice is a clear violation of the nursing standard of care and a violation of the nursing home resident’s rights.

The effect on the defrauded nursing home resident is more than just having to temporarily endure needless pain.  The sudden cessation of regularly taken pain medication can cause serious withdrawal symptoms.  Further, unaddressed chronic pain causes a host of other problems including: depression; interruption of sleep; impaired cognitive function; compromised cardiovascular health; and decreased quality of life.

If you are concerned that a loved one is not receiving his or her pain medication, there are steps you can take.  First, we recommend a meeting with the resident’s doctor, the nursing home’s director of nursing and the resident’s unit manager to discuss the issue.   Second, a urinalysis can be performed to determine the amount of pain medication the person has metabolized.  Lastly, we always recommend that anyone concerned about nursing home neglect or abuse contact Florida’s Department of Children and Families abuse hotline at 1-800-96-ABUSE. Continue reading

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Under intense lobbying by the nursing home industry in 2001, the Florida legislature enacted legislation requiring a pre-suit investigative and notice period before a lawsuit could be filed seeking compensation for death or injury caused by nursing home neglect.  At first glance, the pre-suit requirements may have seemed like a good thing.

Before filing suit, a claimant must have the matter reviewed by a doctor or registered nurse expert.  If the expert comes to the conclusion that the nursing home did something wrong that caused harm to the resident, the case can progress.  After that, the parties are to engage in a 75 day period during which they are to exchange information.  Finally, the parties are required to mediate before suit can be filed.

The problem is that the statute provides no repercussions if a nursing home refuses to provide information and refuses to mediate – and, as a result, that is exactly what the nursing homes do.  In litigating nursing home injury and death claims for more than 10 years in Jacksonville, we have had only one nursing home willing to engage in the statutorily “required” pre-suit mediation.

The truth is that the pre-suit process provides no benefit whatsoever to injured residents.  Instead, it greatly increases the cost and length of time it takes to seek compensation.  Meanwhile, the nursing homes reap huge benefits from this process at no cost.

Florida Statute § 400.0233 requires that the claimant’s attorney conduct a good faith investigation.  To do so, the attorney must have the nursing home’s records for the client in question.  This is where the delay starts –  nursing homes are provided 30 “working days” to produce the records of a former resident.  Given weekends, this allows a nursing home approximately 40 days to simply make a copy of the records.

The lawyer must then review the records to determine what happened.  The records are not easy to read and typically involve hundreds of pages.  In short, the lawyer is working backwards to determine if the injury, illness or death could have been prevented.  To do so, we are scouring the record for signs and symptoms of the impending illness or incident along with any responses made by nursing home staff to prevent the injury or illness.

If the lawyer believes that the nursing home operator was neglectful or abusive, and, in so doing, caused serious harm or death, the statute requires the records be reviewed by a physician or registered nurse.  This is  expensive as a reviewing doctor or R.N. is going to charge expert witness fees on an hourly basis to review all of the pertinent records, typically including those from a receiving hospital.

If the expert comes to the conclusion that the nursing home was negligent or abusive, then a pre-suit notice must be sent by certified mail to every “prospective defendant.”  It can be difficult to determine who the prospective defendants are as nursing homes in Florida are typically operated by a maze of related limited liability companies.  This is purposefully done by nursing home operators in attempt to shield themselves from liability and to avoid transparency regarding their profits.

The statute allows for the parties to request documents and take statements from witnesses.   However, the nursing home operators refuse to comply with these requests.   They get away with this because Florida’s statutes on nursing home claims (unlike the medical malpractice statutes) provide no consequences for the nursing home’s refusal to comply with the statute.

After service of the pre-suit notice, nursing home operators have 75 days to review the claim.  At the end of this period, the operators, or their insurers, are supposed to provide a response either rejecting the claim or making a settlement offer.   The nursing homes almost never do  this as a failure to respond is considered the same as a rejection.

After the 75 day period expires, the statute requires that the parties mediate the case.   This provision is almost uniformly ignored by the nursing homes, and, again, it is because the statute provides no consequence for failing to do so.

In summary, throughout the entire statutory pre-suit process, the nursing home operators do essentially nothing and the injured victim spends an extraordinary amount of time and money for no reason.  The delay alone is a major injustice as victims of nursing home abuse and neglect tend to be elderly or infirm.  Further, after months of this needless delay, nursing home staff  members are no longer as able to recall all of the facts surrounding the resident’s situation.

All of the benefits supposedly provided by the statute – information sharing and an early mediation – are erased by a statute that contains no teeth.   It is time for the statute to be repealed. Continue reading

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Early this morning, a female resident of a Jacksonville nursing home died after falling from her bed.  The incident occurred at the Woodland Grove Health and Rehabilitation Center near Belfort Road on Jacksonville’s Southside.  The Jacksonville Sheriff’s Office is investigating the incident as an accident.  Florida’s Agency of Healthcare Administration will also investigate the matter.

The Centers for Medicare and Medicaid Services ranks all nursing homes that accept payment from Medicare on a scale of one to five stars.  Overall, Woodland Grove Health and Rehabilitation Center scores three out of five stars and scores a two out of five with respect to health inspections.   It is a 120 bed facility owned, in part, by Greystone Healthcare Holdings, which has 26 nursing homes in Florida, with one in Jacksonville, one in Fleming Island (Orange Park), two in Daytona Beach and one in Starke.

Falls are one of the leading causes of injury and death of nursing home residents.  According to the Centers for Disease Control and Prevention, a typical nursing home with 100 beds will report between 100 and 200 falls per year.  In addition, falls are often not reported.  Between 50% to 75% of nursing home residents will experience a fall each year.  Roughly 35% of falls in nursing homes involve residents who cannot walk.

Not only are falls common, the consequences can be catastrophic.  Annually, approximately 1,800 people die as a result of a fall in a nursing home.  Falls also cause serious life-changing injuries including arm, leg and hip fractures.  The immobility that results from such a fracture can lead to functional decline that greatly shortens a person’s lifespan and diminishes his or her quality of life.

Falls in nursing homes have a host of causes including muscle weakness, cognitive problems, changes in medication, wet floors, a nursing home’s failure to provide assistance when transferring from a bed to a wheelchair or toilet, incorrect bed height and improper or missing assistive devices.

There are many ways that nursing homes can reduce the risk of falls.  First and foremost, each resident must be screened for their fall risk.  Residents with an increased fall risk require care plans that put in place appropriate safeguards.  Some residents will require a one person or two person assistance with transfers to and from the bed and toilet.  Others require assistive devices when moving around such as a cane, walker or wheelchair.

The facility itself must also be scrutinized to make sure that hand rails are in place in bathrooms, floors are level and clean and that call buttons work.  Socks, slippers and shoes should have non-slip surfaces.  Beds should be lowered for persons will a high fall risk and cushioned mats should be placed around the bed to minimize any injury that may occur.  Bed rails or anti-roll cushions should be used for persons at risk for falling out of bed.  Residents should be educated regarding common scenarios that lead to falls and how to avoid them.  Finally, the residents should receive physical therapy and nutrition sufficient to keep them as strong and able as possible.
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A video of a resident on resident beating that lasted for over two minutes finally culminated in the state shutting down a beleaguered assisted living facility in Williston, Florida.  Williston is located about 20 miles southwest of Gainesville. The video shows an 86 year old man being punched more than 50 times by a 52 year old resident.  The 86 year old suffers from dementia.  The 52 year old has a history of mental illness and aggression.  During the beating, there were no staff members present in the common area where the incident occurred.  Furthermore, no one was assigned to monitor the surveillance camera that captured the incident.

Florida’s Agency for Heathcare Administration (“AHCA”), which regulates both nursing homes and assisted living facilities, sanctioned the Good Samaritan Retirement Home 17 times over the last 5 years and fined it in excess of $70,000.00.  Despite these measures, the assisted living facility remained in business.

One month after the beating, a female resident fell in the parking lot and was neither taken to the hospital nor provided any medical treatment.  Later that night, the woman was found non-responsive and blood-soaked.  She later died at the hospital.  After that incident, AHCA put in place a moratorium preventing the assisted living facility from accepting new residents; however, it was allowed to continue to operate with the residents already living there.

Two weeks later, another incident occurred which resulted in the arrest of an administrator at the assisted living facility. On December 7, one of the residents had a medical procedure and had to be closely monitored to watch for changes in condition.  Over the next few days, staff reported to the administrator that the resident had deteriorated; however, the administrator took no responsive action.  He was charged with neglect of the elderly.

Citing additional concerns and medication errors, AHCA finally shut down the facility effective December 23, seven weeks after the videotaped two minute beating occurred.  Residents and their families are understandably frustrated by the lack of a more timely response by the state.

The bottom line here is that you cannot rely on the state to vet a nursing home or assisted living facility for you.  If you or a loved one is in need of assisted living or a nursing home, it pays to do your own homework.  As a starter, for nursing homes, we recommend you review the five star rating system created by the Centers for Medicare and Medicaid Services.  Next, you should visit the nursing home or assisted living facility.  While there, you should do your best to observe whether: the facility is clean; whether the facility has an unpleasant odor; whether there are common areas that meet your needs; and whether the staff is qualified to meet your healthcare requirements.  Continue reading

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Recently, shocking video footage was captured at a South Florida nursing home showing a certified nursing assistant striking a resident, pouring mouthwash on him, pushing him and handling him very roughly.  The resident was ninety four years old and suffered from dementia.  The CNA involved claimed she knew nothing of the allegations – until the video surfaced.  Apparently, the resident’s family members were suspicious that he was being mistreated and hid the camera in his room.  Without the camera footage, the abuse would probably never have been proven.

It is common that family members of nursing home residents call us to express a concern that a resident is being abused or mistreated.  Without obvious signs of injury, abuse can be very hard to prove as some residents with dementia may be confused to the point of equating normal movement required for bathing and dressing as abuse.  With advances in technology, it is now economically possible for most people to purchase small video cameras that can be concealed in a room.  Consequently, we have seen a rise in hidden surveillance footage and it is certainly going to continue to increase.

Of course, the use of hidden surveillance cameras also raises ethical concerns.  While a resident certainly has the ability to use such a camera, when the camera is placed by a family member, what if the resident lacks the mental capacity to consent to being filmed?  Nothing in standard power of attorney or health care surrogacy documents addresses this issue.  We support the ethical use of surveillance cameras as one of many tools that can be used in an effort to ensure a resident is receiving safe and respectful care.

Some states have enacted legislation specifically allowing nursing home residents to install cameras, which means that a nursing home cannot remove, or refuse to admit, a resident on this basis.  Most states; however, have no laws addressing the issue.  Florida does not have such a law.  A nursing home industry group, the American Health Care Association, has fought legislation allowing for cameras as it claims that people placing the cameras are more interested in gathering evidence for a lawsuit than in protecting the resident.  They also claim that, with cameras in place, it will be more difficult to hire and keep qualified caregivers.

Our Jacksonville law firm focuses on nursing home neglect and abuse cases.  If you suspect nursing home abuse, we provide free no obligation consultations.  Often, we help guide family members dealing with the issue of whether to leave a resident in his or her current nursing home.  We frequently recommend that the family request a care plan meeting to be attended by the resident’s doctor, the nursing home’s director of nursing and the resident’s nurse unit manager.  When abuse, neglect or mistreatment is more certain, we recommend the resident be moved to a nursing home with strong ratings and we recommend the resident or the resident’s family members contact Florida’s Department of Children and Families abuse hotline at 1-800-96-ABUSE.  Nursing home ratings are published by the Centers for Medicare and Medicaid Services and can be found here.

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Nine residents of a Miami, Florida, nursing home suffered death by agonizing heat distress after Hurricane Irma interrupted the supply of electricity to the nursing home.  The people who lost their lives ranged in age from 71 to 99.  Many other residents were treated for dehydration, breathing difficulties and other heat related issues.

For days following the hurricane, the nursing home’s residents were left in Miami’s sweltering heat and humidity.  The day after the hurricane passed, the temperature rose to 98 degrees.  The fallout from this tragedy is just beginning as the deaths were entirely preventable. A criminal investigation is ongoing and civil damages are likely to exceed $10,000,000.00.

Following Hurricane Wilma in 2005, it became abundantly clear that nursing homes in the state needed to have a backup source of electricity in the event weather conditions cause an interruption of power.  In 2006, legislation was proposed to require that all nursing homes in the state have generators able to cool and run their facilities.  Of course, providing this level of resident safety and comfort came with a price tag.  The nursing home industry successfully lobbied against the bill. Now that there has been a tragedy of this magnitude it is likely that similar legislation will pass.

It should not require legislation for nursing homes to obtain backup electrical power.  Common sense dictates that the loss of air conditioning alone creates life-threatening circumstances for the elderly and infirm.  If a nursing home operator is being paid to provide a safe environment for its residents, it is axiomatic that the operator should make the investment necessary to provide an uninterrupted supply of electricity.

Nursing home operators claim that they operate on slim profits due to the limited amount they receive from the Medicare and Medicaid programs.  However, for the most part, this is not the case.  While balance sheets can make it look like there is little profit to the nursing home owners, many of the listed “expenses” for rent, consulting services, and management services are paid to corporations owned by the same people that own the nursing home itself.  With the average nursing home profiting well over $1,0000,000.00 per year, there are certainly enough funds to finance a backup generator system.

It is my hope that the families of these victims obtain a full measure of civil justice.  With large payments to the families, perhaps this nursing home operator and others will realize that, even if they do not feel morally obligated to provide a safe environment, the short term financial savings in not doing so are outweighed by the legal claims that result.  Continue reading

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On June 28, 2017, the United States House of Representatives passed H.R. 1215 titled, Protecting Access to Care Act of 2017.  Among other provisions in this bill is a limit on non-economic damages that can be recovered from a nursing home that accepts Medicare or Medicaid funds.  This encompasses essentially all nursing homes.  The bill will become law if passed by the Senate by a simple majority.  With the republican majority in the Senate and, with tort reform being a battle-cry campaign platform for the Republican party, the chances of this bill passing are a real concern.

What are the effects of this bill?

Non-economic damages compensate a person for the emotional harm he or she has suffered.  Non-economic damages do not include medical bills, funeral costs or lost wages that might result from injuries caused by neglect.   Economic losses are not subject to any cap or limitation and, under this bill, would remain uncapped.  With nursing home residents, this provides little assistance as there is almost never a lost wage claim given the age and infirmity of the residents.  Further, the medical bills resulting from injuries caused by neglect are typically paid by Medicare or Medicaid, and any sums recovered for medical bills must be turned over to the government.  As such, practically speaking, non-economic damages (i.e., pain and suffering) provide the only recovery that can compensate an injured victim of nursing home abuse or neglect.

Currently, the pain and suffering damages are uncapped.  If a jury is horrified by neglect or abuse, it can render a verdict that provides incentive for the nursing home to provide quality care for its residents.  Without this “check and balance” in place, the nursing homes’ financial incentive will be to minimize their costs.  As the single largest expense of operating a nursing home is staffing, an incentive to lower costs translates into fewer nurses and nurse assistants available to provide care.

The Practical Effects of a $250,000.00 Cap

At first blush, $250,000.00 may sound like a lot of money.  However, it is necessary to keep in mind that this is the worst case scenario for a negligent nursing home operator.  Why would the operator voluntarily agree to pay its worst day?  Rather, in all but the most egregious cases, the operator will offer only a fraction of that amount.  One reason for this is that they know going to trial is nearly impossible for the plaintiff’s attorney with such a cap in place.

Even if we were to achieve a verdict of $250,000.00 at trial, the years of work and tremendous amount of time we spend on these case make such a recovery unprofitable.  Add to that the uncertainty of winning when we decide to take a case and it quickly becomes obvious that agreeing to handle a nursing home neglect case is a poor business decision.

Some specifics may flesh this out.  Abuse or neglect in nursing homes almost always start at the top with a corporate culture of saving money at the expense of resident care.  This is typically done by under-staffing the nursing home leaving nurses and nurse assistants with more work than can be done during their shifts.  In order to prove that under-staffing is the root cause of neglect, we must perform a very thorough investigation.  The time records of every nurse and cna must be evaluation and matched with the shifts in question.  In addition, the census and overall acuity of the health needs of the nursing home residents must be considered.  Multiple expert witnesses are needed to perform this analysis, each with a hefty price.  Further, nursing home operators fight tooth and nail to try to keep the time records and budget information from being provided to us, creating delay and additional expense.

As an example, in a recent case, our law firm spent approximately $150,000.00 on experts and litigation expenses – this figure includes nothing the reflect the value of the time we spent on the case.  We worked on the case for four years.  The result of our work was nothing short of alarming – the nursing home understaffed the facility by: having employees listed as working when they were not; counting nurse managers as providing hands on care when they did not do so; and having a system in place designed to staff the facility at the bare minimums regardless of the overall complexity of the health needs of the facility’s residents.  Only upon the discovery of this damming information was the case was settled for a fair amount.  With the cap in place, we could not have done the investigation and we never would have uncovered the nefarious reason why the nursing staff failed to provide sufficient care.  Simply put, with the cap in place, we cannot prosecute these claims.

Nursing home neglect is a serious problem.  Capping damages decreases the incentive to provide quality care as plaintiff’s lawyers will no longer investigate these incidents.  With the aging of our country, this is the last thing Americans should support.  Continue reading

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Sexual abuse in nursing homes is a sad occurrence.  A CNN  investigation concluded that between the years of 2013 and 2016, the federal government cited over one thousand nursing homes failing to prevent, or otherwise mishandling, allegations of sexual abuse including rape. Even more disturbing is that nearly every instance of sexual abuse is preventable if nursing homes are properly staffed and if employees and residents are properly vetted and supervised.

Several years ago here in Jacksonville, a $750,000.00 verdict was rendered against a nursing home as a result of a female resident being sexually assaulted by a male resident.  The male resident had criminal record for past sexual crimes.  What is worse is that there were also complaints that he was engaging in inappropriate aggressive and sexual behavior at the nursing home before the rape occurred.

Many residents of nursing homes are unable to protect themselves due to dementia or physical limitations, or both.  This makes them vulnerable to resident on resident sexual abuse and abuse from nursing home employees.