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The Marketplace . . . . Political Influence . . . . Fraud . . . .Elkins
The many extracts on this page are from copyright material. They are reproduced here for educational purposes and to stimulate public debate about the provision of health care. I consider this to be "fair use" in the common interest. They should not be reproduced for commercial purposes.

Integrated Health Services and Patient Care

Disclaimer:- The material is selective and not all inclusive. The extracts do not necessarily reflect the perspective of the original. Corporate denials and explanations have not been included. No claim is made that all of the matters referred to are true. The intention is to give the flavour of the material and an idea of the extent of the allegations. Can there be so much smoke without a large fire? This is a matter of public welfare and the interests of the pubic must be placed before those of the corporations.  









Care in nursing homes is supplied primarily by nurses and therapists. Doctors play a smaller part. Corporate administrators control and influence all facets of nursing home activity. Profit pressures are transmitted to all levels. This page examines the way in which IHS relates to nursing staff and to therapists. It then examines the actual care given. Some extracts show the relationship of IHS to the market around it.


Nursing is a low paid profession in which empathy and sympathy for the problems of others generates dedication and service. One of the rewards is the esteem with which they are regarded and the status which they consequently enjoy. This compensates for the poor wages and the long hours.

A corporatised environment destroys most of this. Professionalism is reduced to no more than a paid worker. Corporations have typically adopted an aggressive cost cutting approach to nursing, seeking to reduce total numbers and deskill the workforce. They claim that you do not need a nursing degree to wash and clean the elderly. In fact the aged are among the most difficult to nurse.

Care is no longer prized, but profit is. As a consequence nurses become disillusioned and feel they are no longer valued. They seek more remunerative work in burger bars and seldom come back.

These corporations have moved into post-acute care supplying treatment to patients who are much sicker and in greater need of nursing care. Nurses are grossly overworked and unable to cope. They are aware that they are not supplying the sort of care required They become hardened and stop trying. Those who speak out are fired.

While nurses remuneration is kept at almost subeconomic levels, corporate executives who take no part in care enjoy enormous salaries and massive bonuses.

Nurses are forced to unionise to protect their rights and the situation is compounded by the inevitably bitter industrial conflicts. Corporations pursue these conflicts very aggressively and nurses who act for the unions are discriminated against.

The first set of articles addresses this problem.

SEIU Report Reveals Many Nursing Home Workers Go Without Healthcare; Long-Term Care Industry Reaps Profits While Workers Sacrifice
PR Newswire October 21, 1998

From 1996 to 1997, the operating profits for the top six nursing home chains rose dramatically, with the top executives, not the workers, reaping the benefits. Total compensation jumped an average of 300 percent for the heads of Beverly Enterprises, Genesis Health Ventures, Vencor, Paragon Health Ventures, Integrated Health Services and Sun Health Care Group.

Service Employees International Union Nursing Home Employees Throughout Ohio Set Strike Deadline With Integrated Health Services
PR Newswire April 12, 1999

Today, 650 employees of Integrated Health Services throughout the State of Ohio completed voting on the company's latest comprehensive contract offer. By a vote of 427 to 12, employees overwhelmingly rejected the company's proposal and set a strike deadline for Monday, April 19th at 12 noon. IHS employees are members of District 1199 of the Service Employees International Union. SEIU represents over 12,000 health care workers in Ohio and over 600,000 health care workers nationwide, making it North America's largest health care union.
Integrated Health Services operates 350 facilities in the United States making it the country's fourth largest nursing home chain. However, in the past year, IHS has seen its stock price plunge from a high of almost forty dollar per share to a recent low of less than four dollars per share. On Friday, April 9th, IHS stock closed at 3 5/8 per share. "Given the recent difficulties IHS has faced with regard to investors expectations, we do not understand why IHS has decided to pick this fight with us," said Veronica Davis, Secretary-Treasurer, District 1199/SEIU. Ms. Davis added that IHS's latest offer is substandard in terms of wages, health care benefits and issues that affect the ability of front line employees to deliver high quality patient care.

During the course of negotiations IHS has said it will spare no expense in the event of a strike. The company has been recruiting strike-breakers from as far away as Louisiana and Wisconsin. - - - -- -. Ms. Davis added, "Rather than deal seriously with issues which we believe could be resolved, IHS has resorted to threats and intimidation in an attempt to force workers in Ohio to accept a substandard contract. -- - - "

Union again raises strike threat
The Associated Press State & Local Wire April 21, 1999

A union representing nursing home workers has filed strike notices against 10 homes as part of its campaign to settle contracts with nearly 50 homes.

The 10 homes now face a strike deadline of April 27, officials of the New England Health Care Employees Union, District 1199 said Tuesday.

The facilities facing the walkout deadline include three in Cheshire, Waterbury and New Haven run by Integrated Health Services Inc.; five Mediplex Homes in Danbury, Darien, Milford, Newington and Stamford, owned by Sun Healthcare; Atrium Plaza in New Haven; and St. Mary Home in West Hartford.


Five homes still face strike deadlines Tuesday -- Atrium Plaza in New Haven; St. Mary Home in West Hartford and three homes run by Integrated Health Services. Many of the agreements reached over the past several weeks were hammered out under the pressure of a strike deadline.

Nursing home talks bring strike threat;
The Boston Globe April 24, 1999

Union negotiators yesterday threatened strikes at three Connecticut nursing homes after contract talks with the facilities' operator broke down. No new talks between New England Health Care Employees Union, District 1199, and Integrated Health Services have been scheduled before Tuesday's strike deadline. The Maryland-based, for-profit IHS employs an estimated 485 workers at Greenery Extended Care of Cheshire, Greenery Rehabilitation of Waterbury, and Clifton House of New Haven.

The union representing nursing home workers postponed a walkout against three nursing homes Tuesday, and a strike against a fourth facility ended after about 12 hours.
The Associated Press State & Local Wire April 27, 1999

District 1199 of the New England Health Care Employees Union had set 6 a.m. to walk out against three homes owned by Integrated Health System.

"The company made us a very last minute offer," Deborah Chernoff, a union official said Tuesday morning. "They said that they had a new offer that they wanted to present to us at the table and they asked us to postpone the strike for 48 hours."

Metro Business; Contract Agreement At 3 Nursing Homes
The New York Times April 29, 1999

Three private nursing homes in Connecticut reached a tentative contract agreement with 485 union workers yesterday.
Union officials said the two-year agreements, which need ratification by the members to take effect, include substantial increases in wage rates, with employees receiving raises of at least 10 percent over the life of the contracts.

The nursing homes involved in the agreement are operated by Integrated Health Services of Owings Mills, Md.

Higher wages needed to ease nursing home labor shortage
The Business Journal March 10, 2000

Nursing home advocates are urging state officials to adopt a so -called "wage pass through" law intended to ease labor shortages at Wisconsin's nursing homes.
In addition, the union on March 3 filed with the National Labor Relations Board unfair labor practice charges against the Hartford Care Center and its parent company, Integrated Health Services Inc. of Maryland.


Nursing care was a cost. It reduced profits and so was undervalued. In contrast therapists were paid per item of service. Their work generated increased profits. They were highly valued and highly paid. One is left with the impression of patients who do not receive basic care because there are no nurses to provide it receiving vast quantities of nonbeneficial therapy simply because it brings in the money.

The situation was dramatically reversed when government changed the funding and therapy became a cost. The demand for therapy vanished overnight. Thousands were fired and the salaries of the remainder drastically cut. This was considered to be a legitimate response to changed funding.

This reveals very dramatically the way in which the care given to patients is not based on their needs but on the potential for profit - decisions made in the corridors of power and in corporate board rooms. Almost certainly patients were being grossly over treated - and now are probably being under treated.

Nowhere is Dave Lindorff's (Marketplace Medicine) remark 10 years ago to the effect that clinical decisions are made in the board room rather than the bedside proven more conclusively than in Nursing Home and Post Acute care. When various therapies were profitable because they were paid for as an item of service then this was a growth area. Great empires were built on the misfortune of the frail and elderly. Vast personal fortunes were made.

What has happened to all those patients who needed care? It is clear that vast numbers were treated needlessly and this was a massive fraud at the expense of the taxpayer. It is probably equally true, as the reports below suggest that patients who actually need care are no longer getting it.

If we bring in people who are by nature personally ambitious, greedy and deceitful to look after large sections of the population who are frail, trusting and unable to act for themselves then this is what we should expect.

Modern Healthcare March 15, 1999

In response to the revenues drop-off, the division trimmed 1,000 therapists and lowered salaries for the remaining 5,000. In addition, the company now pays only for productive time,'' when therapists are actually seeing patients. The company has also cut its contribution to employees' health benefits and may also downsize the company itself.

Modern Healthcare April 12, 1999

Surveys of allied health personnel shortages in the 1990s often put physical therapists at the top of the list. But the changing finances of post-acute-care companies have turned rehabilitation therapy from a hot profession into a dud.

In recent months, six of the country's largest nursing home companies have announced personnel cuts of 10% to 60% in their contract therapy divisions, which supply therapists to their facilities and others.
Other long-term-care companies that have laid off up to 20% of their therapists include Atlanta-based Mariner Post-Acute Network, which cut 1,200 therapists; Fort Smith, Ark.-based Beverly Enterprises and Owings Mills, Md.-based Integrated Health Services, which eliminated 1,000 therapists each; and Kennett Square, Pa.-based Genesis Health Ventures, which cut 321 positions.
Most of these companies also have reduced therapists' salaries and benefits. The moves mark a growing oversupply of therapists. As recently as 1996, there were nine therapists for every 10 positions, according to a study commissioned by the American Physical Therapy Association.
In some cases, facilities cut down on therapy by overriding doctors' orders, said Corky Glantz, a founder of contract therapy company Glantz/Richman Rehabilitation Associates, based in Riverwoods, Ill.

''Therapists are up in arms because they feel they are being limited,'' she said.

Since the new payment system took effect last July, treatment and revenues at Glantz's company have dropped by 20%.

The American Occupational Therapy Association conducted a nonscientific survey that found pay levels for half the respondents were static or falling. Some 70% of the 1,000 respondents worked in the long-term-care industry.

Ancillary service providers contend that skilled-nursing facilities are going too far with cutbacks.

''SNFs have viewed therapy as an area where they can cut costs in a significant way,'' said Peter Clendenin, executive vice president of the National Association for the Support of Long-Term Care, a trade group of ancillary services providers to the post-acute-care sector.

''But Congress didn't change the number of strokes that occur in America,'' Clendenin said.


Payor mix is a popular term in the USA. Different forms of insurance paid very different amounts for care. Patients who paid their own fees had no bargaining power and paid most. They were followed by self insured patients, then Medicare, and finally Medicaid. Profits are made by having a good payor mix. Medicaid patients are consequently discriminated against. Under the new system Medicare patients have suddenly become less rewarding for nursing homes.

COMMENT:- How odd that IHS customers (presumably the hospitals and doctors whose funding is DRG based and not changed by the new payment system) are no longer admitting Medicare patients. One can only wonder whether the common corporate practice of securing admissions by paying kickbacks has been abolished now that Medicare patients are no longer profitable. Do these patients need treatment or not?

Integrated Health Services Reports First Quarter
PR Newswire April 30, 1999

The decline in revenue and earnings are primarily the result of the implementation of the Medicare prospective payment system (PPS).

In response to PPS, the company has experienced a reduction in demand for therapy services in its contract rehabilitation division. Customers of the company's contract rehabilitation division are admitting fewer Medicare patients and are reducing utilization of rehabilitative services to a far greater degree than projected. The company, however, has recently implemented additional cost reductions


Corporate administrators did not hesitate to interfere in care when this was profitable. Multiple whistleblower and government actions against most of the large chains alleging similar allegations to those made about IHS leave little room for doubt that the allegations made below are true and widespread. These mostly relate to admitting patients who did not need admission and giving treatment which was not required. Institutionalisation and treatment both carry risks, particularly in the elderly. There are also psychological and life disrupting consequences to which the elderly are more vulnerable.

More worrying is the likelihood that the same approach was adopted to not giving care and that patients who paid poorly (e.g. Medicaid) were discriminated against and not given treatment when it was required. Any treatment given to patients funded by a capitation system (e.g.. Medicaid) cost money and cut into profits.

There is ample evidence to indicate that this is what happened. Allegations made by citizens groups and by individuals in vast numbers of lawsuits have been confirmed by state surveillance figures as well as state and federal investigations. Across the nation basic care, mostly provided under a capitation system has been neglected. Units awash with therapists were starved of nurses. Vast numbers have been deprived of worthwhile years, have suffered needlessly during their declining years and and have died earlier than they need have done.

U.S. joining care-chain fraud case; Whistle-blower initiated suit alleging violations by IHS; Medicare abuses cited; Sparks company's Dallas facility was source of complaint
The Baltimore Sun December 13, 2000 Wednesday

The Justice Department confirmed yesterday that it is joining a whistle-blower lawsuit charging Medicare fraud against Integrated Health Services, the Sparks-based nursing home chain now in bankruptcy reorganization.

The original suit was filed last year by a social worker at an IHS facility in Dallas, alleging that the facility admitted patients who did not need its level of care and billed Medicare for services that were never delivered.
According to Gray's complaint, the Dallas facility inflated patient problems to justify admission to the institution, which is designed to provide a level of service more intensive than a nursing home but less than a hospital. For example:

One patient, according to records, "was admitted because of a fractured hip, a stroke and a motor vehicle accident that caused chest trauma. According to the family, the patient was in the accident 20 years previously and had the stroke two years ago."

"An elderly woman was admitted for pulmonary complications. During her hospitalization, she never had a pulmonary consult and would leave for daily outings with her husband."

"Therapists from different specialties would work together on a patient, then each would charge for a full hour of skilled therapy, regardless of the actual time spent or the type of service provided the patient."

Patient Advocates Sue Firms Over Care Quality ::: Troubled Times in Nursing Homes
Albuquerque Journal August 3, 1999, Tuesday

* Suit alleges records falsified to collect Medicare and Medicaid payments

SACRAMENTO, Calif. -- Advocates have sued Albuquerque-based Sun Healthcare Group and others in federal court here, claiming the nursing-home companies collected government payments for substandard care.

Brought under the federal False Claims Act, the lawsuit claims the nursing-home operators failed to provide the level of care required by Medicare and Medicaid, then falsified records to show otherwise.

The falsified records were then used to obtain reimbursement from the government health-care programs, the lawsuit says.

Sun said in its response to the lawsuit that the litigation makes "sweeping, unspecific allegations" that are "deeply harmful." The company has said it will vigorously defend itself.

In addition to Sun, defendants include Integrated Health Services of Owings Mills, Md., and Crestwood Hospitals.

The lawsuit deals with the care at Crestwood nursing homes in California over several years.

Integrated Health Services managed Crestwood homes for about two years ending in 1996, according to the lawsuit. Sun took over management of some of the homes in 1996 and acquired about a dozen Crestwood homes in 1997, the lawsuit says.
The lawsuit was filed in January 1997 by advocates for nursing-home residents. The advocates are suing on behalf of themselves as well as the U.S. government in what is known as"qui tam," or whistle-blower, litigation.
The lawsuit alleges the defendants had a practice of not employing enough staff to maintain the quality of care required to participate in Medicare and Medicaid.

As a result, the lawsuit says, some nursing-home residents suffered dehydration, malnutrition, mental and social isolation, urinary infections, bedsores and other problems.

"Defendants' conduct was the result of corporate-imposed budget constraints to maximize their profits and to allow their CEO to receive large compensations," the lawsuit says.

As part of the lawsuit, three former employees at Crestwood homes have filed affidavits that records were falsified. One ex-worker said she and other nurses falsified patient charts to cover up that medications weren't given as ordered by physicians.

The lawsuit says the defendants filed false claims to obtain more than $50 million a year in reimbursements from Medicare and Medicaid.

U.S. District Judge Lawrence Karlton in October rejected requests by Sun and the others to dismiss the lawsuit. When a lawyer for Crestwood sought a clarification, the judge said, according to a transcript of the hearing:

"Please, let's get on with the lawsuit. I understand you're desperate to make sure nobody sees the facts."
The number of qui-tam cases nationwide has exploded in recent years, from 33 in 1987 to 417 in 1998, according to statistics from the Department of Justice.

Statistics show health-care providers are targets of the majority of cases.


IHS financial collapse was closely followed by an increasing number of reports of poor care in its facilities. While it is clear that care has been poor in corporate facilities for many years it is likely that this has been exacerbated.

Regulators who previously turned a blind eye have been heavily criticised for doing so. The federal government has warned them of the risks to care posed by financial pressures and they have been urged to increase surveillance. Citizens groups long aware of problems in care are now urging relatives to seek damages through the courts. It is possible that this increased incidence of reported problems in care is partly a a consequence of these factors. Many of the figures and reports however relate to care given when corporations were making millions in profits.

The Palm Beach Post October 23, 1998

Two nursing homes violated a total of nine regulations in failing to protect and supervise an Alzheimer's patient missing for more than a month, says a state report released Thursday.

XXXXXXX, 78, disappeared from the Haverhill Care Center in the pre-dawn hours of Sept. 24, as Hurricane Georges was approaching South Florida. Besides dementia from Alzheimer's, his ailments included pulmonary disease and congestive heart failure.

He'd been at the 120-bed facility at 5065 Wallis Road for only six days, after being transferred from another nursing home, Integrated Health Services Inc. at 2939 S. Haverhill Road.

IHS wanted to transfer Baker after only two days there because he was wandering and ''they could not contain him and needed to send him to (Haverhill) because it was more secure,'' according to the report.

An IHS social service worker's notes said she told the Haverhill admissions director about Baker's wandering during a telephone call, but records documenting it didn't go with him when he was transferred, the report said.

But the Haverhill executive director, nursing director and admissions director all denied knowing about the wandering, the report said. They also thought Baker was admitted directly from his home, and they didn't know he had been transferred from another nursing home, it said.
IHS officials could not be reached for comment.
Alzheimer's patient has been missing more than a month.


Nursing home patient's body found, but cause of death is uncertain
The Associated Press November 3, 1998

The body of a 78-year-old man who wandered away from his nursing home more than a month ago was found in a dry drainage ditch.
The two nursing homes violated a total of nine regulations in failing to protect and supervise Baker, the state has said. The Florida Agency for Health Care Administration will review the case further to determine if more citations are warranted, said Pat Glynn, a spokesman for the agency.

The Palm Beach Post April 14, 1999, Wednesday,

WEST PALM BEACH The family of a 78-year-old man found dead after he wandered away from a suburban West Palm Beach nursing home filed a lawsuit on Tuesday against the two nursing homes where he had stayed.

Money or mercy?
The Tampa Tribune November 15, 1998

In the glossy pages of corporate literature from Florida's largest for-profit nursing home chains there is a repeated image: a frail person gazing with trust and gratitude at a health care worker holding their hand.

The brochures promise compassionate care and healthy profits for the people who invest in their companies. But the reality of life in some of those nursing homes is another thing - quality care and big profits do not always go hand in hand.

A six-month Tampa Tribune investigation has found that residents of for-profit homes had higher than average rates of reported neglect and abuse. Homes owned by four large chains - Beverly Enterprises Inc., Integrated Health Services Inc., Vencor Inc. and Mariner Health Group Inc. - were more likely to fall below state standards than other homes.

Profits can come at high costs
The Tampa Tribune November 15, 1998

Comparing care Nursing homes are inspected at least every 15 months and graded on compliance with federal requirements. A Tampa Tribune analysis of the latest inspections, up to April 1998, showed five of the six largest nursing home companies in Florida had a higher than average number of deficiencies when compared with all nursing homes in the state.

Total deficiencies for every 10 homes Vencor 118 * Mariner Health Group 111 Integrated Health Services 110 Beverly Enterprises 106 Genesis 95 All other homes 89 Health Care & Retirement Corp. 80

Deficiencies that caused "actual harm' for every 10 homes Each deficiency is graded to reflect its severity. Homes owned by five of the six largest companies, which are all publicly traded, had a higher than average number of deficiencies that caused "actual harm" to residents. Health Care & Retirement Corp. had three harmful deficiencies for every 10 homes, four below are the statewide average. Integrated Health Services 12 Vencor 11 * Mariner Health Group 9 Beverly Enterprises 8 Genesis 7 All other homes 7 Health Care & Retirement Corp. 3 Before merger in July 1998 that created Mariner Post-Acute Network

COMMENT:- Vencor is notorious for the way it callously discharged patients once their funding changed from profitable private or Medicare to unprofitable Medicaid funding. They were heavily fined. Many other corporations did the same thing but more subtly so were not detected.

The next article describes this practice in IHS

Nursing home told not to evict
St. Petersburg Times February 12, 1999

Integrated Health Services at Brandon is accused of trying to transfer out Medicaid-eligible patients.

Another nursing home in Hillsborough County has been accused of trying to evict residents eligible for Medicaid to make room for better paying patients.

Integrated Health Services at Brandon was singled out Thursday at a congressional hearing about legislation designed to prevent the eviction of Medicaid patients, who typically can't pay as much for care as people with private insurance.
lawmakers he had learned earlier this month that IHS at Brandon was transferring residents eligible for Medicaid.

Lawmakers were told the facility was trying to remove as many as six residents who were losing Medicare subsidies and being forced to rely solely on Medicaid.

"The facility was noticed of their immediate jeopardy," said Polly Weaver, chief of field operations for the Florida Agency for Health Care Administration. "They have to get their act together."

IHS at Brandon's executive director, Ben Carotenuto, denied any wrongdoing Thursday. "There are no Medicaid patients being dumped," he said.

If IHS does not make a successful appeal, the Brandon facility can be kicked out of Medicare and Medicaid programs and receive only enough funding to ensure that their current residents receiving the government subsidies can make a safe transfer.

"We have put that institution on a fast-track termination if they do not correct the jeopardy that they have created," Hash said.

IHS operates about 2,000 post-acute care locations in 47 states, including the 120-bed facility in Brandon. Following a complaint about IHS at Brandon, the Agency for Health Care Administration investigated Feb. 1, spokeswoman Nina Bottcher said. She said the state is fining IHS $ 6,000 a day until it corrects the situation.

While Medicaid generally is thought of as a program for poor families and children, two-thirds of elderly nursing home patients rely on Medicaid to help pay for their care, at an expense to taxpayers of $ 24.2-billion in 1995.

Medicare benefits help pay for short-term care for elderly patients. When a person of any age is poor, Medicaid benefits kick in that are less lucrative for nursing homes.

U.S. Reps. Jim Davis, D-Tampa, and Michael Bilirakis, R-Palm Harbor, have introduced a bill to prevent nursing homes from discharging or transferring residents if a facility decides to withdraw from the Medicaid program.

The legislation also requires nursing homes to provide future residents with written notice if a facility doesn't accept Medicaid benefits or may transfer residents when they become eligible for Medicaid.

"Over half of the people who are using Medicaid to pay their bills today started out using their own money," Davis said. "They outlived their savings. One of the ways (nursing homes) are not going to beef up profits is at the expense of the people they have led to the facility."

News from Philadelphia and its suburbs
The Associated Press State & Local Wire May 18, 1999

A nursing home has agreed to pay a $ 195,000 civil penalty to settle claims that it failed to give residents adequate nutrition and nursing care, a federal official said.

Assistant U.S. Attorney David R. Hoffman said the agreement was reached Monday with Integrated Health Services of Bryn Mawr, a 160 bed for-profit home.

In 1996, five patients got inadequate nutrition and inadequate care for pressure wounds, and incontinent patients failed to get timely personal hygiene assistance, government officials charged.

The home denied any liability and did not admit any wrongdoing when it agreed to pay the penalty to the federal government.

A public-relations consultant hired by IHS said the company is satisfied with the settlement. He said all the issues in the suit have been resolved for the past two years.

North Albuquerque Home Faces $100,000 Fine ::: Troubled Times in Nursing Homes
Albuquerque Journal August 2, 1999, Monday

Integrated is appealing penalty involving an Alzheimer's patient and other problems at Valle Norte

The Valle Norte Caring Center has been cited for numerous, sometimes serious deficiencies in recent years.

Valle Norte is one of about 26 nursing homes in New Mexico operated by Integrated Health Services of Owings Mills, Md., the state's largest operator operator and one of the nation's largest chains.

Integrated Health Services, which has owned the home since the end of 1997 didn't respond to a request for an interview.

The company's annual report says it has developed a comprehensive quality-assurance program to verify that high standards of care are maintained.

The report also says Integrated "requires that its facilities meet standards of care more rigorous than those required by federal and state law."
A certification survey in October after Integrated bought the home resulted in Valle Norte being cited for 15 deficiencies, including four for immediate jeopardy.
The survey also found:

  • * Some residents dressed in extra clothing because of uncomfortably low indoor temperatures.
  • * Standing water and scum in water and ice dispensers.
  • * Littered food debris, trash and dirty dishes, as well as food spills.
  • * Kitchen workers touching food and dishes with contaminated gloves.
  • * Some residents weren't given sufficient fluids to prevent dehydration and other health problems.
  • * Some residents who were to receive only finger food were given a pork chop and steak.
  • * A walk-in refrigerator had a thermometer reading of 50 degrees.
  • * Turkey breast being prepared for an evening meal was more than 30 days past its shelf life.

The bureau, however, recommended that the Health Care Financing Administration fine Valle Norte nearly $100,000 because of the incident involving the woman and other problems.

The Health Care Financing Administration which sets standards for nursing-home care and oversees Medicare and Medicaid imposed the fine. Valle Norte appealed; the appeal is pending.

The Bureau of Health Facility Licensing and Certification also conducted a complaint survey at Valle Norte in August 1998 that resulted in findings of two deficiencies for actual harm.
Data compiled by the Health Care Financing Administration in June show homes operated by Integrated Health Services in New Mexico had an average of 6.42 deficiencies in their most recent surveys. That compares to an average of 4.74 deficiencies for all New Mexico homes.
The Casa Arena Blanca nursing home in Alamogordo had more deficiencies 19 than any other home operated by Integrated Health Services. It was surveyed in late March.

Four of the deficiencies were for placing residents in immediate jeopardy, and 10 were for actual harm.

Spies report nursing-home ills
Albuquerque Tribune August 10, 1999, Tuesday

Undercover agents for the state logged violations in three of four facilities, including two in Albuquerque.

When Agapito Silva was admitted to Georgia House, an Albuquerque facility that cares for disabled adults, he said he was placed in a room with bedsheets soiled by the previous resident, who had died a week earlier.
At a news conference Monday, the state outlined the findings of its undercover observers.

"In three of the four facilities we found conditions that tell us residents are not identified and treated as people," said Michelle Lujan Grisham, director of the state Agency on Aging.

"In places where there's supposed to be hope, we found despair."
In its recent sweep, state ombudsmen said observers witnessed poor conditions at two other places Valle Norte Caring Center in Albuquerque and Casa Arena Blanca Nursing Center in Alamogordo.

Valle Norte and Casa Arena Blanca are owned by Integrated Health Services, a national corporation.

The only facility visited that did not violate regulations, the agency said, was the state-run Fort Bayard Medical Center in Fort Bayard.
The director of nursing at Casa Arena Blanca, Agnes Wilkins, said she could not comment immediately on the allegations.

Robert Gill, a spokesman for IHS, the Maryland-based company that owns both Valle Norte and Casa Arena Blanca, said the company had no comment.
At Valle Norte, the state Agency on Aging said at the news conference, the undercover observer said call buttons were moved out of reach of patients who were considered bothersome. Additionally, food was unsanitary and residents were left in urine-soaked clothes for hours, the agency said.

Similar disregard was noticed by the observer at Casa Arena Blanca Nursing Center, regional ombudsman Carolyn Hutchinson said.

Hutchinson said residents' privacy was violated, personal belongings were rummaged through and some residents had to wait more than 30 minutes at the table to be served their meals.

State stock index tracks 16 health care companies;
The Tampa Tribune September 8, 1999, Wednesday,

A stock index of 16 large health care companies doing business in Florida was created by an unusual source - a state agency using the data to monitor financial problems that might affect patients.

The Florida Health Care Index was launched Tuesday at stockson the Internet by the Florida Agency for Health Care Administration.

The hospital companies are Columbia/HCA, Health Management Associates, Health South, Integrated Health Services and Tenet. The nursing home companies are Beverly, Genesis Health, HCR Manor Care, Mariner Post Acute Network and National Home Health. Mike Stobbe covers health care and can be reached at (813) 259-7562.

Las Vegas Nursing Home Cited Facility Operated By Maryland-Based Firm
Albuquerque Journal November 10, 1999, Wednesday

A Las Vegas, N.M., nursing home owned by Integrated Health Services of Maryland has been cited by the state for leaving dehydrated patients without water, botching prescriptions, failing to report a facial bruise and not attending properly to a man who could not swallow food for six months.

The Department of Health found eight violations of federal care standards four of which caused physical harm in its September inspection of Southwest Senior Care, a 102-bed facility.

The number of deficiencies was twice the average for nursing homes in New Mexico.

But the problems at the Las Vegas facility were not as severe as at some homes around the state, including an IHS facility in Alamogordo, where the state threatened to take over operations this year after 19 deficiencies placed residents in immediate jeopardy.

Southwest Senior Care is one of 27 nursing homes operated in New Mexico by IHS. The company runs 370 nursing homes across the country.

The Maryland-based company is under severe financial pressure because of large debts and recent changes in the Medicare and Medicaid payment systems, according to the company's annual report.
Since IHS took the facility over in November 1997 from Horizon Health Systems, the Health Department has confirmed at least six complaints where Southwest failed to meet Health Care Financing Administration standards for care.

Two residents were given an overdose of insulin at 10 times the prescribed amount on May 12, 1998, according to a Health Department report. The error was compounded when physicians and family members were not notified of the mistake until the next day, the report said.

Less severe confirmed complaints at Southwest describe a nursing home where several patients were confined to their beds by guard rails for employee convenience, a patient was forced to accept an injection of insulin that was not necessary and nurses failed to make sure physician directions for medication were followed properly, creating the potential for "more than minimal harm."

SUBHEAD: Lack of affordable choices, low staffing lead complaints
Dayton Daily News December 5, 1999, Sunday,

* Nursing homes that neglect or abuse patients face few penalties, even if they violate standards repeatedly. Four of five homes the state targeted for enforcement since 1994 escaped fines, and the typical fine was less than what many homes receive in state Medicaid payments in a single day. Fifty-six homes avoided any fines despite facing proposed penalties three or more times in a five-year span.

* The nursing home industry is increasingly dominated by for-profit companies that typically have more health and safety violations and fewer staff members per resident than non-profits.

The most recent Ohio Department of Health data available show that for-profit homes in 1995 and 1996 averaged more than twice as many serious violations than non-profits, and they made up a disproportionate number of the state's worst-performing nursing homes.
After breaking her hip in a fall at home, Bice entered Carriage Inn of Dayton Nursing Center last February.

Carriage Inn is operated by Integrated Health Services Inc. of Maryland, one of the largest for-profit chains in the country.

Bice was still alert and otherwise healthy when she entered the home, Frantz said, but two weeks later, and just hours before her death, it was a different story.

"I never saw anyone so dehydrated in my life," Frantz said. "She was pasty. Her oral (cavity) was dry. Everything about her was dry."

Carriage Inn of Dayton officials would not comment on Bice's care but defended the quality of the home.

"The care we have here is exceptional," said Dan Like, who took over as administrator of the home in September.

"We are well-staffed, and that's rare for a long-term-care facility in this day and age."

PENALTIES FEW FOR POOR CARE: Nursing homes usually prepare for 'the game'
SERIES: Who Will Care For Them?

Dayton Daily News December 6, 1999, Monday,

The state proposed enforcement actions against Integrated Health Services of Huber Heights at Spring Creek five times in four years, citing it for dozens of violations.

In 1997, inspectors wrote 16 violations there, including four for causing "actual harm" to residents. Those four included inadequate supervision of residents, causing bed sores to develop, insufficient nursing staff and not tending to residents who suffer from incontinence. Surveyors observed that one resident with an open pressure sore on the right buttock was left sitting for four hours without being repositioned or checked for wetness, even though aides told inspectors the resident was supposed to be checked every hour.

The following year, inspectors found another 16 violations, including not adequately preventing and treating bed sores. But because the home cleaned up its problems in followup inspections each year, it did not lose a penny in fines or other penalties.

"When we are cited for deficiencies, we work very hard to clear them up immediately, so at our first follow-up we are completely cleared," said Lisa Miller, a spokeswoman for Integrated Health Services Inc., the for-profit chain that owns Spring Creek. "And we also put systems in place so that they don't happen again."

The inspectors' initial findings at Spring Creek in 1998 cited the home for failing to prevent bedsores in five of 95 residents, enough to categorize the problem as widespread. But the home disputed that finding and state supervisors downgraded the offenses to just two patients - too few to penalize the home for substandard care.

Dennis Swartzbaugh, administrator at Spring Creek, said it's not unusual for inspection reports to be amended once inspectors and their supervisors are presented with all the evidence. "They, like anyone else, are human. They may not have looked at all the documentation at the time," he said.

Nursing home patient's death is referred to attorney general Nurses at Integrated Health Services Estates improperly inserted a feeding tube, investigators say.
THE FORT WORTH STAR-TELEGRAM December 13, 1999, Monday

FORT WORTH - The Texas Department of Human Services has referred the case of a nursing home resident who died after a feeding tube was reportedly improperly inserted into her stomach to the Texas attorney general's office for possible civil penalties.

Human Services investigators concluded that the licensed vocational nurses at Integrated Health Services Estates in far south Fort Worth were not adequately trained to carry out the procedure and "may have" contributed to Barbara Jean Pope's death in October.

"We've referred the matter to the AG's office to pursue civil monetary penalties," said Rosemary Patterson, a spokeswoman for the regulatory arm of Department of Human Services. "We have also referred the matter to the district attorney, the police and the LVN [licensed vocational nurse] board for further investigation. " All are routine actions after a death.
The nursing home initiated the state's investigation by reporting Pope's death, Gill said. Within a few days, investigators found a number of deficiencies at the nursing home and recommended termination of the home's Medicaid contract. The home has since corrected the deficiencies, Patterson said.

Here's a performance report on some nursing home chains
The Des Moines Register December 14, 1999, Tuesday

About 45 percent of the state's homes are owned by 17 corporations or individuals who own at least four homes in Iowa. Here are short descriptions of several of those owners. The state's larger chains were described in Sunday's and Monday's Register.

Integrated Health Services

One of the country's largest nursing home chains, Integrated Health Services of Milwaukee has one of the worst records among chain owners in Iowa.

While spending on patients sometimes barely exceeds 50 percent of all spending, administrative costs range from 20 percent to 29 percent of spending. The state levied $ 8,900 in fines last year against four of the chain's five homes, which had an average of 10 violations each. Integrated Health reported nearly $ 1 million in home office costs in the last half of 1998.

COUNCIL BLUFFS, Iowa (AP) - A Council Bluffs nursing home has been fined by federal officials because of deficiencies confirmed during an inspection in December.
The Associated Press State & Local Wire January 20, 2000,

IHS South has been ordered to pay $150 per day until it is found to be in compliance with federal regulations, according to David Werning, public information officer for the Iowa Department of Inspections and Appeals.

The civil penalty, which is being assessed on the department's recommendation, is retroactive to Oct. 29, when 22 deficiencies were identified during a routine survey, he said.
The nursing home has been ordered to deny admission to Medicaid beneficiaries until it is back in compliance with federal regulations, Werning said.

DCR Downgrades Omega Healthcare Ratings
PR Newswire January 27, 2000, Thursday

The rating downgrades reflect the potential for higher-than-anticipated lease and mortgage concessions for Omega's troubled operator base, and capital structure concerns relating to the potential collateralization of Omega's $200 million unsecured bank line that expires in September 2000.
Based in Ann Arbor, Mich., Omega is a $1 billion (total investments) REIT with equity and first mortgage investments in health care properties. Approximately 90 percent of the company's investments are in skilled nursing facilities, - - - -
While most private operators seem to be surviving the transition, Sun Healthcare (approximately 24.9 percent of Omega investments), and Mariner Post-Acute (5.6 percent) have filed for bankruptcy protection, and a weakened Integrated Health Services (15.3 percent) is in default on its public debt. In many cases, expansion and business diversification efforts by public nursing home chains prior to the implementation of Medicare PPS have served to compound what should have been a far more manageable revenue adjustment.

COMMENT:- Citizens have responded to the poor care in corporate homes by taking to the courts. Judges have been so disturbed by the evidence presented that they have awarded massive punitive damages. Insurance premiums have spiraled and the worst homes are rejected by insurers. This is increasing the financial pressure on corporations.

Nursing home operators say insurance rates have tripled
The Associated Press State & Local Wire February 7, 2000, Monday, AM cycle

Texas nursing home operators say medical insurance premiums have nearly tripled in the last three years and will drive more of them out of business.

Last week, Integrated Health Services became the latest nursing home operator in the state to file for bankruptcy protection from creditors. The state's largest operator, Atlanta-based Mariner Post-Acute Network, filed for bankruptcy last month.
State records indicate that competition is declining among insurers that serve nursing homes. There are three groups of licensed and regulated insurers in the market, down from eight in November 1996.
The Texas Insurance Department has agreed to let the state's 208 not-for-profit homes apply for medical liability insurance from a state-created insurer of last resort.

BestWire February 07, 2000

OLDWICK, N.J. (BestWire) - Skyrocketing general and professional liability insurance loss costs for nursing homes are reaching crisis proportions throughout the United States. The problem is most acute in Florida, where at least 10 carriers have left the state or stopped writing new business.
The loss costs have driven most admitted writers from the market
Insurance is one facet of a larger financial crisis facing long-term care providers. When Integrated Health Services filed for Chapter 11 bankruptcy protection last week, it became the 1,651st U.S. nursing home to seek protection from its creditors, according to the American Health Care Association. The trade group attributed the problems to deep cuts in Medicare, combined with nursing staff shortages and escalating costs of litigation. The litigation issue is especially acute in Florida and Texas, where strong patients' rights laws have invited a flurry of lawsuits on behalf of nursing home residents.

Lawsuits: Poor care resulted in deaths
St. Petersburg Times February 09, 2000, Wednesday

Integrated Health Services is accused of inadequate practices that resulted in two deaths at two of its nursing homes.

ST. PETERSBURG - Integrated Health Services faces a pair of wrongful death lawsuits after two residents died while in the care of two of the company's local nursing homes.
The homes failed to provide adequate care, accurate medical records, recognize changes in patients' health and train and supervise staff members, according to the lawsuits.
It's not the first time Integrated Health Services of St. Petersburg on Jackson Street N has run into trouble.

In 1998, police and welfare officials investigated the death of a a 94-year-old woman who choked to death on a peanut butter and jelly sandwich at a nursing home - despite being on a diet of pureed foods.

The state Agency on Health Care Administration imposed a moratorium on new admissions and cited the nursing home with neglect and failing to report neglect.

The Department of Children and Families also investigated a separate complaint about a patient injury.

The year before, the facility received a "conditional" license with the health care administration after a survey turned up a host of problems, including instances where patients developed pressure sores after being admitted.

Press Journal (Vero Beach, FL) February 16, 2000, Wednesday

Integrated Health Services filed for federal Chapter 11 bankruptcy protection Feb. 2 and has arranged for financing to keep its 400 nursing homes, including the one in Vero Beach, and other facilities operating.

Two recent lawsuits filed against a Vero Beach nursing home blame the facility and its staff for two deaths, including one in which a woman allegedly fell, hit her head and wasn't taken to the hospital for more than four hours.
The first lawsuit alleges IHS staff failed to properly monitor Coniglio, administer his medications and document changes in his medical condition
The second suit, filed Feb. 4, alleges Mrs. Jackson in March fell, hit her head and was not properly evaluated or sent to the hospital for more than four hours.
A short time later, after Mrs. Jackson complained of a severe headache, dizziness and nausea, she was sent to the hospital, where doctors operated on an injury to her brain. Mrs. Jackson died two days later.
The suit also contains one claim for false and misleading advertising.

IHS showcased its services in a booklet that Mrs. Jackson and others relied on before selecting the facility.

They hold themselves out to the public that they will care for people in a certain way, yet these injuries are occurring. Dudgeon said.

COMMENT:- Corporations have claimed that financial pressures do not impact on care. A number of state regulators have made reassuring noises. In practice federal and state regulators are alarmed at the likely consequences and are making extra efforts to monitor care.

Bankruptcy filing means more work for state
Albuquerque Journal February 17, 2000, Thursday

* Nursing homes, patients' welfare must be monitored

The recent bankruptcy-protection filing of Integrated Health Services Inc. New Mexico's largest nursing-home operator has created a challenge for state health officials because of the number of facilities here that must be watched more closely.

The filing forces the Health Department's division of health improvement to seek assistance to check the 28 facilities in New Mexico and step up monitoring, said Steve Dossey, the deputy director of the division.

"It will be a challenge to do the type of monitoring that we need to do because of the number of homes they have here," he said.

Nursing home could face loss of funding
The Denver Post February 24, 2000 Thursday 2D EDITION

A Colorado Springs nursing home with a recent history of substandard patient care has been placed under state monitoring and faces possible loss of Medicaid and Medicare payments.

Integrated Health Services at Cheyenne Mountain, 835 Tenderfoot Hill Road, also has been ordered to develop a plan to correct 15 deficient-care practices.

Uncovered in an unannounced visit on Jan. 28 were ongoing problems with residents' bedsores, nutrition and incontinence care. Similar problems were found in July 1999 at the 148-bed facility, which has a number of residents with dementia.
The 168-page list of deficient care included:

Residents left in their feces and urine for hours, and sometimes all night, resulting in skin damage and emotional distress.

Failure to perform simple grooming tasks such as shaving.

Inadequate nutrition for some residents who weren't given much assistance in eating.

Failure to provide several residents with cushions to prevent bedsores.

Failure to ensure staff followed safe procedures in filling portable oxygen tanks.

Insufficient nursing staff on each shift.

One resident complained about the inattention to incontinence care: 'This is not right. It makes me feel like a dog.'

The state has recommended that the federal Health Care Financing Administration deny payment for new patients until the daily needs of current patients are met and terminate the nursing home's certification to receive Medicaid and Medicare money if current problems aren't corrected within 90 days.

East Florida
State scrutinizes finances of nursing homes
Business Journal February 25, 2000

State regulators are closely monitoring 12 area nursing homes because of concerns about their financial health.

Northeast Florida nursing homes being scrutinized by the state Agency for Health Care Administration are owned by four companies. Three of the companies filed for Chapter 11 bankruptcy protection last year.

Those companies are:

96-year-old woman raped at nursing home
The Associated Press State & Local Wire March 8, 2000

A nursing home aide was arraigned Wednesday on charges he sexually assaulted a 96-year-old woman who lives at the Manchester home.

Daniel Dequoy, 32, was being held on $10,000 cash bail in the Feb. 28 assault at Integrated Health Services of New Hampshire.

He was charged with aggravated felonious sexual assault Tuesday, the day the home reported the assault to police.

More patients complain of being fondled at nursing home
The Associated Press State & Local Wire March 10, 2000, Friday,

A male patient has complained of being fondled by the same nursing home aide who is charged with raping an elderly woman, police said.

Daniel Dequoy, 32, was fired by Integrated Health Services of New Hampshire on Tuesday after the 96-year-old woman reported to administrators that he had "gotten fresh" while bathing her.
On Wednesday, an elderly man told nursing home administrators he had been touched inappropriately by Dequoy when the aide was bathing him sometime in the past week, Lt. Marc Lussier said Thursday. Nursing home director Allan Roy promptly reported the allegation to police.

And police also received a call from the daughter of a former male patient who said her father complained of being fondled in a similar manner by a male staff member last October. The staff member was not named.

Nursing Home Care Reviewed
Albuquerque Journal March 14, 2000, Tuesday

State regulators say they have not seen any overall decline in care during initial reviews at the 26 nursing homes run by Integrated Health Services Inc., which filed for bankruptcy court protection last month.

The company's assisted-living facility, Village at Alameda, however was cited for eight deficiencies, said Roy Weidner, the long-term care program manager for the Health Department's division of health improvement.

Three violations have "the potential for more than minimal harm," he said. They are failure to: perform nutritional assessments of residents; restrain a resident being transported in a vehicle; and train workers on how to operate equipment, Weidner said.

Medicaid crunch hurts nursing homes
The Denver Business Journal March 17, 2000

More than 30 percent of the state's licensed skilled nursing beds are located in homes operating in bankruptcy.

"We're concerned about patient care simply because of the number of facilities in bankruptcy and are monitoring facilities in bankruptcy," said Janell Little, deputy director of the Health Department's Health Facility Division.

In late February, Little's office placed a 148-bed nursing home near Colorado Springs under state monitoring after an investigation turned up residents with pressure sores, nutritional deficiencies and incontinence. The Cheyenne Mountain facility is owned by Marylandbased Integrated Health Systems, a national chain of nursing home facilities that filed a petition with U.S. Bankruptcy Court Feb. 2 and is now in the midst of a Chapter I I financial reorganization.


In less than a year, seven national nursing-home chains have filed for Chapter 11 bankruptcy protection, citing the cuts. Five of them - NewCare Health Corp., Vencor Inc., Sun Healthcare Group Inc., Mariner Post-Acute Network and Integrated Health Services Inc. - operate nearly 30 percent of the 80,000 beds in Florida.

At the least, the industry's financial problems may jeopardize patient care by destroying employee morale and driving the best caregivers out of the business, experts and regulators say. At worst, it will result in widespread closures that could strain Florida's long-term care industry so badly that remaining homes would begin turning elderly patients away. Nursing homes already are near capacity, with occupancy statewide at more than 90 percent.
Wilkes is unsympathetic to the financial plight of the industry. He points to a recent spate of federal actions against large nursing-home chains that allege some companies bilked the Medicare and Medicaid programs out of billions of dollars.
Rather than waste money lobbying legislators to change Florida's laws, companies should focus on stopping corruption and nursing-home abuses, Wilkes said.

"We've got a system that is full of fraud and deceit, and their evil owners are spending money on a political campaign designed to take away their patients' rights," he said.

If Florida's nursing-home industry collapsed under the weight of its financial problems, its elderly patients would be better off, Wilkes said.
"I don't think there should be an acceptable level of neglect," he said. "These people have gone out and committed enough crimes that they've numbed the public to them."
"Medicare was a gravy train," Plush said. "They gambled that it was going to last forever and they lost."

As for the lawsuits, the industry's history of abuses made it an easy target, he said.
Bottom line: Nursing homes have little choice but to pay their premiums. And while there are no easy answers to the industry's current plight, one thing appears certain: Jim Wilkes isn't going away. "They are just evil, and everybody knows it," Wilkes said. "That's why I always win."

COUNCIL BLUFFS, Iowa (AP) - A Council Bluffs nursing home continues to pay a federal fine of $150 per day because it is still violating federal regulations.
The Associated Press State & Local Wire March 31, 2000

* COUNCIL BLUFFS, Iowa (AP) - A Council Bluffs nursing home continues to pay a federal fine of $150 per day because it is still violating federal regulations.

IHS of Council Bluffs South could lose its Medicare-Medicaid contract if it does not meet regulations by April 29
Because Integrated Health Services, which owns the nursing home, has filed for bankruptcy and is operating on interim financing, state officials are checking weekly to make sure the center has enough supplies on hand to meet residents' needs, Werning said*

Woman dies after getting wrong medicine
The Associated Press State & Local Wire April 18, 2000, Tuesday,

Investigators are trying to determine whether a Greer woman's death at a nursing home resulted from her being given the wrong medicine, Greenville County Deputy Coroner Kent Dill says.
Robert Gill, spokesman for Integrated Health Services, which owns the home, said the company is cooperating in the investigation.

State inspection finds uncorrected problems, new issues
The Associated Press State & Local Wire April 20, 2000, Thursday

A follow-up inspection of a Colorado Springs nursing home found continuing problems.

The Colorado Department of Public Health and Environment had given Cheyenne Mountain Nursing Center 90 days to correct 15 problems with patient care identified in January.

A report on the follow-up inspection released Wednesday said earlier problems that remain uncorrected include poor nutritional standards, inadequate grooming and pressure sores on patients who had not been moved.

New problems cited in the report were improper restraint of residents at mealtime, the bathing of residents near trash cans overflowing with soiled undergarments, inadequately dispensed medications and inadequate training.

90-year-old accused in beating death ; Amputee, 76, killed at nursing home
San Antonio Express-News July 7, 2000, Friday , METRO

A 76-year-old double amputee has been beaten to death, and authorities allege his 90-year-old nursing home roommate was responsible.

Vester Cobb died Monday from injuries he suffered June 29. Authorities say his roommate, who has dementia, beat him over the head with a metal footrest from a wheelchair. The incident took place at the Medical Center Nursing Facility at 7302 Oak Manor Drive.
The roommate has not been identified or charged. He has been diagnosed with severe dementia.

"He is a suspect at this point," police spokesman Sgt. Gabriel Trevino said. "It's a very unique situation. We're trying to handle it the best way possible."

Robert Gill, a spokesman for the Baltimore-based Integrated Health Service, which owns the nursing home, said the company is cooperating in the investigation.

Nursing home resident beat to death
The Associated Press State & Local Wire July 24, 2000, Monday

A nursing home resident is being held on charges of murder and aggravated assault after his roommate at a nursing home was murdered, police said.

Elzie Calahan, a 54-year-old paraplegic, died at Parkland Hospital this weekend, after being bludgeoned to death with a dresser drawer and a cane.
Officials with Integrated Health Services, which owns the 155-bed center, declined to comment on most aspects of the case - - - .
Over the years, state officials have made several visits to the four-story Professional Care Center, which has been cited for inadequate supervision and one previous incident of resident-on-resident violence.

Regulators had cited care center; Nursing home official has said beating death couldn't be foreseen
The Dallas Morning News July 25, 2000, Tuesday THIRD EDITION

The Dallas nursing home where a resident was beaten to death Saturday has been cited repeatedly for problems with patient care and was facing $ 163,000 in fines before the death, state records show.

Problems at Professional Care Center have ranged from lack of supervision and poor sanitation to sexual abuse, regulators say. Texas investigators have recommended the federal government terminate the center's contract for Medicaid and Medicare at least eight times since 1996.

"This is a facility that has problems," said Rosemary Patterson, a spokeswoman Texas Department of Human Services spokeswoman. "They have had continuous problems."
The 155-bed center is owned by Maryland-based Integrated Health Services, one of the largest nursing home operators in the country. It is in bankruptcy proceedings, attempting to reorganize.

State health officials visited Professional Care Center, near Inwood Road and Harry Hines Boulevard, as recently as May after a woman lay helpless for hours after falling near an air-conditioning vent between her bed and the wall. She suffered hypothermia.
"I believe what she's [Ms. Hillmon] saying," homicide Sgt. Gary Kirkpatrick said. "I do not think there was anybody around; otherwise, I think they would have tried to stop it."

Staffing issues

"I am angry because this didn't have to happen," Ms. Jackson (who quit as Professional Care Center's medical records director three years ago) said. "In my opinion, this place should have been closed a long time ago."

She said she often had to feed patients and clean their beds even though she was hired to work in the office. "The most astounding thing was the lack of help," Ms. Jackson said.

Local senior advocates say they have been watching the center closely.
"All nursing homes have problems, but to have a lack of supervision where someone gets beaten to death is more than I can fathom," said Bettina Lang, director of the agency's nursing home ombudsman program. "If there is a lack of supervision to that point, what else is going on?"


The center was the focus of one state investigation in 1997 when an HIV-positive male resident sexually assaulted a female resident with Alzheimer's disease, records show.

A 1999 investigation cited the center for, among other things:

* Failure to have an effective system in place to ensure residents were free from sexual and physical abuse.

* Failure to maintain a system where all allegations of abuse were reported to the administrator and state agency.

* Failure to maintain elevators in proper working condition.

* Failure to ensure the environment was kept clean, sanitary and in good repair.

* Failure to ensure medical care was supervised by a physician.

Some senior advocates said they hope the incident sheds light on the severe staffing problems at many nursing homes. Texas, unlike some other states, has no minimum staffing requirements.
Fort Worth attorney H. Dustin Fillmore III has sued Integrated Health Services before on behalf of patients for alleged wrongs that he blames on staffing shortages. Preventable injuries, deaths and suffering can be attributed to industry economics, he said.

Private nursing home companies, he said, typically receive a fixed income from Medicaid, Social Security or other federal aid that each patient can qualify for. This creates a powerful financial incentive to improve profit margins by manipulating the one factor that the boards can control: staffing levels and salaries, he said.

"This industry is sick," Mr. Fillmore said.

State of elder care draws criticism; Dallas beating death puts spotlight on problems with pay, supervision
The Dallas Morning News July 31, 2000, Monday

The beating death of a paraplegic resident at a Dallas nursing home earlier this month has state health investigators questioning supervision of the facility's elderly, disabled and chronically ill residents.

The Texas Department of Health's investigative report on the homicide at Professional Care Center, which is expected to be finished this week, will discuss whether staffing levels and supervision were appropriate, among other things.

Police reports say a nurse's aide arriving for work on July 22 found call lights flashing and no other staff around. When she started checking the rooms, she found 54-year-old Elzie Calahan lying on the floor after having been beaten by a cane and a dresser drawer. Mr. Calahan's roommate, Jose Amador, 45, is being held on a first-degree murder charge at the Lew Sterrett Justice Center in connection with the attack.
Regardless of the state investigator's findings, the case has raised questions about the care of nursing home residents - the same questions that nursing home advocates have been asking for years about a shortage of qualified nursing home workers, staffing cutbacks and low pay.

A government study discussed last week by the U.S. Senate Special Committee on Aging says more than half of nursing homes nationwide have fewer nurses' aides than are needed for adequate care. One-third of the homes don't have adequate numbers of registered nurses, the government study found. And a recent study by the National Citizens' Coalition for Nursing Home Reform says inadequate staffing is one of the reasons malnutrition affects between 35 percent and 85 percent of nursing home residents.

State says man's death couldn't be prevented; Nursing home not faulted in bludgeoning of resident; victim's family angry at finding
The Dallas Morning News August 8, 2000, Tuesday THIRD EDITION

The Dallas nursing home where a disabled resident beat his paraplegic roommate to death was properly staffed and monitored when the incident occurred last month, a Texas Department of Human Services spokeswoman said Monday.
Amelia Hillmon, a 33-year-old worker at the nursing home, told reporters and police after the attack that patients were not being properly supervised when she arrived for work that morning. Ms. Hillmon said she was assaulted by Mr. Amador when she tried to stop the fight.

Mr. Gill said a nurse had been in the room about eight minutes before the attack and didn't notice any problems. The nurse took blood from Mr. Amador and reported that "he was in a good mood," Mr. Gill said.

Ms. Patterson said the center had documentation showing that there was a sufficient number of workers checking on patients.

"There is no way to prove what is on the chart, but we can tell when paperwork has been altered," Ms. Patterson said.

Florida drops six nursing homes from Medicaid
Reuters Monday October 2, 5:03 pm Eastern Time
By Michael Peltier

TALLAHASSEE, Fla., Oct 2 (Reuters) - Florida officials took the unprecedented step on Monday of cancelling Medicaid contracts with six nursing homes as part of a statewide effort to bolster the quality of care at long-term care facilities.
Citing consistently poor care during the past 24 months, Bush said Florida would no longer reimburse the facilities for their Medicaid patients and would transfer those patients to other facilities within 30 days.
State officials entered the six facilities on Monday to begin monitoring patient care during the next 30 days and assist in the relocation of Medicaid residents. State officials also began contacting family members to inform them of the move.
Two - - are owned by Integrated Health Services Inc.

Florida Cancels Contracts with Nursing Homes due to Inadequate Patient Care
The Miami Herald October 3, 2000, Tuesday

TALLAHASSEE, Fla.--In the latest sign of a widening nursing-home crisis in Florida, the state Monday took the dramatic step of canceling state contracts with six homes because of shoddy patient care over a two-year period.

More than 600 frail, elderly patients will be shifted to new institutions, and the six homes face the risk of financial ruin because they are losing their biggest chunk of revenue, under Medicaid. The state sent nurses to the homes, set up a 24-hour toll-free hot line to handle questions and scrambled to make arrangements for patients without family members.

Nursing homes vow to fight Some of the facilities and families of Medicaid patients dispute the state's charges of chronic problems and poor care.
St. Petersburg Times October 04, 2000, Wednesday

TAMPA - Armando Caballero does not want to move his 92-year-old mother.

DENVER ROCKY MOUNTAIN NEWS October 22, 2000, Sunday

One-third of Colorado's nursing home residents are living in facilities run by bankrupt companies.
Three companies, which run 49 of Colorado's 58 bankrupt homes, are being investigated for defrauding Medicare of hundreds of millions of dollars. They are Vencor, Sun Healthcare, Mariner Post -Acute Network and Integrated Health Services (IHS).
In Colorado, complaints about nursing homes to a network of ombudsmen leaped by a third last year to 12,812. State ombudsman Virginia Fraser blamed short staffing for many of the problems.
Not all the problem nursing homes in Colorado are bankrupt, but half the 58 bankrupt homes have been cited in the past two years for harming patients, according to state records:

* IHS-Cherry Creek failed to treat a toe injury, which decayed into gangrene. The patient's toe was amputated. Colorado put the facility under state monitoring and threatened a payment suspension. Spokesman Robert Gill said the home is back in compliance with regulations.
* IHS-Canon City was cited for not noticing a patient fell seven times in six weeks while on a medication that could cause falls. IHS declined comment, saying it sold the home July 1.

Nationally, 54 percent of nursing homes are staffed at dangerously low levels, according to a new federal study. Administrators can't find people willing to train as certified nurse's aides when they pay only $8 to $9 an hour.

While patients suffer, executives treated themselves to corporate jets, private gyms and, in one case, $40 million to a CEO who was running the company into the ground.

American Health Line October 30, 2000

One-third of Colorado's "most frail citizens" reside in nursing homes run by bankrupt companies, the Denver Rocky Mountain News reports. The Justice Department is now investigating four companies that run 49 of Colorado's 58 bankrupt facilities -- Vencor, Sun Healthcare, Mariner Post -Acute Network and Integrated Health Services -- for "defrauding Medicare of hundreds of millions of dollars" (Imse, Denver Rocky Mountain News, 10/22).

Two dead at nursing home, eight others taken to hospitals
The Associated Press State & Local Wire December 8, 2000,

A mix-up in an oxygen system is suspected of causing the deaths of two nursing home residents and the hospitalization of eight others, authorities said.

Investigators believe an in-house oxygen system at the Carriage-by-the-Lake nursing home in this southeast Dayton suburb might have been hooked by mistake to a nitrogen tank Thursday, a fire chief said.
Gill (from HIS) said only a nurse or a nurse's aide, and sometimes the suppliers themselves, are allowed to connect the tanks into the in-house delivery system.
Medical facilities sometimes use nitrogen to purge lines used to carry air, Miles said. The nitrogen tank was included in a delivery of oxygen to the nursing home on Nov. 30, he said.

Coroner won't rule out asphyxiation in nursing home deaths
The Associated Press State & Local Wire December 9, 2000,

Asphyxiation by nitrogen from a suspected mix-up in a nursing home's oxygen system has not been ruled out in the deaths of three of the home's residents, but more testing will be required before the cause of death can be determined, a coroner said.

Supplier says nitrogen delivered to nursing home by mistake
The Associated Press December 13, 2000, Wednesday

The company that supplied oxygen to a nursing home where three residents died did deliver a nitrogen tank to the home by mistake, but it was clearly labeled, a company official said Wednesday.

The tank also was not designed to be hooked up to the oxygen system, said Bob Yeoman, a BOC Gases vice president.

NURSING HOME FACES $ 10,000 FINE::::Infractions at institution where mix-up killed 4
Dayton Daily News December 21, 2000, Thursday,

Integrated Health Services at Carriage-by-the-Lake faces a possible $ 10,000 fine for deficiencies discovered at the Sugarcreek Twp. nursing home following a Dec. 7 mix-up of medical gases that killed four patients and injured a fifth.

Ohio Department of Health investigators, who inspected the nursing home Dec. 8, cited it for failure to create as safe an environment for patients as possible and for inadequate training of personnel charged with handling the nursing home's oxygen supply system. ODH recommended the $ 10,000 fine, the maximum allowed under Ohio law, but federal authorities make the final determination. The nursing home can dispute the ODH findings.

Five of the 10 patients receiving oxygen therapy in the home's skilled nursing unit went into cardiac arrest after breathing nitrogen rather than oxygen through the home's oxygen system. Nitrogen, a harmless gas if used properly, can displace oxygen in the blood, leading to heart irregularities and death.
"Review of facility policy, procedures and in-services failed to reveal that no (sic) measures were taken to educate staff members as to safety measures and needed precautions when connecting oxygen to the facility's bulk oxygen supply."

Report: nursing-home nitrogen tank was initially set aside
The Associated Press State & Local Wire December 20, 2000

A nitrogen tank mistakenly hooked up to a nursing home's oxygen system was set aside earlier by an employee because the fitting looked different than the fittings on oxygen tanks, the Ohio Department of Health said Wednesday.

Four residents of the Carriage-by-the-Lake nursing home in nearby Bellbrook died after the nitrogen tank was connected to the system. The cause of their deaths remains under investigation, but preliminary autopsy results have not ruled out the possibility the residents were asphyxiated by nitrogen.

The department investigated the nursing home after 10 residents who were on oxygen were stricken Dec. 7.

The department's report said a maintenance worker who took delivery of the tanks on Nov. 29 set the nitrogen tank aside because the fitting looked different.

Another maintenance worker at the home connected the tank several days later by removing a fitting from an empty oxygen tank and using it as an adapter, the department said.

Authorities said the nitrogen tank had an oxygen label with a smaller nitrogen label partially covering it. Both employees deny having seen the nitrogen label, the department said.

Dayton Daily News January 30, 2001

XENIA - The investigation into the deaths of four Sugarcreek Twp. nursing home patients, now ruled as homicides, will go to a grand jury next week.

Greene County Coroner Dr. Kevin Sharrett said the deaths, caused by nitrogen asphyxiation, were "clearly . . . the result of the acts of other individuals. As to the intent of those actions, we cannot determine that."

A grand jury will convene Feb. 6 to decide if mistakes leading to the gas mix-up affecting 10 patients at Integrated Health Services at Carriage-By-The-Lake, 1957 N. Lakeman Drive, rise to the level of criminal culpability, Greene County Prosecutor William Schenck said.
Four female patients, ages 53 to 77, died within 11 days after nitrogen was introduced into the home's oxygen system Dec. 6. Gas-tank supplier BOC Gases of Dayton has said the company mistakenly delivered a nitrogen tank to the home Nov. 29; a Carriage-By-The-Lake maintenance worker has said he changed fittings on that tank to connect it to the oxygen system.

Nitrogen deaths of nursing home residents called homicide
ASSOCIATED PRESS Tuesday, January 30, 2001

XENIA, Ohio - Four nursing home residents who died after a nitrogen tank was hooked up to an oxygen system were killed by nitrogen asphyxiation, two coroners said yesterday.

Dayton Daily News February 10, 2001

XENIA - A grand jury on Friday returned criminal indictments against two defendants for their alleged roles in the December homicides of four Sugarcreek Twp. nursing-home patients.

One defendant will face four counts of involuntary manslaughter, while another will face four counts of reckless homicide, Greene County Prosecutor William Schenck said.

The charges are third-degree felonies that carry maximum per-count penalties of five years in prison and a $ 10,000 fine if the defendant is an individual, or a $ 15,000 fine if the defendant is a company.
In addition to the pending criminal charges, four multimillion-dollar lawsuits have been filed against the nursing home; the home's bankrupt owner, IHS of Sparks, Md.; BOC Gases of Dayton; and gas-cylinder manufacturer Chart Applied Technologies of Burnsville, Minn.

The home also faces a possible $ 10,000 fine, the maximum allowed under Ohio law, for failing to create as safe an environment for patients as possible and for inadequate training of personnel charged with handling the nursing home's oxygen supply system.

Companies Face Criminal Charges in Nursing Home Deaths
(Reuters Health) Feb 13, 2001

WESTPORT, CT - A bankrupt nursing home operator and a medical gas supplier are facing criminal charges in connection with the asphyxiation deaths of four nursing home patients who were given nitrogen instead of oxygen.

An indictment filed yesterday in the Court of Common Pleas in Greene County, Ohio, charges Integrated Health Services with four counts of involuntary manslaughter. Sparks, Maryland-based Integrated Health operates Carriage-by-the-Lake, the Bellbrook, Ohio, nursing home where the gas mix-up occurred.
Each company could face a maximum fine of $60,000 if convicted on each of the third-degree felony counts, Greene Country Assistant Prosecutor Craig King told Reuters Health. He declined further comment on the charges.

FDA warns against medical gas mix-ups
The Associated Press State & Local Wire April 11, 2001

COMMENT:- Government has responded to the IHS gas tragedy

The advisory issued Friday by the Food and Drug Administration is the first to address similarities between the nitrogen-asphyxiation deaths of four patients at a nursing home in nearby Bellbrook and three other gas mix-up deaths in Idaho, Nebraska and New York during the past five years, David Horowitz, director of compliance at the FDA's Center for Drug Evaluation and Research, said Tuesday.

In all cases, the people in charge of connecting gas tanks to the oxygen system lacked proper training and failed to examine labels on the tanks, according to the FDA advisory.

Families of victims of oxygen tank mix-up push for legislation
The Associated Press State & Local Wire June 6, 2001
By LIZ SIDOTI, Associated Press Writer

Relatives of nursing home residents who died in December when nitrogen mistakenly was hooked up to the facility's oxygen system told a Senate committee Wednesday that the tragedy could have been prevented.
Authorities said the four women died of nitrogen asphyxiation after a maintenance worker at the home mistakenly hooked up a nitrogen tank to the oxygen system. They said the tank had an oxygen label partially covered by a smaller nitrogen label.
The bill, sponsored by Sen. Steve Austria, a Republican from Beavercreek, would require that all medical gas tanks be clearly labeled with colors corresponding to the types of gases in the tanks and that handlers of the tanks undergo training about how to install them.
The Carriage-by-the-Lake operator, Integrated Health Services of Sparks, Md., has pleaded innocent to four counts of involuntary manslaughter. The medical gas company authorities say delivered the nitrogen, BOC Gases, based in Murray Hill, N.J., also pleaded innocent to four counts of reckless homicide.

Nursing facilities being watched more closely
Philadelphia Business Journal January 12, 2001

Assistant U.S. Attorney David Hoffman is on the front lines in the battle to improve the quality of care at Pennsylvania nursing homes.

Hoffman, who is assigned to the Eastern District of Pennsylvania, helps investigate and prosecute the operators of nursing homes that provide substandard care or fail to properly maintain their facilities.

Since 1996, when Hoffman brought his first case against an area nursing home, a total of six area nursing homes have been fined for problems ranging from providing inadequate nutrition to failing to provide necessary care for residents who suffer from chronic diseases.
In 1999, Integrated Health Services reached a settlement with the government to pay $195,000 for violations at the Chateau, a nursing home in Bryn Mawr, according to Hoffman.

Nursing home agrees to million dollar settlement
The Associated Press State & Local Wire February 12, 2001, Monday, BC cycle

A nursing home's insurance company has agreed to pay a man a million dollars after his mother fell at the home and later died.

Walter Earl Rodden, 65, sued the East Moore Nursing Center, now known as Integrated Health Services of Moore, over the death of Elfreida Majorie Rodden, 86, in 1998.
State nursing home advocates say the case points up a problem familiar to Oklahoma nursing home operators - a shortage of adequately trained staff.

"This was a valid case of blatant neglect," said Bill Fogleman, long-term investigator with the state Department of Human Services.
The lawsuit said that East Moore officials falsified the woman's accident report to downplay the seriousness of the fall.

The lawsuit also claimed that a staff shortage at the nursing home contributed to Elfreida Rodden suffering from "bedsores, dehydration, malnutrition, and infections" after she was moved there April 7, 1997.

Fears unsettled as lawsuit ends Case shows hazards of nursing home neglect
THE DAILY OKLAHOMAN February 12, 2001
- - (Another reference to the same $1 million case)

COMMENT:- The lack of interest in the welfare of the elderly is reflected in the next report. The nursing homes all rejected or failed to respond to an offer of free life saving equipment from the government. When their lack of concern was exposed a whole series of rationalisations and justifications were trotted out.

Cardiac crisis devices on shelf
St. Petersburg Times April 03, 2000, Monday

The county has six defibrillators that can restart a person's heart. The problem? They are free, but acceptance has been slow.
He identified the nursing homes with the most cardiac arrests in 1998 and 1999. One was in Seminole, one in St. Petersburg and one in Pinellas Park. Forty residents had gone into cardiac arrest and only one survived.

So he contacted the homes and offered the equipment, called Automated External Defibrillators.

None accepted.
Nursing home officials who talked to the Times last week said they feared the equipment would be expensive and difficult to use. They also said they worried about the liability they might expose themselves to by using the equipment. But Florida's Good Samaritan law protects anyone, including medical and nursing home personnel, who uses a portable defibrillator to try to save someone's life.

This is maddening to the statewide chief of emergency services.

"The devices are safer and smarter than we physicians are. The electronic way it reads (heart rhythm) is more precise than we are," said Dr. Richard Slevinski, Florida's EMS medical director. "I would think that any nursing home, with an offer of a free AED, why don't they want to offer their people that standard of care? It makes me crazy."
The three nursing homes that generated the most calls for cardiac arrests were the Arbors Healthcare in Seminole, Integrated Health Services of Pinellas Park and Integrated Health Services of St. Petersburg.
Officials with Integrated Health Services of St. Petersburg resisted Barnard's offer of a free defibrillator. The director of nursing there would not talk with a Times reporter Thursday about that decision.
Robert Gill, spokesman for Integrated Health in Miami, said the two facilities hesitated to accept Barnard's offer out of concern over the liability of the employees who might operate the equipment.

"We consider it a generous offer and a potentially life-saving idea, as long as the equipment is used properly," Gill said.

The hesitation of nursing homes is a national phenomenon, according to the manufacturer of the devices given to Pinellas' EMS. Many would rather leave resuscitation efforts to paramedics to avoid any liability claims, said Robert Stanbary, senior marketing manager for Physio-Control.

"Of all the thousands of these we've sold, if we've sold more than 10 to nursing homes, I'd be surprised," said Stanbary. "It's just something they don't buy. It's not just one nursing home that says no. It's been almost all of them. We don't even mess with that market anymore."

The Automated External Defibrillator is considered foolproof by those who advocate its widespread use.
Across the country, portable defibrillators, about the size of lunch boxes, have been placed in casinos, office buildings, sports arenas and airports. Pinellas County's government has asked for a state grant enabling it to buy 50 and place them in public buildings such as libraries and recreation centers.

Tests have shown even 12-year-olds can learn quickly to use the devices correctly.

"This is as scientific as a doctor inventing a new vaccine that saves lives," he said. "It's as exciting as a miracle drug. I didn't expect much resistance."

Nursing home quality declines Facing a tide of lawsuits and horror stories, the industry says it is working to improve, but the Florida Legislature may not wait
The Florida Times-Union (Jacksonville, FL) April 1, 2001
Marcia Mattson, Times-Union staff writer

COMMENT:- An example from IHS was used to illustrate the problem of poor care.

Teague received a plastic brace with Velcro straps for her leg and went back to the nursing home. Touchton and his wife, Traci, thought Teague was healing. Each time they visited her, a blanket covered her legs and the brace.
Teague was sent that day to the hospital, where doctors discovered deep open wounds under the brace. Doctors reported her condition to the state's abuse registry.

'At every point where the Velcro was, there were sores,' Lee Touchton recalled. He can't understand how the nursing home could allow such wounds to develop. 'You could see the white, shiny tendon. . . . It just floored me.'

Doctors amputated Teague's leg Nov. 24. She was discharged to a different nursing home but died Feb. 10 from a blood clot related to the amputation.

Nursing home uses program to train, retain assistants
The Dallas Morning News May 27, 2001
Patricia V. Rivera

COMMENT:- No mention of IHS past record in this promotion.

These days, Ms. Washington draws wisdom and patience for her job from a two-pronged educational program. IHS, which is based in Sparks, Md., implemented the program, CareWorks Career Growth and Bridge Mentoring, in September 1999 to help retain its certified nursing assistants. The initiative gives certified nursing assistants guidance and support in caring for the elderly.
Industry experts said any initiative to raise the knowledge and stature of certified nursing assistants makes a huge difference, yet few facilities develop one.
"By formally recognizing the expertise of our most senior caregivers and giving them the training and support they need to pass on that expertise, we believe we can make a positive impact on the time required to get new staff up to speed," says Paul Wray, director of Clinical Services for IHS.

IHS developed the program with help from Cornell University professor Karl Pillemer, co-director of the Cornell Gerontology Research Institute. Dr. Pillemer argued that a nursing assistant in a long-term care facility holds one of the most demanding jobs in America. These professionals require emotional strength and interpersonal skill as they confront on-the-job suffering, dementia and mortality every day.


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