Maryland Nursing Home Lawyer Blog

Nursing Home Rating System Masks Problems in Maryland Nursing Homes

March 18, 2021 | Lebowitz & Mzhen

The U.S. Nursing Home rating system was introduced twelve years ago, providing for ratings from one to five stars. It was meant to provide a way for people to evaluate and compare nursing homes for their loved ones. However, an investigation by the New York Times recently revealed that the rating system is not an accurate reflection of the quality of care given at a nursing home. The investigation found that many nursing homes have manipulated the system to improve their ratings and hide problems, raising serious concerns for Maryland nursing home residents.

The rating system is based on a combination of self-reported information and on-site inspections. The investigation found that the information submitted to the Centers for Medicare & Medicaid Services (C.M.S.) is often wrong, making facilities appear cleaner and safer, and that the government rarely audits the data provided through self-reporting. Accidents and health issues are often unreported, it also found. Abuse and neglect were discovered through inspections at five-star facilities, but the inspectors rarely found the infractions serious enough to lower the ratings. A previously conducted study from the University of Chicago found that nursing homes did not report about 40 percent of residents who were hospitalized after serious falls.

It also found that the nursing homes were not prepared for the pandemic in part because the rating system allowed them to ignore staffing requirements and infection-control deficiencies. Over 13,000 nursing home residents have died due to COVID-19. The Times found that residents at five-star facilities were about as likely to die due to COVID as residents at one-star facilities. At some nursing homes with five-star ratings, “residents developed bed sores so severe that their bones were exposed.” The son of a resident at a five-star facility on Long Island who died from COVID-19 in the spring believed that the facility was short-staffed or overcrowded because before contracting COVID-19, his mother was moved from a private room into one with other residents.

Holding Maryland Nursing Homes Responsible for Sexual Abuse

March 11, 2021 | Lebowitz & Mzhen

Maryland’s nursing home residents are some of the state’s most vulnerable people. Many families place a loved one in a nursing home when they are no longer able to care for themselves, are aging or disabled, and need regular assistance with daily life activities. When families decide to place a loved one in this type of care, they almost always believe they are doing the best thing for their loved one’s health and well being. That is one of the reasons why nursing home abuse and neglect can be so devastating—families who just wanted to protect their loved ones feel betrayed and shocked to discover that they were facing harm in their nursing home. Particularly traumatic are occurrences of sexual abuse in nursing homes. But, unfortunately, such abuse does occur, in Maryland and across the country.

Sometimes, this abuse is perpetrated by a staff member or caretaker employed by the nursing home to take care of residents. In these cases, Maryland families should remember that they usually have the option of filing a lawsuit against both the staff member and the nursing home. But sometimes, the abuse occurs within the nursing home but not by someone employed by the nursing home—another resident, for example. Recently, this issue came up in a New York nursing home. According to a local news report, state officials cited the home for failing to report instances of sexual abuse. The nursing home discovered that at least three residents were sexually abused by another resident, some on multiple occasions, but did not report these crimes.

While holding the nursing home liable in this case may appear more complicated, since no one employed by the home actually perpetrated the abuse, this case illustrates the important potential for holding nursing homes responsible for being negligent and neglecting to take certain actions. Here, Maryland state law may allow a cause of action for the abused victims (or their families, suing on their behalf) to hold the nursing home accountable for negligence in allowing the abuse to happen multiple times and for their failure to report the crimes or take further preventative action.

In Maryland Nursing Home Abuse and Neglect Cases, Criminal Charges do Very Little to Help a Family

March 4, 2021 | Lebowitz & Mzhen

Maryland nursing home abuse and neglect is a pervasive problem, affecting many residents and their families each year. In some cases, the abuse and neglect, once discovered, is so severe that law enforcement gets involved, potentially filing criminal charges against the bad actors. This is especially likely to happen when an individual living in a nursing home dies as a result of the abuse or neglect they experienced.

Take, for example, a case where a 69-year-old woman died at her assisted living facility. According to a local news article, the woman developed an ulcer on her right heel in 2017. Her case manager at the facility, a registered nurse, failed to properly assess the ulcer. As a result, a plan of care was never developed and the ulcer worsened into a wound. The woman had to undergo emergency surgery on her right foot, which had become septic and gangrenous. She eventually died, a tragic loss for her family and loved ones. Her case manager has since been charged with elder abuse by neglect and could face up to 10 years in prison if convicted.

While some may think a criminal charge is a sign of justice in the aftermath of these incidents, and that the wrongs caused will be righted, families who have experienced the loss of a loved one this way often note that the criminal charges do nothing to actually help them recover. That is why many consider filing a civil negligence lawsuit, even when criminal charges are pending, to help them recover for their losses and begin to move on.

FAIR Act Would Ban Arbitration Agreements in Maryland Nursing Homes

February 24, 2021 | Lebowitz & Mzhen

The U.S. House of Representatives recently introduced the Forced Arbitration Injustice Repeal Act, known as the FAIR Act, that would limit private arbitration agreements. The Act as proposed would prohibit companies from requiring workers and consumers to resolve legal disputes through arbitration. Proponents of the Act claim that forcing arbitration tricks consumers into agreeing to arbitration by using fine-print arbitration clauses and deprives them of their right to seek damages in court from a jury. The proposed legislation would include a ban on forced arbitration agreements for residents in Maryland nursing homes by prohibiting pre-dispute arbitration agreements in long-term care facility admission contracts. The Act was previously introduced in 2019 but did not become law.

In October 2016, the Obama administration banned the use of pre-dispute arbitration agreements in long-term care settings. However, a judge struck down the ban and prevented it from being enforced. The Trump administration later issued a new rule, which went into effect in September 2019. That rule reversed the previous ban on pre-dispute arbitration agreements in nursing facilities but required certain conditions to be met. The recently introduced legislation seeks to address the issue once again.

What Is Arbitration?

After Discovering Maryland Nursing Home Abuse or Neglect: What To Do Next?

February 17, 2021 | Lebowitz & Mzhen

There are many reasons that Maryland nursing home abuse and neglect might go unnoticed for a significant period of time. Often, the victims themselves are vulnerable or even disabled, making it hard for them to report or explain what is happening to them. In some cases, they may not even be able to understand it themselves. Sometimes, their loved ones visiting might suspect that something is wrong, but with some nursing homes limiting and restricting visitation due to the COVID-19 pandemic loved ones may be unable to check-in, and abuse and neglect may continue to fly under the radar. Precisely because this abuse and neglect can fly under the radar for so long, it can be shocking and heartbreaking once family members do discover it. Family members of an abused nursing home resident may find themselves wondering—what do I do now?

For example, take a recent account of a nursing home where multiple residents were found neglected or otherwise harmed. According to a news article, one of the incidents happened in March of 2020. A resident in the home was found to have a bruised face, with a huge gash on her forehead and a lump “the size of a golf ball,” according to her daughter. Police were called to the home to investigate and were concerned about possible abuse happening in the facility. A subsequent investigation found that between 2019 and 2020 there were 272 calls to 911 from the home, with a range of concerning incidents. For example, firefighters once found an injured resident alone lying on the floor and asking for help. When they asked why no one was helping, the woman in charge laughed. In another instance, a patient’s ventilator was not working correctly. Firefighters who responded found that none of the electrical outlets were working in the room. These are just some of the concerning instances that can happen in Maryland nursing homes and sometimes go unnoticed by authorities or loved ones.

What Should Families Do if They Discover Their Loved One Is a Victim of Nursing Home Abuse?

When residents’ families discover this abuse or neglect, they often wonder what to do next to protect their loved ones, stop the harm, and hold the nursing home accountable. In the case of the nursing home above, police were called in to investigate. While calling the police can be an important step to take in these circumstances, it is important to remember that criminal charges, while they can hold the nursing home accountable for their harm, do little to actually help those most harmed by the facility’s actions. That’s why many families decide to also file a personal injury lawsuit. These lawsuits have the goal of helping those injured. While they cannot undo the damage that has been done, they can ensure that the victim and their family are given the financial compensation they deserve for their pain and suffering, their medical bills, and other related expenses.

Proving Causation in a Maryland Nursing Home Abuse or Neglect Case

February 10, 2021 | Lebowitz & Mzhen

Establishing causation in a Maryland nursing home case can be difficult, particularly because residents are often sick when they enter the home. With residents that were already sick, it can be difficult to prove that the nursing home’s neglect or abuse caused the resident’s injuries or death or accelerated them. Additionally, residents also may be unable to testify because they lack competency or have already passed.

A plaintiff in a nursing home negligence case in Maryland must prove that the nursing home’s negligent act or failure to act was both a cause-in-fact of the resident’s injuries and a legally cognizable cause. Proving the cause-in-fact means showing that but-for the nursing home’s negligent conduct, the resident’s injuries would not have resulted. In cases where more than one factor may have caused the resident’s injuries or death, Maryland courts use the substantial factor test. Under this test, a court will consider whether the nursing home’s conduct was a substantial factor causing the plaintiff’s injuries.

What Is Causation in a Nursing Home Abuse or Neglect Lawsuit?

Proving that the defendant’s conduct was a legally cognizable cause means demonstrating that the defendant’s conduct was sufficiently related to the injuries that the defendant should be held liable. Courts may consider whether the resulting injuries were a foreseeable consequence of the defendant’s conduct and whether holding the defendant liable would be fair under the circumstances. A plaintiff must prove causation (and other elements of the claim) under the preponderance of the evidence standard, which requires showing that it is more probable than not that the defendant’s negligent act caused the plaintiff’s injuries. It is insufficient that it is a mere possibility that the defendant’s conduct caused the resident’s injuries.

Could Maryland Be Undercounting Its Reports of Nursing Home COVID-19 Deaths?

February 3, 2021 | Lebowitz & Mzhen

Maryland residents who have loved ones in nursing homes have likely been particularly worried about their loved ones’ health, as well as nursing home abuse and neglect, during the COVID-19 pandemic. Due to the large numbers of people living in one area and the relative vulnerability of those living in nursing homes, it is perhaps not a surprise that the facilities have been hit particularly hard by COVID-19. Outbreaks have spread through nursing homes at alarming rates, and there are concerns that they have potentially been fueled by negligent staffing, medical neglect, and lack of proper sanitation procedures. Additionally, there have been high death rates of individuals living in nursing homes, with recent news revealing that those rates may have been undercounted.

Last month, New York State Attorney General Letitia James released a new report based on an investigation into nursing home policies that caused abuse and neglect and threatened the lives of residents and staff alike. One of the key findings in this report was that the number of nursing home deaths tied to COVID-19 has been undercounted by Governor Andrew Cuomo’s administration by as much as fifty percent.

Why Are Nursing Home COVID Deaths Underreported?

Part of the problem that seems related to the fact that the state only counted residents who died on nursing home property, rather than including those who were transferred to a hospital. But the new report indicates that many deaths occurred in hospitals once residents caught COVID-19 in their nursing homes and were then transferred. For example, one facility reported five confirmed and six presumed COVID-19 deaths to the state’s Department of Health. But the same facility reported a total of 27 COVID-19 deaths at the facility itself and another 13 deaths in hospitals. Discrepancies like this were found in multiple nursing homes.

Why Maryland Families Should Not Sign Nursing Home Arbitration Agreements

January 27, 2021 | Lebowitz & Mzhen

Nursing home abuse and neglect is, unfortunately, a rampant problem in Maryland and across the nation. While Maryland state law, recognizing this problem, allows individuals whose loved ones are injured by instances of nursing home abuse and neglect to file a civil negligence lawsuit against the negligent staff or home, many Maryland families may be unwittingly signing away this right. This is because nursing homes may often ask residents or their families to sign an arbitration agreement when the resident moves in. But Maryland residents should always read the fine print of these agreements very carefully and, generally, should avoid signing these arbitration agreements.

Arbitration agreements are essentially contracts stating that if any dispute comes up between the individual and the nursing home, it must be settled through arbitration rather than through a civil negligence lawsuit. Basically, nursing home residents who sign these can be barred from pursuing their case in court. And in most cases, arbitration is not an adequate substitute for having a case heard in court. Arbitration processes do not include a jury, may cap damages to way below what is available in court, and may limit a family’s ability to access or provide evidence of the abuse and neglect their loved one faced. Arbitration is also binding, with very little opportunity to appeal.

How Does Nursing Home Arbitration Work?

Importantly, the arbitrator (the decision maker in the process) is usually chosen by the nursing home, giving them an incentive to decide in favor of the nursing home. Nursing homes tend to like arbitration agreements for all of these reasons, as well as the fact that arbitration processes are covered by strict confidentiality rules, meaning that the nursing home’s abuse and neglect will stay hidden from the public. In contrast, filing a lawsuit against a nursing home provides plaintiffs with all the rights given to them by law, which may include the availability of larger monetary damages, a jury trial, access to more evidence regarding the abuse and neglect, and an impartial decision maker.

COVID-19 Highlights Issues of Neglect in Maryland Nursing Homes

January 20, 2021 | Lebowitz & Mzhen

After the COVID-19 pandemic hit, many families were prevented from visiting their loved ones living in Maryland nursing homes. Visits often serve as a time when families can spend time with their loved ones, and also observe their loved one’s condition in-person. Some advocates claim that there has been a surge in reports of neglect among nursing home residents. Federal data reflects that almost 30 percent of nursing homes report staff shortages now across the United States. Nineteen percent of nursing homes in Maryland report a shortage of nurses and/or aides.

Federal regulations established through the creation of Medicare and Medicaid allow federal oversight of many nursing homes. Even before the pandemic, in surveys conducted from January 2019 through March 2020, 39% of facilities had incidents with suspected or alleged reports of abuse, neglect, or misappropriation of property. Yet, the Centers for Medicare & Medicaid Services (CMS) actually suspended survey activities last March except in some circumstances. More recent guidance allows for survey activities to resume if the state has progressed in its reopening plan or at the state’s discretion. Nursing homes have a responsibility to care for their residents, keep residents safe from harm, and prevent abuse and neglect. Claims can be filed against facilities in cases where nursing homes or staff members have abused or neglected a resident.

Local Group Calls for Reform of Nursing Homes

Can Maryland Nursing Home Arbitration Agreements Be Assigned?

January 13, 2021 | Lebowitz & Mzhen

As arbitration agreements have become routine in many nursing facilities, questions may arise after ownership of the facility has been changed. Like other agreements, Maryland nursing home arbitration agreements can generally be assigned. An assignment of an agreement allows the assignee to “stand in the shoes” of the original party to the contract by granting all the rights the assignor previously had under the agreement.

A recent federal court decision considered whether an arbitration agreement could be enforced against residents after the facility had been transferred to new owners and new agreements had been signed. The case raised issues about when an arbitration agreement is properly assigned and transferred.

In that case, two residents entered a nursing facility in 2019. In April 2019, one resident entered the facility and signed numerous admission documents, including an arbitration agreement, though the agreement was not a condition of admission. The arbitration agreement stated that all claims relating to the resident’s stay were required to be decided through arbitration. In August 2019, the second resident was admitted and signed the same admission documents. In February 2020, the facility was sold and transfer to a new entity. A transfer agreement assigned the new entity as the assignee for certain agreements.