VENCOR'S CARE, MORALITY AND ETHICS

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.

• Vencor Reviews -- two overview articles which describe Vencor's rise and fall.
• Vencor in the Marketplace -- the business and political face of Vencor.
• Vencor the criminal -- Vencor's involvement in fraud.
• Mount Carmel Nursing Home - a closer look at a very revealing example of failure in care.
• Corporate Explanations - some examples of corporate explanations when confronted by evidence of misconduct.
• Bruce Lunsford :: a Profile - what we know of Lunsford.

Allegations of substandard care and of neglect have been made against all of the large corporate chains and the accumulating evidence leaves little room for doubt that this was so.

In the case of Sun Healthcare this can be traced back to Sun's policies as set out by Andrew Turner in 1996. Vencor is less explicit. Its conduct indicates that it's policies were not very different but they have to be inferred from corporate actions and the comments of nurses and patients. Two matters point particularly to their culture and business thinking.

• . . the aggressive industrial approach adopted to nurses and nursing aids.

  Nurses typically provide far more than their remuneration calls for. They have a sense of dedication and commitment to the community. They gain satisfaction and recognition by serving others. It is very individual. Meanings lie in the day to day interactions with patients and their relatives.

  By setting out to squeeze the nurses and so increase profits Vencor alienated essential staff, removed the tokens of recognition and turned care into a job rather than a vocation. Big Mac paid better for less work and that's where staff went.

  With downsizing staff were overworked and could not provide the sort of care required. They gave up and morale plummeted. This is best illustrated in Mount Carmel.

• . . the primacy of commercial considerations over humanitarian concerns.

  This is illustrated by the way in which Vencor saw the decision to dump Medicare patients who paid poorly from their nursing homes regardless of their medical condition. They encouraged dishonesty and misinformation to accomplish this and allegedly paid bonuses to staff who did so successfully. They saw nothing wrong with this. It was simply business and at least one state regulator agreed with them.

• . . the willingness to indulge in deception and fraud when they felt they could get away with it.

  Vencors massive fraud is addressed on a separate web page. Its meteoric success was built from profits generated from fraud and from cutting the costs of care.

Vencor claims that the problems in its nursing homes are because senior managers from Hillhaven elected not to stay with the company when it was purchased by Vencor. This is an unlikely reason as the nursing home care problems and practices are corporate industry wide. It is more likely that the culture and the practices which resulted from it came with Hillhaven. Fraudulent practices however date from long before this.

The best documented case is that of the Mount Carmel Nursing Home and I have therefore devoted an entire web page to what happened in this nursing home.

FOR THE RECORD ::: Vencor under HHS investigation.
Modern healthcare May 25, 1998 Page 16 Briefs
COMMENT:- This investigation eventually led to Georgia authorities recommending a US $500,000 fine for dumping sick Medicare patients who pay less well than private and Medicare patients.

Vencor under HHS investigation. The Atlanta office of HHS' inspector general's office is investigating long-term-care provider Vencor, according to a letter sent by the inspector general's office to Rep. Fortney "Pete" Stark (D-Calif.). The letter didn't disclose the nature of the investigation. Last month HCFA said it was considering sanctions against a Tampa, Fla., Vencor facility that evicted some patients, but officials decided against sanctioning the company.

WHY CARE ABOUT NURSING HOMES?
The Palm Beach Post August 16, 1998, Sunday
Fran Hathaway

President Clinton orders a crackdown on nursing home abuses. Florida issued a record fine to a home in Jacksonville. Medicare cuts money to nursing homes and, with Medicaid, issues new rules.
--------------------------------
Q. Why did President Clinton order a crackdown July 21?

----- Two-thirds of American nursing homes, the report said, are not complying fully with federal standards, and states vary in their willingness and ability to detect serious problems.
--------------------------------
Q. What happened at the Vencor home in Tampa last April?

A. A home owned by the $ 3.5 billion Vencor company illegally tried to dump 52 Medicaid patients by saying the company was renovating the home. Vencor owns 20 other homes in Florida, including four in Palm Beach County. State health-care investigators recommended a $ 360,000 fine. The home stopped the discharges.

Report says inspectors put 'jeopardy' label on Rapids nursing home
The Associated Press October 16, 1998

Residents of a Wisconsin Rapids nursing home were declared in "immediate jeopardy" after inspectors found a pattern of failing to provide medications when they were needed, a report said.

The 140-bed Family Heritage Medical and Rehabilitation Center relied on couriers to deliver medicine from a Vencor Inc.-affiliated pharmacy 79 miles away in Appleton, according to state records and regulators. The nursing home did not have a local pharmacy as a backup when medications were not available, the report said.
---------------------------------
State and federal regulators notified the Wisconsin Rapids nursing home after an inspection Sept. 23 and 24 that it would be fined $ 5,000 daily until problems are corrected, the Milwaukee Journal Sentinel reported today.

"This is a very serious situation," said Marianne Missfeldt, a regional state regulator in Rhinelander.
--------------------------------
In one case, state inspectors said a woman diagnosed with breast cancer missed 12 of 14 doses over six days in July of a drug used to treat cancer or prevent a recurrence.

The state inspection report said problems with missing, late or mixed-up medications were well-known at the home, but nursing staff complained to state inspectors that their pleas to the pharmacy and supervisors were met with little or no results.

Nursing home passes state inspection
Chapel Hill Herald October 27, 1998

HILLSBOROUGH -- The state Department of Health and Human Services gave a Chapel Hill nursing home a clean bill of health recently following allegations of mismanagement and mistreatment.

Chapel Hill Rehabilitation and Healthcare Center on Franklin Street came under fire in July. It was cited for failing to provide proper monitoring and care of residents, leaving them to remain in their own urine and feces for long periods and not accommodating their need for privacy.

Officials also were cited for not notifying the attending physician of medical changes or following the doctor's orders, failing to have sufficient nursing staff and not providing toilet and feeding assistance.

Beverly Speroff, assistant chief of complaints at the N.C. Department of Health and Human Services, said the facility was inspected again in September and found to be in compliance on all counts.
-------------------------------------------
The facility is owned by Vencor Inc. of Louisville, Ky. When allegations first surfaced, operations Director Sharon Luquire admitted that the facility lacked the necessary staff to carry out proper monitoring and care.

Vencor settlement to benefit state, USF;
The Tampa Tribune November 7, 1998

TAMPA - The state wins its case against a national nursing home chain, and USF programs to help the elderly will benefit.

Nursing home giant Vencor Inc. agreed Friday to pay Florida $ 270,000 for trying to evict poor residents in Tampa.
-------------------------------------------
In April, Vencor tried to throw 54 Medicaid patients out of its Healthcare and Rehabilitation Center of Tampa to make room for more profitable patients who could pay with their own money or private insurance. Vencor backed down after a judge signed an injunction halting the moves.
-----------------------------------------
The company also faces a $ 113,100 federal fine from the same incident and punishment from regulators in other states where similar evictions took place. Federal officials say the company has filed an appeal of its fine.

Vencor agrees to a $ 270,000 fine --- FLORIDA
St. Petersburg Times November 8, 1998
COMMENT:- This article describes the human cost of the evictions quoting residents and their families. It emerges that it was not regulators but a whistle blower who used the courts to stop evictions.

------ the remodeling was a sham intended to rid the home of Medicaid patients who bring in up to $ 18,000 a year less than patients who have private insurance.
---------------------------------------------
Vencor, which owns more than 300 nursing homes nationwide, is appealing $ 113,100 in federal fines. A federal class-action lawsuit against Vencor claims the evictions amounted to racketeering.

A bill to prevent nursing homes from dumping Medicaid patients didn't pass in Congress this year, but Florida lawmakers say they'll try again.

When Vencor ordered Adelaida Mongiovi out, her son blew the whistle. --- - - - - - Nelson Mongiovi Sr. got a judge to stop the evictions. He investigated records to help lawyers file a lawsuit and lobbied for new laws.

Report: Evictions of Medicaid nursing home residents 'fairly common'
The Associated Press November 19, 1998
COMMENT:- I am examining specific companies like Vencor, Sun and IHS. Please understand that these are only examples of behaviour in the corporate marketplace. They are representative of broad patterns of thinking which pervade the system. Only when the behaviour is extreme of frankly illegal is it detected.

Illegal evictions seem to be "fairly common" in Florida's nursing homes but are hard to detect, a report presented Thursday to a state Senate panel has concluded.
---------------------------------------------
After state and federal investigations, Vencor Inc. was fined $ 500,000 ----

Vencor's actions "appear to be more of an aberrant extreme of nursing home facility evictions," according to a staff report for the Health, Aging and Long-Term Care Committee.

But evictions from nursing homes seem to be a "serious problem" for people whose bills are being paid by Medicaid, the report reads. That's nearly 45,000 people in Florida - about two-thirds of the people living in one of the state's nearly 700 nursing homes.

The reason could be financial: Nursing homes get paid a lot more by private insurance or Medicare, which will only pay for a short-term stay.

"Unlike the situation that developed in the Vencor incident, evictions typically occur more on an individual level and incrementally," the report said. "In fact, had the Vencor facilities notified their residents individually over a more protracted period of time, the evictions that it attempted may have never been detected or protested."

NURSING HOME FIRM ADMITS 'BAD DECISION' IN EVICTING 42 --- SEATTLE
SEATTLE POST-INTELLIGENCER December 19, 1998

A Shoreline nursing home that kicked out 42 elderly residents last spring and canceled its Medicaid contract has had a change of heart.

Arden Rehabilitation and Healthcare Center has offered to move the residents back in and has asked the state to allow it to become a Medicaid contractor.

A spokeswoman with Arden's owner, Lousiville-based Vencor Inc., said the company made a bad business decision when it moved the residents out and planned to use the excess space for a "mini-hospital."

But Vencor, which also removed Medicaid patients at seven other homes across the country, also suffered harsh media criticism, government investigations and a fine of $270,000 to the state of Florida as a result.
---------------------------------
Vicki Elting, King County's ombudsman for long-term care, bristles at what Vencor did. Last spring, it caused trauma to residents when they had to move from Arden, and among their friends left behind.

"What was so sad to us is that there were people who had lifelong friendships. Those were relationships that were destroyed," said Elting (ombudsman), whose office looks out for the well-being of people in nursing homes and similar facilities. ------ "The state does have its hands tied," Elting said. "They have no way to restrict this company from coming out and coming into the system."
--------------------------------
Vencor ended Medicaid contracts and kicked out patients at eight homes across the country, but Moss said that proved to be a mistake.

Nursing homes decry reimbursement plan
The Boston Globe December 29, 1998

Though nursing homes can opt out of the Medicaid program, few do. Those that do face fierce public fury. Vencor Inc. of Louisville, this year quickly retreated from plans to evict Medicaid patients from 13 homes in nine states after its first evictions evoked public outcry. Other nursing homes believe they don't have a choice.

Money or mercy?
The Tampa Tribune November 15, 1998
(http://www.tampatrib.com/reports/homes/)

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.

Meanwhile, the system for protecting nursing home residents is so heavily weighted in favor of the nursing home industry that bad homes are given repeated chances to stay in business. Shortcomings at the state agency that regulates nursing homes have further exacerbated the situation, records show.

Profits can come at high costs
The Tampa Tribune November 15, 1998
LINDSAY PETERSON and DOUG STANLEY

Corporate chains increasingly run the nursing home industry, and research shows they have a large share of problems in Florida.
-------------------------------------
More than 10 years ago, Congress heralded its passage of new laws to ensure humane treatment of people in nursing homes. Another institution, however, has quietly imposed its own standards: ---- Wall Street.
------------------------------------------
The six largest nursing home companies in Florida are traded on Wall Street. They control the lives of roughly 20,000 people, about one-third of the state's nursing home population.
------------------------------------------
State and federal records show business profits can come at a high human cost.

About one-quarter of Florida's nursing homes fell below state standards during annual inspections between January 1997 and March 1998. Among four of the state's six major chains - Beverly Enterprises Inc., Integrated Health Services Inc., Vencor Inc. and Mariner Health Group Inc. - the substandard rate was 32 percent to 40 percent.
------------------------------------------
One company, Vencor, responded in early 1998 with a plan to evict its residents on Medicaid in homes across the country, ----------- But away from the spotlight, care elsewhere has suffered under Vencor.

When the company took over PersonaCare of St. Petersburg in mid-1997, nurse Rhonda Poinelli saw the number of nurses and nurses aides drop.

Working in the evenings, Poinelli said, she found supply cabinets locked, and she searched from floor to floor for bandages and catheter bags. Often she couldn't find them, which meant patients did without.

Frequently alone with as many as 40 people, Poinelli would find some wet or hungry, pleading for help, she said. But she couldn't detour to help them or her patients wouldn't get their medications on time.

The nursing director's job had become a revolving door, she added. "It seems like I had a new boss every day. ... I started having nightmares."
------------------------------
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 Integrated Health Services 12 Vencor 11 Mariner Health Group 9 Beverly Enterprises 8 Genesis 7 All other homes 7

Fines don't bite businesses hard;
The Tampa Tribune November 15, 1998
BYLINE: VICKIE CHACHERE
COMMENT:- The big chains deny every criticism, fight every infringement and appeal every fine or stricture through a hierarchy of courts so rendering regulation ineffective. Vencor started this with Mount Carmel. Here are more examples.

Financial pain is applied rarely to problem nursing homes. Government fines often are little, reduced or unimposed.
--------------------------------------
While she wasted away, however, state regulators waited 10 months to fine the business $ 700. Its corporate parent, national nursing home chain Vencor Inc., appealed and dragged the process out for another five months.

Finally, in April 1997, the $ 3.2 billion corporation relented. But it didn't pay the fine until September, when the state sent a letter threatening a civil lawsuit.
-----------------------------------------------

Even Vencor, which acknowledged wrongdoing and apologized to 54 Medicaid residents it tried to evict this year in Tampa, is fighting a $ 113,000 federal fine.

Vencor paid the state in that case a settlement of $ 270,000, part of which will go toward research to improve nursing home care.
----------------------------------------
Caufman's (federal AHCA lawyer) bosses acknowledge the agency's legal efforts are out-gunned by the nursing homes. - - - - - - - Not all companies appeal the fines, but most of the big chains do.

Nursing home solutions start at the top
The Tampa Tribune December 22, 1998
COMMENT:- Once again Vencor is simply representative

This past spring, however, a different dimension of the profit question arose as we learned about the plans by a company called Vencor to evict its Medicaid residents from a home in Tampa.
---------------------------
Vencor is a $ 3.2 billion company that sells public stock. At the time of the evictions, stockholders were upset because of reports that government health care spending cuts would cut company profits.

This brought up a new question about the effect of stockholder demands on nursing homes.
-------------------------------
We found that homes run by large, publicly traded companies had more problems, on average, than nonprofits and homes run by for-profit companies that didn't sell stock So, what was it about having stockholders that changed a company's behavior?

The quest for profits seems to be the obvious answer, but it's more complicated than that.

It's not so much that money is siphoned away from patient care. In many cases it is, but there's another factor. The daily life of a publicly traded company is so intense, as stocks rise and fall minute by minute, the questions of how to nurture workers and care for residents fall by the wayside.
------ And for the most part, they're not customers. They're not in a position to get up and walk out if they get bad care.

GEORGIA
Bed News: The Business Potential Of Nursing Homes Is Elusive, Vencor Finds: Bid for High-Paying Patients Brings Firm Headaches, And It Has to Regroup: Medicaid Is Welcome Now
The Wall Street Journal 12/24/98
By Chris Adams and Michael Moss
COMMENT:- This article discloses what has really been happening. It reveals a situation very similar to Columbia/HCA and particularly Tenet/NME. All policies are driven by the bottom line and the market . Patient care considerations are ignored. The policies come from the top and compliance is monitored.

Staff are offered financial incentives when they do their patients a disservice. Care for the bottom line replaces care for the patient. Misinformation and blatant deception are encouraged. What's more the policies are long standing - driven by profit when affluent and intensified by more recent economic difficulties.

As in Tenet/NME there is nothing secret about this. They do not think they are doing anything wrong. This is the way they think. They are quite open about it - even boasting. Discharge dates are determined by economics. Regular meetings ensure compliance.

Once again it was a whistle blower and not state surveillance which exposed what was happening.

SAVANNAH, Ga. -- Laura Morgan's marching orders were simple. As a social worker at a nursing home owned by Vencor Inc., she was to ensure that as many beds as possible were filled with residents covered by generous private insurance or by Medicare. Patients whose high-paying benefits expired, and who thus ended up on lower-paying Medicaid, were to be moved out as soon as possible.

One of her tasks was smoothing the way with relatives. "I had to sit across from family members and lie to them, manipulate them, tell half-truths," says Ms. Morgan, who resigned in June after alerting state authorities to the practices.

Vencor did a complete flip-flop.- - - - - After years as one of the nation's most selective nursing-home chains, Vencor switched almost overnight to one that was focused on keeping its beds full. - - - (this) vindicated critics of the company's intently profit-focused admissions policy.
-------------------------------------
A critical component of Vencor's strategy was offering high-quality care, to attract patients who could afford to go anywhere they wanted. But its record on care is slipping, too. A Wall Street Journal analysis of government inspection records shows that the number of times Vencor homes have been cited for staff shortages, medication errors or other care problems has grown in the past year.
-------------------------------------------------------
Nowhere was that more evident than in its attempts to boost the number of residents who paid their own way, had private nursing-home insurance or had their stay paid by Medicare,- - - - -

Vencor officials talked about their plans openly, deriding rivals' strategy of filling their beds with the plentiful Medicaid patients. - - - - But Vencor wanted to discharge such patients, so it could fill the beds with others who had high-paying insurance coverage.

Administrators of individual nursing homes were taught to rethink the entire admissions process with this in mind. A strategy memo passed on to Georgia homes urged administrators to plant the seed in the minds of prospective patients and their families that a stay would be short-term. "Begin concept upon admission," the memo specified, and while giving families tours of the home.

Mr. Barr, as chief operating officer, bore down on this in a memo to regional officials in the summer of 1997. "We determined months ago that we did not want to admit low-paying Medicaid only patients," he wrote. "Please let your administrators know that it's time to get on board or leave."

At Savannah Specialty Care Center, admissions director Hope St. Lawrence had to prepare a fresh patient census every morning, to be faxed to headquarters by 9:30. Then she rushed off to seek out new admittees from hospitals, clinics and elsewhere. She screened out as many as two out of three prospects. Just having insurance wasn't enough, she says. The insurance had to cover extensive therapy, and people already on Medicaid were excluded outright, says Ms. St. Lawrence, who resigned this summer.
----------------------------------------
Mr. Norris says he received a memo in the spring of 1997 urging him to step up the effort to discharge Medicaid recipients. He says it suggested giving bonuses to employees who successfully evicted such patients. Mr. Norris brought Ms. St. Lawrence into his office and told her, they both recall, "I'm showing you this just so you know about it. This is illegal and this will never happen in my facility as long as my license is on the wall."

But a few miles away at Savannah Rehabilitation & Nursing Center, the eviction strategy went into full swing starting in April 1997, says Ms. Morgan, who was the facility's resident social worker. At weekly meetings, she says, she would be asked to explain what she was doing to move out the patients the home no longer wanted. "They would say, 'So and so has 10 more days left on Medicare, and she can't stay here. What do you plan to do?' "
---------------------------------------------

Sitting at her kitchen table on a recent evening, Ms. Morgan explains why she eventually alerted state officials to the evictions. Leafing through her records, she spots the receipt for a $100 bonus she says she received for discharging a couple she says were evicted improperly. From another pile she pulls out a note in which the couple's children thanked her for her helpfulness during the transfer. "They don't know what really happened," she says.

To make it appear the home was complying with state rules, Ms. Morgan says, she would falsely indicate on certain records that families had requested a discharge.

In June, the Georgia Department of Human Resources determined that Vencor had violated state regulations in evicting 14 patients from Savannah Rehabilitation; it recommended a fine of more than $500,000. ----- Vencor has asked for a federal administrative hearing to contest this. The company won't address specifics such as bonuses for evicting Medicaid patients but acknowledges "irregularities," which it says were isolated to Savannah.
----------------------------------------------
Both Vencor's admissions strategy and its quality of care have come under withering attack. The company received unwelcome publicity for mass evictions of Medicaid residents at nursing homes in Florida and Indiana. In Wisconsin, North Carolina, Nevada, Indiana and other states, a series of inspections cited company homes for shortcomings in care. Mr. Kuntz attributes such problems to a "loss of focus" and says that "we need to improve."
- - - - annual inspections -- which took place from mid-1997 to mid-1998 -- they had a combined 1,468 citations, nearly 23% more than a year earlier

Admissions banned at nursing home that was fined last year
The Associated Press State & Local Wire January 5, 1999
COMMENT:- Vencor claimed to have abandoned its long standing policy of discriminating against Medicaid patients and paid a $270,000 fine in 1998 for doing so at this nursing home. But in 1999 they are still doing it. Clearly they don't think it is wrong.

A nursing home heavily fined last year for endangering Medicaid residents is accused again of discriminating against its poorest residents.

State officials have banned admissions at Rehabilitation and Health Care of Tampa for interfering with residents' rights to apply for Medicaid, the government health care program for the poor.

The home, owned by Vencor Inc., based in Louisville, Ky., also was accused of improper discharge practices. State inspectors spent several days at the home last week, but Agency for Health Care Administration spokesman Pat Glynn said findings would remain secret until the agency completed its review.

Officials issued an immediate moratorium on admissions Monday because the violation was considered to be a threat to the health, safety or welfare of the residents, according to an agency letter to the home.

"Wer this a very, very, very serious matter," Glynn said.
---------------------------------
The home was caught in a controversy last year when it tried to evict 54 Medicaid residents.

The home was fined more than $ 270,000 for endangering Medicaid residents.

The home received the lowest possible rating after September's inspection found residents wandering away, falling, developing bed sores and not being fed. November's inspection revealed the same problems.

2 Pinellas nursing facilities face test
St. Petersburg Times January 06, 1999

Two Pinellas nursing homes are being targeted under a state crackdown on facilities with the worst track records for complying with state standards.

The Abbey Rehabilitation and Nursing Center in St. Petersburg ----- will join 18 other homes previously stamped as poor performers by the state.
--------------------
"Over the past three years, the owners and operators of these facilities have failed to consistently provide the care and services the residents deserve," said Douglas M. Cook, director of the Agency for Health Care Administration. "These homes sorely lack the effort it takes to maintain a quality care environment."
------------------------------
The other Pinellas facility, The Abbey Rehabilitation and Nursing Center in St. Petersburg, has a record of violations dating back to 1996, the report states. The violations include accident hazards, failure to have a care plan for all residents, patients losing weight because of inadequate nutrition, insufficient nursing staff and dehydrated patients.

Most recently, the state placed a moratorium on The Abbey in early December after finding 17 violations during a recertification survey.

ALSO FROM THIS ARTICLE

In a separate action, a Tampa facility that previously was fined $ 270,000 for trying to dump Medicaid patients, has been ordered to stop taking new patients. The state health care agency is accusing the Rehabilitation and Healthcare Center of Tampa of restricting residents from applying for Medicaid and discharging patients without proper planning.

Fine for nursing home suggested by state regulators
The Associated Press January 7, 1999

A nursing home here should be fined at least $ 70,000 for discharging two residents into dangerous home environments, state regulators said.

That fine would escalate $ 10,000 for every day Rehabilitation and Health Care of Tampa failed to meet state standards.

In a report released Wednesday, inspectors said a woman who was taken to the nursing home for Medicare-covered therapy was sent home after six weeks when her therapy ended, even though she lived alone and wasn't able to walk, dress or bathe herself without help.

The woman was returned to the nursing home last week after someone called the Elder Abuse hot line.

The woman told inspectors that the nursing home's social worker told her that her time was up and she had to leave or stay "forever in long-term care."

The second resident had heart problems and was sent to the nursing home after a hospital stay. Before that, she had been in an assisted-living facility.

After two weeks at Rehabilitation and Health Care, she was sent back to an assisted-living facility, even though she had problems making decisions, was incontinent and couldn't care for herself without help, the report said. She was quickly returned to the nursing home.

The home, owned by Vencor Inc., based in Louisville, Ky., was banned Monday from accepting new admissions because of the discharges.

The same nursing home was fined $ 270,000 last year for trying to evict its 54 residents on Medicaid, the government health care program for the poor.

VENCOR'S TURMOIL; Stock price hurt by new rules, probes
The Courier-Journal (Louisville, KY.) January 23, 1999

The Georgia Department of Human Resources notified Vencor in early June of 14 violations at its Savannah Rehabilitation and Nursing Center. The violations ranged from discharging patients when they still needed care to lack of treatment for bedsores.

RAPE ALLEGATION LAWSUIT EXPECTED TO GET TRIAL DATE
Sarasota Herald-Tribune February 4, 1999

A trial date will be set this month to hear a lawsuit against the owners of a Sarasota nursing center, filed by a woman who says she was raped there by another resident.

The woman, a 51-year-old partial quadriplegic, charges that the center's administrators knew her assailant was dangerous. But they didn't provide a safe environment, and didn't call police when she told them of the assault, she alleges.

The lawsuit names as defendants Vencor Nursing Centers East LLC and Vencor Inc., which operates East Manor Medical Care Center through a subsidiary. The woman said the assault happened in early 1996.

The incident was not reported to police, and no one was ever charged.
------------------------------------
According to police and court documents, the man had been accused of harassing and exposing himself to employees and others. Documents said he had suffered brain damage and used a wheelchair-like device, but could move around on his own.

He was charged in 1996 with stalking, battery and two counts of soliciting sex from a child, following allegations by an employee of East Manor. The employee said the man harassed her at work and at her home, and inappropriately touched her and her daughter.
------------------------------------
After the incident, the woman said she tried to tell staff members, but could find none in the halls or at the nurses' station.

''I found several staff members outside the building where they go to smoke and talk, and I told them what happened,'' she said. ''They simply shrugged it off. They did not contact police nor did they have me examined.''

PREPARED STATEMENT OF ROBYN GRANT ON BEHALF OF THE NATIONAL CITIZENS' COALITION FOR NURSING HOME REFORM BEFORE THE HOUSE COMMITTEE ON COMMERCE SUBCOMMITTEE ON HEALTH AND ENVIRONMENT Hearing on H.R. 540 - The Nursing Home Resident Protection Amendments, 1999
Federal News Service FEBRUARY 11, 1999, THURSDAY
COMMENT:- Note the thinking of the corporation. What they were doing was quite legitimate. It was a business decision. That was what mattered. Note that exactly this thinking was reflected in the state survey agency which was of no help. "In fact, that agency stated that deciding not to keep residents on Medicaid was a business decision, which the facility had every right to make." It was stopped by a citizen who took the matter to court.

Summary

My name is Robyn Grant and I represent the National Citizens' Coalition for Nursing Home Reform (NCCNHR). NCCNHR is a non-profit consumer organization that seeks to define and achieve quality for residents in long term care facilities. For 8 years I served as the Indiana State Long-Term care Ombudsman.

During my tenure as state ombudsman, the Vencor corporation evicted flail elderly residents from Wildwood Health Care Center simply because their care was paid for by the Medicaid program. I am here to share with you the devastating effect of the corporate decision to withdraw from the Medicaid program on residents, and their families.

NCCNHR strongly supports H.R. 540 which would prohibit nursing homes that accept Medicaid reimbursement from transferring or discharging residents solely because they are Medicaid beneficiaries.
---------------------------------
The Nursing Home Resident Protection Amendment would ensure that Medicaid eligible nursing home residents do not have to live their lives in fear of being evicted due to their payment status and would guarantee that nursing home residents do not become disposable pawns in corporate games to maximize profits.
-------------------------------------
Many residents start off a nursing home stay by paying privately. However, with the average annual cost of nursing home care between $40,000-$50,000, most people cannot continue such payments for very long. They quickly exhaust their resources and have no choice but to rely on Medicaid.
----------------------------------
The Devastation Experienced By Residents Evicted From Their Homes I'd like to share with you what residents experience when nursing facilities are allowed to evict residents simply because they are on Medicaid.

Beginning in January 1997 residents on Medicaid at Wildwood Healthcare, a Vencor facility in Indianapolis, Indiana, were singled out and told that they were being transferred to other nursing homes solely because they were Medicaid recipients.

I - - - -had the opportunity to speak with several of those residents and their families. These residents told me that they were devastated when they learned they had to leave. They were extremely upset and distressed. One family member told me her mother was thrown into a deep depression upon being informed she could no longer live at Wildwood.

The residents I talked with said that everywhere they looked, they saw other residents crying inconsolably at the news. The people, many of whom had lived there for several years, explained to me that this facility had become their home. As we all do in our homes, they had put down roots. They had established important friendships with other residents in the facility and strong relationships with staff.
-----------------------------------
They reported to me that they had never in their entire lives been thrown out of any place. They were mortified. Their self-esteem was badly affected by being targeted in such a public way for something they could not help.

The effect on residents was magnified by the atrocious and deplorable way the transfers were handled by the administration at Wildwood. Once this eviction process was set in motion, it moved forward inexorably. Outcries from residents and families did little good. Complaints to the state survey agency were of no help. In fact, that agency stated that deciding not to keep residents on Medicaid was a business decision, which the facility had every right to make.

It was only as a result of outspoken residents and family members, the work of United Senior Action, a citizens' advocacy organization in Indiana which is a NCCNHR member group, and attention from the media that Vencor reversed its policy and agreed to stop the Medicaid evictions.

Nursing home bill is just a start
St. Petersburg Times March 15, 1999
COMMENT:- We do need laws, not so much to punish criminals but to give objective form to our values. More importantly we need a society where the overall interaction between people is such that the sort of thinking which lies behind Vencor's behaviour would become unthinkable. In her Australian ABC radio lectures Eva Cox called this a civil society.

A year after the Kentucky-based nursing-home chain Vencor Inc. tried to dump its Medicaid residents out on Tampa's streets, Congress is on the verge of making sure nursing homes do not treat their residents like garbage again. With some heavy lifting from Reps. Jim Davis, D-Tampa, and Michael Bilirakis, R-Palm Harbor, the House overwhelmingly approved an "anti-dumping" bill this week, and the Senate is expected soon to follow suit.

Bill to protect nursing home residents goes to president
The Associated Press March 15, 1999

Congress sent to the White House on Monday a measure that would bar nursing homes from evicting residents who rely on lower-paying funding from Medicaid.
----------------------------------------
"America's seniors should be treated with reverence, not handled like refuse," said Sen. Bob Graham, D-Fla., a chief sponsor of the bill. The House sponsors are two Florida lawmakers - Republican Mike Bilirakis and Democrat Jim Davis.

CYPRESS POINTE; Report: Nursing home gave poor care; Facility faces suit
Morning Star (Wilmington, NC) April 9, 1999

After being hospitalized for a light stroke in 1992, Daisy Bell Williams of Southport checked into a Wilmington nursing home (owned by Vencor Inc) to relearn how to eat, bathe and dress. - - - - - When Ms. Williamson showed symptoms of another stroke on Jan. 27, 1997, the nursing home reacted slowly and failed to meet its basic responsibilities, according to a division report.
------------------------
After his mother died, Mr. Williams notified state regulators, who investigated the complaint and fined Cypress Pointe $ 6,100. Cypress Pointe earned a federal discount on the fine for not contesting the deficiency finding and paid $ 3,965. - - - - Mr. Williams has sued Cypress Pointe and its parent company and Dr. xxxxxx.
----------------------------------
"Surveys conducted in the nation's 17,000-plus nursing homes in recent years showed that each year, more than one-fourth of the homes had deficiencies that caused actual harm to residents," the March 18 report said. "Although most homes were found to have corrected the identified deficiencies, subsequent surveys showed that problems often returned."

HOW FAR THEY HAVE FALLEN ONCE SOUGHT AFTER, REHABILITATION THERAPISTS HIT BY CHANGES IN MEDICARE REIMBURSEMENT
Modern Healthcare April 12, 1999

Last June, Vencor said it had eliminated 1,000 therapist positions, but the Louisville, Ky.-based company declined to say whether it has made any cuts since.

NURSING HOMES: HCFA URGES STATES TO BOOST OVERSIGHT
Health Line April 23, 1999

The Wall Street Journal reports this morning that HCFA officials, "concerned about the precarious finances of some big nursing home chains" have been exhorting state officials by telephone to "redouble efforts to ensure the health and safety of nursing-home residents."

In addition, HCFA has prepared a draft letter for Sally Richardson, director of its Center for State and Medicaid Operations, to the states, pointing to several national nursing home chains -- including Vencor Inc. and Sun Healthcare Group Inc. -- as "the focus of special concern." The letter warns that nursing home companies, under pressure from cuts in federal reimbursement, may take "cost-cutting measures which could impact on the quality of care in their facilities."

Nursing home finances worry state officials;
The Tampa Tribune May 5, 1999

TAMPA - Nursing home financial troubles and bankruptcy fears alarm regulators.

State officials are beginning to pay close attention to the companies that control many of Florida's nursing homes, fearing that some are facing financial collapse.

"We're very concerned," said Pete Buigas, deputy director of health quality control for the Florida Agency for Health Care Administration. - - - - concerned to the point that we're developing a comprehensive plan, something like an emergency response plan."

Much of the focus lately has been on Vencor Inc., - - - . The company runs about 20 other homes statewide and several acute-care hospitals.
----------------------
The high (medicare) payments lured many nursing home companies, including Vencor, into the therapy business. As they invested heavily in new rehabilitation facilities, Medicare nursing home costs began to soar.

In 1997, an alarmed Congress approved a new payment system as part of the Balanced Budget Act. It reimburses homes with a fixed amount per resident. - - - - - those who were deeply involved in providing therapy services are suffering. ----- "Therapy volume is down 80 percent, and that business generated cash - lots of cash. - - - - The reason some companies are in dire straits is that cash is gone."

Shumway needs $25 million more; warns of nursing home troubles
The Associated Press State & Local Wire May 18, 1999
COMMENT:- Vencor and Sun give the lie to the claims made here. They are already compromising care.

Shumway (Health and Human Services Commissioner) told the Senate Finance Committee on Monday his agency needs another $ 25 million to keep pace with medical costs and other expenses.
-----------------------------------
A number of homes no longer make mortgage payments and some could face Chapter 11 bankruptcy, he said.

Shumway said his agency is keeping a close watch over the nursing homes to ensure residents' care doesn't suffer. He said the homes are part of national chains facing financial problems. He did not name them. - - - - Both Poirier and Shumway insisted safeguards are in place to protect residents from feeling the effects of any financial upheaval. -- "No one should worry," Poirier said.

Muncie nursing home faces forced closing
THE INDIANAPOLIS NEWS June 9, 1999

The Indiana State Department of Health said Tuesday it wants to close a Muncie nursing home because it isn't providing adequate care.

The department said the Muncie Health and Rehabilitation center violated state law by not providing the right kinds of social services, activity programs or mental-health treatment for his residents.

The center is owned by the Vencor Nursing Center Partnership.

The center could lose its license or be placed on probation.

Nursing home eviction draws lawsuit; Firm accused of unloading Medicaid clients
The Florida Times-Union (Jacksonville, FL) June 12, 1999

SAVANNAH (GEORGIA)-- A man evicted from a nursing home when his private insurance ran out is suing the corporation that operates the home for $ 25 million in damages. - - - was told to leave the Vencor -owned Savannah Rehabilitation and Nursing Center in February 1998 -- incontinent, partially paralyzed and unable to take care of himself -- despite being eligible for Medicaid coverage. Government-sponsored Medicaid pays nursing homes far less than what they can get from private insurance.

The home administrators never informed Wright's sister, Audrey Lang, that he had a legal right to stay, she said.
--------------------------------
Lang was given less than a week's notice to get him out.

Despite encouragement from Georgia Legal Services, she had no intention of suing the Louisville, Ky.-based Vencor Corp. until the nursing home threatened to take her to court last July for what they claimed was $ 425 in unpaid bills.

The Georgia Department of Human Resources recommended more than $ 500,000 in fines last year after it discovered Vencor's pattern of dumping Medicaid patients at Savannah Rehabilitation. The state documented 14 cases of inappropriate discharges.

Nursing chain pays $ 52,500 to settle suit over English-only rule
The Associated Press State & Local Wire June 16, 1999

A nursing home chain will pay $ 52,500 to settle a suit by employees who said they were disciplined for speaking in languages other than English, civil rights lawyers announced. - - - a suit originally filed against a San Rafael nursing home in 1995 by the U.S. Equal Employment Opportunity Commission.

The suit said the Fifth Avenue Health Care Center's former owners, Hillhaven Corp., imposed an English-only policy in 1991 or 1992. The center was bought in 1995 by Vencor Inc., which tightened enforcement of the policy, the suit said. Vencor will pay the settlement.

Nursing Home Industry's Financial Crisis Threatens Patient Care
The Washington Post June 19, 1999

Much of the nation's nursing home industry is in such dire financial straits that regulators and other observers are worried about the care elderly residents will receive.- - - - . One large firm, Vencor Inc., reported in April that it may not be able to stay in business.

The industry's problems are so glaring that the Health and Human Services Department recently issued an alert to the state agencies that license and monitor nursing homes.
-------------------------------
One patient advocate says she is skeptical of the industry's pleas for relief from the new payment system. 'We've seen poor care for so long by so many of these large corporations that it's too early to tell whether this is going to make it worse or not," said Elma Holder, founder of National Citizens' Coalition for Nursing Home Reform. "If they were gaming [the Medicare system] and the system changes and they're not able to do that the same way, that obviously would have a major impact on their financial situation."

Labor leaders: Unfair practices common
Chicago Sun-Times June 22, 1999
COMMENT:- This article uses Vencor as the focus for a discussion of the way in which corporations fire union members and make every effort to crush unions. Nursing home chains are particularly bad - hence the additional problems they have in staffing, now that nurses are in short supply. Sun and Beverly have been particularly aggressive in victimising staff who criticised their conduct.

When Vencor Hospital cut respiratory therapist staff here 25 percent because of budget cuts, workers worried patient care would suffer and attempted to form a union, past and present employees say.

Nearly a year later, one union vote has been tossed out because of alleged misconduct by the employer and another has yet to take place. Meanwhile, a nurse, Patricia Davis, says she was fired because she spoke out in favor of union representation.

The case is now before the NLRB, which has jurisidiction over such matters. But labor leaders say that process is currently too lengthy to be effective, and urge reforms.

Alabama health officials warns of harm to nursing home residents
The Associated Press State & Local Wire June 23, 1999

An Alabama agency has warned federal health officials that some nursing home residents could die if financial problems now plaguing nursing home chains across the country force one of them to close all of its facilities in the state.

"We would be unable to effectively assure continued resident safety and protection from neglect," said Rick Harris, director of the Bureau of Health Provider Standards in the Alabama Department of Public Health.

"It is highly likely that we would see adverse outcomes, including serious transfer trauma, and possibly death," he said.
-----------------------------------------
At least two of the financially troubled chains operate in Alabama. Vencor - - - -Inc. of Louisville, Ky., which has three nursing homes in Alabama,- - - - - - Sun Healthcare Group Inc. of Albuquerque, N.M., which operates six nursing homes in Alabama,

HOME BUILDERS LOOK TO IMMIGRANTS, HOPE FOR LAYOFFS
St. Louis Post-Dispatch July 18, 1999, Sunday,

- - - awarded 25-year-old Kimberly Hanks $ 912,000 after finding that Vencor Hospital did not properly treat an infection in her right leg, leading to its amputation.

NURSING HOME CRISIS; ASSISTED-LIVING UNITS, U.S. REIMBURSEMENTS BLAMED FOR SLUMP
THE ARIZONA REPUBLIC July 25, 1999 Sunday, Final Chaser

Overall, the investment value of nursing homes has fallen as much as 30 percent in the past year, appraisers say. "Facilities such as Vencor and Sun are in terrible shape," said Linda Greub, an analyst with Banc of America Securities in San Francisco.

"If Sun did something wrong, then everyone did the same thing," said Rob Mains, an analyst with a New York investment firm who has followed the company since its beginning. "We could easily see Mariner and Vencor go bankrupt as easily as (we might see it happen to) Sun."
------------------------------------
Fewer dollars are available to spend on everything, including staff, several nurses and certified nursing assistants said. Because employees represent the biggest portion of nursing home costs, they are likely targets for cuts, said Virginia Tallent, a Glendale nurse who has been taking care of older people for 20 years. And because the state sets no minimums for number of staff, cuts can go too deep, she said.

Vencor lawsuit settled in face of new federal regulations
The Associated Press State & Local Wire July 27, 1999

Among the dozens of Medicaid residents that Vencor Inc. tried to force from a Florida nursing home to boost its bottom line was 93-year-old Adelaida Mongiovi. - - - - Her son, Nelson Mongiovi, sued the company on her behalf, - - - - The battle led to an emergency order stopping the evictions and eventually helped push passage of federal legislation protecting elderly Medicaid residents.

The lawsuit, - - - - has been settled, citing a new federal law signed by President Clinton in March. The settlement did not include monetary damages.

"One of the things that we wanted to do was put an end to dumping," said attorney James Wilkes. "I think it's a good result." - - - - - all documents related to the case are available if individuals want to file their own lawsuits.

Louisville, Ky.-based Vencor operates nursing homes and hospitals in 46 states. About 600 to 700 residents who were threatened or actually discharged must receive a letter from Vencor stating that they can pursue individual lawsuits, Mongiovi said Tuesday.
--------------------------------------
But news of the evictions came the same day their top executive was quoted in The Wall Street Journal as saying they planned to rid their nursing homes nationally of Medicaid patients, who bring in about $ 18,000 a year less than private patients.

Vencor admits Medicaid evictions
St. Petersburg TimesJuly 28, 1999
COMMENT:- Same case

To settle a lawsuit, the nursing home giant admits shooing Medicaid patients from homes in Tampa and elsewhere.

Vencor settles federal challenge;
The Tampa Tribune July 29, 1999, Thursday
COMMENT:- Same Mongiovi case

TAMPA - A nursing home and hospital chain resolves a federal case with an agreement that helps former residents.

Nursing home chains warn of possibility of bankruptcy Sun Healthcare, Vencor say residents would face no danger
The Dallas Morning News July 29, 1999, Thursday

Two national nursing home chains have told state regulators that they are considering the possibility of filing for bankruptcy reorganization, state officials said Wednesday night.

Representatives of Sun Healthcare Group Inc. and Vencor Inc. have assured the state (Texas) that if they file for bankruptcy, residents of their nursing homes will be in no danger, said Jim Lehrman, associate commissioner of the Texas Department of Human Services.

Sun owns 26 nursing homes in the state; Vencor has five.

VENCOR SAYS BANKRUPTCY WON'T AFFECT THE CARE OF PATIENTS; COMPANY HAS 2 ACUTE CARE HOSPITALS IN MISSOURI; STOCK CLOSES AT 10 CENTS A SHARE
St. Louis Post-Dispatch August 11, 1999, Wednesday, FIVE STAR LIFT EDITION

Hospital administrators at Vencor Inc., one of the country's largest providers of long-term health care, are assuring regulators in Missouri and Illinois that patient care will not be affected if the company files for bankruptcy.
-----------------------------
The company has 57 long-term acute care hospitals including two in Missouri and four in Illinois. The company has 293 nursing homes. None are in Illinois or Missouri.

Nursing home chief wins case; Jury's $3 million award will likely be reduced
San Antonio Express-News August 20, 1999, Friday
COMMENT:- Corporate morality is well illustrated in this case. The full report shows that Warren was clearly an experienced operator and was given responsibility which she exercised RESPONSIBLY. When she had a stroke (and so was predisposed to further illness) the company searched for a pretext to fire her. The jury were so disgusted they awarded US $3 million.

A Bexar County jury awarded a former nursing home administrator $3million Thursday after finding that Vencor Inc., the nations largest network of nursing homes, maliciously fired her because she suffered a mild stroke from which she was making a full recovery.
---------------------------------
Vencor's position was that Warren was fired because she didn't Get authorization to pay the medical director for Normandy Terrace, the nursing home she was managing. The medical director, a pulmonologist, hadn't been paid in a year and was owed $24,000. - - - "It was just a matter of integrity,'' Warren testified. "It's due.You pay your bills.''

Defense attorney Carrie Hoffman also claimed Warren lied to Gurka, claiming she had no knowledge that she had authorized the payment.
-------------------------------
Gurka told her to take over Normandy Terrace on an emergency basis. - - The facility had severe problems, including nursing staff shortages, a defective fire alarm system and an inoperative backup generator for the facility's ventilator patients, Warren said. - - - Doctors had lost confidence in the facility and were removing theirpatients.

One doctor testified Gurka held a meeting with the doctors to reassure them that Vencor was committed to turning the situation around and to tell them Warren had "carte blanche'' on management and financial issues.

State stock index tracks 16 health care companies;
The Tampa Tribune September 8, 1999, Wednesday
COMMENT:- Officials in Florida have accepted the lessons from Vencor - that there is a link between corporate profit and the welfare of citizens. The problem is recognised to be "systemic". They have started monitoring the stock market. This may tell them who to watch. This is a message to which politicians in the USA and Australia are most resistant.

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 www.fdhc.state.fl.us/ stockson the Internet by the Florida Agency for Health Care Administration.

It includes companies traded on Nasdaq and the New York Stock Exchange. The firms have large financial assets and large numbers of customers in Florida, said John Noble, AHCA director of corporate affairs and architect of the index.

In May, Noble started tracking stocks and Securities and Exchange Commission filings of the companies to get an earlier view of situations with potential repercussions in Florida.

His agency hopes to avoid the kind of situation that occurred last year when nursing home chain Vencor Inc. of Louisville, Ky., tried to evict 54 Medicaid residents from a Tampa facility. Vencor stock had been faltering, and Medicaid pays at a lower rate than other insurance programs.

Staffing rules advocated for nursing homes U.S. should step in to set minimum levels, advocates say
Milwaukee Journal Sentinel September 19, 1999, Sunday Final
COMMENT:- Note the sympathy for Vencor despite its US $1.3 billion fraud! Note that staffing problems are worse at for profit homes including Vencor. Could this be because of the way they are treated, working conditions and the confrontational approach adopted by the corporations?

Severe staffing shortages and financial problems at nursing homes in Wisconsin and across the country are generating new calls for strong federal intervention in the industry.

The staffing crisis is reviving talk of a national standard mandating the minimum number of workers needed to ensure adequate care. The problem was underscored in Wisconsin by new evidence confirming high turnover of nurses aides.
-----------------------------------
On Oct. 3, a hearing on Capitol Hill will spotlight neglect of residents because of short-staffing. The U.S. Senate Special Committee on Aging, which includes Kohl, will preside.
-----------------------------------
Meanwhile, the nursing home industry has launched a national TV advertising campaign to pressure Congress into restoring 1997 cuts in Medicare reimbursements to nursing homes. The reductions were part of the Balanced Budget Act of 1997 and were aimed at ensuring Medicare's survival.
------------------------------------
Greene Burger expressed little sympathy for Vencor, a hospital company that bought some 300 nursing homes in the mid-'90s and developed a specialty caring for very sick Medicare patients. Vencor was the owner of Mount Carmel Health and Rehabilitation Center in Greenfield, which nearly closed last year after widespread care problems and severe short-staffing.

The company's struggles were evident in the new Wisconsin figures. Ten of the Kentucky-based chain's 13 homes in Wisconsin exceeded the state average for nurses-aide turnover, a Journal Sentinel analysis found. Most of its homes here were on the lower end for overall staffing hours.

The data reported by Wisconsin's 429 nursing homes show that turnover among nurses aides -- the primary caregivers -- surged in 1998.- - - - , and for-profit homes showed much higher turnover rates than government-run or not-for-profit facilities, the state figures show.

Losing money and staff, nursing homes become the targets of legislation
The Associated Press State & Local Wire September 20, 1999, Monday, PM cycle
COMMENT:- More on this legislation. Note nurses comments. The nurses have been warning of the problems in corporate care since 1994. The market ignored them.

Vencor, like many nursing home owners in Wisconsin and nationwide, has had great trouble retaining staff.

A union leader who represents the state's nursing home workers said he saw the problem coming years ago, when large chains were doing well financially and declined to pay health benefits to nurse aids.

"This is a national disaster," said Dan Iverson, president of Service Employees International Union Local 150.

The state budget, which is pending, includes a 5 percent wage supplement for nursing assistants.

CONNECTICUT NURSING HOME CORPORATIONS IN RECEIVERSHIP - LETTER FROM Edward M. Dale 28/9/99
Nursing Home Insolvencies & Closures
Edward M. Dale, Director, Elder Law and Legal Assistance to Medicare Patients, Connecticut Legal Services, Inc.

Three nursing homes are currently in receivership and one, - - - with residents being transferred, some being forcibly moved far from family and community supports. - - - Vencor, with several nursing homes in Connecticut, recently declared bankruptcy. Several other homes and chains, including Sun Healthcare Group, report being in financial trouble.

At present, Connecticut has no effective means of preventing insolvencies or dealing with the consequent harm to residents: - - - no system of financial deterrents against facility owners who continue to collect millions in public funds, yet fail to remain financially viable.- - - no effective means to discourage profiteering by owners - - - no system in place for careful and humane relocation of residents so as to minimize transfer trauma in the event of facility closings.

Not-so-golden years Nursing homes face cutbacks, closures; patients face uncertain future
USA TODAY September 30, 1999, Thursday,
COMMENT:- This article is a broad one covering several corporate chains.

The nursing home's roof leaked for so long that a section of ceiling fell into one wing. Towels were in short supply. Fewer nurses' aides worked the day shift.

"I looked at the situation and thought, 'This place is going to go under,' " recalls Anna Spinella, who relied on a Tampa nursing home to care for her frail sister and two other relatives.
--------------------------------
Cases of nursing homes abruptly closing, leaving aged, disoriented residents uprooted, their health threatened, are not new. But fears are growing that such stories may become more common as the industry's financial troubles deepen.

"I want things changed so people don't have to go through this," says Spinella, who was able to move her relatives to a nonprofit home in St. Petersburg, Fla. But the three spent months on a waiting list before getting in.
-------------------------------
She's worried that things could get worse because the home's owner, Vencor, has filed for bankruptcy protection.

"We're terrified the home is going to close," she says. "They kept saying, 'Oh no, we're not going to file for bankruptcy,' " says Olson, who now fears the administrators may be mistaken when they assure her the home won't close.

Nursing home sues former employee
The Tampa Tribune January 22, 2000, Saturday, FINAL EDITION
COMMENT:- SLAPPs (Strategic Lawsuits Against Public Participation) are tools used by corporations to temporarily, even permanently silence their critics. Tenet/NME took two SLAPP defamation actions against me. Neither was prosecuted. The Vencor suit below was most unwise as the public were already up in arms about Vencor.

ST. PETERSBURG - A former employee fights a nursing home that moves to silence her allegations of poor care.

A St. Petersburg nursing home with a history of care problems has sued a former employee, saying she should be barred from entry for waging a "war of defamation and trespass."

Karol Sue Carter was a nursing aide at The Abbey Rehabilitation Center from 1990 until 1998, when she and others lost their jobs after Vencor Inc. bought the home.

After her dismissal, Carter said this week, she often heard complaints from remaining workers about conditions at the 150-bed home. They would report there were too few aides to care for residents.

In response, Carter would call the state abuse hot line, which takes reports on child and elder abuse and neglect. Sometimes she would call St. Petersburg police and news media.

State fines Corydon nursing home for failure to take care of residents. Two patients had sores that were not properly cared for
The Courier-Journal (Louisville, KY.) February 23, 2000, Wednesday IND/INDIANA

The State Department of Health has fined a Corydon nursing home $ 5,000 for failing to give necessary treatment to two residents with pressure-related sores.

Indian Creek Convalescent Center, a Vencor nursing home, faces two fines of $ 2,500 each for not properly treating a resident with a diabetic skin ulcer and a resident who had sores from sitting in a wheelchair

The department, acting on a complaint from a resident, found during an inspection Jan. 5 that the home's nurses weren't repositioning the two residents often enough or doing enough to relieve pressure on the sores, according to the inspection report.

Nursing home workers rip staffing levels; company denies charges - - The public accusations of union employees, the company says, are incorrect and are simply a contract-negotiation tactic.
The Providence Journal-Bulletin February 24, 2000, Thursday

FALL RIVER - Health-care workers representing two area nursing homes owned by Vencor Inc. held a press conference yesterday to accuse the company of understaffing their facilities and seriously undermining the level of care offered to residents.
-------------------------------
It's been terrible. We're working short (of staff) every day. If we work with a full staff once a month, we're lucky, said Ida Terra, a nursing assistant who has worked at Crawford for five years.

We don't have enough time to bath (residents) in the morning. It's like an assembly line, said Theresa Moniz, another nursing assistant at Crawford.

Moniz said residents are supposed to be changed every two hours, but are being changed less frequently. Asked how frequently, they are being changed, she said, You don't want to know.

Feds join suits against Vencor
Modern Healthcare February 28, 2000, Monday

- - two more civil whistleblower fraud lawsuits against Vencor, bringing the total to four. - - (not) providing medically unnecessary care to Medicare patients and minimizing care to Medicaid patients, delaying discharges to maximize reimbursement, - - - - - admitting inappropriate patients to hospice care in an attempt to maximize Medicare reimbursements.

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

Severe cutbacks in federal funding and a labor market where quality staff are in short supply have pushed almost a third of Colorado's nursing homes into bankruptcy and state regulators are concerned about patient care.
---------------------------
More than 30 percent of the state's licensed skilled nursing beds are located in homes operating in bankruptcy.

Patient dies from burns at nursing home
St. Petersburg Times April 15, 2000, Saturday

Catherine Malowney, 79, died Wednesday at Tampa General Hospital, where she had been in critical condition since April 6. She suffered second- and third-degree burns over 70 percent of her body after her nightgown had caught fire while she smoked a cigarette on the porch of Carrollwood Care Center at 15002 Hutchinson Road. - - - - The center is owned by Vencor, which owns at least 20 nursing homes in Florida.

Patient dies from her burn injuries
St. Petersburg Times April 15, 2000, Saturday, 0 South Pinellas Edition

The state will review how she could catch on fire while smoking in her Tampa nursing home.

Nursing home gets ultimatum
The News and Observer (Raleigh, NC) April 27, 2000 Thursday
Catherine Clabby, Staff Writer

Conditions at a Raleigh nursing home (Raleigh Rehabilitation and Healthcare Center) are so dangerous, according to recent inspections, that federal officials are fining the facility $5,500 a day and threatening to suspend Medicare and Medicaid payments, which could shut it down.

After receiving 14 complaints, some alleging many problems at once, - - - They found that:

- mishandled feeding tubes --- failed to update the medical records of at - - - patients were not adequately monitored or treated during their stays. - - -delayed transferring a weakening patient to the hospital - - - A woman was left untreated for pain in her hips - - the problems are serious, very serious," said Steve White,

State officials have not finished compiling a list of all they found at Raleigh Rehab, but they alerted federal Health Care Financing Authority officials of the most serious shortcomings last week to prompt swift action. A fuller report is expected next week.
-------------------------
Owned by the national nursing home chain Vencor Inc., Raleigh Rehab would not respond Wednesday to questions about its operations from The News & Observer.
-(The nursing home) - often displays a large blue banner reading: "Love is Ageless. Visit Us."
----------------------
This is not the first time that Raleigh Rehab has been cited for substandard practices. In March 1999, state inspectors said the nursing home had failed to provide sufficient staff, prevent bed sores and meet professional quality standards, among many things.

State: Vencor has 'deficiencies' - - Regulators limit the Tampa hospital to only emergency admissions until it adopts a plan to improve medical care.
St. Petersburg Times May 31, 2000, Wednesday
COMMENT:- The series of articles which follows reveals how chains use the law to frustrate attempts to penalise them.

TAMPA - State regulators have barred Vencor Hospital-Tampa from admitting new patients after finding some patients were given the wrong medications or treatments that jeopardized their lives.

The moratorium was imposed May 19, one day after state officials went to Vencor's facility at 4555 S Manhattan Ave. to investigate a complaint about medical mistakes.
-------------------------------
"There were some severe deficiencies," said Liz Dudek, assistant deputy

director of managed care and health quality for the AHCA. "We don't take those lightly," she said. "We're concerned about the health, safety and welfare of the residents that are there."

- - - (A list of serious drug errors is reported) - -
Vencor's troubles extend far beyond the recent admissions moratorium. Complaints about medical care have dogged the company for years.

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.

It was the first time the state dropped a nursing home from its list of approved Medicaid facilities.

Three of the homes are owned by Vencor Inc.

Key details about six nursing homes losing Medicaid
The Associated Press State & Local Wire October 2, 2000, Monday, BC cycle

Abbey Rehabilitation and Nursing Center
St. Petersburg, formerly known as Personacare of St. Petersburg
Owner: PersonaCare of St. Petersburg, Inc.
Chain affiliation: Vencor
152 beds, 49 Medicaid residents
Medicaid paid for the care of 78 percent of their residents last year

Colonial Oaks Rehabilitation Center
Fort Myers, formerly known as Hillhaven Health and Rehab of Fort Myers
Owner: Vencor Nursing Center East, LLC.
Chain Affiliation: Vencor
120 beds, 74 Medicaid residents
Medicaid paid for the care of 69 percent of their residents last year

Rehabilitation and Healthcare Center of Tampa
Tampa, formerly known as Hillhaven Rehab Center
Owner: Vencor Nursing Centers East, LLC.
Chain Affiliation: Vencor
174 beds, 123 Medicaid residents
Medicaid paid for the care of 70 percent of their residents last year.

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

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.

"These are chronically failing institutions," Gov. Jeb Bush said. "I'm convinced it was the right thing to do."
---------------------------
Trial lawyers say the burst of lawsuits is a result of slipshod care that threatens human safety, including chronic understaffing and profiteering by national chains that have gobbled up many independent nursing homes.

The Legislature created a 19-member Long Term Care Study Commission to recommend ways of reviving the nursing-home industry in Florida, the state with the highest elderly population in the United States. Lt. Gov. Frank Brogan chairs the panel, which is conducting hearings across the state this fall.

Nursing homes vow to fight
St. Petersburg Times October 04, 2000, Wednesday

Some of the facilities and families of Medicaid patients dispute the state's charges of chronic problems and poor care.

Medicaid battle turns to court
St. Petersburg Times October 06, 2000, Friday

TAMPA - Nursing home giant Vencor Inc. is challenging a move by the state to cancel Medicaid contracts at six nursing homes and force the relocation of 628 elderly or disabled residents by the end of the month.

In a complaint filed Wednesday in U.S. District Court in Tampa, Vencor says the Florida Agency for Health Care Administration violated federal regulations and its own administrative procedures by canceling the contracts Monday.

Nursing home chain files for federal injunction against state
The Associated Press State & Local Wire October 6, 2000, Friday,

Judge: States Can't Cut Medicaid
<http://dailynews.yahoo.com/h/ap/20001010/us/nursing_homes_1.html>
Tuesday October 10 7:08 PM ET

TAMPA, Fla. (AP) - A federal judge ruled Tuesday the state cannot cut Medicaid payments to three nursing homes that regulators say are substandard.

Florida cuts off Medicaid for 3 Vencor homes Reprieve granted, but case further tangles bankruptcy
The Courier-Journal (Louisville, KY.) October 11, 2000, Wednesday

Vencor Inc., already struggling to emerge from Chapter 11 bankruptcy, finds itself in a legal battle with the state of Florida that may complicate that effort.

State agrees with Vencor to stop Medicaid cancellation
The Associated Press State & Local Wire October 18, 2000, Wednesday,

State nursing home regulators Wednesday halted the transfer of hundreds of indigent patients from three nursing homes run by Vencor Inc. in exchange for the company agreeing to better care.

The agreement was reached the day a federal judge was to hold a hearing on an injunction Vencor sought against the state.

Patients won't have to relocate
St. Petersburg Times October 19, 2000, Thursday
BYLINE: JEFF TESTERMAN

Wednesday, the state rescinded the cancellation of the contracts for three of the homes and entered into a "unique partnership" (with Vencor) to guarantee quality care at the subpar nursing homes.

The "partnership" resulted from a settlement between the owner of the three homes, Vencor Inc. of Louisville, Ky., and Florida's Agency for Health Care Administration. It came only after Vencor obtained a restraining order against the state and the sympathy of a federal judge.

Inadequate care led to patient's death, suit claims
St. Petersburg Times October 17, 2000, Tuesday
CARY DAVIS

The wrongful death lawsuit, filed Friday in Pasco-Pinellas Circuit Court, alleges that the staff at Windsor Woods Convalescent and Assisted Living Facility failed to provide adequate care for Vivian Fels during the seven years she spent at the nursing home.

Specifically, the suit claims, the staff did not properly maintain Fels' urinary catheter, failed to prevent bed sores and allowed her to become severely malnourished and dehydrated.
------------------------
Also named in the suit is Windsor Woods' parent company, nursing home giant Vencor Inc.

BANKRUPTCY HITS NURSING HOMES STATE'S FRAILEST CITIZENS PUT TRUST IN 58 FACILITIES RUN BY AILING COMPANIES
DENVER ROCKY MOUNTAIN NEWS October 22, 2000, Sunday
COMMENT:- This is a long article reviewing the issues.

One-third of Colorado's nursing home residents are living in facilities run by bankrupt companies.

Residents include people who cannot speak up for themselves because of Alzheimer's or dementia, who can die of thirst because they cannot take a sip of water without help.

Yet the state's most frail citizens are relying for care on corporations facing huge debt loads, federal investigations for Medicare fraud and executives negotiating massive severance packages.

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:

Cornerstone Care in Lakewood let a patient become so dehydrated that she was hospitalized, with a poor chance of recovery. - - - is managed by another bankrupt chain, Vencor. It has less than half the number of nursing staff per patient than the average nursing home, according to the federal Medicare Web site.

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.

Justice Department or regulators - - - are reluctant to crack down too hard for fear of closing too manynursing homes.
--------------------------
Does that mean bad nursing homes are getting away with it?

"Absolutely," says ombudsman Fraser.

VENCOR BANKRUPTCY UPDATE: Lawsuit permitted
11/13/2000  In this excerpt from the November 13, 2000, issue of Vencor bankruptcy News, the court allows a negligence suit to be pursued against a Vencor facility.

Upon the motion of Arthur B. Smith, personal representative of the estate of Margaret Williams, Judge Walrath approved modification of the automatic stay, to permit the movant to prosecute the state court action against Colonial Palms East, which may include the debtor by virtue of its apparent claim to ownership of the Colonial Palms East.

Margaret Williams (deceased) was a resident of the Colonial Palms East during 1997. Mr. Smith alleged that, due to the negligence of Colonial Palms East and its employees, Margaret Williams developed severe deep left thigh and left leg abscesses which condition continued to worsen until she was hospitalized and ultimately died.

Violations could bring revocation of nursing home's license
The Associated Press State & Local Wire February 3, 2001

Operators of a nursing home here could lose their license if they don't correct security problems and other violations uncovered by a state investigation

The Indiana State Department of Health said Friday it plans to revoke Valley View Health Care Center's license or put the facility on probation, depending how quickly the center moves to remedy the problems.

Valley View is owned by Vencor Nursing Centers L.P., a Louisville, Ky.-based nursing home group.

State health investigators said inadequate safety measures at the home enabled three residents to wander outside during the last three months. Employees spotted residents in snowy, below-freezing conditions without boots or coats on.
---------------------------------
That inspection marked the third time investigators have returned to the facility since September and found it in violation of federal standards, Joseph said.

Sexual Assault at Lexington, Ky., Nursing Home Latest in String of Problems
Lexington Herald-Leader February 8, 2001, Thursday

The Lexington nursing home where an 80-year-old resident was allegedly sexually abused Monday night has a history of problems.

The Lexington Centre for Health and Rehabilitation, 353 Waller Avenue, had 34 deficiencies noted during an inspection in July and is named on a recently released "nursing home watch list" published by Consumer Reports.

Among the problems found during an inspection last year were that the home had failed to "hire only people who have no legal history of abusing, neglecting or mistreating residents" or that it had not reported and investigated reports of neglect, abuse or mistreatment, the U.S. Medicare Web site states.
-----------------------------
"I'm sure that this event will trigger an investigation on the part of the state," said Kathy Gannoe, executive director of the Nursing Home Ombudsman Agency of the Bluegrass.

She said the federal government froze the center's authority to admit Medicaid patients sometime last year after problems were uncovered there, but she said that sanction has since been lifted.

"They were in serious trouble," she said.
------------------------------------

In October, the center was cited by the state because a 66-year-old man died after suffering 10 falls there during a two-month period.
------------------------------------
A spokeswoman for Vencor, the company that owns the 180-bed for-profit nursing home, did not return telephone calls yesterday.

According to the Medicare Web site, Lexington Centre for Health and Rehabilitation had 34 deficiencies at its July 2000 inspection, compared with a statewide average of seven deficiencies per nursing home. The national average is five deficiencies.

The site also states that the nursing home has a higher frequency of bed sores, incontinence and unplanned changes in patients' weight than the national average.
------------------------------------
The Lexington Centre for Health and Rehabilitation has a resident-to-nursing staff ratio of 1 to 0.6, which is below the national average of 0.9, the Medicare Web site says.

CASE: In re Vencor Inc.
Chapter 11 Update April 2001

COMMENT:- Note the integrity agreement below. Are these the sort of people who can be trusted to fulfill the terms of an integrity agreement involving care? Their track record is far from reassuring. Supposedly independent government monitors have been singularly ineffective in the past. Should the public accept all this?

Vencor Inc. has agreed to enter into a $219 million settlement with the government to resolve allegations of inadequate care at its nursing homes and to resolve claims filed by whistleblowers in nine separate civil False Claims Act cases.-
----------------
The settlement incorporates a Corporate Integrity Agreement reached last fall, which was pending approval by the bankruptcy court. That agreement resolved charges made by the government when it intervened in a False Claims Act lawsuit last year. United States ex rel. Lanford and Cavanaugh v. Vencor Inc. et al., No. 97-2845-CIV-T-23B (M.D. Fla.). The agreement is "unprecedented in its focus on ensuring excellence in the delivery of long-term care," the Office of Inspector General said at the time. The agreement creates a "quality assurance infrastructure," and Vencor has agreed to have a team of independent monitors oversee its policies, procedures and operations.

COMMENT:- In spite of its integrity agreement Vencor does not seem to have done much about the care in its homes while it was negotiating. It is still being cited. Two recent articles describe the same problems in some detail. Only overview extracts are included.

Nursing home cited for serious violations
The Associated Press State & Local Wire April 2, 2001

A nursing home owned by Vencor Inc., was cited by the state Cabinet for Health Services for failing to more closely monitor the care of five patients, a newspaper reported.

The 106-bed Danville Centre for Health and Rehabilitation was cited last Thursday for two serious violations," said a story in Monday's editions of The Advocate-Messenger of Danville. The Advocate-Messenger obtained a copy of the report under the state open records law.-
--------------------------
Two of the five patients subsequently died at the nursing home, the report shows. It does not indicate whether their death was related to the care.-
--------------------------
The fine for this type of citation ranges from $1,000 to $5,000, but can be tripled to $15,000 per citation, Lawson said. The cabinet has not yet decided on whether to impose fines but has ordered the nursing home to take "immediate corrective action," said Lawson.

State cites Raleigh Rehab
The News and Observer (Raleigh, NC) April 3, 2001
ANNE SAKER, STAFF WRITER

RALEIGH -- For the third time in three years, state regulators have cited Raleigh Rehabilitation and Healthcare Center and threatened a cutoff of Medicare and Medicaid funds because of chronic problems in the care of patients, including neglect, poor recordkeeping and erroneous administration of drugs.

The Department of Health and Human Services told the center it would recommend that the federal government impose a daily fine of $ 3,050 retroactive to Feb. 13, a punishment that totaled nearly $ 150,000 as of Monday. The department also warned the center's officials that unless the "immediate jeopardy" of patients was corrected, the state would urge that the center no longer be allowed to obtain reimbursements from federal medical care programs as of April 11.-
--------------------------
The center, known informally as Raleigh Rehab, is a familiar building on Wade Avenue near downtown. In 1999 and 2000, state regulators found recurring problems at the 174-bed center. The earlier reviews discovered nurses mishandling feeding tubes, patients suffering from untreated pain and others left in their beds after soiling themselves.-
---------------------------
Raleigh Rehab is one of six Triangle care facilities owned by Vencor of Louisville, Ky.

COMMENT:- Vencor is notorious for the way it treated its staff in its Mount Carmel and other facilities -- and the consequences for patients. The pressures on it to contain nursing costs are as large as ever. It has not realised that to meet its integrity agreement it will have to create working conditions and salaries acceptable to staff and competitive with other occupations. The chains do not think in this way. Nurses are simply the main part of the cost and this must be reduced. The patients are the victims of the vicious fight which follows from this confrontational approach.

Walkout continues, job losses predicted
The Associated Press State & Local Wire May 8, 2001

There are moves being taken by at least one nursing home operator to permanently replace workers who have been on strike since last week.

One nursing home company has told employees it will begin permanently replacing strikers if they do not return to work by Wednesday.

The letter was sent to employees of Kindred Healthcare at Andrew House in New Britain and may have been sent to workers at Kindred's four other union homes in the state as well, union officials said.
--------------------------
Deborah Chernoff, a union spokeswoman, said Kindred is "one of the nastier employers that we deal with" and that the letter is meant to frighten workers. She also questioned the validity of the threat, given the current shortage of healthcare workers in the state.

About 4,500 nursing home workers have been on strike since last week, demanding higher wages and increased staffing levels.

2 MORE NURSING HOMES SEEK TO REPLACE STRIKERS
THE HARTFORD COURANT May 9, 2001
By ANDREW JULIEN; Courant Staff Writer

Two more nursing home companies have announced plans to begin hiring permanent replacements for striking workers starting today, bringing to 13 the number of nursing homes where workers are facing the same threat, union officials said Tuesday.-
----------------------
Chernoff said the threat has been made at nursing homes owned by Kindred HealthCare, Roncalli Health Care and Mariner Health Group, which employ more than 1,000 of the 4,400 or so workers who are striking. The strike is now in its second week.-
----------------------
To continue providing care during the walkout, the nursing homes are using temporary nurses and aides under contract with a Colorado company at rates at least double the usual pay.

"Ironically, these very same operators have told us in negotiations that they can't improve staffing ratios because of the shortage of nursing personnel," Chernoff said.

Nursing home faces negligence suits
Sarasota Herald-Tribune September 6, 2001

The three suits, filed last week in the 12th Judicial Circuit Court against Casa Mora Rehabilitation and Extended Care seek more than $15,000 each in damages to cover medical and funeral expenses.
-----------------------
Robert Myers, 81, died at the nursing home on June 4, 2000, after suffering pressure sores, unexplained weight loss, multiple falls, poor hygiene and inappropriate treatment for physical, mental and emotional problems, the suit says.
--------------------------
One of the complaints said Hollie Myers had fallen there 13 times, bruising her face and hip and breaking her elbow and nose. It also said she suffered from poor hygiene, medication errors and pneumonia.

The third case was filed by Janet Jacoby of Bradenton. She is the granddaughter of Tedder, who died July 7, 1999, after living at Casa Mora for more than two years. Court documents said Tedder, 99, suffered multiple skin tears, unexplained dehydration and other problems.
--------------------------
According to the Agency for Health Care Administration, Casa Mora since December 1998 has been the subject of at least six complaints. Allegations ranged from patient abuse and lack of supervision to refusal to discharge patients and clutter in a resident's room.
------------------------
Steven Vancore, a spokesman for the law firm, said evidence will probably show that the Bradenton nursing home was short-staffed.

"It's so common, we see this everywhere," he said Casa Mora is owned by Personacare of Bradenton Inc., a Delaware corporation whose parent company is the former Vencor Inc. of Louisville, Ky.

THE BOTTOM LINE OF CARING: National chains earn poor inspection reports
The Atlanta Journal and Constitution July 28, 2002

It's a different story at the national chains' homes.

At a Savannah home run by the Kindred Healthcare chain, staff did not call a doctor for more than 36 hours after a resident began vomiting violently. The man died in September, the day after he was taken to the emergency room with a broken hip, possible bowel obstruction and high white cell count. State inspection records say this was one of 80 citations for actual harm in the last four years at Kindred's Georgia homes.
---------------------------------------
According to the AJC analysis, the $1 million operating margin at the average Kindred facility dwarfs the $93,000 margin that is typical for the state's other for--profit providers.
--------------------------------------
Four of Kindred Healthcare's seven nursing homes in Georgia have been threatened with losing Medicaid funding since 1998 because of dangerous conditions. Kindred said the four homes each cleared more than $679,000 in fiscal year 2001.

NURSING HOME HIT WITH ONE-DAY STRIKE
The Boston Globe February 20, 2003

Strikers picketed a Massachusetts nursing home for the first time in three years yesterday after the owner of the Star of David nursing home in West Roxbury unilaterally cut workers' hours.

The strike by nursing aides, kitchen help, and housekeepers was planned for only one day, but it reflects growing problems facing the nursing home industry.
----------------------------------
Workers at Star of David Nursing, Rehabilitation and Alzheimer's Center voted to join Local 285 of the Service Employees International Union 14 months ago in large part because management had cut staffing, leaving fewer aides to care for more patients. On the home's Alzheimer's unit, for example, they said management cut two positions, leaving four licensed nurses and nurse's aides to care for 37 patients.

During the impasse earlier this month, management cut workers' hours from 40 to 37 1/2,
-------------------------------------
Union leaders filed a complaint with the National Labor Relations Board citing unfair labor practices. "We want respect," said RoseMarie Jean, a nurse's aide who has worked at the home for 15 years and was picketing yesterday. "We've been working here so long, we're like a family. Instead, they're trying to get us to leave so they can hire people for less money."

Although turnover among nursing home staff statewide is a big problem, many of Star of David's workers have been employed there for at least a decade. New nurse's aides get about $9 per hour, while those with many years' service earn $14 per hour
----------------------------------
Yesterday, Star of David administrator John A. Brennan said in a statement that the cut in hours was an important "efficiency," given the financial crisis in the industry. He and corporate officials declined to answer questions.
------------------------------------
The home scored low on the state's quality survey, ranking in the bottom 7 percent. Workers said they had worked hard to improve the care, but that there were not always enough workers to feed residents properly or to keep them from falling or hurting themselves.

Brennan's statement said the home was "committed to providing quality care."

Workers said Kindred had cut staff hours in 11 of its 34 homes in the state, but not in its four other unionized homes in the state.
---------------------------------
Strikers drew support from city and state politicians yesterday. State Representative Michael F. Rush, a West Roxbury Democrat, joined the picket line. "I know Kindred wants to save money," he said, "but they seem to be taking it out of the backs of the workers."

Ky. AG investigates quality of care at Kindred
Modern Healthcare's April 1, 2003

Kindred Healthcare, Louisville, Ky., said the Kentucky attorney general's office is investigating several cases related to quality-of-care issues at the company's 17 nursing facilities in the state, including the "abuse or neglect of residents and Medicaid billing fraud related to the alleged provision of substandard care." The investigation, disclosed by Kindred in its 10-K filing with the Securities and Exchange Commission, could result in civil and/or criminal charges, as well as the possible exclusion of the company's nursing facilities from the Medicare and Medicaid programs, Kindred said.

SAFETY, CARE VIOLATIONS WIDESPREAD IN REGION; STAFFING AND MONEY ARE CRITICAL, BUT TOO OFTEN FALL SHORT
The Virginian-Pilot(Norfolk, Va.) April 27, 2003

Kindred Healthcare, a Louisville, Ky.-based company that operates 305 nursing homes nationally and four in South Hampton Roads, earned an average $1 million profit per facility in 2001.

Yet, its Harbour Pointe Medical & Rehabilitation Center in Norfolk was cited for 35 violations of health-quality standards in one 12-month inspection period - more than any other nursing home in Virginia. The average for Virginia homes during that period was four violations.

Nader Baheri placed his wife, Mary Taylor, in the facility on Hampton Boulevard in Ghent after she was injured in a 1997 auto accident. The crash caused brain damage that made her prone to seizures.

In a lawsuit filed in 2001, Baheri described what happened as he sat with his wife in her room on Aug. 30, 1997.

"I witnessed the continuous seizure of my wife, which lasted approximately 1 1/2 hours," he is quoted as saying in a sworn statement filed in court. "My wife turned dark blue. Bubbles were coming from her mouth, and she was soaking wet. I pleaded with the nurses to do something to stop the seizure, screaming at them: 'Call 911 - this is an emergency.' "

Baheri said the nurses responded that they would call the facility's medical director and "everything would be okay." He alleged in his lawsuit that his wife suffered further serious, permanent brain damage and requires round-the-clock care.

Baheri, who was driven into bankruptcy by his wife's medical bills in 1999, now cares for her at home. Kindred settled the lawsuit for $110,000.

State inspections at the Harbour Pointe facility have turned up repeated instances of patient injuries, bedsores and medication errors. Here are some examples of the inspectors' findings, recorded in summary statements of deficiencies:
-------------------------------------------
n A 70-year-old woman, while being fed through a tube, was left lying nearly flat, causing her to breathe feeding formula into her airway. She was hospitalized with aspiration pneumonia and died two days later. The nurse on duty told the inspector she felt "overwhelmed with the nursing care responsibility for 43 residents," 11 of them tube-fed, with only one aide to help her.
-----------------------------------
n The staff failed to adequately monitor the medications of nearly half the patients surveyed during one inspection. When a diabetic's blood sugar dropped dangerously low, his doctor was not notified and the man died. A woman's anti-psychotic prescription went unfilled for seven days and she suffered paranoid delusions. Another woman was given a double dose of a sleep-inducing drug and died the next day.

In the past three years, federal regulators have imposed three cutoffs of Medicaid and Medicare payments for new admissions at the Harbour Pointe facility and levied $176,500 in civil penalties for violations of quality standards.

Post-acute pain; Modern Healthcare survey shows mixed results for providers in '02, with end of Medicare add-on payments among the challenges
Modern Healthcare May 5, 2003

Meanwhile, Kindred said it would shed its Florida facilities and add $55 million in liability reserves

A nonprofit organization that advocates on behalf of nursing home residents is suing several long-term care chains over what it claims is inadequate staffing
Long-Term Care Wire May 10. 2003

The Foundation Aiding the Elderly has filed suit in northern California against Covenant Care California, Kindred Healthcare, Mariner Health Group and Pleasant Care Corp. FATE is seeking injunctions to force the companies to hire enough nursing staff to comply with state law.

"Understaffing of skilled nursing facilities is a deplorable practice, as well as a clear violation of state law," says attorney Mark Todzo of The Lexington Law Group, a San Francisco-based law firm representing FATE.

Kindred stock slides on los; : Shares dip 7 percent; Ventas deal ignored
The Courier-Journal May 16, 2003

The deal to sell 15 nursing homes in Florida and one in Texas was sparked by Kindred's rising lawsuit-related costs there, which have lowered profits.

Kindred's outlook improves : Stock soars 35% in wake of divestiture
The Courier-Journal August 15, 2003

On top of a strong earnings performance by Kindred's long-term care hospitals, the company was able to hold the increase in hospital labor costs to 2 percent when compared with a year earlier.

Update Comment August 2003 (see above):- Kindred Healthcare, now out of bankruptcy shows little evidence of being more ethical or providing better care. It is forced to sell in Forida and Texas where it is suffering heavy losses from litigation. It is according to the reports still disrupting well established nursing communities and cutting staff. It is facing actions by patients' relatives, the Kentucky attorney general and a community group in California all related to quality of care issues. The reason why it is performing better in the marketplace can be deduced.

---

LINKS TO MAPS
Central Map ..... Initial Map ..... USA Map ..... Australian Map ..... International Map ..... Corporate Practices Map..... (to print)

---

Path
 Home Page ..... US Corporate page ...... Aged Care ...... Vencor Access

---

Vencor Reference Pages
Reviews ... in the marketplace ... the criminal ... Mount Carmel ... Explanations ... Lunsford

---

This page created Jan 2001, updated Mar 2001, Aug 2001 and Aug. 2003 by Michael Wynne