Setting the stage: The advocates' struggle to address gross neglect in Philadelphia nursing homes

Journal of Elder Abuse and Neglect

Volumn 8, Issue 3, 1997, Pages 5-20

  Hirschel, Alison E ^a,b  

^a North Philadelphia office of Community Legal Services Inc   (United States)

^b UNIVERSITY OF PENNSYLVANIA LAW SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 21444436134     PISSN: 08946566     EISSN: None     Source Type: Journal    
DOI: 10.1300/j084v08n03_02     Document Type: Article

References (39)

1. In Philadelphia, both the Northwest Interfaith Movement (NIM) and the Coalition of Advocates for the Rights of the Infirm Elderly (CARIE) provided ombudsman services to nursing home residents as subcontractors to the Philadelphia Corporation for Aging, the local Area Agency on Aging.
2. The Elderly Law Project of Community Legal Services, Inc. received partial funding from the Philadelphia Corporation for Aging to provide representation to low income residents of Philadelphia nursing homes.
3. Throughout this article, the staff of the Office of the Ombudsman and of Community Legal Services, Inc. will be referred to as "the advocates." At various times, other professionals and lay people, including residents and their families, joined the ombudsman and legal services staff in their advocacy efforts.
4. According to the Form 10-K Annual Report the Corporation filed with the Securities and Exchange Commission for the fiscal year ending May 31, 1993, 80 percent of the facilities' patient days were attributable to Medicaid reimbursement, five percent were attributable to Medicare reimbursement, and 15 percent to private pay and other sources. Geriatric and Medical Centers, Inc. Annual Report, 1988, p. 7.
5. Since the Corporation's urban homes had a higher Medicaid population than its suburban homes, the Philadelphia homes had Medicaid populations that significantly exceeded 80 percent of the total resident population. The amount of revenue the Corporation received from the Medicaid and Medicare programs was staggering; for the fiscal year ending May 31, 1988, it received approximately $61,050,000 in Medicaid and Medicare reimbursement. Geriatric and Medical Centers, Inc. Annual Report, 1988, p. 23.
6. Author's interview with former corporate employee who was responsible for planning the annual Christmas party and picnic, September 29, 1995. The employee, who wished to remain anonymous, asserted that no expense was spared on these occasions and that the award recipient received an elaborate plaque. Lavish gifts were sometimes also made to the recipient's family and to those who sat on the dias or made a speech for the occasion.
7. Interview with Ilene Warner, a nurse who worked briefly for the Corporation in the early 1980s. Ms. Warner was also a discharge planner at a Philadelphia hospital from 1983-1988. Telephone interview with Ilene Warner, September 22, 1995.
8. Interview with a former director of nursing who wished to remain anonymous, September 29, 1995.
9. According to a former director of nursing at one of the Corporation's facilities, the home was constantly short of both licensed practical nurses and aides. The worst shortages occurred on weekends and holidays. Administrative staff was urged to seek additional staff solely from the Corporation's own temporary nurse agency and, despite numerous meetings and repeated pledges, the company consistently failed to provide the number of temporary employees requested by the facility. Moreover, the corporate office allegedly refused requests from administrative staff at the facilities to schedule staff above the minimum staffing levels required by law regardless of the needs of the residents. Interview with former administrator who wished to remain anonymous, September 29, 1995.
10. Interview with former director of nursing who wished to remain anonymous, September 29, 1995.
11. For example, in the company's 1988 Annual Report to stockholders, the chairman and president noted that "a shortage of qualified nurses and service personnel . . . sharply affected your Company's performance." To address this problem, the Corporation reported it had established a new division to train and recruit entry level employees, create nursing pools, and provide transportation for employees when necessary. 1988 Annual Report, p. 2.
12. In an article in the Philadelphia Business Journal, the chairman and president bemoaned the shortage of nurses and aides which he said necessitated a reliance on agency staff. He asserted that the company was stepping up recruitment efforts at local nursing schools and recruiting staff in both Ireland and the Philippines. "Geriatric and Medical reports another unhealthy quarter," Philadelphia Business Journal, February 22-28, 1988.
13. For example, Ilene Warner who worked for the Corporation briefly in the early 1980s recalled being offered a job as a nursing supervisor on the very day she received her nursing license. The position entitled her to a higher salary but did not involve any additional orientation or training. Telephone interview with Ilene Warner, Sept. 22, 1995. Another former administrator noted that she was promoted to administrator of one of the largest and most challenging facilities only five months after receiving her nursing home administrator license. Interview with former administrator who wished to remain anonymous, September 29, 1995.
14. Interview with a former corporate employee and administrator and a former director of nursing, both of whom wish to remain anonymous, September 29, 1995.
15. Interview with a former administrator and a former director of nursing who wished to remain anonymous, September 29, 1995.
16. Interview with a former director of nursing and a former administrator who wished to remain anonymous, September 29, 1995.
17. Interview with former administrator and former director of nursing who wish to remain anonymous, September 29, 1995.
18. See Capezuti and Siegler, "The Role of the Academic Nurse and Physician in the Criminal Prosecution of Nursing Home Mistreatment."
19. Geriatric and Medical Centers, Inc. Annual Report, 1988, p. 2.
20. Between the first quarter of 1987 and the first quarter of 1990, the stock fell from a high of 8 1/4 to a low of 1 1/4.
21. Report of Charles Phillips, Ph.D., M.P.H. to Community Legal Services, Inc., January 30, 1990, p. 4.
22. Geriatric and Medical Centers, Inc. Annual Report, 1988, p.2.
23. See also, "Geriatric Selling Units in Effort to Reduce Debt," Philadelphia Inquirer, March 3, 1988, p. B8.
24. The corporation often touted its various programs allegedly designed to improve quality of care in its facilities. For example, in a 1986 article in the American Health Care Association Journal, the vice president described several aspects of its "Quest for Quality" program. These included an "Interaction Program" involving representatives from all levels of staff charged with identifying and addressing administrative and patient care problems; the "Buddy System" in which facilities were paired for a period of one year so that staff at the two facilities could evaluate and advise each other; and the "second cup of coffee" program, an innovation which allegedly became a slogan throughout the Corporation, in which residents were permitted a second cup of coffee on Sunday mornings. "Moving the Quest Forward," American Health Care Association Journal, July 1986.
25. Testimony of Dr. Margaret Yeakel before the Pennsylvania Department of Health Division of Need Review regarding CON-92-A-1938-B, December 13, 1993.
26. As in the cases of Ms. G. and Mr. J. which were described at the beginning of this article, the Corporation's medical records were often confusing and many important records such as body sheets showing the location and severity of pressure ulcers, transfer forms to and from the hospital, and notations of changes in the resident's condition were missing. In addition, several former employees of the corporation reported being directed to falsify medical records. Telephone interview with Ilene Warner, September 22, 1995; Interview with former director of nursing and administrator who wished to remain anonymous, September 29, 1995. In fact, the medical records of Ms. G. were not only incomplete and inadequate, but also contained evidence that an attempt may have been made to falsify information.
27. Statement of the Commonwealth of Pennsylvania Department of Aging presented to the Pennsylvania Department of Health Division of Need Review regarding Certificate of Need applications nos. 92-A-1128-B and 92-A-0938-B.
28. Interviews with a former corporate staff person and administrator and a former director of nursing, both of whom wished to remain anonymous, September 29, 1995.
29. Interview with a former corporate employee and administrator and a former director of nursing, both of whom wish to remain anonymous, September 29, 1995.
30. "Advocates for the Aged Face a Nursing Home Dilemma in the City," Philadelphia Inquirer, March 12, 1994, p. B.1.
31. Interview with Michael Campbell, staff attorney, Pennsylvania Health Law Project, September 22, 1995.
32. See footnote 4.
33. According to James Pezutti, Director of the Office of Long Term Care Client Services in the Department of Public Welfare, it was extremely unusual for the Department to exercise its ability to withhold Medicaid funds from a facility if the Department of Health was not simultaneously pursuing a licensure action against the facility. Telephone interview with James Pezutti, October 5, 1995. Thus, despite the fact that the Department of Public Welfare did have its own oversight procedures, it rarely acted independently.
34. Telephone interview with Dennis Gallagher, Chief of Survey and Certification Operations, Region III, Health Care Financing Administration, U.S. Department of Health and Human Services from November 1988 to July 1991, October 6, 1995.
35. Gallagher interview, October 6, 1995.
36. According to Ilene Warner, a discharge planner at a Philadelphia hospital from 1983-1988, doctors at the hospital joked before even seeing a patient who had been admitted from one of the Corporation's homes that they could predict the patient's diagnoses: malnutrition, dehydration, and multiple infected pressure ulcers. Ms. Warner also said she refused to place patients in either of the homes in which Ms. G. or Mr. J. resided because she considered them to be among the worst facilities. Telephone interview, September 22, 1995.
37. Telephone interview with Michael Campbell, staff attorney, Pennsylvania Health Law Project, 35.
38. The families of both Ms. G. and Mr. J. did file actions against the Corporation and others responsible for their care. Mr. J. accepted an undisclosed settlement of his action. Ms. G's case finally settled in April, 1996 for $295,000 after the commencement of a jury trial.
39. The Commonwealth licensing boards for nurses, doctors and nursing home administrators generally took several years to investigate complaints and closed the majority of cases without taking any action. Although the advocates did not expect that they would necessarily achieve any important victories in this forum, they decided that pending complaints created an extra pressure on the corporation and its professional staff and served as another reminder that the serious neglect of residents was being documented and reported.