The Depraved Indifference in Nursing Care – The Ashmedai – The Owners Who Choose Profit Over Care – Part I

The word “Ashmedai” it is said is used to refer to the King of the demons – all that is evil. “The author of the Ra’aya Meheimna in the Zohar (3:253a) distinguishes between three types of demons: (1) those similar to angels; (2) those resembling humans and called shedim Yehuda’im (“Jewish devils”) who submit to the Torah; (3) those who have no fear of God and are like animals.” [https://www.jewishvirtuallibrary.org/demons-and-demonology]

nursing fraud

[EDITORIAL – IN HONOR OF SHAVUOT AND THE ELDERLY AROUND THE COUNTRY WHO NEED OUR HELP] (updated 6.10.19) (updated 6.11.19)

Nursing Home Scandals in the US – A Special Duty Should be Required in Nursing Care and a Special Class of Punishments Established for Those Who Abuse

Nursing home care is a profitable business. There are “nursing home” moguls chomping at the bit to get hold of another for his or her portfolio. There are those owners/managers with their names on dozens of homes. There are straw-men who act as placeholders so the majority owners don’t need to report. It is a racket.

While the US government is supposed to restrict owners with repeated complaints from acquiring additional homes, those who are serially neglectful of rules and care, it doesn’t. Websites are not up-to-date. Nursing facility conglomerates just change ownership stakes, re-brand their product and start again with a new name and no oversight. Or, they put a straw-man in place, someone who is seemingly the owner, but in reality, is not.  The entire system is a breeding ground for greed, indifference, dereliction of duty, fraud and neglect. When it comes to the care of the elderly and patients requiring rehabilitation, the families don’t complain because they are vulnerable, they need help and most don’t know to whom to turn. The result is a pattern of victimization, victimizing patients, families and even healthcare providers.

And, Medicaid and Medicare do nothing to stop the fraud that drains their coffers. And the industry itself couldn’t give a tinker’s damn about the injury that patients sustain as a result of profit over care.

Fraud, abuse and neglect is rampant. Look no further than recent news article, some of which we have listed below. Bad actors would rather file suit for defamation than deal with the problems. Denial works wonders, particularly if it is played out in court by those with deep pockets against those with fewer financial resources. 

As an example and one that we were alerted to a few months back, a patient in a nursing facility is charged for services he or she did not receive and should have. The first crime is charging for those services not provided.  It is a fraud perpetrated on the patient and upon the healthcare system as a whole. We all suffer for it. The second crime is not providing the services at all. That second crime is worse than the first, insofar as it reflects an indifference to the health and well being of the person entitled to that service. The third crime is that of those who are supposed to be overseeing the system. No one bothers to contact patients to ask if they are receiving care. All are guilty, no one is accountable and everyone suffers.

Another scenario so common it borders on unfathomable, a specialized nursing facility is habitually short-staffed and lacks sufficient specialized skilled nursing to recognize if a patient has a bladder infection, for example. The patient sits in pain, urinates uncontrollably and is often forced to sit for hours in his or her own urine. The lack of skilled nursing is a dereliction of the requirements of a skilled nursing facility. It is also a form of neglect and if the nursing facility is billing on those services, it is also a fraud. The pain faced by the patient is a form of abuse and sitting in one’s own urine is inhumane, at best, and utterly criminal at worst – cruel and unusual punishment.

These types of nursing facilities are rated under a system proposed by the government, one that is supposed to provide guidance to families. And yet it is an abject failure. There is no oversight. The money is lost from the system and basically handed to the nursing facilities to help owners and managers line their pockets, and line them they do. 

Another example, closer to home, an incapacitated stroke patient lies on his or her back for 10-12 hours at a time unless periodically moved, which requires assistance. Alternatively, the patient will and does develop bedsores. The nursing facility is short staffed and does not have the manpower required to watch over patients requiring this level of care. If that patient’s position is not changed regularly those bedsores can ulcerate, can get infected, can cause sepsis. They are painful, excruciating and thousands of patients in beds in nursing and rehabilitation facilities throughout the United States suffer because the personnel required to make sure these virtually immobile patients are getting their care costs money and requires compassion. The nursing and rehabilitation facilities do not want to hire additional nursing or support staff. It costs money taken from their exquisitely padded pockets. And compassion is sorely lacking, non-existent and when the scales are weighted between money and compassion, compassion is not a tipping point.

What is not emphasized in an overall analysis of our healthcare system is that hiring someone to constantly change a patient’s position is less expensive to the entire system then the cost of paying for sepsis. But in the ultimately financial analysis, the nursing and rehabilitation facilities do not get rewarded when they help patients to leave. They get rewarded when beds are filled, even if they are filed with patients who might be healthy enough to go home. In fact, the application for new homes requires that potential owners have a plan for keeping their nursing facility full. The system is utterly broken. Nursing home owners profit from money that comes from lengthened and prolonged stays within their facility. There is absolutely no motivation to help people. There IS MOTIVATION TO KEEP THEM SUFFERING.

Looking to the codes used for billing, sepsis can be charged to by a hospital or facility for treatment purposes. In other words, it is a “billable event.” Moving a patient to help prevent bedsores cannot be billed. The former is profitable and the latter is not. Owners of these nursing homes are not incentivized to keep patients comfortable and healthy, improve their quality of life. That requires “compassionate care” and few nursing homes have the moral and ethical wherewithal to even make that a consideration in their ownership and management of their facilities.  Simply put, they do not want to spend the money, they want the profit and the system feeds into fraud and abuse.

The Jewish community can claim ownership of a significant percentage of beds in the greater US nursing home arena [www.briuswatch.org] . This is a fact. Most large nursing and rehabilitation groups are Jewish run and Jewish owned [https://data.medicare.gov/widgets/y2hd-n93e]. How are we not shaming our own into treating the elderly with respect, dignity and a quality of care that reflects a level of humanity, compassionate and empathy commensurate with a decent Jewish soul? A level of care that reflects and overall basis in human dignity? How are we allowing our fellow Jews to utterly demoralize the elderly for personal gain?

The ultra-Orthodox, fighting for better conditions in jails were able to raise millions in a 72 hour period.  However, they look the other way when their friends and neighbors, their fellow synagogue members, wealthy nursing home owners defraud the system and abuse patients. Why is fighting for better healthcare oversight not as important, if not more so, then prison reform? The criminal element gets more attention than the elderly, those who spent years looking after us and are then neglected.

In reality, in most cases the inmates in US prisons are treated better than the elderly in US nursing and rehabilitation facilities. Perhaps when people get old and start to get sick, they should commit crimes. The reality in the US is that they would receive better care growing old, spending their golden years behind bars then they do subjected to nursing home treatment.

There are some crimes that many of us, those with a heart, compassion, empathy and a modicum of humanity find to be absolutely unthinkable. Among them is the rape of a child, the slaughter of people as they daven in synagogue or pray in other houses of worship and the blowing up of buildings by suicide as prime examples. There are so many others. Sources tell us that sexual predators and rapists have the worst reputations going into jails and prisons and are treated accordingly. Why are those who abuse the elderly not equally as worthy of our collective revulsion?

When we hear about crimes committed in Nursing/Physical Rehabilitation homes, why are we not equally as transfixed by the sheer weight of the depravity of the crime? How is the population not so moved as to lose sleep over what is happening to our elderly in nursing care? How can substandard care in nursing facilities be ignored? Have we as a society just accepted, with some form of cognitive dissonance, that this is simply the state of affairs? And don’t the members of the Jewish community who trade regularly in the nursing home business owe their patient class some level of humanity?

Federal and state websites, which are supposed to update the quality of nursing and rehabilitation facilities are not updated regularly, though they profess to be.[https://nursinghomereport.org/ownername-joseph-schwartz/ ] There is often little follow-up on complaints of neglect, abuse and fraud. The “grading system” is inconsistent throughout the different US states and is subjective. And, it is not uncommon to find repeat offenders given license to continue to purchase additional homes to add to their portfolio of nursing homes. It is both pathetic and almost laughable.

[https://data.medicare.gov/widgets/y2hd-n93e]

How can we as a civilized society accept this outcome? How can we be looking the other way? How can social workers in hospitals around the country be sending patients from their hospitals to substandard conditions in nursing and rehabilitation facilities? What is the duty of care of these social workers? And what obligation does the US healthcare, Medicare and Medicaid systems have to protect those within our society who are being harmed by nothing more than depraved indifference.

 

ADDITIONAL READING:

Whether Worth Less or Worthless, Quality of Care Issues Under the FCA are Worth Noting

WHERE IS THE OVERSIGHT?

SICK, DYING AND RAPED IN AMERICA’S NURSING HOMES

How N.Y.’s Biggest For-Profit Nursing Home Group Flourishes Despite a Record of Patient Harm

Nursing home care: A growing crisis for an aging America

Questions Remain About Pennsylvania’s Vetting of Skyline Healthcare

Elder Abuse in Residential Long-Term Care Settings: What Is Known and What Information Is Needed?

Esformes will appeal convictions on 20 charges in $1.3 billion healthcare fraud case

Nursing Homes Held by Skyline Owner Face Crisis, Bouncing Paychecks in Mass.

Ex-independent living home employee found guilty of elder abuse

It’s a scheme’: Nursing homes owe thousands to Fall River pharmacy

Federal Way woman must repay state in workers’ comp scam

Nursing Home Abuse Statistics

The statistics reflecting incidents of abuse involving elderly residents in nursing homes and care facilities are both staggering and disheartening. At the broadest level, more than two (2) million cases of elder abuse are reported every year, and almost one (1) out of every ten (10) elderly individuals will experience some form of elder abuse. Moreover, virtually all parties working closely with the elderly on topics such as nursing home abuse have noted that the overwhelming majority of abuse incidents remain unreported. Sadly, while those figures reflect a national epidemic of violating the vulnerable, but also, most likely grossly understate the problem of elder abuse in the United States.

 

 

 

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