Jury imposes maximum damages on Skilled Healthcare; nursing home chain faces upwards of $600 million for health code violations
Eureka Healthcare
The jury in the class-action lawsuit against Skilled Healthcare returned to Humboldt County Superior Court and rendered a verdict on Tuesday, opting to impose the maximum amount of damages totaling nearly $619 million for health code violations.
The verdict comes more than seven months after the start of the case, which is believed to be the longest civil suit in Humboldt County history.
”This is a really strong statement to Skilled Healthcare that they have to follow the law,” said plaintiff’s Attorney Michael Thamer, who delivered the closing arguments in the case and specializes in fighting corporate abuse. “They need to know that they are going to be held responsible.”
The issue at the heart of the case is a California statute that mandates 3.2 nursing hours per patient per day. The lawsuit covers the years 2003 to 2009, and represents a class of some 32,000 patients.
Along with the statutory damages, the jury awarded an additional $58 million for a violation of the California Consumer Legal Remedies Act, bringing the total damages to nearly $677 million.
Skilled Healthcare is one of the largest nursing home chains in the country, employing approximately 14,000 people. The company is based in Southern California, and operates 78 nursing facilities in seven states.
Eureka, Granada, Pacific, Seaview and St. Luke Healthcare and Rehabilitation are the five Skilled Healthcare facilities here in Humboldt County. The
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total amount of damages imposed on the five Humboldt County facilities is nearly $135 million.
Because of multiple changes to the computer system the courthouse uses to track cases, there is no way of determining how the length of the Skilled Healthcare lawsuit compares to previous Humboldt County civil suits. But many people in the courthouse say the trial, which began November 30 of 2009, is the longest civil suit in county history. And it isn’t over yet.
Next week the jury will decide the extent of additional punitive damages. Judge Bruce Watson will then decide if the court will issue an injunction against Skilled Healthcare that would mandate the company to keep staffing levels compliant with the law in the future.
Defense Attorney Kippy Wroten was not in court for the verdict and declined to comment, instead issuing a statement via e-mail.
”With respect to the court and to these judicial proceedings as a whole, we strongly disagree with the outcome of this legal matter. We remain confident that our facilities are well staffed and are extremely disappointed with this result. Unfortunately we cannot comment further as the matter is ongoing.”
The second phase of the jury trial, which will establish the net worth of the company in order for the jury in order to decide the extent of any punitive damages, is set to begin next week.
Cindy Cool testified earlier in the case on behalf of her father, a former patient at Eureka Healthcare and Rehabilitation before he died from complications of Alzheimer’s disease. Cool was in court again Tuesday, and had to fight back tears after she heard the verdict.
”I’m so thankful for this,” said Cool, who added that while it may be too late for her father to receive justice, she hopes the lawsuit makes things better for future patients. “We just want our loved ones to be taken care of.”
BY THE NUMBERS:
The following is a breakdown of the penalties imposed on Skilled Heathcare’s five Humboldt County facilities by the jury. These numbers include statutory damages and penalties for violating the Consumer Legal Remedies Act:
* Eureka Healthcare and Rehabilitation Center, LLC — $25,573,913
* Granada Healthcare and Rehabilitation Center, LLC — $30,880,270
* Pacific Healthcare and Rehabilitation Center, LLC — $13,620,239
* Seaview Healthcare and Rehabilitation Center, LLC — $26,732,565
* St. Luke Heathcare and Rehabilitation, LLC — $37,893,698
TOTAL — $134,700,685
SOURCE: mercurynews.com Matt Drange/The Times-Standard
Posted: 07/07/2010 01:30:15 AM PDT
Several experts have theories that Assisted Living and Residential Care for the Facilities for the Elderly (RCFE’s) occupancy has been linked to the unemployment rate.
Previous Stats ….According to the U.S. Department of Labor’s Bureau of Labor Statistics, there are nearly 31 million people currently unemployed — that’s including those involuntarily working part time and those who want a job, but have given up on trying to find one. In the face of the worst economic upheaval since the Great Depression, millions of Americans are hurting. “The Decline: The Geography of a Recession,” as created by labor writer LaToya Egwuekwe, serves as a vivid representation of just how much. Watch the deteriorating transformation of the U.S. economy from January 2007 — approximately one year before the start of the recession — to the most recent unemployment data available today.
The FBI along with other law enforcement and social agencies raided 4 homes in Paso Robles early Tuesday morning, arresting two people on charges of knowingly and intentionally concealing, harboring, and shielding illegal aliens within the U.S.
Paso Robles Sleepy Hollow FBI Raid
Maximino Morales, 44, and his wife Melinda Morales, 46 were taken into custody by federal agents without incident. They operated elder care facilities within the four homes. They were arrested on suspicion of recruiting and smuggling Fillipino nationals to the U.S. and then allegedly harboring the victims by forcing them to labor in working conditions that were sub-standard. They used threats of deportation and threatened harm to their families and them if they left their employment prior to paying off their debt. ( the cost of getting to the U.S. )
The investigation began last November when the FBI received some tips concerning allegations involving the abuse of workers employed at the four residential care facilities for elderly citizens in Paso Robles.
“The defendents in this case allegedly lured the victims with the promises of legitimate work and a better life in the U.S…Then smuggled them into this country through fraud and forced victims to work in rigorous, inhumane conditions, thereby depriving them of their basic civil rights,” said Steven Martinez, Asst. Director in Charge of the FBI in Los Angeles.
One resident in the house was David Haney when the FBI arrived this morning. “I just can’t believe that this is happening. I thought it was a fire drill.”
It was no drill though. Many FBI agents and other personnel came searching for evidence. “When I tried to pick up my dad, I tried to go in the house and of course I was stopped, ID’ed, I had numerous people surround me asking me for the same information, my address, my name, who I was,” said Keelen Haney.”
Doug Price, the FBI Asst. Special Agent in Charge said, “Often times we think of human trafficking in terms of some of these sexual crimes, like prostitution, but human trafficking covers all areas. It’s really when someone is held against their will…in a form of enslavement.”
He also noted that “it can be in many situations. This was an elder care facility. Again, it’s not what you normally think of in this type of situation, but there are many instances of where these types of things are happening.”
County social services say family members have already picked up thirteen of the seniors who had been living in the homes. There were a total of 19 living in the four homes that were raided and they will make sure the rest are cared for until their relatives arrive.
Neighbors said they were surprised to see what happened in their usually quiet street, Sleepy Hollow, which today didn’t seem to fit its’ name. “It’s surprising, it really is a surprise. I’m sorry to hear it because it is a great neighborhood. Never had a problem in the four years I’ve been here,” said Teresa Sollazzo.
Another neighbor however, thought a couple of things seemed a little odd. “I thought it was a little suspicious that I never saw the elderly people outside, and the workers were from what I heard encouraged not really to associate with the neighborhood,” said Debby Owens.
Both Maximino and Melinda Morales are anticipated to be released on bail tonight. The charge of harboring illegal aliens carries a maximum statutory penalty of ten years in federal prison on each count.
A: The Dakim BrainFitness is the product of inventor, founder, and CEO Dan Michel’s experience with his father’s thirteen-year struggle with Alzheimer’s disease. Dan’s participation in cognitively stimulating activities with his father over the course of several years made him recognize the therapeutic and emotional value of mental stimulation. He also saw a pressing need for a more effective means of providing brain fitness exercise to help seniors use rigorous cognitive stimulation, long-term to defend their brain health-to prevent or slow the development of dementia. Dakim’s team has spent the last eight years developing, testing and refining what senior living providers consider to be the most advanced, effective, user-friendly and entertaining way to help virtually all seniors enhance their quality of life.
How does the Dakim BrainFitness improve seniors’ quality of life?
A: Experts have found that brain health is a ‘use it or lose it’ proposition. Dakim BrainFitness engages the brain with challenging exercises across six cognitive domains, and turns rigorous cognitive exercise (based on standardized neurological tests and exercises) into a compelling and entertaining experience. The Dakim BrainFitness makes the entire experience so much fun for seniors, they’ll want to use it again and again! At Dakim, we believe fun and enjoyment enhance everyone’s quality of life!
Who is Dakim BrainFitness for?
A: Virtually all seniors can benefit from the Dakim BrainFitness cognitive fitness system, from those with normal brain function to those with mild cognitive impairment and even moderate dementia. Dakim BrainFitness is designed to enable seniors to use rigorous cognitive stimulation to prevent or slow the development of dementia. As Gary Small, M.D. says, ‘It’s never too early or too late to start a brain fitness program.’
How many cognitive domains does the system exercise?
A: The Dakim BrainFitness exercises six cognitive domains, including memory (short-term and long-term), language, calculation, visuospatial-orientation and critical thinking.
How long does a Dakim BrainFitness session last?
A: A typical session usually lasts about 20 to 30 minutes, but this can be adjusted-by home users or by care providers in senior living communities, to suit the specific needs of the community and/or its residents.
Does Dakim provide new exercises?
A: Yes! New content is downloaded and automatically installed, via the Internet regularly, as often as every day or two. Our fresh, entertaining content, which is constantly being created and customized for our users, is the key to making the Dakim BrainFitness fun and beneficial!
Irene G. Methe of Belchertown bowls every Monday. But she doesn’t have to don soft-soled shoes or make a trip to the local bowling alley.
Senior Woman Wii bowling
Instead, Methe, 78, heads over to the Belchertown Senior Center where she and a few other seniors compete in a “virtual” bowling competition using Wii Sports, a video game system produced by Nintendo in which players use a remote control device to mimic actions performed in real-life sports. In addition to bowling, Wii users also can play simulated golf, tennis, baseball and boxing.
Wii Sports, Wii Play and Wii Fit programs have swept the nation, with Nintendo reporting that by March 2009, some 50 million units have been sold worldwide, making Wii the most popular video game system in the world.
The Wii craze has taken hold in retirement communities and senior citizen centers across the country, and locally, many facilities are beginning to offer Wii programs.
At the Belchertown Senior Center, for example, people have been playing Wii bowling, golf and tennis for the past couple of months and there’s a weekly Wii bowling league. The Easthampton Senior Center has a program they call “Say Oui to Wii,” and seniors have formed a Wii bowling league. The Hadley Council on Aging recently held an orientation program for seniors to learn how to use a new Wii system, while at the Lathrop Retirement Community in Easthampton, seniors also are playing Wii golf and bowling. The Northampton Senior Center is trying to raise money to buy a Wii system. A new Wii console, that includes Wii Sports games, costs about $250.
“I’d never done Wii bowling before we got it set up at the senior center,” Methe said. “We are having such a ball with it. I like it a lot. It makes you move and gets you some exercise and it’s fun to be able to get up and participate with different people at all different skill levels. We are all learning together.”
Methe, the mother of six children, bowled as a young woman in a mother’s bowling league, but hasn’t played the sport in many years. She said the Wii program is very similar to real bowling.
“The whole thing keeps score and does everything for you,” she said. “All you have to do is aim the remote straight and release it.” Methe said she would like to bowl at an actual bowling alley, but said it would be difficult to find transportation and people to play with. “This is all right here at the senior center for us,” she said. “We don’t have to go anywhere.”
Methe said the Wii system allows many people at the center with physical limitations to bowl. Methe is the center’s top bowler, with a score of 181, the highest score bowled so far. “That’s better than I did in my normal bowling,” she said. “And there were witnesses!”
Local health experts say any form of exercise is good for seniors, including Wii.
“Exercise is extremely important for elderly folks and there is so much new information now on how beneficial it is,” said Dr. H. Jon Schiller, a family practitioner with Valley Medical Center in Amherst. “If Wii fosters participation in exercise, then I am all for it,” he said.
At the VA Medical Center, Wii is used in all the in-patient units for recreation as well as for physical therapy, says Sandra Diamond, the center’s rehabilitation supervisor. Diamond says she particularly likes the features that track participants’ fitness levels, body-mass index, balance reactions, and other areas, and appreciates the ability to modify the games to accommodate different abilities, including for people who must be seated. Ankle and leg weights can be used for added difficulty, she noted. The Wii is especially popular among young veterans returning from Iraq and Afghanistan, she said, but also is used by older veterans.
“Wii is such a great distraction,” she said. “Everyone likes to stare at TV and now you can combine that with some fun exercise.”
For many seniors, like Methe, the Wii games provide an opportunity to participate in sports in the “virtual” world that they once enjoyed in their everyday lives. Some of these seniors do not have the mobility to get out to a golf course or bowling alley any longer. Inclement winter weather keeps those who are mobile stuck indoors.
“Wii is something you can do inside and it’s easily accessible if you are not as physically able as you were once were,” said Kim Jensen, activity coordinator at the Easthampton Council on Aging and Senior Center. The center just launched a weekly Wii bowling league and plans to offer golf and other Wii games in the future.
For example, Jensen said, bowling is inaccessible to many elderly people because the balls weigh between 5 and 15 pounds or so. In Wii bowling, the player “bowls” with a remote device that “weighs no more than a tissue box.” The game can even be played while seated by those who have trouble standing for long periods or who are confined to wheelchairs.
“If you are sitting in a chair, you can still swing your arm and you don’t even need to have a full range of the arm to play,” Jensen said.
The center offers private one-on-one training sessions for seniors who may find the technology of Wii unfamiliar and intimidating, Jensen added. Once they get the basics, players can join their friends for the weekly Wii bowling league.
“Some people need time to get used to the idea of playing a Wii game,” Jensen said. “They may have seen their grandchildren or great-grandchildren play with Wii and they think of it as just a video game. I tell them it’s a lot more than that. It’s a whole-body game that will get them up and moving.”
Health benefits
Schiller, of Valley Medical Center, said regular exercise, like that provided by the Wii Sports games, can improve balance, stability and coordination for senior citizens and help them retain muscle strength.
“Research shows that seniors who exercise regularly have a 30 percent decrease in falls and a 20 to 40 percent decrease in hip fractures,” he said. Exercise also lowers blood pressure and benefits the heart, increases endurance and prevents osteoporosis and bone loss - all of which are significant concerns for elderly people. Schiller noted the latest research also indicates that exercise can have a beneficial effect on lifting depression, which many senior citizens grapple with, particularly those who are more isolated.
“Sweat is the new antidepressant,” Schiller said. “Exercise improves sleep, reduces anxiety and depression and helps us cope with stress. The news that is exciting us lately is that exercise actually increases the ability of the brain to function and some studies show that new brain cells are formed with regular exercise. … It’s like Miracle Grow for the brain. Exercise improves the functioning of the frontal lobe and literally can help stave off Alzheimer’s disease.”
While Bill Korzenowski, director of the Belchertown Senior Center, says it is too soon to know whether the Wii games are improving the health of seniors there, he said it is clear that people are having fun.
“The people who are using it really enjoy it,” Korzenowski said.
That enjoyment may be part of the key to Wii’s success, says Dr. Beth Warner, an osteopath and hospitalist at Cooley Dickinson Hospital in Northampton.
“It’s always good for exercise programs to be fun and I could see that being a motivating factor for people to use Wii,” Warner said. For elderly people with “reasonable” balance, she says, Wii Sports games are a good option for exercise. “Most efforts at exercise programs among older adults should incorporate a blend of strength training, endurance and balance,” she said, adding that regular exercise helps senior citizens maintain independence and prevents falls. Once an elderly person falls, she said, they often become anxious about the next fall and may be afraid to go out. Frequently, they become increasingly housebound and immobile, relying on caregivers.
Warner cautioned that elderly people with balance issues should see a physical therapist before participating in Wii Fit, which uses a balance board; players must be able to safely step on and off the board. A simple exam by a physician to screen for joint pains, high blood pressure, cardiovascular problems, or dizziness should suffice for most elderly patients in good health, she says.
Senior center directors stress that their facilities still offer traditional exercise classes such as yoga, Tai Chi, and osteoporosis prevention, and the Wii is not meant to replace those activities.
Wii has been especially appealing to people who once bowled or golfed or played tennis, but cannot any longer. In most cases, the games are projected on a large screen television, which makes it easier for seniors to see and participate in the action.
“It’s accessible on so many different levels,” Jensen, of the Easthampton Senior Center, said. “People say, ¿Oh those days are over for me,’ and I say, ¿no they are not.’ ”
Once people see others playing, they often become curious and want to join in on the fun. “It’s exciting for people to say, ¿Hey, I can still get up and bowl, no matter what age or physical condition I am in,’ ” Jensen said. “Wii encourages the body to have some body memory and do what they used to do, but on a smaller scale.”
Fun and games
Whether or not they are drawn to the exercise aspect, many senior citizens are getting hooked on Wii.
“I would say that part of it is just the fun and games of it,” said John Clobridge, activities coordinator at Lathrop. “It’s more of a social event. People like playing Wii with other people. Kids like to sit alone and play video games ad infinitum, but it’s not like that with seniors. They enjoy seeing other people do it. It’s even become a spectator sport here.” Several seniors have been golfing on the Wii system at Lathrop and the retirement community is planning a Wii golf tournament this spring.
Ann Hess, 71, who plays on the Wii bowling league at the Belchertown Senior Center, said, “It’s definitely a lot of fun. … It seems like it’s real bowling and you can get a little bit of exercise with it. I think people have found it easy to use. I’d recommend it for seniors everywhere.”
Jensen said it’s been a pleasure to see some previously inactive seniors participate in the Wii bowling.
“For older people who have closed the box on physical activity, the Wii helps open that box back up and takes the lid off,” Jensen said. “When we do the Wii bowling, people are cheering each other on. Someone makes a gutter ball and everyone laughs and they try again and finally get a few pins down. It’s wonderful watching their faces light up.”
Sandra Dias is a freelance writer based in Holyoke.
SOURCE: gazettenet.com
CCLD Senior Care Policy Interpretations
Prepared for California Assisted Living Association (CALA) and California Hospice and Palliative Care Association (CHAPCA)
In Response to Questions Presented at CALA/CHAPCA Conferences - Spring 2009
Q1. What is the difference between an exception and a waiver?
A1. “Exception” means a variance to a specific regulation based on the unique needs or
circumstances of a specific resident or staff person. Requests for exceptions are
made to the licensing agency by an applicant or licensee. They may be granted for
a particular facility, resident or staff person, but cannot be transferred or applied to
other individuals.
“Waiver” means a variance to a specific regulation based on a facility-wide need or
circumstance which is not typically tied to a specific resident or staff person.
Requests for waivers are made to the licensing agency, in advance, by an applicant
or licensee. Typically waivers are granted to allow for program flexibility related to
the entire facility.
Q2. Is it a breach of confidentiality if a hospice care nurse signs in at a facility?
A2. Licensees are required to develop and implement policies and procedures
related to the protection of confidential resident information. If the licensee
determines that a visitor’s presence in the facility may compromise the
confidentiality of a resident’s care, the facility may choose to develop a separate
sign-in/sign-out for medical professionals that is maintained in a non-public area.
The licensee may consider other options as well. Policies developed, however;
must not infringe on the personal rights of residents to receive visitors.
Q3. What is the CCLD policy related to physician’s e-communication orders?
A3. Electronic physician orders are allowed. The electronic order must have the name,
address and license number of the physician.
Q4. Specific to hospice care, can a RCFE accept an order given by the
physician and written by the hospice nurse for change in dose for
medication?
A4. Yes. The order indicating the change in medication must be subsequently faxed to
the facility and placed in the resident’s record. This applies to all changes in
medication orders, including new medications. It is, however; incumbent of the
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hospice care nurse to explain the changes in medication, reason for change, side
effects, contraindications, etc. to the resident or the resident’s responsible person,
and the licensee/care provider.
Q5. Is an exception required for hospice resident medications to be crushed?
A5. No exception is necessary in order to crush a resident’s medication to enhance
swallowing or taste. There are certain conditions under which medications may be
crushed, and specific documentation must be placed in the resident’s file [Refer to
Regulation and Regulation Interpretation Section 87465(a)(6)(D)].
Q6. Are pre-filled syringes allowed for medications?
A6. Medications may be set up in advance for a period not to exceed 24 hours. For any
medication that needs to be pre-drawn into an individual syringe or oral dosing unit,
at a RCFE, the following shall apply:
o Only a licensed nurse can perform this function.
o The medication may not be drawn up in a syringe to be used for an injection.
o The pre-drawn medication in the individual syringe or oral dosing unit must be
properly labeled and stored.
Q7. What is the update on administration of medications for hospice care
residents?
A7. See Evaluator Manual, Section 87633 (b)(5)
A relative or friend NOT receiving monetary or any other form of compensation for
their services, and who is trained by the hospice agency may administer
medications through a route, (e.g. oral, sublingual, subcutaneous, etc.) to his/her
relative or friend in a residential care facility for the elderly provided it is specified in
the hospice care plan; the hospice agency provides a statement for the licensee’s
records that the relative or friend has been trained; and there is a plan in place to
ensure that the resident can receive the needed medication by a licensed health
professional if the relative or friend fails to arrive at the appointed time. Licensees
must maintain documentation on procedures and on the training activities.
Q8. Can a medical technician administer medications to a hospice care
resident?
A8. No.
Q9. Can an exception be requested to provide total care to hospice care
residents?
A9. Yes, an exception or waiver can be requested to any regulation. Currently,
guidelines are being developed to allow terminally-ill residents who are receiving
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services through a licensed hospice agency to remain in the facility after they
become dependent on others for all activities of daily living.
Q10. Who is allowed to stage a Pressure Ulcer, Stage 3-4?
A10. Only a physician or registered nurse may stage a pressure ulcer.
Q11. Can a hospice aide be prohibited from entering certain areas of the facility?
A11. Yes. A licensee may have policies and procedures related to visitors. They should
not, however, be contrary to a resident’s needs and services plan.
Q12. If a resident’s oxygen cannula falls out or is removed by a resident and the
caregiver puts it back on the resident, is this considered administering
medication?
A12. Trained direct care staff may assist with the self-administration of oxygen to include
the repositioning of a nasal cannula or mask.
Q13. Under what circumstances can a spouse, who is also a resident of the facility,
administer medications to his/her spouse who is a resident at the facility and
receiving licensed hospice care at the facility?
A13. Specific to hospice care residents only, an uncompensated spouse who is also a
resident of the care facility may administer medications to a resident who is
receiving licensed hospice care services under the following conditions:
The facility requests an exception to allow the resident’s spouse to administer
medications.
The request shall include:
o A statement that all conditions of the hospice waiver are being met by the facility
or through the services provided by a licensed hospice care agency.
o A statement that all conditions of the hospice care plan are being met by the
facility or through the services provided by a licensed hospice care agency. This
includes provision for an alternate caregiver in the event that the spouse is no
longer willing or able to assist with the administration of medications.
o A statement that the facility will obtain a physician order or like documentation
that the spouse of the resident has the mental and physical capacity to
administer and handle the resident’s medication.
o A statement that the facility will ensure that the hospice agency provides
sufficient and on-going training to ensure appropriate administration and
handling of medication.
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Q14. Can a hospice care resident store medication in his/her room at the facility,
including use of small refrigerator?
A14. This depends on the facility’s policy related to medication management. Licensees
must ensure that medications are inaccessible to other residents if they pose a
danger. A licensee may require a locked storage device or locked resident rooms.
Q15. Is consent required if a hospice care roommate is a spouse?
A15. Yes, the regulations do not distinguish the relationship of resident roommates.
Regulations do, however, require roommate consent for hospice care services.
Q16. Do hospice care volunteers need to be fingerprinted?
A16. If the volunteer is a member of interdisciplinary hospice team and is working under
the auspices of a licensed hospice agency, the licensee does not need to fingerprint
the volunteer.
Evaluating An RCFE Assisted Living Facility - A Check List Amenities and Personal Care
RCFE Assisted living communities provide more personal care services than an independent living retirement community.
They offer a less-expensive, residential approach to delivering many of the same services available in skilled nursing, either by employing personal care staff or contracting with home health agencies and other outside
professionals.
Amenities in assisted living typically include:
Three meals a day served in a common dining area
Housekeeping services
Transportation
24-hour security
Exercise and wellness programs
Personal laundry services
Social and recreational activities
Personal care in assisted living typically includes:
Staff available to respond to both scheduled and unscheduled needs
Assistance with eating, bathing, dressing, toileting, and walking
Access to health and medical services, such as physical therapy and hospice
Emergency call systems for each resident’s apartment
Medication management
Care for residents with cognitive impairments Consumer Checklist
Do the residents seem to be appropriate housemates for you or your loved one?
Are staff members appropriately dressed, personable, and outgoing?
Do the staff members treat each other in a
professional manner?
Are the staff members that you pass during your tour friendly to you?
Are visits with the resident welcome at any time? Physical Features
Is the community well-designed for your needs?
Is the floor plan easy to follow?
Are doorways, hallways, and rooms accommodating to wheelchairs and walkers?
Are elevators available for those unable to use stairways?
Are handrails available to aid in walking?
Are cupboards and shelves easy to reach?
Are floors of a non-skid material and carpets firm to ease walking?
Does the community have good natural and artificial lighting?
Is the community clean, free of odors, and appropriately heated/cooled?
Does the community have sprinklers, smoke detectors, and clearly marked exits?
Does the community have a means of security if aresident wanders? Needs Assessments, Residency Agreements, Costs and; Finances
Is a residency agreement available that discloses personal care and supportive services, all fees, as
well as move-in and move-out provisions?
What are the policies for refunds and transfers?
Is there a written plan of care for each resident?
How frequently is it reviewed and updated?
Does the community have a process for assessing a resident’s need for services, and are those needs
addressed periodically?
Does this periodic assessment process include the resident, his or her family, and community staff,
along with the resident’s physician?
Are there any government, private, or corporate programs available to help cover the cost of services
to the resident?
Are additional services available if the resident’s needs change?
Are there different costs for various levels or categories of personal care?
Do billing, payment, and credit policies seem fair and reasonable?
Are residents required to purchase renters’ insurance for personal property in their units?
Is there an appeals process for dissatisfied residents? Medication and; Health Care
Does the community have specific policies regarding storage of medication, assistance with
medications, training and supervision of staff, and
record keeping?
Is self-administration of medication allowed?
Is there a staff person to coordinate home healthcare visits from a nurse, physical therapist,
occupational therapist, etc., if needed?
Does the community have a clearly stated procedure for responding to a resident’s medical
emergency?
To what extent are ancillary services available, and how are these services provided? Ask if there is an
additional charge for any of these services. Services and; Amenities
Can the community provide a list of personal care services available?
Is staff available to provide 24-hour assistance with activities of daily living (ADLs) if needed? ADLs
include dressing, eating, mobility, hygiene and
grooming, bathing, and toileting.
Does the community provide housekeeping services in personal living spaces?
Can residents arrange for transportation on fairly short notice?
Are barber/beautician services offered on-site? Consumer Checklist
Does the community provide scheduled transportation to doctors’ offices, the hairdresser, shopping,
and other activities desired by residents?
Individual Apartment Features
Are different sizes and types of apartments available?
Are apartments for single and double occupancy
available?
Do residents have their own lockable doors?
Is a 24-hour emergency response system accessible from the apartment?
Are bathrooms private and designed to accommodate wheelchairs and walkers?
Are residents able to bring their own furnishings for their apartment? What may they bring? What is
provided?
Do all apartments have a telephone, cable or satellite TV, and internet access?
How is billing handled?
Is a kitchen area provided with a refrigerator, sink,
and cooking element?
May residents keep food in their apartments?
May residents smoke in their apartments? In public spaces?
May residents decorate their own apartments? Social and; Recreational Activities
Is there evidence of organized activities, such as aposted daily schedule, events in progress, reading
materials, visitors, etc.?
Do residents participate in activities outside of the community in the neighboring community?
Does the community have its own pets?
Are residents’ pets allowed in the community? Who
is responsible for their care?
Do volunteers, including family members, come
into the community to help with or to conduct
programs?
Does the community create a sense of inclusion by encouraging residents to participate in activities?
Food Service
Do dining room menus vary from day to day and meal to meal?
Does the community provide three nutritionally balanced meals a day, seven days a week?
Are snacks available?
May a resident request special foods, and can the community accommodate special dietary needs?
Are common dining areas available?
May residents eat meals in their apartment or suite?
May meals be provided at a time a resident would like, or are there set times for meals? Additional Questions
Does the community conduct criminal background checks on employees?
Does the community train staff on elder abuse and neglect? Is there a policy for reporting suspected
abuse?
Does the community have a special wing or floor for residents with cognitive impairments such as
Alzheimer’s disease? If so, is it secured?
Does the community allow hospice to come in and care for residents?
Does the community accept long-term care insurance?
Does the community allow a loved one, such as a grandchild, to spend the night? Is there a charge?
Does the community participate in the Veterans’ Administration Aide and Attendance Program? Will
the community help complete the paperwork?
Does the community accept Medicaid?
What are the most common reasons why a resident may be asked to move out of the community?
How can I file a complaint regarding a facility, a facility licensee, or a facility staff person?
RCFE -Residential Care Facilities for the Elderly–contact the Senior Care Program Office where the facility is located
How will my complaint be handled?
It is the responsibility of the licensing agency, the parents or other responsible party, and the provider to ensure that licensed Community Care Facilities are providing safe care. Community Care Facilities are required by state law and regulation to follow basic health and safety practices
The licensing agency will make an unannounced visit to the facility to investigate the complaint within 10 days of receipt of the complaint
You will be informed of the results of the investigation
In the interim, should you have any questions or concerns, you may contact the local licensing agency
REMEMBER: WHEN YOU REPORT SUSPECTED VIOLATIONS, YOU NOT ONLY PROTECT INDIVIDUALS IN CARE FACILITIES, BUT ALSO PERFORM A SERVICE TO YOUR COMMUNITY.
