The Ensign Group

Complaints led to a major lawsuit for the Ensign Group, a nursing home provider located in California. In the lawsuit, Ensign was alleged to consistently have staffing levels that were below those required by the staffing laws. The suit went on to explain that it has been proven that low staff numbers consistently mean poor quality care. At the time of the lawsuit, 13 of the Ensign Group’s California facilities were operating with only 2.82 hours of skilled nursing each day per resident, while the state minimum is 3.2 hours. By following these staffing practices, Ensign was saving over $1 million each year, on top of the $10 million in profits they were making at the time. The lawsuit was seeking injunctions to ensure staffing requirements were met, as well as fines and restitution for the residents.

Fraudulent Claims

Fraudulent claims are another issue that results in nursing home neglect and abuse. In many cases, such as in a lawsuit that was filed against the Ensign Group, patients are provided substandard care, while the facility receives full payment from Medicare and Medicaid. In some cases, these practices can lead to patients being subjected to additional treatments that are not needed, and even being kept in a facility longer than their needs require.

In the lawsuit against Ensign, the facility was accused of filing false claims and providing unnecessary rehabilitation, occupational and speech services – even when the patient’s condition did not warrant the additional services. Additionally, the lawsuit cited that staff members were incentivized to increase the amounts of therapy provided to further increase the payment amounts from Medicare and Medicaid claims. Also included were claims that the facilities billed for services that were never rendered, and kept patients in the facilities when it was no longer needed.

The Ensign Group agreed to pay a $48 million settlement in answer to the allegations. They also agreed that all facilities would follow the terms of a Department of Health and Human Services Office of Inspector General Corporate Integrity Agreement.

In both understaffing situations and fraudulent claims, nursing home residents often do not receive the care they need for their best health. Instead, they may suffer from abuse, or be forced to undergo unnecessary treatments – both of which are forms of neglect. While both of these issues may be difficult to notice, if you feel that staffing is not adequate in your loved one’s nursing home, you should always contact an attorney to ensure this issue is addressed properly.

When most think of neglect or abuse in a nursing home, their immediate thoughts turn to failure to provide the care and support needed for the seniors to remain as healthy as possible and maintain their quality of life. While this is true, there are other issues that can result in negligence as well: understaffing and fraudulent claims.

 Staffing Requirements

Nursing homes are notoriously understaffed, but they must still meet federal requirements for staff levels. These requirements maintain that each nursing home must ensure that staff levels are sufficient to meet the daily nutrition, exercise, activity, medication and other needs of every patient to ensure that the highest levels of physical, psychosocial and mental well-being are met. When these staffing levels are not met, it can result in a wide range of issues for residents, including:

  • Increased falls
  • Development of bedsores
  • Increased chances of malnutrition and dehydration
  • Medication errors
  • Unsanitary conditions, including being left in soiled clothing for extended periods
  • Decrease in quality of life
  • Use of chemical restraints to control residents and decrease the chances of complaints
  • Abuse from overworked employees who lash out

Sources:

http://www.justice.gov/opa/pr/nursing-home-operator-pay-48-million-resolve-allegations-six-california-facilities-billed

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