How would you feel if you went to visit your elderly parents at a rest home, and found an eviction notice posted on the door, stating that the home was going to be sold at auction or that the home residents were being evicted? Suppose further that this was the first notice you had that the rest home was in financial trouble, and that your parents might have just a few days, or less, to find a new home?

According to a recent New York Times article, When Foreclosure Threatens Elder Care Homes, that is the situation that Brenda Wing, pictured here, found herself in when she went to visit her 84-year-old father in the Northstar Manor care home in Woodland, here in Northern California. Records show that the home was in foreclosure but the homes owners gave their elderly residents no warning that eviction could be imminent, and they even lied to Brenda Wing when she asked them about it, telling her that there was nothing to worry about, and when she persisted, that it was none of her business.

How big of a problem is this? The New York Times analysis shows that here in the San Francisco Bay Area there are 1,600 board and care homes -- small residential care homes for elderly who need simple “custodial” care or assistance with activities of daily living such as eating, bathing, dressing and grooming – and that 16 percent of them have been in some stage of foreclosure since June 2006. That includes more than 100 homes under foreclosure in the last six months, with as many as 700 elderly residents affected.

Board and care home owners are taking advantage of a gap in California law, which lets them keep their elderly residents in the dark as to the care home’s financial troubles, even when foreclosure of the care home or eviction from the home is imminent. The board and care home owners involved would rather hide the foreclosure than take the chance that their elderly residents would move before the property was sold.


Anthony Chicotel, a Staff Attorney with advocacy group California Advocates for Nursing Home Reform (CANHR), who is working on changing the law, is quoted by the Times as pointing out that the elderly can be evicted “without any notice, without preparation, without any arrangements for an alternative residence. Not only are they losing their home, but they are losing the services that allow them to live.” To rectify that, CANHR has asked State Senator Mark Leno, to introduce legislation that would require care home owners to notify the licensing authority, and the elderly residents and their families, within 24 hours of notification of foreclosure, bankruptcy, missing a mortgage payment or the prospect of a utility cutoff. The proposed law would also fine owners who failed to do so $100 a day, and permanently disqualify them from operating elder-care homes in California.

The bill won’t be voted on until June. California Governor Schwarzenegger may need a push to sign this legislature, assuming it passes the California legislature. Click here to email him to support the change in the law and protect the elderly from unexpected foreclosures.

What can you do to protect yourself from this type of situation or if you are in this type of situation?

1. Check the property address on a real estate website
such as www.zillow.com, which may list whether they
are current on their mortgage, whether the
property is in foreclosure or preforeclosure.

2. Ask the owner of the board and care if they are
behind on their mortagage, in pre-foreclosure or
foreclosure, whether they are any plans for the
property to change hands in the next year, and
whether they are having any financial
difficulties. Bring someone with you as a witness
so it won't be just your word against theirs.

3. Get the owner's commitment to inform you of any
difficulties that could force the sale of the
property, as soon as they materialize.

4. If you learn of foreclosure, contact the bank
(the name will be posted on the eviction
notice)directly and try to negotiate a delay
of the sale until you can relocate.

5. Consult a lawyer and call the state licensing
office, the Department of Social Services
Community Care licensing. Their website is
www.ccld.ca.gov.


Click here to read the Times article.

Felicia Curran
www.ElderAdvocacyLaw.com

The advocacy group California Advocates for Nursing Home Reform (CANHR) has announced that California governor Arnold Schwarznegger has signed the following CANHR-sponsored bills into law:


"SB 781 (Leno): The RCFE Eviction Protection Act This law will add requirements to eviction notices that will require the facility to inform residents of their rights when faced with an eviction and will require the facility to provide a list of resources available to identify alternative housing and care options.

AB 392 (Feuer/Jones): Restoring Long Term Care Ombudsman Funding_

AB 392 appropriates $1.6 million from the federal citation penalty account to the local ombudsman programs on a one-time basis. It helps replace part of the $3.8 million in funds for these programs cut by Governor Schwarzenegger in 2008. Co-sponsored by numerous other groups. AB 392 was signed by the Governor on August 6, 2009 and took effect immediately.

AB 407 (Beall): CCRC Closure Protections This law will impose requirements on a Continuing Care Retirement Community (CCRC) provider faced with a permanent closure to ensure residents have adequate time to find new housing and to ensure that residents receive adequate compensation should they be required to move. Co-sponsor: California Continuing Care Residents Association (CALCRA).

AB 329 (Feuer): The Reverse Mortgage Elder Protection Act of 2009 This law will prohibit any person who participates in the origination of the mortgage from referring the borrower to anyone for the purchase of other financial products. The bill would require the lender to provide the prospective borrower with a list of not fewer than 10 nonprofit counseling and would require the borrower receive a suitability checklist specifying issues the borrower should discuss with a counselor before the loan application is approved.

AB 1169 (Ruskin): CCRCs. Co-sponsored with CALCRA, this law will increase transparency in financial reporting and establish limits on the transfer of CCRC funds.

AB 76 (Yamada): Life and Annuity Consumer Protection Fund
Will eliminate the sunset provision and extend the $1 fee imposed against insurers for sales of annuities and life insurance policies sold in California. Fees from the Fund are distributed to the Department of Insurance and to the District Attorney offices to provide protections for consumers of life insurance and annuity products.

AB 215 (Feuer/Smyth): Posting Nursing Home Ratings
This law would require nursing homes to post ratings issued by the federal Centers for Medicare and Medicaid Services (CMS) in a visible, public location.

AB 1457 (Davis): Nursing Home Admission Contracts - Ownership Disclosure
This law would require nursing home admission contracts to contain an attachment that discloses the name of the owner and the name and contact information of a single entity that is fully accountable for all aspects of patient care and operation at the facility and would also require written notice to residents and their representatives containing the name and contact information for a new owner when a change of ownership takes place."

Another great job by CANHR getting laws passed that protect the elderly.

CANHR says it will post a more detailed list of bills signed or vetoed on its website www.canhr.org by the end of the week.

Felicia Curran
www.ElderAdvocacyLaw.com

Do you know what a pressure ulcer is? I didn’t, until my mother acquired a Stage 4 pressure ulcer during a hospital stay ten years ago. I had no idea what they were, or how they were formed. I learned quickly, though, and helped my mother get appropriate care that got her back home with my Dad -- though only after a two-month stay at a convalescent hospital.

Pressure ulcers can be a red flag of poor care at a hospital or a nursing home. A pressure ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies. Also referred to as “wounds,” "bed sores” and “decubitus ulcers,” a pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater.

The most common places for pressure ulcers are over a bony prominence such as the shoulders, back of the head, elbows, sacrum, hips, heels, and ankles.

Residents of nursing homes who are immobile are at high risk for developing pressure ulcers because they may sit or lie for long periods of time in one place or position. They may be too weak or too ill to move themselves, and they are totally dependent on nursing home staff to help them reposition.

Pressure ulcers are preventable. For pressure relief, immobile individuals need to repositioned at least every two hours in bed, and at least every 15 minutes if they are sitting in a chair or wheelchair. The nursing home should use a written schedule, posted on the wall for verification, for systemically turning and repositioning the resident.

At poorly managed nursing homes and rest homes, residents develop pressure ulcers because they are left unattended sitting or lying in bed for long periods of time, due to staffing shortages or because staff are poorly trained.

Poorly trained nursing home staff may cause pressure ulcers by even dragging the resident’s body across the bed onto the chair, instead of using a lifting device, such as a trapeze, to move the resident. Shearing of the skin can occur when a resident is pulled up in bed, instead of using a technique such as placing a half sheet under the person’s torso to lift the resident up off of the bed.

Another red flag of poor care at a nursing home is when the pressure ulcer gets worse, and not better, or multiple ulcers develop in different locations. Signs that the ulcer is getting worse include:

the ulcer gets wider, deeper, longer;
the ulcer develops dead tissue (usually black);
the ulcer develops “undermining” (a thin lip of tissue around the edges of the wound);
the ulcer turns black (indicating dead tissue);
the ulcer has drainage (watch out for yellow, green, or grey drainage);
the ulcer has a foul odor.


Pressure ulcers are staged 1 to 4 according to the degree of tissue damage involved, with Stage four being the worst.

Stage 1: A reddened area on the skin that, when pressed, is "non-blanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop.



Stage 2: The skin blisters or forms an open sore. The area around the sore may be red and irritated.

Progression of a pressure ulcer beyond Stage 2 most likely means that the nursing home or care home is not providing appropriate care, or that they have not fixed the problem that caused the pressure ulcer in the first place - for example, they are still dragging the person across the bed, or they leaving the person sitting in a chair all day.


Stage 3: The skin breakdown now looks like a crater where there is damage to the tissue below the skin.







Stage 4: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.


If a pressure ulcer becomes infected, the infection can spread to the rest of the body and cause serious problems, including blood infection (sepsis) and bone infection (osteomyelitis). Either of these are life-threatening conditions.

A red flag of poorly trained staff at a nursing home is that the staff does not know the signs and symptoms of infection.

Signs of an infected ulcer include:

A foul odor from the ulcer
Yellow, green, or grayish discharge from the ulcer
Redness or tenderness around the ulcer
Skin close to the ulcer is warm and swollen

Fever, weakness, and confusion are signs that the infection may have spread to the blood or elsewhere in the body.

The pressure ulcer that my Mom had was able to heal because, after two months of failed treatment at the convalescent hospital, we found out about a new technology, a vacuum pump, that helped draw the fluid out and close the wound up. She was able to go home with the pump, and her wound completely healed in another three weeks. Previously, the wound had been so deep that you could see her sacrum bone.

Don’t let pressure ulcers happen to your Mom or Dad. Educate yourself on the causes of pressure ulcers. If your loved one develops a pressure ulcer, be pro-active in getting appropriate treatment, and don't let them tell you that it can't be healed. A general guide to prevention from the National Pressure Ulcer Advisory Panel (NAPUAP) is available online, in PDF format.


Felicia Curran
www.ElderAdvocacyLaw.com

What happens to the elderly residents of a residential care facility when the facility decides to close? Do existing laws provide adequate legal protection to elders in those situations? Look at what's happening in Oakland, California to 105-year-old Josephine Dukes, as reported by the Oakland Tribune.

Mrs. Dukes surely thought that the Matilda Brown Home would be her home for the rest of her life when she arrived there four years ago. After all, the Matilda Brown Home, in the Temescal district of Oakland, has been operating as an assisted-living facility for low-income women since 1928.

Mrs. Dukes is remarkedly healthy, mentally intact, and still walks with the use of a cane. But, life has thrown her some curve balls the last few years.

Josephine Dukes was born in 1902 in Mississippi, where she says the doctor told her mother that she was “too small and weak to survive.” That's a good one! She graduated from college and was a teacher for many years. She and her husband moved to California during World War II, where she and her husband had an income tax business and owned rental properties. “She was very active in the West Oakland community helping other people” according to her legal guardian, Tommie Lindsie.

In the 1990s, her home and rental properties were sold after her husband passed away. She should have been sitting pretty, but she was the victim of financial elder abuse. She lost most of her life savings when she loaned a “friend” money to pay off a lien in the 1990s. But, as she says, “I was a victim of a rip-off scheme.”

So, at 97 years of age, she went back to work, working 20 hours a week at the Housing Authority telephoning other seniors to check on their well being. She retired from that job at age 100. She now relies only on her late husband’s Army pension of $700 a month.

Mrs. Dukes and 16 other residents of the Matilda Brown Home were notified on March 10, 2007 that the home will be closing its doors June 15, 2007. The nonprofit Ladies Home Society, which runs the home, says that dwindling finances and escalating expenses are forcing the closure. They are expecting Mrs. Dukes’ legal guardian, Tommy Lindsey, to find her a place to live, but with her limited finances, it is not easy, and certainly not with just 90 days notice.

Says Tommy Lindsey, “This [closure notice] all came about so fast. Here we thought she was settled for life. They’ve given us an organization we can contact, and I’m trying to get the paperwork together. But, gosh, Mrs. Dukes being 105 and having to be moved back and forth like a vagabond - this shouldn’t happen.”

Yes, why the big rush when evidently the home has had financial problems going back to 2002? The head of the Ladies Home Society told the Tribune reporter, “There’s obviously the question of whether three months notice was enough . . . If it had been five or six months, we would have lost our best employees, and would have been operating at a greater and greater loss as residents moved out. We thought three months would give everybody ample time to find another place.”

Does this sound like they decided that if someone’s ox needed to be gored, it would be the elderly residents', such as Josephine Dukes, and NOT the nonprofit corporation's? I hate to criticize a nonprofit with such a great history of community service (they even provided a subsidy of $2,000 a month to Mrs. Dukes so that she could live there on her monthly pension), but that's what it sounds like to me. Given that the residents are low income, the nonprofit knows that it will not be easy for them to relocate.

Imagine what happens to residents of assisted living facilities run by FOR-PROFIT CORPORATIONS that are closing. Very often the residents get a few weeks notice.

Mrs. Dukes’ situation may be the kick in the pants the California legislature needs in order to pass laws guaranteeing elders legal protections when assisted living facilities close. Assembly Bill 949 (Paul Krekorian) is coming before the California Assembly Human Services Committee on April 24, 2007. The proposed legislation would require residential care facilities for the elderly to prepare an evaluation of the relocation needs of each resident PRIOR to giving the residents 90 days notice of closure of the facility. The evaluation would have to include "a listing of other facilities that are available and adequate to meet the resident’s needs" per the text of the bill. The closing facility would have to pay a relocation fee of $2,500 to each resident, to help defray moving costs. The closing facility will be subject to daily fines if they don’t follow the relocation requirements.

To read the text of AB 949, click here.

If anything, the question is whether the proposed law goes far enough, and whether 90 days notice is enough. 90 days notice isn’t enough unless the closing facility has for each resident that will be displaced the names of comparable facilities that are ready, willing, and able to take on each resident, and which the resident can afford. A list of places that “in principle” are available is meaningless.

Send your thoughts about AB 949 to Jim Beall, Chair Assembly Human Services Committee, State Capitol, Room 4206, Sacramento CA 95814, fax (916) 319-2189, and copy California Advocates for Nursing Home Reform (CANHR), the advocacy group that spearheaded the legislation, at fax (415) 777-2904.

In response to the Tribune’s April 14 article, community members immediately offered Mrs. Dukes spare rooms in their homes, and a neighborhood group Friends of Matilda Brown has been formed to try to stop the home from closing altogether.

Thanks to Angela Hill of the Oakland Tribune, for her excellent coverage, which has brought Mrs. Dukes' situation to light. To read her articles, click here and click here.


Felicia Curran
www.ElderAdvocacyLaw.com

A colleague in our firm recently asked me if I could tell her how she could check the track record of a residential care facility that her father has moved to. The short answer is, “Realistically, you can't.”

California Residential care facilities for the elderly (RCFEs) are licensed by the California Department of Social Services Community Care Licensing Division, Senior Care Program Offices (“DSS” for short). As part of its oversight responsibilities, DSS investigates complaints made on behalf of residents, conducts surprise inspections, generates reports, and issues citations and fines to facilities who are caught violating the licensing regulations. DSS investigates so infrequently, and sometimes so ineffectively, that many bad facilities dodge the bullet and have a clean licensing file. So if DSS has actually cited or fined a facility, or found the facility to be in violation of regulations relating to resident’s rights or resident’s care, that is something you should know about before your loved one goes to live there. Department of Social Services does not post any of this vital information on the web. The only information they post is name, license number, and number of beds. To see their website,

click here

This is a typical entry from the DSS website, for a RCFE in Albany:

Facility No: 015600285 Capacity: 0013
License Status: Licensed
RN3 LOVING CARE HOME
906 CORNELL AVENUE
ALBANY , CA 94706
(510) 526-2533
Contact: CHENG, FANGJUAN
DO: CENTRAL COAST SC/RES (14)
DO Phone: (650) 266-8800

I have no personal information about the RN3 Loving Care Home, and the point is that neither will you, just by looking at the DSS website. But you should. The only way to access the DSS information now is to go to one of the 5 DSS Senior Care Program Offices around the State (Rohnert Park, San Bruno, Woodland Hills, San Diego, and Sacramento). That’s not reasonable access to this vital public information.

Posting of citations, fines, and evaluation reports for each facility would alert unsuspecting family members about that facility, and could actually force a change for the better in how these facilities care for their residents. The New York Times recently had an article about a new website put up by the U.S. Department of Health and Human Services

www.hospitalcompare.hhs.gov.

The website says that it “provides information on how well the hospitals in cities across the country care for all their adult patients with certain medical conditions, on a comparative basis.” The New York Times article described how in the year preceding the launching of this website, several prominent hospitals actually improved their performance in key aspects of their patient care for the reason that the hospitals knew that their ”score cards” would soon be on the web for all to see. The hospitals were candid in admitting that the prospective posting of the data on the website actually spurred them to improve performance.

RCFEs, like the hospitals listed on the www.hospitalcompare.hhs.gov website, would very likely do a better job for their elderly residents if they knew their track record would be there on the web for all to see. There is no excuse for hiding this information from California residents and their families.

Contact Ben Partington, Program Administrator at the DSS Sacramento Office, 744 P Street, MS 10-90 Sacrament, CA 95814, fax (916) 653-9335 and Governor Schwarzenegger (click here) and let them know what you think.


Felicia Curran
www.ElderAdvocacyLaw.com