The operator also has come under fire for allegedly not following emergency procedures such as cohorting infected or suspected patients. But the nurse supervisor who suspected she had the coronavirus and still worked, allegedly while not observing safety mandates, thus far faces the most severe backlash.

“Someone knowingly going into a facility, not feeling well and then going maskless is reckless behavior that endangered the lives of residents and led to this tragic situation,” Mairead Painter, a state long-term care ombudsman, told the Hartford Courant.  

An investigation by the state’s department of public health at Three Rivers Healthcare in Norwich, CT, is still ongoing. Officials so far have learned that the employee at the center of the probe was the facility’s supervising nurse, who came to work in late July even though two of her family members were waiting for their test results. 

Multiple workers told the agency that they saw the nurse working without a mask during a shift on July 24. She also told them about her symptomatic family members and that she wasn’t feeling well, according to the report. The worker tested positive for the disease three days later, and the first resident tested positive on Aug. 2. 

Five employees and 22 residents have tested positive for the disease overall since early August. An ombudsman complaint against the home facility is being considered for the way it handled the outbreak.

“We are looking at all of our options to hold individuals responsible for their action,” Painter added. “I do feel that this clearly rises to the level of an elderly abuse issue.” 

Painter added that her office plans to look at pursuing the nurse’s license, administrative action and a criminal complaint during an upcoming meeting with the Coalition of Elder Justice to determine what actions should be taken against the nurse and facility, according to the report.

“The directives were pretty clear for cohorting and they just didn’t follow the appropriate procedures,” she alleged. “It’s not like they didn’t have access to information and procedures. They just didn’t do what they were supposed to do.”

The agency issued an updated memo Thursday reminding facilities that federal nursing home regulations, along with the CARES Act, require that the state long-term care ombudsman must have continued direct access, or virtual access, to residents during any portion of the public health emergency.

CMS noted that in-person access may be restricted during the public health emergency if there are concerns about infection control or the transmission of COVID-19. If that’s the case, providers must facilitate resident communication — by phone or through the use of technology — with the ombudsman.

“The CARES Act does not repeal or amend CMS requirements under sections 1819 or 1919 of the act or implementing regulations. Nor does it place a time limit or expiration date,” the agency wrote. “Instead affirms that the current pandemic requires the ombudsman program and long term care facilities to support resident access and communication in a variety of methods.”

In an annual report released Monday, the Iowa Office of Ombudsman said it had received more than 225 complaints in 2017 regarding the private insurance companies that run Medicaid health programs for more than 750,000 poor and disabled residents.

That’s more than double the nearly 85 complaints lodged in 2016, when the privatization program began. The findings come as more states consider increasing managed care or privatized care options around the country.

The Iowa ombudsman’s report included 15 examples of Medicaid investigations, many of them looking into contractors who reduced care or funding by arguing that beneficiaries were receiving too many services or duplicated services.

Earlier this year, the program drew harsh criticism when a managed care doctor was caught on tape saying a man with cerebral palsy whose home care was reduced could be a “little dirty” for a few days between visits.

In her report, ombudsman Kristie Hirschman said official notices of similar reductions were often not provided as required by law, and that the managed care organizations pressured members to sign new care plans along with their service providers and case managers.

“In our view, this tactic by the MCOs amounted to strong-arming members into accepting reduced services against their better judgment,” Hirschman wrote. “It also deprived members of their due-process rights to appeal the reductions in hours since they never received an official rejection. Family members of these patients, some of whom quit work to care for their loved ones, often continued to provide services at a much-reduced rate.”

The state originally contracted with Amerigroup, AmeriHealth Caritas Iowa and UnitedHealthcare Plan of Iowa to offer managed care plans,  but Caritas later withdraw leaving beneficiaries with fewer choices.

The office said complaints were up for the fourth year, citing both Medicaid privatization and the state’s corrections system as reasons, according to U.S. News & World Report.

Hirschman added that she’s not convinced the Iowa Department of Human Services is providing adequate oversight of the private insurance companies, but a bill moving through the Legislature could address some concerns.

Cynthia Pederson, the state’s long-term care ombudsman, has not lobbied Iowa lawmakers on any bills in 2018 and has not shown interest in doing so, the newspaper claimed. Grappling with sizeable budget cuts to her office, she also has ceased onsite visits to nursing homes, performing them by phone instead, the report said.

Each state is required to have its own such LTC ombudsman, who is charged with operating as nonpartisan voice for the elderly population. Ombudsmen are charged with delving into complaints against nursing homes, free from interference from other state agencies. In Iowa, the office has suffered through budget cuts and alleged interference from the state governor’s office, critics claim.

Pederson is in her fourth year with the ombudsman’s office, and seventh month leading it.

“I’m still getting a good understanding of exactly where this office needs to be going,” she told the newspaper. “I don’t want to jump in too hastily and make a bad decision that would impact us negatively.”

A consultant who advocates for the elderly was having none of it, according to the Register report.

“The ombudsman’s office is simply not doing its job,” said John Hale. “And the Iowans who depend on that office, and who depend on the state to serve and support them, are being let down.”

The Register questioned whether eliminating the in-person visits to nursing homes violates state law. Reportedly, only two or three such visits have been conducted in the last eight months.

Mary Pfingston, 41, was arrested Thursday and charged with felony elder theft, theft of $10,000 to $100,000, financial exploitation of an elderly person and three counts of public contractor misconduct.

Authorities began investigating Pfingston in 2015 after receiving a complaint that said she had made “several suspicious transactions” from the bank accounts of an assisted living resident she was representing. Among the reported transactions were an attempted wire transfer of $15,000 and cashing a $4,000 check, the Chicago Daily Herald reported.

Pfingston had been employed by Senior Services Associates, which was contracted by the Illinois Department of Aging to provide ombudsman services, according to the newspaper.

Bette Schoenholtz, executive director for Senior Services Associates, declined to comment to McKnight’s Long-Term Care News about the specifics of the case, but stressed that residents, family members or staff who see “anything unusual” in a long-term care facility should report it to authorities or the ombudsman program in order to protect residents.

If convicted Pfingston faces up to seven years in prison; she’s scheduled to appear in court Dec. 15.

Last week during a talk at the Pennsylvania Department of Aging 2017 Ombudsman Conference, audience members told me that they’re having difficulty speaking to administrators and other senior staff when they visit the facilities. In fact, some people reported that the administrators close their office doors when they find out the ombudsman is in the building!

While I can imagine from an administrator’s point of view that an unexpected interruption from someone complaining about problems is not exactly a welcome visit, perhaps there’s a way to shift the relationship to mutual advantage.

In fact, ombudsmen may be able to use their resources to help you solve problems within your facility.

Their role

Long-term care ombudsmen act as advocates for residents to address problems and to facilitate quality care. According to The National Long-Term Care Ombudsman Resource Center, ombudsmen promote “the development of citizen organizations, family councils and resident councils.” Ombudsmen and the councils can identify areas of potential improvement and, if properly guided, can offer solutions and assistance.

Local ombudsman’s offices have, for example, sponsored training programs on culture change and invited facility staff free of charge. Ombudsmen have arranged trips for staff to visit nearby Green Houses and provided free staff training on various resident care matters.

Pennsylvania’s Ombudsman Program is very active in promoting resident participation. Their ombudsman-trained PEERs (Pennsylvania’s Empowered Expert Residents) focus on improving the quality of life for residents. PEER efforts include initiating activities in which elders have the opportunity to assist others, such as a program making blankets for the homeless. That would make a nice mention during the prospective resident tour, don’t you think?

Ombudsman contact tips

While it’s likely that your ombudsman will be sharing resident complaints with you, it’s better to hear about these problems from them than from a state surveyor. Consider the following methods to improve your working relationship and to enhance resident care:

•  Tell your ombudsman the best way to connect with you. Perhaps he or she should be making an appointment to see you rather than popping in to your office, or maybe a drop-in visit is fine on certain days and times.

•  Are you tired of hearing only complaints? Ask them to share what they see that’s working. This will provide important information and simultaneously change the interpersonal dynamic from antagonistic to collaborative.

•  Benefit from their viewpoint. Workers are undoubtedly on their best behavior when administrative personnel are on the floors. Ombudsmen have the opportunity to see staff behaviors that you don’t and they’re in the position to tell you about it (unlike other staff members who see things but wouldn’t dream of telling management).

•  Enlist their help. If the ombudsman is raising an issue about resident care such as the shower procedures, perhaps he or she can work with the residents to create a training program for staff.

•  Use their resources. Ombudsman programs may be able to get grants or to collaborate with other organizations to provide training or information for your team. Put your ombudsman to work on your behalf.

•  Ask your colleagues for best practices on engaging with ombudsmen. You may hear ideas that will inspire partnership.

Developing a working relationship with your ombudsman can help you identify problems before surveyors arrive, improve the quality of care, enhance the training of staff, and develop innovative programming that sells your facility. Perhaps it’s time to open your doors to what they have to offer.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Gold Medal blogger in the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with more than 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

But as Mama used to say, it if walks like a duck and talks like a duck, it probably has waterfowl DNA.

These days, Lee is the executive director of the harmless-sounding Families for Better Care. The organization calls itself an “advocacy group dedicated to creating public awareness of the conditions in our nation’s nursing homes and other long-term care settings and developing effective solutions for improving quality of life and care.”

And who just happens to be underwriting, er, supporting this quality improvement organization? Why, none other than personal injury attorney Jim Wilkes, a.k.a. “Mister Nursing Home Lawsuit.”

Wilkes, as many of our readers are all too aware, has earned a fortune suing nursing homes. Here’s how the Miami Herald describes his modus operandi:

“Wilkes’ model, which has been successfully employed in Florida and eight states where he has offices, is to not only target the owners and management companies — which can often be shell companies that shield the assets of owners and investors — but to target the investors, vendors and contractors, when he can show they have a role in the company’s decision-making. He also seeks large punitive damages.”

So why would the Wilkes & McHugh law firm be a major supporter of Brian Lee’s organization? Do you suppose the fact that Families for Better Care is essentially finding nursing homes to sue might have something to do with it?

Not only does the organization’s website list the top 10 states for civil monetary penalties against nursing homes, it recently released a state-by-state breakdown of where more than $100 million in such fines have been levied. All in the interest of better nursing home care of course.

In a recent story, Lee denied that he is helping find cases the trial lawyers.

“That’s ridiculous,” he’s quoted as saying.

But in the same piece, he later admits that his organization “wouldn’t be able to exist without Wilkes & McHugh.”

Which reminds me of a Groucho Marx quote that goes something like this: “Who are you going to believe, me or your own eyes?”

But that’s a rather lengthy way to describe what’s playing out in Florida. Perhaps these two words are a better fit in Lee’s case:

Quack, quack.

John O’Connor is McKnight’s Editorial Director.