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The nursing home’s linen room reeked of urine. Some residents’ rooms were so grimy, a state inspector’s shoe came off when it stuck to the floor, according to a report investigators filed in May about the Twin Oaks Center in Danvers.
At the Maplewood Center in Amesbury, administrators in May acknowledged to inspectors that they were so short of certified nursing assistants, they had to use an activities director and an admissions executive to help feed patients.
In November, administrators at Meadow View Center in North Reading agreed to pay a $56,000 federal fine after a resident with a high fever, “delirious, and talking about monsters,” died from massive inflammation following an untreated urinary tract infection, according to a state report.
The three nursing homes are owned by Genesis HealthCare, a Pennsylvania company that has grown into a behemoth in the past four years, more than doubling in size, to become the largest owner of nursing homes in Massachusetts and nationwide. Genesis, which as of July was partly owned by a private equity firm, counts nearly 500 nursing homes, including 32 in Massachusetts, in its portfolio.
But with rapid expansion has come an erosion in quality of care, federal and state data show. Nearly half of the nursing homes owned by Genesis have seen their ratings by federal regulators decline since 2010, a Globe analysis shows. And most of those whose ratings remained the same were ranked as below average in quality.
At the same time, health and safety problems have climbed. Federal regulators assign a score to each nursing home based on the severity and extent of problems discovered in facilities. A Globe analysis of those numbers found that Genesis homes had strikingly worse scores than the state as a whole.
The analysis suggests that problems at Genesis facilities worsened over time, and by early this year, the score for Genesis homes was twice as bad as the statewide number.
In a statement issued to the Globe, Genesis said it is “committed to providing quality care to each and every patient in the centers it owns and operates across the United States.”
The statement, which did not address specific questions about the company or the Globe’s findings, acknowledged some hurdles.
“The integration of centers, and the improvement of quality and performance in an incredibly difficult operating environment, is a challenging and long-term effort,” the statement said.
The Genesis experience underscores the growing turbulence in an industry that cares for some of the nation’s most frail residents. Across the country, nursing homes are being bought and sold at a rapid pace, analysts say, as companies vie for facilities that attract more higher-paying patients.
This year alone, companies have notified Massachusetts regulators about plans to sell 58 nursing homes. That’s 14 percent of the state’s roughly 400 nursing homes.
Just a few years ago, Genesis nursing homes were considered to be respected long-term care facilities, say lawyers who routinely field calls from distraught families about nursing home injuries and deaths.
That has changed.
“Now, I get a lot of calls on Genesis,” said David Hoey, a North Reading attorney who specializes in nursing home-related cases.
Hoey said the problems reported by families, such as pressure sores and broken bones from falls, are typically seen when nursing homes do not have enough staff to monitor and care for residents.
Hoey said his office has litigated about a half-dozen cases involving Genesis homes in the past few years. But he said he could not discuss specific cases because Genesis, reflecting widespread industry practice, typically requires confidentiality agreements in legal settlements with families, barring them or their lawyers from discussing a case.
Saul Gruber, a New Jersey lawyer and executive board member of the Nursing Home Trial Lawyers Association, reports similar experiences with Genesis.
“We have seen more abuse cases, more cases that simply come from not paying attention, and not watching the resident, which is surprising for Genesis,” Gruber said.
“In the past couple of years, people are choking and dying because someone allowed them to have food they weren’t supposed to. Who does that, unless you are understaffed?” Gruber said.
Staffing shortages in nursing homes are not unusual. But the Globe analysis found more pronounced gaps in nurse staffing levels in Genesis homes in Massachusetts compared with median levels statewide.
Federal data for this year show registered nurses at Genesis homes spend roughly 19 percent less time caring for patients than federal regulators expected, based on the severity of patient illnesses. Nursing assistants spent 14 percent less time.
However, Genesis licensed practical nurses — who provide more specialized care than nursing assistants but less than RNs — spent more time than expected.
The Globe analyzed data collected by the Centers for Medicare & Medicaid Services, the federal agency that regulates nursing homes. The data included information about health and safety problems uncovered at each Massachusetts nursing home and nurse staffing levels.
That information was used to compare the performance of Genesis homes with others statewide, a methodology suggested by university researchers. (Click to continue reading)
Billionaire resolved issues with granddaugter Keryn Redstone
Accord is final chapter in legal fight begun by ex-Viacom CEO
Media mogul Sumner Redstone resolved his court fight with granddaughter Keryn after a “difficult and emotional” meeting between the two, his lawyer told a Massachusetts judge on Friday.
The resolution ends all outstanding disputes over Redstone’s trust in state probate court in Canton. In August, Keryn Redstone, the daughter of Sumner’s son Brent, agreed not to oppose the decision of the 93-year-old man she calls "Grumpy" to resolve related lawsuits over the removal of Viacom Inc. Chief Executive Officer Philippe Dauman.
Redstone’s mental health was at the center of a months-long battle over control of his $40 billion media empire anchored by Viacom. The fight, which pitted the billionaire against his old friends, eventually led to Dauman’s ouster. His granddaughter had joined Dauman in urging the court to require him to undergo a mental examination.
“These prolific papers and lawyering were not just about the number of digits to the left of the decimal point in my view,” Judge George Phelan told the lawyers after the hearing. “Ultimately this was about loyalty family and the dignity of an American business icon whose perhaps most important goal and legacy is father and grandfather.”
While Dauman’s removal from the company helped settle lawsuits in Massachusetts and Delaware, it didn’t end three investor complaints filed in June and July and later consolidated. A judge in Delaware ruled Thursday that Sumner Redstone won’t have to answer lawyers’ questions under oath and stopped the process of gathering evidence until he decides whether to allow the case to proceed, a ruling that won’t come until next year.
The shareholders challenged decisions made by Viacom’s board to keep Redstone as a board member and as well as Redstone’s decision to replace certain Viacom directors, including Dauman and George Abrams.
The case is Dauman v. Redstone, 16-E0020, Massachusetts Probate and Family Court, Norfolk County (Canton).
Pivotal Nursing Home Suit Raises a Simple Question: Who Signed the Contract?
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Scott Barrow’s reflection in a portrait of his mother, Elizabeth Barrow, who was killed at a nursing home in 2009.Credit Ian Thomas Jansen-Lonnquist for The New York Times
Elizabeth Barrow celebrated her 100th birthday at a backyard gathering with her son and three grandchildren in the coastal Massachusetts town where she raised her family and cooked lunches in a school cafeteria.
A month later, in September 2009, Mrs. Barrow was found dead at a local nursing home, strangled and suffocated, with a plastic shopping bag over her head. The killer, the police said, was her 97-year-old roommate.
Workers at the nursing home, Brandon Woods in South Dartmouth, Mass., had months earlier described the roommate in patient files as being “at risk to harm herself or others.”
After a police inquiry, the roommate — despite her age and dementia — was charged with murder. The authorities did not focus on the nursing home, though. Brandon Woods claims that, except for some minor arguments, the two women got along nicely. When the roommate was deemed unfit to stand trial and committed to a state hospital, the sensational case that shocked this corner of New England essentially disappeared.
Examining how clauses buried in tens of millions of contracts have deprived Americans of one of their most fundamental constitutional rights: their day in court.
More than six years after the killing, Mrs. Barrow’s only son, Scott, is still trying to hold the nursing home accountable. “The woman had a history of problems,” Mr. Barrow said of the roommate in an interview this month. “She should not have been living in that room with my mother.”
Mr. Barrow was barred from taking Brandon Woods to court in 2010 because his mother’s contract with the nursing home contained a clause that forced any dispute, even one over wrongful death, into private arbitration.
He has been trying ever since to get back to court, and next month he will finally get that chance. A Massachusetts state court is scheduled to hear Mr. Barrow’s case against the home, which has evolved into much more than a lawsuit about one woman’s death. It has become a crucial test of a legal strategy to prevent nursing homes across the country from requiring their residents to go to arbitration, where there is no judge or jury and the proceedings are hidden from public scrutiny.
Arbitration clauses have proliferated over the last 10 years as companies have added them to tens of millions of contracts for things as diverse as cellphone service, credit cards and student loans. Nursing homes in particular have embraced the clauses, which are often buried in complex contracts that are difficult to navigate, especially for elderly people with dwindling mental acuity or their relatives, who can be emotionally vulnerable when admitting a parent to a home.
State regulators are concerned because the secretive nature of arbitration can obscure patterns of wrongdoing from prospective residents and their families. Recently, officials in 16 states and the District of Columbia urged the federal government to deny Medicaid and Medicare money to nursing homes that use the clauses. Between 2010 and 2014, hundreds of cases of elder abuse, neglect and wrongful death ended up in arbitration, according to an examination by The New York Times of 25,000 arbitration records and interviews with arbitrators, judges and plaintiffs.
Judges have consistently upheld the clauses, The Times found, regardless of whether the people signing them understood what they were forfeiting. It is the most basic principle of contract law: Once a contract is signed, judges have ruled, it is legally binding.
Mr. Barrow’s case is pivotal because, with the help of his lawyers, he has overcome an arbitration clause by using the fundamentals of contract law to fight back.
As is often the case when elderly people are admitted to nursing homes, Mr. Barrow signed the admissions paperwork containing the arbitration clause on his mother’s behalf.
Although his mother had designated Mr. Barrow as her health care proxy — someone who was authorized to make decisions about her medical treatment — his lawyers argued that he did not have the authority to bind his mother to arbitration. In 2014, a judge ruled in his favor.
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Mrs. Barrow did not sign the nursing home admissions paperwork that contained an arbitration clause.Credit Ian Thomas Jansen-Lonnquist for The New York Times
It is a straightforward argument that is catching on. Appeals courts across the country have been throwing out arbitration agreements signed by family members of nursing home residents.
For years, judges hearing elder-abuse cases rejected arguments that arbitration clauses in nursing home contracts were patently unfair because they were signed by people who did not understand them or perhaps even realize they existed.
In a circuit court case involving a man in a Mississippi nursing home who could not read, write or sign his name, the judges held that under state law, “illiteracy alone is not a sufficient basis for the invalidation of an arbitration agreement.”
“Any normal human being would say that these contracts don’t pass the smell test. But the courts don’t accept this,” said Martin S. Kardon, a plaintiff’s lawyer in Philadelphia with a focus on nursing home cases.
A few years ago, Mr. Kardon and a small network of lawyers across the country tried a different tack. They began making hyper-technical arguments about the validity of nursing home contracts.
They argued that unless family members had power of attorney, they lacked the authority to agree to arbitration.
“We had to start speaking the language of judges,” Mr. Kardon said.
When Mr. Barrow, now 67, brought his parents to the nursing home in 2006, signing the paperwork seemed like little more than a formality, the final step of an already tough process.
At first, his parents — sweethearts since they met working at a textile mill — shared the same room at the home, a tidy brick building with a decorative pond outside. After his father died the next year, his mother had a string of roommates. Known for walking the halls, asking other residents if they needed hugs, Mrs. Barrow made friends easily. And the light in her south-facing room was perfect for cultivating her beloved African violets.
Things changed in 2008 when she got a new roommate, Laura Lundquist, who was moved because of an argument with her previous roommate, Mr. Barrow’s lawyers said in a court filing.
The change of scenery did not seem to help Ms. Lundquist, who had been diagnosed with dementia, delusions, anxiety disorder, depression and paranoia.
Ms. Lundquist did not like to eat in the dining hall, so Mrs. Barrow would take her own meals in their room to keep her company, Mr. Barrow said.
In court papers, lawyers for Brandon Woods cited those meals as evidence that the two women “generally carried on a caring friendship.”
In January 2009, court records show, workers at the nursing home reported that at times Ms. Lundquist “became jealous of her roommate, who she perceived sometimes got extra attention.”
Her agitation, the records show, grew when Mrs. Barrow had visitors. Ms. Lundquist also accused Mrs. Barrow of having “too many flowers and of taking her belongings,” according to records made by workers at the home just a month before the death.
Knowing that his mother was not one “to rock the boat,” Mr. Barrow said he asked a member of the nursing staff whether she should get a new roommate. The staff member did not seem to think there was a problem, he said.
On Aug. 21, Mrs. Barrow turned 100. Her son and three grandchildren took her on a shopping trip to Walmart. They ate cake with green frosting, and she declared it her goal to live to 104.
A month later, back at the nursing home, a simple disagreement between the roommates escalated.
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Mr. Barrow’s case against the Brandon Woods nursing home will be heard in Massachusetts state court next month.Credit Ian Thomas Jansen-Lonnquist for The New York Times
It began when Mrs. Barrow asked a nursing assistant to move a table from the foot of Ms. Lundquist’s bed so that she could get to the bathroom. At that request, Ms. Lundquist got out of bed, screamed, “was verbally abusive and hit” the nursing assistant, records show. It took two staff members to calm Ms. Lundquist.
Officials at Brandon Woods and lawyers for the nursing home did not respond to requests for comment.
In the court papers, lawyers for the nursing home said Mrs. Barrow had assured the nurse that she felt safe in the room “and that Ms. Lundquist would cool off.”
At 6:20 the next morning, a staff member found Mrs. Barrow in bed with a plastic bag on her head and the covers pulled up. The table was back at the foot of Ms. Lundquist’s bed.
When the nursing home called to inform Mrs. Barrow’s son of her death, he had to press for details. “They said, ‘There was more to it,’ ” Mr. Barrow said.
For weeks Mr. Barrow knew nothing, until he came home from a sales trip to find his driveway filled with television news trucks. The Bristol County district attorney had just filed charges against the roommate.
That was not the way to seek justice for his mother’s death, Mr. Barrow said. “It’s like charging a 2-year-old who happened to take a gun off a table and shoot a sibling,” he said.
Ms. Lundquist’s lawyer, Carl S. Levin, said, “We maintain her innocence.”
Having been blocked from court, Mr. Barrow was forced to go to arbitration. The nursing home had to turn over files that included the details about Ms. Lundquist’s past behavior.
Mr. Barrow said he was optimistic but soon became disillusioned with the process. His legal team said they discovered that the arbitration firm running the hearing had previously handled more than 400 arbitrations for the law firm representing the nursing home company.
His lawyers David Hoey and Krzysztof Sobczak questioned whether the process could be objective when the arbitration firm had drawn so much business from one of the parties. The arbitrator ultimately ruled in the nursing home’s favor but provided no explanation. His ruling consisted of a single check mark, indicating that Brandon Woods had not been negligent in its care of Mrs. Barrow.
But Mr. Barrow kept fighting. For him, the case has always been about the nursing home, not about Ms. Lundquist, who is now 104 and remains in a state hospital in Massachusetts. She is evaluated yearly to determine if she can stand trial, but given her age, that seems unlikely, a spokesman for the district attorney said.
“I can’t do anything for my mother,” Mr. Barrow said, “but I want people to realize that they have to investigate nursing homes. Everyone could end up there.”
