Our mission is to expose and remedy corruption in the Probate Court of Cook County, Illinois. We assist, educate and enlighten families of the dead, the dying, the disabled and the aged to better understand their rights in order to protect themselves from the excesses of the Probate Court of Cook County. ProbateSharks.com is dedicated to networking the human element of people to people. We join together in reforming the corrupt Cook County Probate Court system.
Businessman Seth Gillman was sentenced Tuesday to 6 1/2 years in federal prison for masterminding a $20 million hospice care fraud scheme that exploited some of Illinois' most vulnerable residents.
"I am ashamed of what I did and I am sorry for it and I have no excuse," Gillman told the court, his voice hoarse and cracking.
By paying kickbacks to nursing homes and giving bonuses to employees who took part in the fraud, Gillman built his Passages Hospice LLC into the largest such company in Illinois, serving terminally ill patients in 89 counties and billing Medicare more than $90 million from 2008-2012, government records show.
But Passages didn't provide much care to many of those patients, and Medicare was "paying huge sums of money for basically nothing," prosecutors wrote in one court filing. Gillman pocketed millions annually and enjoyed a lavish lifestyle that included corporate airplanes, luxury sports cars and "ingesting cocaine on a daily basis," as Gillman's lawyers put it in one federal court pleading.
"I betrayed the trust of Medicare and I besmirched the integrity of hospice altogether," Gillman told U.S. District Judge Thomas Durkin. "I was stupid and I was wrong."
Noting Gillman's privileged background — he was licensed as both an attorney and nursing home administrator — Durkin said: "There's nothing that drove this other than greed."
Under Medicaid rules, hospice care is typically reserved for patients who are medically certified to have less than six months to live. But Passages colluded with nursing homes to designate their patients as close to death — including many who were not that sick and had years to live.
This higher level care, known as "general inpatient" services, or GIP, would boost Passages' Medicare reimbursement from an average of about $150 per day to well over $600 for each patient.
Gillman then paid himself a $75-per-day "bonus" for each patient elevated to GIP — he took $1.2 million in bonuses in 2009 and 2010 alone, court records show, in addition to his $320,000 annual salary. And he passed out smaller bonuses to other key hospice managers who assisted in the scheme.
"They would cut deals with nursing homes to give them a share of the GIP rate," paying the homes about $250 per day for every patient upgraded to GIP, Assistant U.S. Attorney Stephen Lee said in court.
Federal investigators named several of those nursing home chains in court documents, but none has been charged. Lee said Tuesday that Gillman waited until last year to begin cooperating with authorities who were trying to build additional cases. "This was far too late to be effective."
Starting in 2008, Gillman berated and fired nurses who challenged his fraud attempts, and several former employees filed whistleblower lawsuits. Federal agents finally raided Passages' Lisle offices in 2012, and Gillman was indicted two years later. The hospice firm collapsed financially and ceased operations. Several key Passages employees have also been convicted in the case.
In addition to Passages, Gillman also ran his family's nursing home company, Asta Healthcare. The Tribune's 2009 "Compromised Care" investigation found that Asta consistently failed to notify state officials that they were housing sex offenders who molested elderly and disabled patients.
In the wake of the Passages prosecution, Gillman gave up his stake in Asta as well, records show.
In court Tuesday, Lee recommended a 10-year sentence. Gillman's attorney, Edward Genson, asked for three years in prison, asserting that Passages actually did provide extra assistance to hundreds of patients. He said Gillman got into the hospice business because he is religiously devout, altruistic and caring, but he "went out of control. ... He was drinking. He was involved in drugs."
Previously, Gillman pleaded guilty to one count of felony health care fraud. Gillman on Tuesday also agreed to an $18 million civil judgment to be paid to the federal government, as well as to paying $9 million in restitution to Medicare.
Durkin, however, noted that authorities have little chance of collecting that money because Gillman says he is broke. "In my mind it's fool's gold," Durkin said.
Taxpayers weren't the only victims of Gillman's fraud scheme. In some cases, the families of former patients told the Tribune that Passages employees misled them into believing that their loved ones had serious or terminal illnesses — when they didn't.
"They lied to me about everything. I could never comprehend anyone being that cruel," said Cynthia Chadwick, 65, of Watseka, Ill., who was told by Passages in 2012 that her younger sister needed hospice care because she had terminal cancer and would die in six to eight weeks.
"She never had cancer. Never ever," Chadwick told the Tribune. "It really indicated to me how low down they were, using a deaf and blind person. That's despicable."
In addition, Passages employees told the Tribune they were not paid for their final months' work.
"He owed a lot of people a lot of money," said Sonya Anderson, an assistant director of nursing at Passages. "Elderly people, people that are dying — and you take advantage of them? That's low."
Another former Passages employee, clinical director and nurse Karen Wilson, said outside of the courtroom Tuesday that she was glad to see Gillman sentenced to prison, but added: "I think he deserved more." dyjackson@chicagotribune.comgmarx@tribune.com Twitter @poolcar4 Twitter @garyjmarx
Editor's note: This Shark believes with all the crooks who have been reported to the FEDs in Chicago, why was this venue was omitted from arrests? Authorities have only to read the court transcripts of Gore, Tyler, Sykes and Cefalu to see the frauds being perpetrated. Lucius Verenus, Schoolmaster, ProbateSharks.com
Authorities arrest 243 people in $712 million Medicare fraud
(Reuters) - The U.S. Department of Justice said on Thursday that 243 people have been arrested across the country, charged with submitting fake billing for Medicare, a government healthcare program, that totaled $712 million.
Attorney General Loretta Lynch described the arrests as the largest criminal health care fraud takedown in the history of the Justice Department.
Those arrested included 46 doctors, nurses and other licensed medical professionals. The charges are based on a variety of alleged fraud schemes, the government said, including submitting claims to Medicare and Medicaid, the healthcare program for low-income individuals, for treatments that were medically unnecessary and often never provided.
The nationwide sweep, led by the Medicare Fraud Strike Force and the U.S. Centers for Medicare and Medicaid Services, involved about 900 law enforcement officials. It's the largest both in terms of the number of those charged and the amount of money lost.
Many of the arrests were in Florida, long an epicenter of Medicare fraud. In Miami, 73 defendants were charged with offenses involving approximately $263 million in false billings.
One mental health facility there billed close to $64 million for psychotherapy sessions that were nothing more than moving patients to different locations, Lynch said in a press conference.
Other cities involved include Houston, Dallas and McAllen, Texas; Los Angeles; Detroit; Tampa; Brooklyn, New York; and New Orleans.
One case in Michigan involved a doctor who prescribed unnecessary narcotics in exchange for patients' identification information, which was used to generate false billings. Patients then became deeply addicted to the prescription narcotics and were bound to the scheme as long as they wanted to keep their access to the drugs.
"In the days ahead, the Department of Justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives," Lynch said.
Since 2007, as part of increased efforts to tackle Medicare fraud, federal authorities have charged nearly 2,100 people with falsely billing the Medicare program more than $6.5 billion, according to the Justice Dept. Thursday's arrests bring that total to over 2,300 people who have billed over $7 billion.
(Reporting by Megan Cassella in Washington; Editing by Jeffrey Benkoe and Chris Reese)
In January 2013, 80-year-old Esther Brown was found lying in her bed at a Pennsylvania nursing home with blood covering her hands and her pillowcase.
A nurse’s aide at the home reported that one of her co-workers had hit Esther and then had thrown a can of shaving cream in her face, striking the elderly woman above the eye. The incident was reported to the police, and Esther died several months later.
Her family sued the nursing home, alleging negligence and battery. But before the case could proceed to trial, the judge had to rule on whether the family had the right to file such a lawsuit. When Esther was admitted to the facility in 2011, she and her daughter signed a contract that required her, and her family, to submit any quality-of-care complaints to an arbitrator rather than to a judge or jury.
Late last year, Judge Jeffrey Sprecher upheld the family’s right to sue, finding the arbitration agreement “unconscionable” because it was presented to Brown at emotionally difficult time; consisted of long, confusing passages; improperly portrayed the deal as beneficial to all parties; and included a confidentiality provision that Sprecher said was “designed to bury all proof of bad things that may be alleged to occur in a nursing home.”
The sad reality is that these types of arbitration agreements are fairly common now among nursing homes, and they are often upheld by the courts. Prospective residents, who may be in the midst of a health care crisis, are asked to forfeit their right to sue as a condition of admission. As the judge in the Esther Brown case ruled, these binding arbitration agreements are sometimes “forced down the throat” of residents.
As Sprecher pointed out, these agreements also attempt to “inject fear in the patient by suggesting that a court action takes so much longer than arbitration, so that unless you select arbitration, the patient may die before his court case could be finished.”
At first glance, arbitration might sound like a reasonable, effective way to address complaints without resorting to litigation. The problem is that through litigation, complainants have the ability to use the discovery process to procure documents that speak to patterns of abuse or neglect. They can also subpoena witnesses for depositions, and secure sworn testimony as to the facts of the case. And all of that is handled through a public proceeding before a judge or a jury of one’s peers.
Many of the arbitration agreements restrict a complainant’s access to records, as well as the number of depositions and witnesses. Some place limits on how much a party can recover in damages.
The federal government could easily bar these types of mandatory agreements as a condition of a home’s participation in the Medicaid program — but it has repeatedly refused to do so. In fact, the federal Centers for Medicare and Medicaid Services is considering major changes in nursing home regulations, but under the proposed new rules, homes will only be required to “explain” arbitration agreements to residents.
Of course, many individuals are placed in nursing homes precisely because their cognitive abilities are greatly diminished. How many of them are in a position to understand the legal rights they are forfeiting by signing these agreements?
Fortunately, CMS says it is still considering whether it should simply prohibit binding arbitration agreements altogether, noting that residents who depend on nursing homes for urgently needed care may feel pressured to sign the contracts even when they’re not required as a condition of admission.
It’s time for CMS to ban arbitration agreements in nursing homes. If care facilities feel that’s an intrusion on their right to dictate the terms of admission, they’re free to bow out of the Medicaid program and accept only private-pay residents.
But as long as public money is paying for the care provided in these homes, the regulation of these facilities should be designed to protect the public and not to appease the industry.
Voice your opinion
CMS is accepting public comments through Sept. 14 on the proposed new nursing home regulations. To voice your opinion, go to regulations.gov, and enter “CMS-3260-P,” with the quotation marks, in the search engine. That will direct you to a link to the proposed regulations, labeled as Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities. Through that link, you can submit your written comments.
How do people use, misuse or abuse Hipaa, the federal regulations protecting patients’ confidential health information? Let us count the ways:
■ Last month, in a continuing care retirement community in Ithaca, N.Y., Helen Wyvill, 72, noticed that a friend hadn’t shown up for their regular swim. She wasn’t in her apartment, either.
Had she gone to a hospital? Could friends visit or call? Was anyone taking care of the dog?
Questions to the staff brought a familiar nonresponse: Nobody could provide any information because of Hipaa.
“The administration says they have to abide by the law, blah, blah,” Ms. Wyvill said. “They won’t even tell you if somebody has died.”
■ Years ago, Patricia Gross, then 56, and a close friend had taken refuge in a cafe at Brigham and Women’s Hospital in Boston, where Ms. Gross’s husband was dying ofcancer. She was lamenting his inadequately treated pain and her own distress when a woman seated at a nearby table walked over.
“She told me how very improper it was to be discussing the details of a patient’s treatment in public and that it was a Hipaa violation,” Ms. Gross recalled.
■ In 2012, Ericka Gray repeatedly phoned the emergency room at York Hospital in York, Pa., where her 85-year-old mother had gone after days of back pain, to alert the staff to her medical history. “They refused to take the information, citing Hipaa,” said Ms. Gray, who was in Chicago on a business trip.
“I’m not trying to get any information. I’m trying togiveyou information,” Ms. Gray told them, adding that because her mother’s memory was impaired, she couldn’t supply the crucial facts, like medicationallergies.
By the time Ms. Gray found a nurse willing to listen, hours later, her mother had already been prescribed a drug she was allergic to. Fortunately, the staff hadn’t administered it yet.
Each scenario, attorneys say, involves a misinterpretation of the privacy rules created under theHealth Insurance Portability and Accountability Act. “It’s become an all-purpose excuse for things people don’t want to talk about,” said Carol Levine, director of the United Hospital Fund’s Families and Health Care Project, which has published aHipaa guide for family caregivers.
Intended to keep personal health information private, the law does not prohibit health care providers from sharing information with family, friends or caregivers unless the patient specifically objects. Even if he or she is not present or is incapacitated, providers may use “professional judgment” todisclose pertinent information to a relative or friendif it’s “in the best interests of the individual.”
Hipaa applies only to health care providers, health insurers, clearinghouses that manage and store health data, and their business associates. Yet when I lastwrote about this topic, a California reader commented that she’d heard a minister explain that the names of ailing parishioners could no longer appear in the church bulletin because of Hipaa.
Wrong. Neither a church nor a distraught spouse is a “covered entity” under the law.
Last month, Representative Doris Matsui, Democrat of California and co-chairwoman of theDemocratic Caucus Seniors Task Force, who has heard similar complaints from constituents, introduced legislation to clarify who can divulge what and under what circumstances.The proposed billwould require the Department of Health and Human Services, which last yearissued new Hipaa “guidance,”to make that statement part of its regulations and to create model training programs for providers and administrators, patients and families.
“A lot of times it’s just misunderstanding what is and isn’t allowed under Hipaa,” Representative Matsui said in an interview.
So, what is and isn’t?
Family members can provide information, as Ms. Gray attempted to do. “How does keeping information confidential stop you from listening to someone?” said Eric Carlson, the directing attorney forJustice in Aging, a legal advocacy group in California. “There’s no Hipaa privacy consideration there.”
An assisted living facility or nursing home can report a death. It can also give someone’s general condition and location, assuming the patient remains within the facility. And if, as Ms. Wyvill suggested, residents ask administrators to keep a list of those who want their neighbors to know they’ve gone to a hospital, that’s perfectly legal under Hipaa.
The law gives providers flexibility in disclosing information in the patient’s interest, but it doesn’t require them to. Clinton Mikel, chairman of anAmerican Bar Associationgroup on e-health and privacy, said that providers sometimes decided, “‘We could, but we’re not required to, and we think this situation is a mess, so we’re going to exercise that option.”
A caregiver’s strongest defense, Mr. Mikel said, is to be the patient’s personal representative — a health care proxy or guardian, or with power of attorney — or to have the patient authorize the release of information. In such cases, providers must comply.
Hipaa doesn’t require patients to give consent in writing. They can verbally ask that a relative or friend receive information. Facilities may legally demand a signature on a form, nonetheless, and many do.
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Staff members’ fears of the consequences of an unintended Hipaa violation are probably overblown. Patients can complain to the Health and Human ServicesOffice for Civil Rights, which latelyhas intensified enforcementof many aspects of the privacy rules, Mr. Mikel said.
Still, the civil rights office “is not in the gotcha game,” he said. The office generally tries to resolve complaints by fixing problems, not levying penalties.
“Do I see it going after a health care provider for disclosing something to a family member in good faith? I don’t,” Mr. Mikel said. An assisted living staff member or hospital aide isn’t likely to lose her job.
Another common complaint about Hipaa enforcement, by the way, is the lack of access to patients’ own health records, which they have a right to see or copy, though providers can charge copying fees.
Within families, decisions about how much health information to share, and with whom,often become complicated, as a recent study in JAMA Internal Medicine found. When researchers working to design online patient portals convened two sets of focus groups — one for people over age 75, another for family caregivers — they heard the usual tension between older adults’ need for assistance and their desire for autonomy.
“Seniors say, ‘I don’t want to burden my kids with my medical issues,’ ” said Bradley Crotty, the director of patient portals atBeth Israel Deaconess Medical Centerin Boston and the study’s lead author. “And the family is saying, ‘I’m already worried. Not knowing is the burden.’ ”
The older group wanted help but not second-guessing or “spying,” Dr. Crotty added. They might agree to disclose the medications they take — just not all of them.
Moreover, the dynamic often changes with increasing disability or a health crisis.
“Say a senior has a serious medical condition — a stroke, for instance — and requires a lot of help and support,” Dr. Crotty said. “He could recover enough to want to take back control of his health information. It may go back and forth.”
Such negotiations require continuing discussions of what patients want to divulge and what families need to know. Personal relationships are tricky terrain.
The law, on the other hand, is comparatively straightforward.
“Providers may be disinclined to give out information anyway, and this provides an easy rationale,” Mr. Carlson, the Justice in Aging lawyer, said. “But Hipaa is more common-sense than people give it credit for.”
Correction: July 17, 2015 An earlier version of this article referred incorrectly to the circumstances under which a health care provider may disclose medical information to a relative or friend. A provider may not disclose such information if the patient objects and is not incapacitated. It is not the case that even if the patient objects, providers may use professional judgement to disclose information.
A version of this article appears in print on July 21, 2015, on page D2 of theNew York editionwith the headline: Hipaa as a Code of Silence.Order Reprints|Today's Paper|Subscribe
We need your help! The media is disinterested in Health Care Fraud and in particular elder cleansing.
The family and friends of the victims of this Health Care fraud are grateful that this news blackout is finally showing some cracks.Indeed, it is a scandal that Medicare continues to pay for pharmaceuticals for months after the patient dies, pay Medicaid to ineligible subjects or allows the routine testing of aged seniors for drug dependency.The health care facility has literally become a money center Bank for the health care promoter and a problem that assaults the ‘core’ of American values.An aging population means a large market is developing for extended care and hospice facilities.
The elder cleansing industry has developed right here in America and in many situations has become a metastatic cancer that is literally destroying our Constitutional privileges and immunities. All too often the facilities offered to senior citizens and the disabled are very expensive virtual ‘hell holes.’ The Soviet Gulags are resorts by comparison and it has become a dirty little secret that a disabled person or a senior citizen is herded into a nursing home wherein he/she is drugged and stripped of his/her humanity. Corrupt judicial officials and the guardians that they appoint guide the pathways of this American Holocaust. Media silence, and lawyer regulatory groups suppress citizen complaints with great regularity.
To be fair there are sparse reports of some of the fraud but the industry that has developed flies under the radar.[1] However, even though the Government Accounting Office and theBlogsreport the horrendous outrages of the ‘elder cleansing’ nary a word is reported or acted upon. The guardianship scandal is under the radar to everyone except those who have to deal with it as a victim, family member of a victim, or lawyer. Corrupt judicial and public official maintain a Code of Silence that is no less an assault on America as any of the terrorist forays.
Just as an example, the in re:Mary Sykes case 09 P 4585(Circuit Court of Cook County) is an example. Mary discovered a theft of $4000.00 by her older daughter and was lured into the Court system. The miscreant daughter commenced an incompetency proceeding and the case was assigned to a corrupt judge. Recognizing that a guardianship meant a forfeiture of civil liberties the Illinois Legislature provided aprocrusteanroad map to protect the rights of citizenship for the alleged disabled person. The protections were all ignored! It appears that the Judge in her twelve years administering the guardianship act never read it or understood it. As an example when Mary’s treating doctor refused to declare in an affidavit that Mary was incompetent, the Judge – who was supposed to be neutral and require proof of the specific incompetency by clear and convincing evidence – instructed the miscreant daughter to obtain a more co-operative doctor. One of the two appointed guardian adlitemprovided the names of doctors who regularly find the victims incompetent.
Jurisdictional criteria – such as the notifications required by 755ILCS5/11a – 10 were ignored. The victim was now before the court and the fleecing began. Mary’s younger daughter complained! A guardian adlitemmade totally falseaverments(without investigation) and the daughter’s assets were impaired. Lawyers were routinely intimidated as Mary was isolated from her family[2], friends, and her prior life. Her assets were pillaged. A coin collection having a value of over a million dollars disappeared out of safety deposit box and was never inventoried. Thousands of dollars of assets similarly disappeared.
[NB: Whathapppenedin the Mary Sykes case appears to happen routinely across the United States in Probate Courts. A guardianship is a sentence of death for the ward (victim) and with the routine isolation the guardian is fee to ravage the estate and redistribute the proceeds to himself and his cronies. Every statute is consistent with the Americans with Disabilities Act and requires specific findings of incompetency and the nature and extent of the incompetency - however, the Government Accounting Office and others have found that seldom is the act of ADA even considered in this War against the Elderly and the Disabled. Some Lawyer disciplinary Administrators and their servants openly and notoriously not only ignore the law, but act to aid and abet the violation of the law and obstruct any attempt at justice. An effective law enforcement operation in my opinion would start by indictment of some of the Disciplinary Administrators (such as JeromeLarkin) as accessories and acting in concert (18USCA371). This type of obstruction of justice by persons such asLarkinis detrimental to the proper Administration of Justice and should be made an example}
Mary as a disabled person was systematically denied legal representation. A guardian adlitempatrolled the fiefdom and informed the judge of any attempt to provide Mary with representation; and the Judge summarily dealt with any attempt to obtain due process for elderly cleansing[3]victims.[4] This judge in the Mary Sykes case obscenely pointed out in August of 2010 that even final orders were not protected in the probate division by her. Thus, for four and one half years Mary Sykes has been literally held hostage in an abusive guardianship to the great profit of the Court appointed guardians. The toll mounts on a daily basis:
Mary has lost:
1)All her civil and human rights.
2)A Million dollar gold coin collection and other collectibles worth hundreds of thousands of dollars.
3)Mary’s home was sold for a fraction of its value.[5]
4)Mary’s Constitutional Rights were violated as was the Americans with Disabilities Act.
5)At least one attempt was made to garner the warehousing facilities of an extended care facility so that Mary could be drugged and warehoused.
Family and friends have lost and still lose the companionship of Mary and are all being subject to an assault on their civil rights. Mary’s younger daughter has been physically beaten, had her privacy invaded, intellectual property stolen, and been literally robbed of her own assets. Those who have tried to help have been also punished. AttorneyJoAnneDenisonwho has written a blog on the Mary Sykes case is being subject to loss of her law license (and I have been suspended for four years for writing to law enforcement demanding an Honest complete and comprehensive investigation.
Unfortunately, the Sykes case is essentially routine. Alice Gore (another victim) was not only stripped of her dignity, her liberty, her property, but over two dozen of her teeth were pulled so that the elder cleansers could harvest the gold from her filings! She was so isolated from her family that her death was not timely reported to her family. Indeed, family members protesting have not been well treated. Gloria Sykes was only beaten. Attorney Barbara Stone’s attempts to protect her mother from the juggernaut of the Cottage Industry of ElderCleansingshave resulted in not only frustration and desperation, but criminal charges being brought against her.
There are common facts in just about every one of these elder cleansing cases. The guardianship is an entry into the extended care world and the ‘kickbacks’ to the corrupt judicial and public figures. It does not take a Philadelphia lawyer to figure out that when it costs less than $2000 a month to warehouse the victim of elder cleansing a charge to either the Estate of, or the government of $8500 plus yields a substantial profit.[6]
Translating the above information, it is clear that not only is the public getting a handsome ride through the fields of corruption and health care fraud, but the public consumer is being fleeced. The corrupt judge appointing a corrupt guardian (including guardian adlitem) is usually money in the bank for the corrupt operator of an extended care facility. With corrupt officials (such as JeromeLarkin) monitoring the words and phrases of the legal profession the most likely group of reporters of corruption are also silenced. This silence has allowed the industry of elder cleansing to flourish and make very single individual a potential commodity for exploitation as we age. With health care fraud augmenting health care costs by 300plus percent it prevents any health care being affordable. Worse yet this cancer is attacking our core values and assaulting the Bill of Rights.[7]
This elder cleansing is a serious problem. The amounts of money involved are obscene and influencing the distortion of not only our legal system, but, our democracy. If there are 350 residents in a extended care facility is not uncommon in Chicago for 350 votes to be cast for the dominant political party candidate and zero for the other candidates; however, the nursing home operator has been known to let particular dominant party candidates that unless the candidate does thus and so those votes will either be withheld or voted for a non- dominant party candidate. Recently, the operators nominated their own candidate. Until the dominate party candidate attorned to the wishes of the operators the nominee was quite viable.
[1]The Seth Gilman reported large kick=backs are alleged given for the referral of “subjects” to hospice facilities. Some of the patients actually qualified, but too many others were just being railroaded. The Omnicare scandal revealed the fantastic amounts of money that are generated from the legal drug traffic of the extended care and hospice facilities. The drug usage disclosures confirmed for many of the family members of victims that their loved ones were being drugged and warehoused. Informal inquiries suggested that the obscene profits were generated at the expense of the victims and the United States of America. (NB. Routine billing of $8500 a month for a patient had a net cost to the facility of between a $1000 to $1500 a month)
[2]Including her two elderly siblings and her younger daughter
[3]Elder Cleansingis defined as: the placing of an elderly person in a guardianship, the separation or isolation of the elderly person from family, friends and/or prior life, the forfeiture of the elderly person’s liberty rights, the systematic looting of the elderly person’s estate, and finally a process that amounts to an involuntary assisted suicide.
[4]I was engaged to represent Mary by her family and a contingent of her friends. When I started my investigation I was threatened, and when I ignored the threats the two guardian ad litem appointed and the attorney for the older sister filed a petition for sanctions against me. The fact that I had not appeared in the case did not bother anyone (jurisdiction) what disturbed everyone was the fact that I noted that Mary was still doing her own banking, was active in community affairs, active in her church, and her doctor appeared not to believe that she was incompetent. For this heresy I was sanctions and ultimately fined $4500.00. When I was successful in an appeal, Mr. Jerome Larkin and the Illinois Attorney Registration and Disciplinary Commission charged me with communicating with Attorney General Holder and law enforcement and I received a four year suspension of my law license. I’ve continued to campaign for Justice for the victims of elder cleansing.
[5]Mary’s home is on a large lot, appraised at more than $700,000.00. By Court order it was sold for about $300,000.00. The sale was conducted by a firm believed controlled by the family of a political operative. (Related to the former governor of Illinois who is now in prison). It is expected that a group of mesne sales will be orchestrated so as to disguise the theft before the property is actually sold to a third person.
[6]An examination of the Books of a typical nursing home (or similar proceeding) will note the following:
1)Just about every service is furnished by a separate corporation. Utilities are furnished by ***** Nursing services by **** corporation, Linen Supply by *****, Pharmacy by O****, Cleansing by ***** etc.
2)A separate company purchased the real estate. The real estate is managed by another corporation, and the operation of the business is yet another corporation.
3)Certain well known lawyers who are also major political figures are paid substantial fees.
4)Even though the partnership statute prohibits the general partners from charging the other partners’ fees from managing the partnership substantial charges are made for the same, and apparently reimbursed by the United States of America.
Simply put, Enron was child’s play compared to these operations. If you check the voting records it appears that these facilities seem to induce all the residents to vote as the operator of the facility votes!
[7]The First Ten Amendments to the United States Constitution.
Editor's note: This Shark believes as long as the Kawamotos, Solos and their clones of the world exist...this injustice will continue. Lucius Verenus, Schoolmaster, ProbateSharks.com
Fighting to Honor a Father’s Last Wish: To Die at Home
Photo
Maureen Stefanides at NewYork-Presbyterian Hospital with her father, Joseph Andrey, waiting to move to a nursing home despite their efforts to arrange for 24-hour care at his apartment.Credit Victor J. Blue for The New York Times
Joseph Andrey was 5 years old in 1927 when his impoverished mother sold him to the manager of a popular vaudeville act. He was 91 last year when he told the story again, propped in a wheelchair in the rehabilitation unit of a nursing home where it seemed as though age and infirmity had put a different kind of price on his head.
Craning his neck, he sought the eyes of his daughter, Maureen Stefanides, who had promised to get him out of this place. “I want to go home, to my books and my music,” he said, his voice whispery but intense.
He was still her handsome father, the song-and-dance man of her childhood, with a full head of wavy hair and blue eyes that lit up when he talked. But he was gaunt now, warped like a weathered plank, perhaps by late effects of an old stroke, certainly by muscle atrophy and bad circulation in his legs.
Now she was determined to fulfill her father’s dearest wish, the wish so common among frail, elderly people: to die at home.
But it seemed as if all the forces of the health care system were against her — hospitals, nursing homes, home health agencies, insurance companies, and the shifting crosscurrents of public health care spending.
Her father had been discharged by a hospital to a nursing home like this one, supposedly for rehabilitation, so many times that even she had lost count. The stays, long or short, had only left him weaker, harder to care for at home with a shrinking allotment of help from aides and more prone to the infections that sent him back to the hospital.
This time she had fiercely opposed his being discharged to anywhere but home, a small walk-up apartment in Manhattan that her parents shared for half a century before her mother’s death. Yet over her protests and his own, he had been transferred here anyway, to Jewish Home Lifecare in Morningside Heights, a sprawling institution an hour from where she lived. Later, he would ask, “Are you sure you didn’t put me here?”
“No matter what I do, they want you in a nursing home,” Ms. Stefanides told him, promising the placement would be temporary. “I think they’re making money off you.”
Records would show that her father’s case let the nursing home collect $682.48 a day from Medicare, about five times the cost of a day of home care.
By now Ms. Stefanides was a veteran of battles with the health care system, but it still baffled her. A public-school teacher, she could not afford out-of-pocket home care, and though her father qualified for both Medicaid and Medicare, the flow of money seemed to bypass what he actually wanted at the end of life.
Even hospice was limited. Now mostly for-profit, hospice companies would provide supervision and visits at home a few times a week through Medicare if a doctor certified that Mr. Andrey had only six months to live. The hidden catch: He would lose all Medicaid home care, the daily help he needed to be home at all.
In their last days, older patients are increasingly likely to be shuttled among hospitals, nursing homes and hospices in pursuit of Medicare and Medicaid coverage. Ultimately, most die in an institution, rather than at home.
Among Medicare beneficiaries over 65 who died*
Place of death
Place of care
Percentage receiving treatment in last days**
Transfers
Among facilities and home, average number in last 90 days
70%
3
Hospital
31%
35%
34%
Home
50
Nursing
home
2
Acute
care
hospital
Hospice
33
25
27
30
Intensive
care unit
1
Nursing
home
28
25
27
10
Other
14
13
10
’00
’05
’09
’00
’05
’09
’00
’05
’09
*Excludes Medicare Advantage members. **Patients may get care in more than one place. Those receiving hospice care may get it anywhere, not just in a stand-alone hospice.
Among Medicare beneficiaries over 65 who died*
Place of care
Percentage receiving treatment in last days**
Transfers
Among facilities and home, average number in last 90 days
Place of death
70%
Hospital
3
31%
35%
Home
34%
Nursing
home
50
Acute
care
hospital
2
Hospice
33
25
27
30
Intensive
care unit
Nursing
home
1
28
25
27
10
Other
14
13
10
’00
’05
’09
’00
’05
’09
’00
’05
’09
*Excludes Medicare Advantage members. **Patients may get care in more than one place. Those receiving hospice care may get it anywhere, not just in a stand-alone hospice.
Ms. Stefanides smoothed her father’s hair and touched his cheek, preparing him for her exit.
At 54, she was still slim as a girl and fragile-looking. For most of the past year, she had lifted and rolled and washed her father by herself after the home care aide’s eight-hour shift ended. She would rush to her father’s place from the East Harlem school where she taught fifth grade, feed him supper and get him in pajamas, leave him sleeping under a neighbor’s eye, and then head home, 35 blocks away, to her waiting husband and the dogs she rescued from animal shelters.
She was prepared to do as much again, but she could not quit her job. And now the home care agency had refused to reinstate her father’s aide services.
“He’s in and out of the hospital too much,” an office manager for the agency said when she demanded an explanation. “This is not allowing our girls to make any money.”
Her father was a World War II veteran who had paid taxes all his life, working the night shift in the Murray Hill post office. She was his health care proxy and had power of attorney. But what good was all that?
“It’s a terrible situation they’ve put us in,” Ms. Stefanides said in an agitated phone message left on this reporter’s voice mail. “My father wants to die at home, he knows he’s dying. And here I am proving I’m power of attorney, that I’m guardian, and it means nothing, it falls on deaf ears.”
Her recorded voice continued, rising in anger and resolve as she rushed to explain her father’s straits before being cut off in midsentence.
The message was left at 4:46 p.m. on May 23, 2013, the day after he was taken by ambulance to his fourth or fifth nursing home stint in two years. She would have eight months and eight days to fight for her father before he died.
Dying in America
Photo
Photographs from Mr. Andrey’s life, on display at his funeral. He performed vaudeville as a child and fought in World War II.Credit Victor J. Blue for The New York Times
While Joseph Andrey’s daughter battled the health care system, a national panel appointed by the federally funded Institute of Medicine was preparing a sweeping critique of how the system handles just such cases. The report, “Dying in America,” released last week, calls for a fundamental overhaul of the country’s end-of-life care.
For most people, death does not come suddenly, the report points out. With 48 times as many people reaching 85 than a century ago, and triple the number who turn 65, the likely course of death is long and unpredictable. In the new demographic reality, the immediate family is older, too, often literally unable to do the heavy lifting for the long haul.
Yet the system was never engineered to support families through this, and its financial incentives reward harmful transitions among homes, hospitals and nursing homes, said Dr. Joan M. Teno, a gerontologist and one of the report’s authors.
“We have these frail older people moving about in the medical-industrial complex that we’ve constructed,” Dr. Teno said. “It’s all about profit margins. It’s not about caring for people.”
Many geriatric experts say that if the wasteful medical spending on this stage of life could be redirected, it could pay for all the social supports and services actually needed by today’s fragile elders and their families. Instead, public money has been shuffled in the same system, benefiting health care businesses but not necessarily patients.
A prime example is the abuse of short-term rehabilitation in nursing homes, improper charges that cost the public more than $1.5 billion a year, federal inspectors for the Department of Health and Human Services reported in 2012. Medicare will pay premium rates for up to 100 days of services in a nursing home to rehabilitate patients. While such efforts can be beneficial, government investigations and lawsuits document a pattern of excessive or fraudulent orders for such services, often just before death.
As for dying at home, “you can’t believe the forces of the system that are arrayed against it,” said Jack Resnick, once a health system executive and now a doctor with a geriatric house-call practice on Roosevelt Island. “The way the reimbursement system works, these decisions are not made on the basis of what the individuals need. They’re based on what the institutions need.”
To Dr. Joanne Lynn, a veteran hospice physician consulted for the Institute of Medicine report, the problem goes beyond perverse financial incentives. Most developed countries spend much less on medical care over all than the United States, but nearly twice as much on social supports.
“Why can I get a $100,000 drug but I can’t get supper?” she asked, pointing to the budget sequestration that slashed federal spending on meals for seniors last year.
In the end, only a humane case-by-case approach can provide the right care for the last chapter of a long life like Joseph Andrey’s, added Dr. Lynn, who directs the Center for Elder Care and Advanced Illness at the Altarum Institute, a research organization based in Ann Arbor, Mich.
Photo
In 1927, a New York newspaper published a request that “a prosperous family” adopt Mr. Andrey, far left, then 5, and a brother.
“You have to get to know the real situation, what this person really needs to live comfortably and to have some meaning in their lives,” she said. “They are more than just bodies with heart beats.”
Mr. Andrey was the oldest child in a family so poor they begged in the street. His mother appealed to one of New York’s newspapers. “Wants Her Sons Adopted,” the front-page headline said on Aug. 7, 1927, above a family photograph “taken before domestic dissension set in.”
In the picture, little Joseph stands solemnly with a younger brother before their father, a Greek immigrant. His Irish Catholic mother holds a baby on her lap. “As a result of her husband’s failure to support her and the children,” the caption says, she had decided “to seek a good home with a prosperous family for the two older boys.”
The publicity drew the show business agent for the Loomis Twins, singing sisters looking for a sidekick. Money changed hands. And just like that, 5-year-old Joseph went from hunger in the tenements to room service at the Waldorf-Astoria and beyond, to the dining cars of trains speeding to vaudeville stages around the country.
“It was the best thing that happened in my life,” he rasped from his wheelchair last year, recalling the highlight of his childhood: Dancing the leading toy soldier in a Christmas show at Radio City Music Hall.
Just as abruptly, at age 7, the idyll ended. His mother demanded him back, or else more money. He was returned to finish out a ragged childhood. To support the family, he left school at 14 for menial jobs, always longing to get back to the stage.
The draft took him instead to the Pacific theater in World War II. It was the ultimate escape from his parents’ squalid fights, as he told it. Still in uniform, he met Florence Agnew, his future wife, at New York’s Roseland Ballroom.
“They danced together all the time,” their daughter remembered. “They danced around the house, for no reason at all. And then he danced with me.”
Photo
A photo of Mr. Andrey, his wife, Florence, and their daughter, Maureen, taken in a photo booth.
Just for fun, all three would pile into a photo booth at Woolworth’s, her father cracking them up with his Mighty Mouse voice when the shutter lights flashed.
By then he was sorting mail all night and working in hotel security on the side. He regretfully gave up his Broadway dreams. But he had achieved another fervent childhood goal: a happy marriage.
“It was like a dream,” his son-in-law, Dean Stefanides, would say later, recalling how the couple laughed at their own infirmities.
The medical histories repeated again and again in hospital records were not such a big deal. Yes, she had an early hysterectomy, and in his 50s, he lost the tip of his penis to a cancer that never recurred. Yes, he had a stroke before 70; he seemed to recover completely, though five years later he would have to take medication daily to control seizures, and by 80, began having trouble with his legs.
But for years love and humor seemed to trump the toll of aging. Unable to extract each other from a cab one day, they told a funny story about it. Hard of hearing, they made fractured conversation another comedy routine.
Then Alzheimer’s changed everything. At the couple’s 50th wedding anniversary party, two weeks after the Sept. 11 attacks, relatives drew Ms. Stefanides aside: “Something is wrong with your mom.” She had been calling a cousin from her apartment at 3 a.m., saying she wanted to go home.
She was 80. Her steep decline would last eight years.
Like many of the 15 million Americans caring for a relative with Alzheimer’s, Ms. Stefanides and her father learned that Medicare does not cover long term day-to-day help, in any setting. They would have to turn to Medicaid, the shared state and federal program for poor and disabled people.
They were lucky. Under New York’s unusually expansive version of Medicaid, a home attendant went daily to their fourth-floor walk-up in the Yorkville neighborhood to provide eight hours of unskilled “personal care assistance.” Eventually, it was not enough.
The calls from her father would start at 5 a.m.: “I’m scared. What is it with your mother?”
She sometimes brought her mother to her place so her father could sleep, but that put new strains on her marriage.
She and her husband, an art director, had bought their duplex near Beekman Place in the early 1990s, before the advertising industry imploded. Now the apartment doubled as his freelance work space.
One day in 2007, her father broke down. Florence was banging on other tenants’ doors, seeking her childhood room.
“I can’t take it anymore,” he said. “I can’t run after her. Is there like a really nice place where we can put her?”
“I was so ignorant of what nursing homes are,” Ms. Stefanides would say later. “My mother kept holding on to my sleeve, saying, ‘Take me out of here.’ ”
One day the nightgown slipped off her emaciated shoulders, revealing a mass of bruises. The woman in the next bed confided that Ms. Andrey, then wordless, had been beaten by an aide when she resisted some daily routine.
“The roommate told me that she cried under the covers when she heard my mother’s screams,” Ms. Stefanides recalled.
Now, the nursing home declines to discuss the case. At the time, her own complaints to the administration, the State Health Department and the police went nowhere. Fruitlessly, she hunted for a better place until her mother died.
‘Where’s My Dad?’
Photo
“I want to go home, to my books and my music,” Mr. Andrey said while in a nursing home and as his daughter continued to try arrange care for him at home.Credit Victor J. Blue for The New York Times
Mr. Andrey’s health worsened after he was widowed in 2009. But the less he could walk, the more he loved being home after brief hospital stays, nested with his Nat King Cole albums, cared for by live-in aides through Medicaid.
Ms. Stefanides was not prepared for the abrupt end of that way of life. Her father was in Lenox Hill Hospital for a urinary tract infection in spring 2011 when a discharge worker called her at school: He would not be sent home, because his home health agency, Excellent, had ended his services, and no one was there to care for him. Instead, he was to go to a nursing home for rehabilitation.
“Absolutely not,” Ms. Stefanides declared, rushing over. His hospital bed was empty. “Where’s my dad?” she cried.
He had been whisked to Kateri Residence, a Catholic nursing home on West 87th Street. And for more than a year, as his legs atrophied and he begged to go home, she was unable to get him out: No home health agency would take him.
Agencies like Excellent no longer wanted high-hours home care cases like her father’s, explained Jack Halpern, the chief executive of MyElderAdvocate.com, when she briefly hired him to try to get her father home. Such cases were no longer lucrative.
She came to realize that it was the start of a larger upheaval. The administration of Gov. Andrew M. Cuomo was shifting billions in public spending on long-term care to private managed-care companies, which were paid a flat Medicaid rate for each enrollee. Key players were shunning fragile clients like her father in favor of seniors robust enough to bike to a social adult day care center for table tennis.
“They don’t want heavy-care people, so they’re denying them services,” Mr. Halpern said later. “Everyone’s getting shoved into nursing homes.”
The nursing home, Kateri (which has since been sold and renamed), had financial incentives to keep Mr. Andrey: For up to 100 days, Medicare would pay roughly double Medicaid’s daily rate for regular nursing home care. Later, he was relegated to a unit with so little staff that he rarely left bed. Finally, in spring 2012, when he was showing signs of dementia, Kateri declared him a permanent resident and moved to take his whole income.
At the last moment, Ms. Stefanides cobbled together his escape: She persuaded Gentiva Health Services, a national company, to provide eight hours of home care on weekdays — much less than the live-in care he had before — while her husband, still freelancing, signed papers promising to do the rest. In reality, the schedule relied on her visits and a neighbor’s vigilance.
They managed, barely, for a year. But in 2013, they faced the same problem, only worse. The home care company, under new ownership, dropped her father, and NewYork-Presbyterian Hospital sent him for rehabilitation — to DeWitt.
“When the elevators open, you get this terrible stench,” Ms. Stefanides said of DeWitt’s upper floors at night. “I was hearing people screaming for help and nobody coming. My father was on the verge of tears — in his defecation for three hours, and he kept ringing the bell.”
(DeWitt’s lawyer, Neil Ptashnik, now says: “The only comment the facility has is: We’re well run, adequately staffed, we’ve had no problems with the Department of Health, and our residents seem quite happy.”)
The nursing home sent him to the hospital after 10 days, with a recurrent infection from an improperly placed catheter, medical records show. The hospital soon discharged him to the next nursing home, Jewish Home Lifecare, where orders for therapy and skilled services brought the price of his care up to $682.48 daily under Medicare.
Ben Taylor, a lawyer at the New York Legal Assistance Group, thought he could break the cycle. By law, he said, the state should require Gentiva to reinstate eight hours of daily home care pending a fair hearing. Meanwhile, Ms. Stefanides should contact managed-care plans, which were not supposed to rule out round-the-clock home care.
But she reached receptionists who said 24-hour care was unavailable. Jewish Home insisted her father could not safely go home with less. And day by day in the nursing home, he was sinking.
On arrival May 22 last year, Mr. Andrey was “alert and verbal,” with a good appetite, clinical notes said. Less than a week later, he was eating only half his food. On Day 12, he was found on the floor: He had fallen from bed, hurting his knee.
By Day 14, when Medicare had spent nearly $10,000 on his care, a pressure sore was eroding the flesh of his right heel. Despite treatment, ulcers later covered his left buttock and feet. When physical therapy ended, the wounds became another reason for the institution to extend his stay, now costing Medicare $585.49 a day.
In late July, Mr. Taylor won a state directive for Gentiva to restore home services, if the doctor approved. Separately, a social worker at one managed-care company, GuildNet, told Ms. Stefanides that Mr. Andrey might be accepted for home care if the nursing home agreed.
But the nursing home said he was too weak to be released. Instead, it transferred him to a long-term-care wing.
Nursing Home Limbo
Photo
Mr. Andrey in the cafeteria of Jewish Home Lifecare in August 2013.Credit Nina Bernstein/The New York Times
On a Wednesday evening in mid-August 2013, in the dining room, Mr. Andrey poked at the lid of his ice cream cup with a fork. Beside him, a blind woman fumbled to find the food on her tray, the staff too short-handed to help. At the next table, a woman with dementia kept screaming. Mr. Andrey’s voice could not be heard above the din.
On this wing, emaciated Alzheimer’s patients wandered into his shabby room. From a skinny 138 pounds on admission, he was dwindling to 128.
“Why am I with these people?” he would ask his daughter. “Why am I losing this weight?”
“Dad, this is all through atrophy,” she told him. “We have to get you moving again.”
“They never move me,” he answered. “I’m lucky if they come to change me.”
On some days he went hungry, he told his daughter. Rushed workers left his food tray on the air-conditioner, where he could not reach it. Several times, he fell out of bed trying.
Medicaid now paid the home $307.70 a day for his care, much less than Medicare did before. On Aug. 20, two days after his Medicare stint ended, so did his protein supplements. If his daughter wanted him to drink Ensure, the staff told her, she should buy it herself.
In rehab, a psychologist had noted that Mr. Andrey brightened when he spoke of “the pleasure he derived from the arts.” Now there was not even a television in his room. Visitors found the bathroom filthy, garbage uncollected and Mr. Andrey left half-covered in a diaper. A friend, Dyandria Darel, was so appalled that she documented the scene in photos.
(Jewish Home’s chief medical officer at the time, Mark Levy, who secured Ms. Stefanides’s permission to discuss the case, strongly defends the care provided, calling it “professional, compassionate and well done.” At the same time, he said, “if you fit it all together from the perspective of Mr. Andrey, I don’t think the United States health care system did a great job of meeting his needs.”)
Mr. Andrey’s only hope of escape now was GuildNet, the managed-care company. He was interviewed; the apartment was inspected; both passed. But the nursing home’s assessment was missing.
One Sunday evening that summer, Ms. Stefanides and her husband found her father falling from bed, in agony from his contracted legs. His pain medication, Oxycodone, had been halted over the weekend — “doctor’s orders,” the head nurse said when Ms. Stefanides confronted her, adding something about preventing kidney damage.
“My father’s dying, put him on goddamn morphine!” Ms. Stefanides cried. The flustered nurse gave her a number to reach a doctor. But the one who picked up said angrily that he was off the clock, and hung up. Not until Monday could a doctor be found.
By then, Ms. Stefanides felt as though she were petitioning for her father’s release from prison. Another month went by. All told, four months, 11 days and $61,033.62.
But at 6:45 p.m. on Oct. 2, 2013, Joseph Andrey left the nursing home by stretcher as a GuildNet enrollee, his daughter at his side. He was carried up the stairs to the old apartment, newly equipped with a special bed. Soon the smell of good cooking filled the air. An aide fed him with a spoon.
The first week, his daughter crowed, he gained five pounds.
More Than Aides Can Handle
Photo
Maureen Stefanides in her father's bedroom after he died.Credit Victor J. Blue for The New York Times
It was the aides who mattered most and earned the least, Ms. Stefanides reflected. The primary care physician whom GuildNet assigned to her father never met him. The nurses who showed up to treat his deep ulcers kept changing. Yet the two aides who split the week as “live-ins” were paid so little by a subcontractor that they had to take second jobs, they told her.
Both aides seemed nurturing, but one, a recent immigrant, was inexperienced in washing a bed-bound patient. The other rebuked Mr. Andrey when he woke her up, his daughter later learned.
Nearly immobile now, his skin frayed and flesh gaping, he needed more care than they could give, especially at night. When an aide asked for more help, Ms. Stefanides first called the subcontractor, Allen Home Care, and then the GuildNet case manager.
The case was already too costly, she was told. In fact, a caseworker confided, the only reason GuildNet had taken her father was that he was not expected to live long.
(GuildNet declined to comment. Calls to the chief nurse and marketing director at Allen Home Care were not returned, but a team coordinator said, “We basically do what we’re told by the insurance company.”)
In theory, GuildNet was now coordinating all of her father’s care. In practice, he careened between the sleep-deprived aides and a dozen different doctors at NewYork-Presbyterian Hospital.
When he had trouble breathing, his aide called 911, and he went by ambulance to the emergency room. The aide was told to check back in three days for the results of a urine culture, but she forgot. The bad news reached the family 10 days late: The bacteria were resistant to his prescribed antibiotic. By then he had a septic ulcer in his scrotum.
The result: Emergency surgery, a different antibiotic, 13 days in the hospital ($108,895.37), followed by a brief discharge home without pain pills or a refill for his antiseizure medicine — and a seizure that sent him back. Two days in medical isolation while doctors ruled out multidrug-resistant bacteria ($20,721.82). Home again, increasingly incoherent.
On Christmas Eve, suffering chills, fever and mental confusion, he went back to the hospital for the third time in three months.
A Father’s Question
“Thank you for keeping me alive,” he told his daughter, teary with gratitude, when he emerged from days of delirium. “When are you taking me home?”
He still wanted to live, she realized. But the doctors said there was nothing more to be done. Now they wanted him sent somewhere else to die.
She felt they were bullying her to disregard her father’s wishes. “They almost told me I was wasting their oxygen and their medicine,” she said.
His sepsis would keep recurring. His system, likely colonized by bacteria acquired in health care institutions, was breaking down. Demented, contracted, hurting — he had no quality of life, doctors said, urging hospice.
But as the hospital’s own social workers had explained, hospice benefits from Medicare came with a catch: Her father would lose all Medicaid home care. In home hospice, that would leave huge gaps, unless she could tend to him around the clock. The alternative was hospice in a nursing home.
Not that, she vowed, vividly recalling her mother’s monthlong death in hospice at DeWitt, after a doctor said withholding liquids was “the humane way.” Once, arriving for her daily visit, she had unthinkingly carried in a cup of tea. Not quickly enough, she hid it behind a curtain, seeing her mother pass her tongue over parched lips.
“She was suffering, and I contributed to that,” she said, sobbing. “I will never forgive myself.”
For her father, she was determined to do better. She told the doctors she needed more time to consider home hospice, and wrestled with her inability to make the open-ended commitment. School administrators had long since lost patience with her absences, and all but accused her of using her parents’ health as an excuse to miss work. She had weeks to go until early retirement, and she had been postponing surgery to replace a hip injured in an icy fall.
The hospital finally proposed another option: Haven, a hospice inside Bellevue Hospital Center run by Visiting Nurse Service of New York. On Jan. 29, with her father unintelligible again, she reluctantly signed the papers.
The people who met them wore masks. Suddenly alert, her father grabbed her sleeve. “Don’t leave me here,” he said. “Something’s going to happen here. Why did you bring me to Bellevue?”
A hospice worker strapped him down, looking for a vein. As the painkiller reached his bloodstream, his daughter saw him gasp for life. She ran out in distress, asking for a priest.
“My God, the last rites, you’re at a hospice!” Ms. Stefanides said later. “No priest to be found.”
(A Haven official later expressed deep concern, saying, “We are reviewing this case to make sure this is the isolated case we believe it is.”)
As she and her husband took turns at his side, Ms. Stefanides’s father lived on — one day, two days. Death came the third morning, before she arrived, on Feb. 1 of this year, three weeks before his 92nd birthday.
Photo
At a Manhattan funeral home. Mr. Andrey died on Feb. 1, three weeks before his 92nd birthday.Credit Victor J. Blue for The New York Times
The funeral home director told her the deep pressure ulcers on her father’s body were the worst he had ever seen. The records she obtained showed that in the last year of his life, his care cost at least a million dollars. Was that the best, she wondered, that a million dollars could buy?
“He didn’t die in his bed, and that’s what he wanted,” she said. “I still feel that I let him down.”
After the wake, she stayed behind with his body. In a last rite of her own, she placed her hand on his chest and said the act of contrition: “Please forgive my father for all his sins.”
Nearby, on display, was his life in pictures: dashing soldier, dancing husband, loving and demanding father. Through the winter gloom, it still gleamed.
Correction: September 25, 2014 An earlier version of a picture caption with this article gave an incorrect location. Joseph Andrey was shown in the cafeteria of Jewish Home Lifecare, not NewYork-Presbyterian Hospital.
