Nursing Home Abuse Lawyer Blog

My personal experience as a Missouri Nursing Home Lawyer is that far too many nursing home residents are overmedicated by those responsible for providing quality care. In my job I often meet with residents and their families in nursing homes. On some of those occasions, the residents simply could not wake up. Their eyes fluttered as though they were struggling to wake up and participate in the conversation happening around them. Sadly, the government has determined that my experience is not unique.

The U.S. Department of Health and Senior Services recently prepared a report entitled Medicare Atypical Antipsychotic Drug Claims For Elderly Nursing Home Residents that found that too many nursing home institutions failed to comply with regulations designed to prevent overmedication. It is well known that prescribing antipsychotic medication to elderly residents with dementia is potentially lethal, yet 88% of these individuals receive such prescriptions.

Family members must make certain that they know what medications their loved one is receiving. They must educate themselves on the medications and the proper dosages. They must regularly ask questions of the caregivers and insist upon answers. Family members must know what the possible side effects are and should closely monitor their loved one for any signs of side effects.

Why would a nursing home overmedicate a resident? First, to be fair to the nursing home industry, many times the overmedication is completely unintentional. Elderly residents are more much more susceptible to overmedication than are younger people. The second reason is an indictment of the nursing home industry. Overmedicated residents do complain and are, therefore, easier to care for with a reduced staff. Residents who ask to be taken to the restroom, or who need more water or need help walking down the hallway often require assistance from staff members. When a nursing home operates on reduced staff (as most nursing homes do) drugged residents are easier to manage than those who are alert and active.

If you are concerned about the care your loved one is receiving in a nursing home, call our St. Louis personal injury lawyer David Terry for a free consultation at 1-888-317-2525.

A ninety-seven year old Iowa nursing home resident is dead after a traffic accident caused injuries that contributed to her death.

Corine Armentrout was the passenger in a van that was returning residents to Ridgecrest Village, a Davenport, Iowa nursing home facility, after the residents had attended the Festival of Trees celebration. Armentrout, who was wheelchair-bound, was thrown from her wheelchair onto the floor of the van when the van's driver abruptly stopped for a traffic light. According to the Iowa Department of Inspections and Appeals, while the wheelchairs were appropriately secured to the floor of the van, the residents were not wearing safety belts. The driver of the van reportedly admitted forgetting to fasten the safety belts.

Armentrout was rushed to a local hospital, where she was resuscitated and received blood transfusions. Her injuries were numerous: two broken legs, a broken wrist, broken finger, possible neck fracture, and acute blood loss. The other injured resident suffered a fractured pelvis. Armentrout died twelve days after the accident from congestive heart failure that was attributed to her broken leg and severe blood loss.

The facility was fined $10,000 as a result of the incident.

The Terry Law Firm offers their condolences to the Arementrout family on their loss.

Eighty-nine year old Wilbur Jackson went to Grinnell's Friendship Manor Care Center for rehabilitation after hip surgery. He was at the facility a mere 17 days before he sustained an injury that led to his untimely death.

In June 2009, Jackson was to be transported to a local hospital for testing. Midwest Ambulance Service of Iowa came to the facility and strapped Jackson to a gurney and began wheeling him to the facility's driveway, where the ambulance was parked. At that point, Jackson was fully alert and joking with facility staff.

As the gurney was leaving the facility, one of the gurney wheels dropped into a crack on the sidewalk, flipping the gurney. Jackson's head hit the pavement. He lapsed into a coma and never regained consciousness. He died on July 5, 2009.

Jackson's family sued the company that owns and manages Friendship Manor and Midwest Ambulance. According to the deposition of Richard Achenbach, the facility Administrator at the time of Jackson's accident, he repaired the cracks in the sidewalk after the accident; in fact, he ordered them repaired after examining the cracks the morning following the accident. According to Achenbach, "When I seen the crack like that, I considered it could be a safety issue."

A deposition of owner Tim Boyle revealed that Boyle did indeed know of about the sidewalk cracks and that the rebar used to reinforce the concrete was exposed and protruding through the cement. According to Boyle, "Although the rebar was exposed...it did not stick up far enough to be hazardous."

Last week, a jury found the facility to be 90% at fault and Midwest Ambulance to be 10% at fault. Damages were assessed at $546,386, with a $491,747 judgment against the facility. Midwest Ambulance was ordered to pay $54,639. Additionally, after Jackson's death, Friendship Manor was fined $3,250 by the federal government.

Reportedly, Friendship Manor has a history of violations. In 2005, a facility employee was convicted of sexually abusing two residents. In 2008, the facility was fined $112,650 after Ruth Louden, a resident at the facility, had to have her legs amputated due to gangrene.

An Iowa nursing home facility was recently fined by the Iowa Department of Inspections and Appeals after it reportedly failed to protect its mentally disabled residents from repeated sexual abuse. The facility's owner was fined $6,000.

Abington on Grand, a nursing home facility located in Ames, Iowa, reportedly has had a history of health and safety violations. In fact, between 2005 and 2008, the facility was on the federal list of Special Focus Facilities. Special Focus Facilities are facilities that fail repeatedly to comply with state and federal nursing home guidelines and, as a result, are inspected twice a year to ensure compliance and improve performance. In the past, the facility was reportedly cited for hiring workers without conducting required background checks, residents eloped and were found wandering near the facility in traffic, and for having dead mice in the kitchen.

According to the Iowa Department of Inspections and Appeals, residents at the facility were recently subjected to repeated acts of sexual abuse and threats. One of the alleged perpetrators was a man whom the court ordered committed to the facility late last year. Facility records show repeated documentation where the man threatened to kill people or sexually assaulted residents. Staff reportedly told inspectors that the man committed sexual acts with other residents daily. In fact, one facility employee told inspectors that she saw the man engaged in sexual relations with another resident but was told by a charge nurse to "keep an eye on the two".

A female resident of the facility with a severe mental impairment also reportedly engaged in inappropriate sexual conduct with other residents. A facility employee reportedly saw her in a male resident's room engaged in sexual relations.

State inspectors reported that the facility documented instances of sexual abuse by marking a plus sign in the residents' files. According to a nurse employed by the facility owners, the company had no policy on dealing with "resident-on-resident behavior issues".

The facility is owned by American Healthcare Investment, a company with a history of resident care problems. The President and sole shareholder of the company is Brian Hoyle, who holds a stake in dozens of care facilities nationwide. According to Hoyle, "I'm just the owner. The company I have is just the owner of the real estate. We have nothing to do with the operation."

This detachment from reality is allowed because legislatures around the country have failed to prohibit the corporate spiderweb strategy employed by most nursing home companies. Owners create multiple corporate entities that effectively suck all money from the nursing home itself, leaving residents living at poorly funded facilities. Owners, meanwhile, are often cashing in and enjoy the same plausible deniability employed by Mr. Hoyle.

An Iowa nursing home erroneously portrayed itself as an assisted living facility, rather than as a residential care facility, and was caught by the Iowa Department of Inspections and Appeals (DIA).

Emeritus at Silver Pines was slapped with $13,000 fines after an investigation by the DIA revealed that the facility was falsely portraying itself as an assisted living facility rather than as a residential care facility. According to the state, Silver Pines is only licensed to provide personal assistance and supervision, not high levels of medical care required at an assisted living facility. The facility also received 17 other violations for violations involving medical records, training, etc. It received 14 similar violations back in March 2010. The average number of health deficiency violations for an Iowa nursing home facility is 7.

The facility's owners were also ordered to hire a new administrator after the state determined that the current administrator was not qualified to hold that position.

The Iowa Department of Inspections and Appeals has fined three Iowa nursing homes after finding residents in their care were being neglected. The facilities affected are: Golden Age Skilled Nursing and Rehabilitation, Griffin Nursing Center, and Sunnybrook of Adel.

Griffin Nursing Home

Griffing Nursing Home faces a $10,000 fine for reportedly failing to treat open wounds that a resident had developed. The resident was transported to a hospital only after a staff member found large amounts of bloody fluid draining from an ankle wound that exposed her bone. The female resident's leg had to be amputated due to infection.

Additionally, the facility was fined $500 for failing to provide adequate fluids to multiple residents, $2,000 for failure to prevent resident falls, and $2,000 for failing to address weight loss among some of its residents.

The facility was also cited for using a defective mechanical lift to move residents in and out of bed. Facility employees complained that the lift frequently malfunctioned and left residents in the air for as long as five minutes. An inspector found large cracks in the lift and a manufacturer's representative reportedly called the lift "unsafe". Facility owner Jim Griffin said that "the lift was in "perfect" condition and was still being used." Sadly, many owners focus on the cost of equipment rather than the benefit of the equipment.

Griffin Nursing Home has been given an overall rating by Medicare.gov of 2 stars, which is defined as a "Below Average" nursing home. While the average number of survey deficiencies in Iowa is 7, this facility had 14 deficiencies in 2007, 7 in 2008, and 9 deficiencies in the most recent reporting from June 2009.

The Iowa Department of Inspections and Appeals has fined three Iowa nursing homes after finding residents in their care were being neglected. The facilities affected are: Golden Age Skilled Nursing and Rehabilitation, Griffin Nursing Center, and Sunnybrook of Adel.

Golden Age Skilled Nursing and Rehabilitation

This facility faces approximately $20,000 in fines after the facility was found to have willfully disregarded open wounds on a defenseless resident's arm, leg, and toes. The wounds were only discovered after the resident was taken to the hospital for shortness of breath and hospital workers uncovered the wounds. According to a hospital nurse, she found the wounds when she smelled a foul odor and pulled down the resident's socks. She found a blackened, open wound the size of a half-dollar that was oozing.

Twenty caregivers at the facility denied knowing that the resident had these wounds, even though the resident was scheduled to have regular skin assessments and baths. Both the facility's Administrator and Director of Nursing expressed shock after seeing photographs of the resident's wounds. Sadly, this resident died 16 days after these wounds were discovered by the hospital staff.

Golden Age has been rated a one star facility overall by Medicare.gov, which is defined as "Much Below Average". In its most recent year of inspections, this facility had 10 deficiencies compared to an Iowa average of 7.

A Coralville nursing home faces up to $92,400 in state and federal penalties after it attempted to cover up the sexual abuse of an elderly resident.

Windmill Manor nursing home faces stiff fines and its former director of nursing, Karen Etter, faces criminal charges.

The problems stem from a November 2009 incident wherein a male resident was found in bed with a female resident and both were completely undressed. On Christmas Day, the two residents were found having sexual intercourse in the male resident's room. The woman, who suffers from Alzheimer's disease, is and was unable to provide consent.

According to the Iowa Department of Inspections and Appeals , director of nursing Karen Etter reportedly threatened staff members not to tell anyone about the incident if they wanted to keep their jobs. One worker told inspectors that she was instructed not to report the incident to the head of the dementia unit because the facility could face a fine from state inspectors. That same employee felt that the attitude of her boss was such that she could be fired for reporting.

Iowa law requires caregivers to report all suspected abuse. The Christmas Day incident went unreported to the state, although the male resident's physician ordered medication for him to decrease his sex drive.

Etter is no stranger to problems with the state. In March, the State of Iowa alleged that she threatened seven employees if they reported quality of care concerns.

After failing to meet minimum federal care standards for the past six months, an Iowa ManorCare facility is set to lose its federal funding. The federal government intends upon terminating ManorCare Health Services' participation in the Medicare and Medicaid program on Wednesday, May 12, 2010. According to ManorCare spokesperson Julie Beckert, ManorCare intends upon making up the loss of federal benefits to the residents so they will not have to relocate. She also said that the facility intends upon coming back into compliance. The facility has had problems as of late. Late last year, three residents suffered broken bones in a two month period: a broken leg, a broken arm, and a broken hip. According to a facility staff member, the residents reportedly waited an hour for pain medication. In November 2009, the facility was cited for taking between 20 and 45 minutes to respond call lights and for failing to notify a doctor of a resident's fall for ten days after the incident. Additionally, one resident who needed to use restroom facilities was reportedly told by a staff member to wet the bed instead. The facility was fined $18,000 in early 2010 for failing to treat and prevent bedsores, failing to provide a safe environment, and taking up to 75 minutes to respond to a call light. The facility was fined again in March 2010 for failing to provide a safe environment. A fine was assessed in April 2010 for failing to follow physicians orders. Owned by the Carlyle Grop, one of the world's richest private equity funds, the facility is one of Iowa's largest and newest nursing homes. While considered to be a state of the art facility, ManorCare Health Services reportedly continues to have problems with resident neglect and short staffing.

Belle Plaine Nursing and Rehab Center was fined $10,000 for failing to assess a resident and provide timely care.

The fine is connected with a February 1, 2010 incident where a resident was found in bed with a fractured thighbone around 6:20 a.m. The resident suffered from dementia and osteoporosis, among other things. The facility, reportedly unaware of how the resident sustained the injury, was unable to offer an explanation. According to an orthopedic surgeon, the broken thighbone was the result of a trauma that could not have occurred while lying in bed. The injury was the result of a fall or twisting of the leg. After being treated at the hospital, the resident was returned to the facility.

On February 4, 2010, a hospice nurse noticed a large bump on the same resident's arm. The bump turned out to be another fracture. The resident died on February 5, 2010 with the death certificate listing cardiopulmonary failure and failure to thrive as causes of death.

According to an investigative report, the facility failed to assess the resident prior to administering morphine on February 1 around 12:20 a.m. after the resident was moaning and agitated. Staff reported that while anti-anxiety medications did not work for the resident the previous day, morphine was calming for the resident.

We discussed alleged whistleblower retaliation at select Iowa nursing home facilities, including Windmill Manor in our March 25, 2010 blog. Reportedly, the Director of Nursing at Windmill Manor, a Coralville nursing home facility, threatened to fire seven facility employees if they reported any abuse or neglect violations to state inspectors. She reportedly told her staff that "she had a stack of applications" from prospective employees. She admitted to state investigators that she made the threat during a luncheon during Nurses' Appreciation Week but would not have carried through on it.

According to the Des Moines Register, the Iowa Department of Inspections and Appeals fined the facility $5,000 for the incident and referred the matter to Johnson County authorities for prosecution. The Director of Nursing, Karen Etter, now faces a criminal charge of attempting to impede or interfere with state inspections at the nursing home facility and is scheduled to appear in court on April 19, 2010. While her nursing license currently remains in good standing, she is no longer employed at Windmill Manor. In addition to the individual prosecution of Etter, she faces possible federal charges as investigators recently met with federal prosecutors about the possibility of federal charges or criminal sanctions against whistleblower retaliation offenders.

Windmill Manor now resides on the federal list of "special focus facilities" that have a history of noncompliance with health and safety standards. These facilities are subject to bi-annual inspections and closer review.

More information has come out about two other Iowa facilities that were fined for whistleblower retaliation around the same time as Windmill Manor. Granger Nursing and Rehabilitation Center was fined $5,000 for firing an employee that told state inspectors about equipment problems that occurred prior to a resident's death. Crossbridge Homes of Marshalltown was fined $1,000 when its former administrator, who faxed a list of concerns to the inspections department, was demoted.

In a rare move, the Iowa Department of Inspections and Appeals has assessed fines against three Iowa nursing home facilities for alleged whistleblower retaliation.

Iowa has a mandatory reporter law, which specifically makes it a crime for caregivers not to report a suspected case of abuse or neglect. Unfortunately, the law is rarely enforced, making it easy for those to follow the law to be exposed to retaliation.

Within the past five weeks, the Iowa Department of Inspections and Appeals has assessed fines against the following facilities:

Windmill Manor: Assessed Fine: $5,000. Reason: Reportedly, the Director of Nursing threatened to fire seven employees if they reported quality of care concerns to state inspectors. The threat was made during a Nurses' Appreciation Week luncheon and she told her staff that she had "a stack of applications" from prospective employees who were available to take their places. The Director of Nursing actually admitted making the threat but told the state that she would not have gone through with it. The facility is appealing the fine saying, "We are confident that when all the facts are presented that the citation will be reversed and the fine rescinded."

Granger Nursing & Rehabiltiation Center: Assessed Fine: $5,000. Reason: Reportedly, threatening, demoting or firing employees reporting resident care concerns to inspectors.

Crossbridge Homes of Marshalltown: Assessed Fine: $1,000. Reason: Reportedly threatening, demoting or firing employees reporting resident care concerns to inspectors.

We discussed the situation at Friendship Manor of Grinnell in a previous blog.

Ruth Louden entered Friendship Manor of Grinnell for rehabilitation after she fell and fractured her ankle. Her doctor put her in a medical stocking and brace and facility staff were to monitor her leg for circulation and check her skin every shift for signs of redness or swelling. Sadly, while Ruth complained to facility staff of "horrible" and "excruciating" pain for the next four weeks, no one every checked her leg.

Approximately one month after Ruth's fall, a physical therapy aide noticed that Ruth's leg smelled like "rotting meat" and the stocking showed blood seepage. Ruth was taken to the hospital and physicians there found that the wound dressing that had been put on a month earlier looked like it had never been touched. Ruth was diagnosed with gangrene and doctors were forced to amputate her leg to save her life. Sadly, she died three months later.

The facility was fined more than $101,000 due to the incident and the owner, Tim Boyle, appealed the penalty. The case was settled in early January 2010 with the facility agreeing to pay the U.S. Centers for Medicare and Medicaid Services $75,000.

Iowa's Department of Inspections and Appeals investigated and found that during Ruth's stay at Friendship Manor - 25 days - no one ever removed her stocking to check her leg and no physician ever examined her. Sadly, Ruth's doctors told state inspectors that Ruth's bone fracture was nearly "nonexistent" and that her amputation was avoidable.

A Muscatine, Iowa woman faces two counts of unlawful procurement of a prescription drug, a Class C felony, after she reportedly stole prescription drugs from residents at a nursing home facility where she worked. She also faces three misdemeanor counts of possession of a controlled substance, identity theft, and fifth-degree theft.

Kristine Renee Maher, a registered nurse who formerly worked at Carrington Place of Muscatine in Muscatine, Iowa, allegedly stole prescription drugs from the residents she cared for and falsified prescriptions for her own use while employed at the nursing home facility.

If convicted, Maher faces up to 20 years in prison and $20,000 in fines.

Carrie Garza pleaded guilty to three Class C felony charges of prohibited acts and three aggravated misdemeanor charges of wanton neglect of a resident at a health care facility. Her crime? Stealing pain medications from vulnerable residents at an Iowa nursing home facility.

Reportedly, a woman called the Alverno Health Care Facility in Clinton, Iowa on September 15, 2008, alleging to be a pharmaceutical provider and claimed to have recall information on Fentanyl patches. She requested the names of the residents using the medication.

Shortly after making the call, Garza came to the facility and staff directed her to the rooms of three female residents. Garza removed the patches from the residents and left the facility.

Clinton police received a tip on September 19, 2009 that Garza reportedly had been arrested for similar acts in Rock Falls, Illinois. She was identified in a line up by one of the facility's nurses.

Garza was ordered to serve two years supervised probation. The Court suspended three ten year prison terms and three two year prison terms and suspended the fines on the charges. Garza has already completed a substance abuse program and must pay restitution.

The Terry Law Firm is experienced in handling cases of nursing home abuse and neglect. Please contact us with any questions or concerns at www.nursinghomejustice.com.

Daniel Larmore recently resigned as the Administrator of Harmony House Care Center in Waterloo, Iowa. He remains the current Chairman of the Iowa Board of Nursing Home Administrators. The question some have is: should he hold that position?

The Iowa Board of Nursing Home Administrators is responsible for licensing and disciplining Iowa's nursing home administrators, but has not taken any action against an administrator in two years.

A Des Moines Register report published this week listed instances of nursing home administrators who were accused by the state of failing to prevent or investigate resident abuse without being disciplined by the Board. Interestingly, Larmore found himself in this position in 2004 when he was the Administrator of Harmony House and serving on the Board; he was never disciplined by the Board. Public health officials could not say if Larmore's case was ever reviewed by the Board, but Larmore acknowledged that the Board failed to review some cases that were sent in for potential disciplinary action.

In 2004, the Iowa Department of Inspections and Appeals alleged that Larmore failed to properly investigate and respond to complaints that a female nurse aide was repeatedly engaging in sexual intercourse with a 29 year old brain injured male resident. Co-workers had witnessed several suspicious encounters between the two and the resident's roommate also complained about the two allegedly having sex on the other side of the privacy curtain. Larmore argued that "The relationship was initiated by, and was meaningful to, (the resident)...The presented situation was one of mutual interest of a (resident) and a caregiver and, although inappropriate, did not present potential or actual harm to the consumer due to the reciprocal fond relationship." In Iowa, a professional caregiver who engages in sexual intercourse with a nursing home resident can be criminally charged with dependent adult abuse.

We discussed Dubuque Retirement Community and Jefferson Point Assisted Living Center and their intent to forego government licensure and inspection in our previous blogs. Now, Iowa officials have warned the owners of these facilities that if they move forward with plans to forfeit their licenses, they will be violating Iowa law.

In the past, both facilities had problems meeting minimum standards of care and have a combined total of more than $40,000 in fines in the past 18 months. Essentially, facility owners believe that, by forfeiting their licenses, the facility will be acting as a landlord rather than a health care provider and the facilities can avoid all inspections and regulations that come with assisted living centers. Allegedly, a separate company will deliver health care services to the residents.

State officials will not comment on what action could be taken against the facilities, but owners could be charged with running illegal, unlicensed care facilities.

As of August 21, 2009, Assisted Living Concepts informed Department of Inspections and Appeals Director Dean Lerner that it disagreed with his assessment of the situation and that plans to forfeit the license remain unchanged.

Fejervary Health Care Center, a nursing home facility located in Davenport, Iowa, faces yet another fine for its role in a recent patient death. The facility has had a history of problems and fines from the Iowa Department of Inspections and Appeals. The most recent fine was assessed in July 2009 in the amount of $6,000.

On June 12, 2009, a resident was admitted around Noon. The resident and spouse both advised the facility of the resident's recent history of falls. The facility identified the problem on the resident's Care Plan and listed interventions that included a bed alarm and body alarm.

Around 9 p.m., the resident attempted to get out of bed and the alarm sounded. Later, around 4:25 a.m. on June 13, 2009, the alarm sounded again. Responding facility employees found the resident on the floor in a puddle of urine. The first employee responding said that the resident fell head first but failed to tell the nurse that the resident had hit their head. After bandaging a small hand wound, the resident was asked if they were hurt and the resident responded "no". No one checked the resident's pupils or performed any neurological checks.

Around 9:20 a.m., the resident complained of hip pain and was given pain medication. Once again, the resident was not assessed.

Around 10 a.m., the resident "became restless and agitated, looking for cigarettes. The resident complained of having a headache above his/her right eye." Upon returning to the room, the resident was unresponsive and was taken to the hospital. The resident later died. The facility failed to inform the resident's physician about the fall.

Last year, the facility was fined $7,500 in connection to a missing resident, a resident who required additional monitoring due to inappropriate sexual behavior, and a resident who was left in a dark cafeteria waiting for breakfast for more than two hours.

The Terry Law Firm is experienced in handling cases of nursing home abuse and neglect. Please contact us with any questions or concerns at (888) 317-2525 or visit us on our website at www.nursinghomejustice.com.

We discussed two Iowa care facilities that were opting to relinquish their licenses and avoid state regulation in our previous blog.

Now, the Dubuque Retirement Community is defending its decision to give up its license. The facility will relinquish its license on September 14, 2009 and will become an unregulated facility not subject to annual inspections, state oversight, or sanctions for inadequate care. The facility is owned by Assisted Living Concepts, which operates six other assisted living centers in Iowa: Amelia House, Eiler House, Reed House, Swan House, Floyd House, and Allen House. According to Laurie Bebo, Assisted Living Concepts' CEO, the company considers its decision to give up its license to be a pilot program that will be evaluated over the next several months and "we need to see what the repercussions are".
Further, Bebo says the license forfeiture "doesn't have anything to do with the fines", which was met with laughter and groans from its residents during a recent meeting.

According to David Werning, the spokesperson for the Iowa Department of Inspections and Appeals, the agency is concerned about the facility's recent move and the repercussions it may have on its residents. Currently, the law prevents assisted living facilities from caring for people from caring for individuals needing multiple workers to assist with transfers. Once the facility gives up its license, the agency is worried that "we'll get a complaint that what they're actually running is an unlicensed nursing home. That's a real serious issue that we're trying to address with them now." Additionally, the agency is also concerned that Swan Home Health, which is a care provider owned and operated by Assisted Living Concepts, is nothing more than a dummy corporation. According to Werning, "It's a legal question as to whethere they've set up a fictitious corporation, Swan Home Health, to provide assisted living services just so they don't have to maintain an assisted living license."

The Dubuque Retirement Community is also in the eye of the Iowa Department of Inspections and Appeals for failure to comply with a March 12, 2009 order banning the admission of new residents while the facility's license is on conditional status due to past care problems. Despite the order, the facility has continued to admit new residents and according to CEO Bebo, she was unaware that the state would have a problem with that.

Jefferson Point Assisted Living Center in North Liberty, Iowa and Dubuque Retirement Community in Dubuque, Iowa are assisted living centers in Iowa that may soon be skirting the law and operating without any oversight. Both facilities plan to give up their licenses and separate health services from the housing, which will enable them to bypass state regulations that were designed to protect vulnerable, elderly residents. Both facilities plan to become only "landlords" and provide only housing to its residents. Health care services will be offered through a separate home health company.

One concerned nursing home and assisted living owner, Ed Osby, stated, "So there won't be any oversight there at all. You've got a renegade facility there that's doing an endrun around the regulations." According to an Assisted Living Concepts executive, the lack of oversight will not have any negative effect on care and will allow some residents to remain in their apartments without being sent to a nursing home when their health deteriorates.

Unfortunately, both facilities have had problems meeting minimum care standards in the past. The Dubuque Retirement Community was fined $16,500 in the past 18 months and Jefferson Pointe has been fined $10,000.

Interestingly, Jefferson Point was constructed with $7.2 million in federal assistance in the form of state approved loans and tax credits through the Iowa Finance Authority and Iowa Department of Economic Development. Jefferson Pointe intends to forfeit its assisted living license to attract more residents and both governmental agencies have granted approval.

The Center for Medicare Advocacy had contacted government officials concerning the imminent switchover. The Center for Medicare Advocacy is also objecting to Assisted Living Concepts' practice of evicting residents once their savings are depleted and they are dependent on Medicaid. Federal law prevents this practice in nursing home facilities but does not prevent it in assisted living facilities.

Bureau Chief for the Iowa Department of Inspections and Appeals Ann Martin has stated that while the actions to appear to be legal, they are unprecedented. "There will be no oversight at all. It's unheard of," she said.