As the coronavirus continues to spread across the United States, officials are tracking cases in nursing homes, where residents are at a heightened risk. According to a recent report, state officials have now reported at least 60 Maryland nursing homes and senior living facilities have confirmed coronavirus cases in the state. There have been six deaths at one facility in Mount Airy. Health officials have reported that 147 nursing homes across 27 states have at least one resident with coronavirus, according to one news report.

The Centers for Disease Control and Centers for Medicare and Medicaid Services looked into the high fatality rate at the Life Care Center nursing home in Kirkland, Washington, where at least 35 residents or staff have died from the virus. CMS found that the center failed to quickly identify and manage sick residents, notify the state’s health department about the rate of respiratory infection among its residents, and failed to have an adequate backup plan when the facility’s primary clinician became sick.

Seniors are at a greater risk because they are more susceptible to complications from the virus, a CMS administrator said in a statement. People over 65 years old are at a high risk of serious illness and death from the virus, according to the CDC. CMS said it would enhance its inspection process for nursing homes in light of its findings.

Nursing homes fill an important role in today’s society; as the population ages and life expectancy increases, more and more Americans are placing their loved ones in nursing homes to care for them when they are no longer able to care for themselves. Unfortunately, not all nursing homes are safe for residents, and sometimes residents may suffer abuse or neglect from the individuals tasked with caring for them. While the federal government has regulations governing nursing homes and standards of care, the current administration has recently attempted to loosen these regulations, causing concern for Maryland nursing home residents.

The proposal to relax regulations governing nursing homes was introduced in July of 2019 but has been drawing particular attention recently due to the coronavirus. According to an article in the New York Times, the federal government’s proposed changes would loosen regulations established during the Obama administration meant to curb deadly infections and diseases in nursing homes. Specifically, the rule would eliminate the requirement that nursing homes employ at least one specialist in preventing infections. Infection-prevention specialists are currently supposed to be at all nursing homes in the country, ensuring that employees are washing their hands and following other safety procedures. Their role is considered especially important when considering that, every year, about 380,000 nursing home residents are killed by infections.

While this proposed change is of concern even without the current pandemic, the coronavirus illustrates the vulnerability of nursing homes to infectious diseases. For example, one nursing home in Washington state has lost 13 residents to coronavirus, and dozens of other residents and employees have gotten ill. National reports indicate that the elderly are particularly susceptible to the coronavirus, with a significantly higher death rate than the general public. Additionally, those living in nursing homes are less able to practice social distancing, increasing their risk. Thus, advocates are urging the federal government to withdraw the proposed changes, which could lead to increased medical neglect, less infection control, and more illnesses and deaths in nursing home populations.

Individuals across the world are beginning to experience the devastating impact of Covid-19, commonly known as the novel coronavirus. The new strain of the virus has been identified in every state and is linked to the death of over 150 U.S. residents. Out of these deaths, at least 40 are connected to a single nursing center in Washington, and residents of other long-term care facilities. The widespread exposure throughout these nursing facilities shines a light on the fundamental problems nursing homes have containing the spread of disease. Maryland nursing homes should take the necessary precautions to limit the spread of these types of fast-spreading diseases and infections.

The coronavirus shares some similarities to the flu in that it quickly spreads through person-to-person contact or through respiratory droplets. Further, although the flu can be severe and have high rates of mortality, experts have years of studying the flu and generally know what to expect each season. In contrast, relatively little is known about the new virus and the diseases it causes. However, it is clear that, like the flu, the disease is highly contagious and spreads quickly.

Maryland nursing homes should follow the Center for Disease Control (CDC) recommendations for preventing the spread of disease. These diseases thrive and spread quickly in confined spaces, such as, assisted-living facilities and long-term care facilities. Healthcare workers must follow strict procedures to prevent serious illnesses, injuries, and deaths to their residents. Nursing home workers should practice proper hand hygiene, wear protective equipment, restrict visitors from contacting infected patients, and prevent infected healthcare staff from contacting patients. Nursing homes that do not engage in these practices may be responsible for the spread and consequences of a virus.

Generally, when two parties sign an arbitration agreement, they must resolve their claims out of court through the arbitration process. Thus, by signing an arbitration agreement, the resident waives the right to sue the facility in court. Of course, the parties must voluntarily consent to arbitration through an agreement or otherwise. This means that in a Maryland nursing home case, the person bringing the claim must have signed, or be bound by, an arbitration agreement with the facility.

One state’s highest court recently ruled that a family member could not file a wrongful death claim against a nursing home where the resident had an enforceable arbitration agreement with the facility. In that case, a resident’s daughter had power of attorney for her mother. The daughter signed an arbitration agreement for her mother when her mother was admitted to the facility in 2013. Her mother developed bed sores and died after undergoing surgery for the sores. The daughter filed a wrongful death suit against the facility, but the facility argued the claim had to be resolved through arbitration.

The issue in the case was whether the arbitration agreement was enforceable against a family member filing a wrongful death claim. The court found that based on the state’s statute, the state’s interpretation of wrongful death claims, and the decisions of other state courts, the arbitration agreement was enforceable. The court ruled that the state’s wrongful death statute did not supersede the arbitration agreements signed by the residents, and that a resident’s agreement to arbitrate extends to their family members in a wrongful death claim.

With the population aging and life expectancies increasing, nursing homes are becoming a part of more and more Maryland residents’ lives. Although many Maryland nursing homes offer quality care and safe facilities, nursing home abuse and neglect are still persistent problems across the state. It can be difficult to know the risk of this type of abuse and neglect when choosing a nursing home. While there may be warning signs to look for – such as past instances of abuse, or unclean or unsecure facilities – there are some cases where a seemingly fine nursing home may make decisions that then lead to abuse and neglect. Specifically, facilities that fall into financial trouble may cut staffing in the home, leading to new problems in a previously fine home.

For example, one nursing home was recently cited by the Centers for Medicare and Medicaid Services for making staffing decisions that led to several dangerous incidents. According to a news report covering the story, the home, which once operated seemingly without issue, suffered financially in recent years, leading them to cut staffing to save money. These personnel cuts led to an increase in quality-of-care violations cited by state regulators, with six violations in 2017 that jumpted to 22 in 2018 and 36 in 2019. The incidents included not having portable liquid oxygen tanks for patients who needed them, hiring an unlicensed caregiver, allowing a kitchen worker to supervise the dementia ward, and multiple instances of sexual abuse and medication errors. Additionally, inspectors found that the home, because it was short-staffed, was unable to adequately respond to residents’ requests for assistance. Some residents reported soiling themselves as they waited 40 minutes for someone to come to help them.

Incidents like these, which were particularly bad at this specific nursing home, unfortunately happen in facilities all across the country. Oftentimes, the patients are extremely vulnerable and frail, and may be unable to defend themselves or even tell someone else what is happening. Because of this, it is particularly difficult to catch nursing home abuse and neglect. When it is identified and caught, however, the state law allows the victims and/or their loved ones to file a suit against the home and hold them accountable for their actions. These suits may be difficult but can result in significant monetary compensation for those who have been harmed as a result of negligent staffing or other negligent actions performed by the nursing homes.

These days, nursing homes in Maryland routinely incorporate arbitration provisions or agreements into their admission paperwork. People often do not question signing the agreement—until nursing homes try to force them into arbitration later on. Arbitration allows nursing homes to avoid costly litigation in a private decision-making process, generally with no right to appeal. However, an arbitration agreement may not be valid in some cases. A patient may lack the necessary capacity to enter into a contract, the person may have signed under duress, the provision may violate a state, federal, or local law, or the person who signed the agreement may not have had to the legal authority to sign on the resident’s behalf, as in the case below.

Court Invalidates Arbitration Agreement Signed by Resident’s Son

In a recent case before another state’s appeals court, the court invalidated an arbitration agreement that was signed by the resident’s son. In that case, the mother had been a resident of the nursing facility for about a month in 2016. The son signed an admission agreement and an arbitration agreement when his mother was admitted to the nursing facility. The son signed under “Responsible Party.” Under the agreement, Responsible Party was defined as a person with legal authority to sign for the resident, including a legal guardian or an attorney-in-fact.

When someone is unable to care for themselves, they will often end up staying in some sort of residential institution, such as a nursing home or a rehabilitation center. These facilities are supposed to care for individuals and make their lives easier. Maryland law imposes a duty on these facilities to care for their residents, and if residents suffer abuse or neglect, such as neglecting medical needs or causing psychological harm, they can hold the institution liable in a civil negligence suit.

One of the most common types of lawsuits filed against a nursing home is a medical malpractice claim, particularly for failing to transport a patient to the hospital when they clearly needed to be treated by a professional. In a recent opinion, a state supreme court considered one of these cases, affirming a jury verdict awarding over $2.2 million dollars to the plaintiff.

According to the court’s written opinion, the seventy-six-year-old plaintiff began experiencing significant knee pain in her right knee, causing her to undergo surgery in early 2014. To recover from the surgery, the plaintiff was transported to a rehabilitation center. While in the center, the plaintiff continued to experience excruciating pain and then began showing signs of confusion in mid-March of 2014. The notes taken by nursing assistants caring for her indicated her confusion, which got worse throughout the night, an elevated heart rate, massive bruising on her leg, and that her right foot curled inward and appeared to be limp. According to the notes, the plaintiff told the nursing assistants that she was in the worst pain of her life, asking them to shoot her to end her misery.

More and more Maryland nursing homes are having their residents sign arbitration agreements, raising concerns for victims of nursing home injuries, abuse and negligence. Arbitration agreements force residents to settle disputes with the nursing home through arbitration, a private and confidential process with no possibility of appeal, rather than having the option to bring a civil negligence suit in court. Essentially, by signing an arbitration agreement, which may or may not be obvious and apparent in the nursing home’s contract and forms, Maryland residents may be waiving their right to sue if something goes wrong.

Arbitration agreements come in many forms, however, and just because a resident signed one does not necessarily mean that they have unequivocally waived their right to sue. Many arbitration agreements dictate a specific type of claim that must be settled in arbitration, leading to eventual disputes over whether or not a plaintiff’s claim falls into that category. For example, a state appellate court recently issued an opinion considering such a dispute in a wrongful death and negligence claim. According to the court’s written opinion, the resident was admitted to the nursing home in 2013 with various cognitive and physical ailments, including Parkinson’s disease, heart disease, dementia, psychosis, functional quadriplegia, and chronic kidney disease. When admitted, her son, as her representative, signed an “Admissions Agreement.” This agreement included an arbitration clause for “any dispute as to medical malpractice,” which was further defined as disagreement over whether medical services rendered to the resident was necessary, unauthorized, or improperly, negligently, or incompetently rendered.

In 2016, a little over three years after living in the home, a nursing assistant was pushing the resident back to her room after breakfast. While on their way, the resident’s foot got caught in a loose cord, which catapulted her headfirst onto the floor, breaking her neck. Tragically, the resident died five days later due to her injuries. In the aftermath, her estate sued the nursing home for wrongful death and negligence, and the nursing home moved to compel arbitration under the Admissions Agreement’s arbitration provision. However, the court found that the nursing home could not compel arbitration under their agreement, because the agreement only covered disagreements over medical services rendered. Although the incident led to medical services and medical evidence was produced against the defendant nursing home, the dispute was not itself over medical malpractice, and thus the nursing home could not force the plaintiffs to arbitrate.

Each year, more states enact laws that allow for cameras in nursing homes and assisted living homes, which provide much-needed protection for residents. The laws allow residents and their families to place cameras in the residents’ rooms. In 2003, Maryland enacted a law requiring the Maryland Department of Health and Mental Hygiene to develop guidelines for electronic monitoring. Under those guidelines, the state currently allows electronic monitoring in Maryland nursing homes with resident consent—but only if the nursing home allows it.

Meanwhile, other states continue to enact electronic monitoring laws, many that provide much greater protections to residents. According to a local news source, Minnesota recently passed an electronic monitoring law to protected elderly adults. The law, entitled the Elder Care and Vulnerable Adult Protection Act of 2019, took effect on January 1, 2020. A state ombudsman said that electronic monitoring is a right included in the state’s Home Care Bill of Rights.

The law was advocated for by families whose loved ones were abused or mistreated. Under that state’s law, there is a consent form required in order to obtain the monitoring device. Providers such as nursing homes must tell residents about the law and have the forms available to use. Consent is required from all people living in the same room. Before the law was enacted, according to the ombudsman, residents and their families were installing cameras, but there was nothing to stop others from removing the cameras. Under the new law, residents there can install cameras without letting the providers know.

The Centers for Medicare and Medicaid Services (CMS), an agency that oversees Medicare and Medicaid and works to identify and eliminate nursing home fraud and abuse, recently released a memorandum detailing their 2020 priorities. These updated priorities are important for Maryland families to understand, as they affect the rights of nursing home residents as well as a resident’s ability to recover in case of nursing home neglect or abuse.

One of the major updates included in the 2020 memorandum concerns arbitration agreements. Arbitration agreements, if signed, require an injured nursing home resident to settle disputes with the home through a confidential arbitration process, rather than in court. This process operates privately, and while it is much faster than traditional litigation, plaintiffs lose any right to appeal and evidence shows plaintiffs are more likely to lose in arbitration. CMS’s recent memorandum states that the agency will allow nursing homes to use binding arbitration agreements with their residents, but that such agreements cannot be required as a condition of receiving care. For instance, if a resident refuses to sign the agreement, nursing homes cannot refuse to care for them solely on that basis. Additionally, CMS indicated in the memorandum that nursing homes must also explain to residents or their representatives that they can still receive care without signing.

CMS also stated that it plans to make changes to how instances of abuse and neglect are reported and investigated. For instance, new guidelines released later this year may include changes in the time frame required for investigations, the collection of certain evidence and investigative report, and general new policies and procedures to be implemented in nursing homes to catch instances of abuse.

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