As arbitration agreements have become routine in many nursing facilities, questions may arise after ownership of the facility has been changed. Like other agreements, Maryland nursing home arbitration agreements can generally be assigned. An assignment of an agreement allows the assignee to “stand in the shoes” of the original party to the contract by granting all the rights the assignor previously had under the agreement.

A recent federal court decision considered whether an arbitration agreement could be enforced against residents after the facility had been transferred to new owners and new agreements had been signed. The case raised issues about when an arbitration agreement is properly assigned and transferred.

In that case, two residents entered a nursing facility in 2019. In April 2019, one resident entered the facility and signed numerous admission documents, including an arbitration agreement, though the agreement was not a condition of admission. The arbitration agreement stated that all claims relating to the resident’s stay were required to be decided through arbitration. In August 2019, the second resident was admitted and signed the same admission documents. In February 2020, the facility was sold and transfer to a new entity. A transfer agreement assigned the new entity as the assignee for certain agreements.

One of the reasons that Maryland nursing home abuse and neglect are so horrible is because they can fly under the radar for so long. Nursing home residents who are being abused or neglected may be cognitively impaired and not even understand what is happening to them, or have trouble letting other people know. Unfortunately, the COVID-19 pandemic has only exacerbated this problem, making it even harder for Maryland nursing home abuse and neglect to be identified and investigated.

The COVID-19 pandemic has hit nursing homes particularly hard, and many of them are hot-spots for the virus, with the unfortunate combination of group living and COVID-vulnerable residents. Extra precautions have been taken in many to prevent the spread of infection within the facilities, or from the facilities to the surrounding area. This led to the Centers for Medicare and Medicaid Services to halt on-site visits and surveys to state-run nursing homes, and, in general, investigators and those tasked with monitoring the facilities have not been able to enter nursing homes to respond to complaints.

Additionally, due to the COVID-19 pandemic, many nursing homes have restricted the visiting of residents. Before, family members played an important role in spotting nursing home abuse and neglect—they might notice red flags before anyone else. If they suspected that their loved one was being mishandled, not being given their medicine, or being underfed, they were able to report that concern or ask their loved one about it. But now, with COVID-19 concerns and restricted visiting hours and opportunities, family members may not be able to play this important role, and abuse and neglect might go unseen.

Many nursing home residents rightfully rejoiced this week as nursing homes began receiving vaccines for distribution. Long-term care facilities have suffered many of the COVID-19 deaths in the country. At least a third of COVID-19 deaths in the United States have been among residents and employees of nursing homes and other long-term care facilities. There have now been more than 20,000 cases of COVID-19 in Maryland nursing homes, group homes, and assisted living facilities and at least 2,200 resident deaths during the pandemic. Deaths in these facilities have accounted for about half of the state’s death toll.

According to a recent news report, CVS and Walgreens pharmacies are finally beginning to distribute COVID-19 vaccinations this week in the state’s long-term care facilities. Many residents are anxious to get vaccinated and end a long period of isolation from their families. Vaccinations have begun to be administered in facilities just as the conditions in the facilities have deteriorated again. According to the American Health Care Association and National Center for Assisted Living, there have been almost 20,000 cases and about 5,000 deaths per week in recent reports.

However, even as residents and staff are beginning to get vaccinated and celebrate this milestone, Maryland nursing homes and long-term care facilities must still take care not to spread COVID-19 in the facilities by relaxing precautions yet. Vaccinations are voluntary, so most nursing homes likely will not be able to vaccinate all residents and staff. Facilities may also have difficulty obtaining informed consent from patients who lack the capacity to make the decision on their own. Facilities will still have to protect residents who do not get the vaccine. In addition, it is not clear if the vaccine will be 95 percent effective among older people who are more vulnerable to disease in general.

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It’s hard to believe that Maryland nursing home abuse and neglect occurs. When individuals place their families in a nursing home, they expect that the home and the staff will take care of them, look after them, and keep them safe. Families place loved ones in a facility to be cared for because their aging family member can no longer care for themselves. That is one of the reasons the reality of Maryland nursing home abuse and neglect is so tragic, and it can be difficult for individuals to wrap their minds around.

A recent tragic example of nursing home abuse was reported last month, concerning a 91-year-old disabled woman. According to a local news report, the incident occurred late at night and into the early morning, when one staff member put the resident on the toilet inside of her apartment at 8:20 PM. The staff member instructed another caregiver to put the resident to bed once she was finished. But the caregiver never did. Instead, the resident was left on the toilet. She was not found until more than six hours had passed, around 2:45 AM, at which point she was on the floor. The whole ordeal was captured on video by a camera that her daughter had placed in her room. In the video, the woman could be heard moaning, crying, and repeatedly saying, “help me.” To add insult to injury, the two employees were caught on video surveillance cameras in a dining room, taking selfies for over an hour, according to an arrest report.

In addition, the resident’s daughter told investigators that this was not the first time her mother was left on the floor of her apartment. Once before, her mother had been left for five hours—a concerning pattern.

Nursing home residents may feel as though they have lost the ability to make decisions for themselves and that they have no rights when they enter a facility. This may be particularly true during the COVID-19 pandemic, when many nursing homes have limited the movement of residents and while many facilities struggle to meet resident needs. However, all Maryland nursing home residents have rights and legal protections, even during a pandemic.

Maryland’s Office of Health Care Quality monitors the quality of care in the state’s health care facilities. Under Maryland law, suspected abuse of assisted living residents must be reported to the Office of Health Care Quality. Reports of abuse can be made at 877-402-8219. Maryland’s Department of Health Long Term Care Unit investigates complaints of abuse and assists with the prosecution of abusers.

Under the Code of Maryland Regulation 10.07.09.08, Maryland nursing home residents are afforded some of the following basic rights.

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When Joe Biden is sworn into the office of the President of the United States, there are going to be some major changes. Indeed, he and President Trump clashed on many of the most important issues facing the country. However, one very important issue that got relatively little attention was how a Biden administration might impact Maryland nursing home arbitration agreements.

Arbitration is a way for litigants to settle a claim out-of-court. Instead of filing a case in court and letting a judge or jury decide the outcome, in arbitration, a neutral arbitrator hears the evidence and issues a binding decision. While this may seem good in theory, it often works in favor of nursing homes, who get to choose the forum and are intimately familiar with the rules of arbitration. Additionally, there are generally very few ways to appeal an arbitrator’s decision, limiting a resident’s ability to obtain any form of judicial review. For these reasons, and others, many nursing home residents end up at a major disadvantage when they are forced to arbitrate their claims.

During the Obama administration, the Centers for Medicare and Medicaid Services precluded nursing homes from asking residents to sign pre-admission arbitration contracts. The reasoning behind this was that nursing home residents and their families may not be in a position to negotiate the terms of the agreement, and would likely just accept them, even if they are against their interest.

Although there has been significant attention given to the risk and prevalence of COVID-19 in nursing homes throughout the pandemic, the pandemic may be the cause other detrimental circumstances suffered by Maryland nursing home residents. According to one news source, advocates say that workers in nursing homes that are overburdened because of the pandemic have not been able to properly care for residents and that many are suffering as a result. Advocates say that there has been a surge of reports of neglect, including residents being left in dirty diapers until their skin peeled off and others with bedsores that cut to the bone. In addition, some residents’ mental health has significantly declined because of their prolonged isolation, which some believed led to their death. One expert estimated that for every two COVID-19 victims in nursing homes, another died prematurely due to other causes.

The numbers suggest that other residents who were lucky enough not to contract COVID-19, were also impacted—as staff attended to infected residents or because staff members were absent because they were infected themselves. A 75-year-old man became so malnourished and dehydrated that his weight dropped to 98 pounds. There were signs of an untreated urinary infection, poor hygiene, and that he was not getting the help he needed to eat. His son claims that the nursing home abandoned his father. An 83-year-old woman in another nursing home died from dehydration, according to her daughter. As COVID-19 spread throughout her facility, while she did not contract COVID-19 herself, staff members failed to ensure she was drinking enough fluids. Federal data reveals that almost 1 in 4 nursing homes report staff shortages now in 20 states.

The Rights of Maryland Nursing Home Residents

A Maryland nursing home resident has the right to be free from abuse and neglect and live in a safe facility. A Maryland nursing home claim can be filed in cases where nursing homes or their staff have abused or neglected a resident. Some potential signs of abuse and neglect are bedsores, unexplained injuries, insufficient funds, and fear of certain persons. Signs of neglect may include poor personal hygiene, lack of mobility, unexplained injuries, unsanitary living conditions and inadequate security, physical symptoms from lack of nutrition, and psychological issues, including anger, resentment, and depression.

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Abuse and neglect can, unfortunately, run rampant in Maryland nursing homes, putting residents in danger of serious injuries, illness, or even death. Oftentimes, incidents of abuse and neglect may go unnoticed or unreported, and residents or families of residents may have no idea of the extent of the problem. If, for example, 20 residents are all being abused or neglected in subtle ways not recognized by their families, family members may think their loved ones are in a safe facility and well taken care of when in reality they are not. Even if individual family members realize that their loved one is being harmed, they may assume that it is an isolated incident, or chalk it up to an accident. This is one of the key reasons that nursing home abuse and neglect in Maryland nursing homes can go on for so long and cause so much harm.

According to a recent news report, a group of about 15 people gathered outside a nursing home decided to speak out against the alleged abuse and neglect that their loved ones suffered during their time at the facility. The group believes that the situation is a crisis. For example, one woman’s father claims he was punched by a nursing home staff member. His family also found multiple bruises going up and down his body, which suggested that he was carelessly slung into a wheelchair. In addition, family members believe that residents are not being fed properly. One woman told reporters that her father lost almost 50 pounds, and that she believed “they are not feeding these people. They are starving them.” Another woman reports that her 76-year-old mother, who uses a wheelchair, has had three major falls in just seven months, including one where she broke her femur.

As explained above, it can be difficult for families to uncover nursing home abuse and neglect. But when they uncover these tragic and alarming instances, state law allows them to hold the nursing home accountable through a Maryland personal injury lawsuit. These lawsuits can be incredibly valuable for victims of abuse and neglect and for their families. If successful, they can result in large monetary amounts awarded to the plaintiffs to cover the harm that was caused, including for medical expenses, pain and suffering, or even funeral and burial costs if the resident dies.

Many Maryland families will one day make the decision to place a loved one into a nursing home, if they have not already. As the population ages, nursing homes are becoming more and more necessary for individuals who can no longer care for themselves and need assistance in their daily activities. While many residents may have pleasant experiences in their nursing homes, the tragic fact is that nursing home abuse and neglect are still common occurrences in Maryland and nationwide. In fact, one survey of nursing home residents showed that up to 44% of them had been abused at some point, and almost 95% had witnessed someone else be neglected. Despite its prevalence, this abuse and neglect might sometimes fly under the radar, especially when the resident victims are ill, confused, and unable to report it themselves.

Thus, unfortunately, the onus may be on family members to identify abuse or neglect in nursing homes. In some situations, the signs will be subtle, or easily written off as something else. Still, family members should, when visiting their loved ones in Maryland nursing homes, pay close attention to some “red flags” that may indicate abuse or neglect.

Some of the signs are situational—what are the living conditions like? Unsanitary conditions in the residence may be a sign of general neglect. Other signs have to do with resident behavior. Does the resident act oddly when staff members are around? Do they have sudden unusual behaviors, such as a fear of being touched or extreme irritability? Lastly, the physical condition of the resident can shed some light on the situation. Unexplained bruises, cuts, or other injuries should definitely raise concern, as should poor hygiene, sudden weight loss, falls, fractures, or infections.

Maryland nursing homes must meet certain standards under state and federal regulations. They must follow state laws and regulations applicable to nursing homes. In addition, facilities that accept Medicare and Medicaid patients are also required to meet federal nursing home standards. Federal and state regulators ensure compliance by conducting surveys, visits, and investigations.

According to a recent news report, the Democratic candidate for president Joe Biden has said that he plans to spend $775 billion to expand community-based senior services if elected. He also wants to enact nursing home reform in the wake of the coronavirus pandemic. The current administration has generally maintained less oversight with a goal of reducing perceived paperwork burdens and focusing on public-private partnerships to tackle issues. For example, the administration plans to rely on retail pharmacies CVS and Walgreens to distribute a COVID-19 vaccine in nursing homes. The administration has proposed less frequent surveys of the highest-ranked nursing facilities to concentrate on “low performers.”

Biden has said he would make federal nursing home surveys more frequent and increase the current penalties to force compliance with federal standards. He also proposed requiring that each facility have a mandatory infection disease specialist, requiring the federal Department of Health and Human Services (HHS) to audit nursing home cost reports, and increasing personal protection equipment (PPE) supplies by invoking the Defense Production Act. The proposal also calls for restoring a previous ban implemented by President Obama on forced arbitration agreements for residents—a ban that President Trump reversed.

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