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Jacuzzi or Injury – How Medicare Handles “Dangerous” Nursing Homes

medicare

Imagine sitting in a large, luxurious arm chair next to a babbling waterfall fixed in Zen garden. As you look to your right, you can see a long hallway filled with rooms that lead to a relaxing Jacuzzi. To your left, another long hall lined with rooms leads to a lounge cluttered with every amenity you could think of (coffee, cookies, HBO access, the works).  The reception desk welcomes you to this inviting location.

While this scene appears to be one like a five-star hotel on Michigan Avenue, instead, a new trend among some nursing homes and other rehabilitation centers tries to lure new patients in order to gain Medicare benefits. However, although the amenities of the facilities seem top of the line and successfully entice patients, some nursing homes fail to provide the type of care comparable to their amenities.

Warning Signs

Although millions of Americans live at wonderful nursing home facilities with experienced and wonderful staff, some nursing homes give the rest a bad name. Several facilities hire unskilled nurses and workers and lack a sufficient number of doctors. Additionally, understaffing affects the rehabilitiation and medical care needs of the residents.

According to a study conducted in 2014 by the Department of Health and Human Services’ Office of the Inspector General, 22% of Medicare patients staying in a nursing home for a duration of 35 days or less experienced injury or harm from the medical care received. Additionally, 11% of Medicare patients endured some sort of temporary injury. The study stated that Medicare spent an estimated $2.8 billion on hospital visits and treatment for the injured Medicare recipients.

Hour to Hour Care

Most people typically picture a nursing home filled with older people needing hour to hour care. However, nursing home and rehabilitation centers alike welcome short term stays for anyone utilizing Medicare insurance. In fact, these centers are pushing to enroll more Medicare patients as opposed to Medicaid patients. Currently,  Medicare pays facilities 84% more for short term patients than Medicaid pays for long term residents.

With large percentage difference in payment, nursing homes and rehabilitation centers eagerly welcome Medicare recipients. But what is the difference between a Medicare recipient and a Medicaid recipient?

Medicare v. Medicaid in Nursing Homes

According to the Medicare.gov website, “Medicare is the federal health insurance program for people who are 65 or older.” Additionally, younger people with disabilities or for people with End-Stage Renal Disease can use Medicare

There are three kinds of Medicare plans:

  1. Hospital Insurance (Part A)
  2. Medical Insurance (Part B), and
  3. Medicare Advantage Plans (Part C).

In contrast, “Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources.”

While these two benefit services are separate, it is important to note that a person can have both Medicare and Medicaid coverage. In terms of determining who pays first, Medicare.gov states that “Medicaid never pays first for services covered by Medicare.” Instead, Medicaid pays after Medicare and all other insurance coverage providers have paid.

Special Focus Status

Due to a growing number of Medicare recipients needing rehabilitation center and nursing home care, Medicare as begun to impose higher scrutiny on the facilities. Medicare officials note the number of Medicare recipients at a facility who have needed hospital care based on an injury. The federal government then places the facility on “special focus status.” This status is the highest and strictest forms of monitoring that is reserved for the poorest performing facilities in the nation. “Special focus status” facilities are required to either fix gaps in patient care while the government provides increased inspections or be threatened with losing Medicare and Medicaid funding. Facilities can also be punished with monetary fines.

Medicare Rights for Residents of Nursing Homes

The Medicare.gov website states that residents of nursing homes and rehabilitation centers have rights and protections under both state and federal law. Some of these rights and protections include:

  • Freedom from discrimination
  • Right of respect and dignity
  • Right to be informed on services and fees
  • Freedom from restraints
  • Right to manage money
  • Right to privacy, property, and living arrangements
  • Freedom from abuse and neglect
  • Right to proper medical care
  • Right to receive visitors
  • Protection against unfair transfer or discharge
  • Right to social services
  • Right to complain
  • The Right to see family and friends

Facilities must honor these rights granted to patients, and facilities that violate those rights that involve the proper care of patients are put on “special focus status.”

If you know someone who has had any of these rights violated by their nursing home, please contact the experienced nursing home lawyers at the Law Offices of R.F. Wittmeyer, Ltd. today for a free consultation.

How Does the Government Define a Dangerous Nursing Home?

The government puts a nursing homeon “special focus status” when

  • Giving a patient incorrect medication
  • Failing to protect patients from violent or bullying residents or staff members
  • Neglecting to tell the patient’s family or physician about injuries
  • Failing to provide adequate care by having a sufficient number of registered nurses and qualified doctors
  • Failing to conform to federal government regulations given to facilities to ensure safety of patients

Facilities can end their high watch status by fixing the issues stated by the federal government. However, of the 528 nursing homes in 2014 that lost their “special focus status,” 52% have relapsed into providing dangerous care, harming patients, or placing patients in serious jeopardy.

These relapsing violators are usually not placed back under “special focus status” and watch. Instead, the government imposes fines.However, facilities can continue to operate with unpaid fines and multiple penalties.

How to Research a Nursing Home

As a consumer, you can choose where you. Don’t just look at the Jacuzzis and Zen gardens. Ask about their hiring practices

And go to https://www.medicare.gov/nursinghomecompare/search.html to compare nursing home rankings and reviews and to make the best choice for you.

Senate Confirms Supreme Court Justice Neil Gorsuch

Neil Gorsuch

On Friday, April 7th, after more than thirty hours of debate, the Senate confirmed Judge Neil M. Gorsuch, with a final tally of 54-45 in favor of confirmation, who is now the 113th justice of the Supreme Court. For over a year, the Supreme Court has only had eight justices because of a political battle over who was going to sit on the bench. President Donald Trump appointed Justice Neil Gorsuch after committing to appointing a conservative to the bench after Justice Scalia died last February. The new justice may serve for over three decades.

[Read more…]

2017 Hon. Timothy C. Evans Law School Scholarship

Timothy C. Evans and Ron Wittmeyer

Ron Wittmeyer with Chief Judge Timothy C. Evans and Judge Neil H. Cohen at the 2016 NWSBA’s Judge’s Night

The Timothy C. Evans scholarship was established to honor the commitment and dedication that the Chief Judge of the Circuit Court of Cook County has devoted to the Northwest Suburban Bar Association (NWSBA) and to the community of Cook County.

Who Is Timothy C. Evans?

As the Chief Judge of the Circuit Court of Cook County, Timothy C. Evans presides over one of the largest unified court systems in the world. Cook County has more than 400 Judges and more than 2.4 million cases filed annually. During his tenure as Chief Judge, Judge Evans has innovated safe haven programs for children of parents attending or guardians attending court. Additionally, he has been a tireless champion of expanding opportunities for women and minorities in the court system. Also, Chief Judge Evans led the effort to open the new, domestic violence courthouse located at 555 W. Harrison Street in Chicago, which opened in 2005.

The NWSBA Foundation, which was established to increase the association’s charitable reach, is honored to recognize Judge Evans’ contribution to the legal community through this scholarship.

In 2013, Chief Judge Timothy C. Evans received the NWSBA’s Public Service Award at the NWSBA’s annual Judges’ Night. Also, Judge Evans was in attendance when Judge Neil H. Cohen received the Northwest Suburban Bar Association’s 2016 Public Service Award.

Who Is Eligible for the Timothy C. Evans Scholarship?

The Scholarship is available to law school students currently attending an Illinois accredited law school who reside in the Northern District of Illinois, Eastern Division. This division includes Lake, Kane DuPage, Cook, Will, Kendall, Grundy and LaSalle counties. The law student should have demonstrated a commitment to the highest scholastic standards. Additional considerations include scholastic achievement, involvement in school and extracurricular activities, in addition to financial need.

The deadline to apply for the Hon. Timothy C. Evans law school scholarship is March 23, 2017.

Crosswalks: Being Safe While Crossing

Accidents in CrosswalksWith the beginning of the school year, more students walk as they head to school and will use crosswalks. Many parents rightfully worry about the safety of their children while walking to school. It is too often that pedestrians or bicyclers are killed or fatally injured while using a crosswalk. Recently, a Mount Prospect cyclist was killed after a driver failed to stop at a crosswalk. At this particular crosswalk, a special beacon flashed to warn drivers that someone is crossing. People wonder if a more effective way exists to warn and alert drivers of pedestrians in crosswalks. [Read more…]

Tammy Duckworth to Replace Mark Kirk

Tammy DuckworthThe 2016 election came with many surprises, but the election of Rep. Tammy Duckworth to the Senate surprised very few pundits. For now, Republicans have a majority of the seats in the House and the Senate. This means that it will most likely to push Republican policies through. This Tuesday, Illinois elected a new senator, Tammy Duckworth. Rep. Duckworth will replace Mark Kirk as senator. As of 2017, both Senate seats in Illinois are occupied by Democrats. While this election did come with many surprises, Duckworth winning the Senate seat did not come as a surprise to many.  [Read more…]

Watch Out for Cubs World Series Ticket Scams

2000px-chicago_cubs_logo-svgFor the first time since 1945, Chicago experiences a Cubs World Series as the Cubs have made it to the World Series, and Cubs fans in Chicago are excited for this historic moment. The whole county roots for the Cubbies! Additionally, the Cubs have not won the World Series since 1908, and some people have waited their whole life for this moment to happen, so it is safe to say that it is a pretty big deal. Additionally, this World Series is historic because the Cleveland Indians have not won the World Series since 1948, and Cleveland has not had much luck with sports for many years, up until this past summer when the Cavaliers won the Championship. Unfortunately, some people may try to capitalize on this historic moment by selling fake tickets to fans who want to be a part of the moment.

Additionally, if you want a chance to win a W flag each time the Cubs win, enter our current giveaway.

[Read more…]

Mount Prospect: Driver Involved in Bicyclist Death Faces New Charges

Mount ProspectIn June, a driver struck and killed a 55-year old woman riding her bicycle in Mount Prospect. Police revealed that the woman who was driving the car was the person who caused the collision. But they also claim that the bicyclist contributed to the crash as well. Shortly after the accident, concerns raised about the safety of crosswalk beacons that the bicyclist used to cross. This new crosswalk has caused people to question the safety benefits of crosswalk beacons.

Crosswalk Beacons

In order to make a busy crosswalk safer for pedestrians, the city of Mount Prospect installed a crosswalk beacon. Just months after the installation, a driver struck and killed a bicycler in Mount Prospect on this crosswalk. Irregardless, these beacons continue to pop up more and more all across Illinois. Crossing beacons are installed on traffic signal poles with regulatory warning signs to try to alert the driver of a crosswalk when the driver approaches the crosswalk. This allows drivers to know that pedestrians might be present so that drivers can slow down and stop for pedestrians to cross. To activate the beacon, the pedestrian presses a button and drivers are alerted that a pedestrian will cross.

Benefits of a Crosswalk Beacon

2750714149_36a7b7bfe0_bOn paper, beacons seem to benefit pedestrians who are attempting to cross a crosswalk. A study revealed that, at crossings with no beacons, drivers yielded to only 18% of pedestrians, but when beacons were present, drivers yielded over 80% of the time. Additionally, these beacons

  • increase driver compliance with the law and drivers stop completely at these crosswalks,
  • cause drivers to become aware of pedestrians, and
  • increase the flow of traffic since drivers do not have to stop if no pedestrians are present.

New Charges Against the Driver

Initially, the driver in the accident was charged with failing to reduce speed to avoid an accident. The driver allegedly drove without corrective lenses and that the driver allegedly improperly passed a vehicle stopped at a crosswalk. The police have also indicated that a state traffic law says a pedestrian should not enter the roadway when another vehicle is dangerously close. The victim’s wife responded to this allegation calling the police’s words slanderous, irresponsible, and insulting. Her family states that the bicycler activated the warning signals, waited for vehicles to stop before crossing on the crosswalk, but then was struck as she got to the middle.

Is There Another Safer Option Besides Crosswalk Beacons?

Another option exists for those who question the effectiveness of crosswalk beacons: another type of crosswalk signal. Commonly known as a pedestrian hybrid beacon, this beacon could fix some of the problems that regular traffic beacons have failed to reconcile. This device hangs over the road and is dark until a pedestrian activates the device by pressing a button. Once the pedestrian presses the button, the device emits a yellow warning light to alert drivers of the presence of a pedestrian. Then the beacon turns red, which would force drivers to stop. Therefore, the pedestrian can safely cross the road. A study conducted in Texas and Arizona found that 96% of drivers stopped with this type of cross walk signal.

What Drivers Must Do 

Since a new traffic signal will require action in Mount Prospect and state legislature’s part, drivers must start making changes today. Drivers should pay attention to

  • the traffic beacons that are currently in place, and
  • always stop completely at them, even if no pedestrians appear to be present.

Especially since school has begun, drivers should be aware of little children that might be harder to see than an adult. Most importantly, drivers should always yield the right of way to pedestrians.

How to Avoid Bicycle Accidents as a Driver

  • Recognize that bicyclists the right of way. Bicyclists have all the rights of drivers of cars and trucks,
  • Pay close attention to the road and check for bicyclers before entering an intersection.
  • Before backing out of your driveway, check for any young children riding their bikes by the end of your driveway,
  • Give bicyclists enough room when you pass them.

Car Insurance Rates Increase With Accidents


Got Car Insurance?Everyone has car insurance. Or at least the law requires everyone to have car insurance. But no one wants to use their car insurance! After a car accident, the driver files a claim with the insurance company if he or she wants to be reimbursed for the damages. Yet, when the damage is minor, a lot of drivers try to avoid filing minor claims. They fear a claim will trigger a higher premium for their car insurance.

Recently, analysts tied the rise in car insurance rates to an increase in accident rates. They point to distracted driving and drowsy driving as the cause. These conditions have led not only to higher insurance premiums, but also many fatalities. Drivers absolutely need to pay closer attention to the road when behind the wheel. [Read more…]

“How can Cook County help you today?” – Putting Services First with New Website

As many people are frustrated with the DMV or jury duty, sometimes people are frustrated when they log onto a website that is supposed to provide services that the government offers. A lot of times, people have to click through several pages of confusing materials before they can actually find who to contact for the service that they need. Cook County has taken a seemingly revolutionary approach by making “services” the number one focus of their website.

With their new website, Cook County has made finding it easier for users to find a lost pet, apply for a job, pay for a ticket, request a birth certificate, or report something.

What Was Wrong with the Old Website?

cook county illinoisPeople rarely visit a government website to figure out how the government works. Most users visit government websites to figure out who to contact for a certain service. The old website focused more on “who does what” in the government, so the user was not really the focus of the website. Cook County saw that this was problematic, since it has long been held an American belief that the government should be designed to serve the people. After all, that’s where our tax dollars go, why should the people have to navigate through complicated websites just to find a service that the government is required to offer?

What Changes Has Cook County Made?

The new website puts the user first by focusing on services. In fact, when a user goes to the website, the first thing the user sees is a large search box with the words “How can Cook County help you today?”  When a user types in the box, suggested search terms pop up, and when a user searches for something, the results are very user friendly. After conducting a search, the user can filter the results, and a list of services related to the search term appears below the results.

What Else Is New on the Cook County Wesbite?

At the top of the page, the first main menu item says “I want to.” If a user opens that menu, a list of services will drop down. These are the most commonly requested services, and now they are very easy for users to find. Some of the most commonly requested services that are included in the drop down menu instruct people on how to apply for a job, get information regarding worker’s compensation, find where to vote or property information, pay property taxes or a hospital bill, request to postpone jury duty, and report an environmental complaint.

Several other services are now on the drop down menu so users do not have to go searching through the website to find them. It does not matter if you are using a smartphone or a computer; the website will adjust to whatever you are using.

What If Users Want to Search by Agency?

Users can still search by agency if they want, but these pages have been updated as well. On each agency page, users will find the agency’s location and contact information. The services that the agency offers will be listed as well. Users will also find a section called “Transparency” where documents that the agency holds will be listed. A list of related agencies and upcoming events are on each agency’s page.

Everything Is Connected in Cook County

cook county websiteThat’s because everything on the website is connected to make it as easy as possible for users to get to where they need to be. The creators of the new website wanted to use links to bring people to an agency within the county, another county website, or a document held at another website. Linking websites together, and linking one agency to another, is much easier than telling users to go to a different website.

About 10,000 people visit the site each day, so officials will be monitoring the website to see how people use and find information. To create this website, the County worked with Smart Chicago, an organization that works to improve people’s lives through better online access. Smart Chicago brought hundreds of testers to make sure that the website is running as efficiently as possible. Residents of Chicago can be certain that the website will become easier and easier to navigate a more users frequent the website.

Understanding Workers’ Compensation in Illinois

Workers’ compensation protects workers who have experienced work-related injuries. It is a no-fault system of benefits paid by employers. Illinois State law requires employers to bear the cost of workers’ compensation insurance. Most employers buy workers’ compensation benefits and the insurance company pays the benefits on the employer’s behalf, while other employers obtain the state’s approval to self-insure. If an employer self-insures, the employer is responsible for its own claims through a self-insurance mechanism. At one point, workers’ comp rates in Illinois were at the fourth most expensive in the country, but they have been declining over the past few years.

[Read more…]

About the Firm


Ronald F. Wittmeyer, Jr. practices plaintiffs' personal injury law at his office in Arlington Heights, Illinois.

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