Learn what was untrue in the Frontline broadcast.
During the course of their investigation and reporting, ProPublica and Frontline asked us for a substantial amount of information, which we happily provided, including making our employees – including our CEO – available for interviews. Unfortunately, they chose not to use the vast majority of information we provided them. As a result, they made numerous misstatements. Here are just a few, corrected with the actual facts of the case.
Claim: Emeritus puts profits over people.
Fact: Care is absolutely our top priority. It is what we are passionate about, and from a business standpoint, if we deliver exceptional care and services, we will achieve the customer satisfaction that naturally results in successful growth and revenues to keep operating. From this, we can give our communities the resources they need to care for each resident as well as the business results necessary for our continued operation and growth. The success of any senior living business – or any other consumer driven business for that matter – is centered on excellent customer satisfaction. In our business, customer satisfaction is a result of providing great care and services, from a compassionate team of employees, that ultimately delivers trust and peace of mind to our residents and families. We have done this successfully for 20 years now.
Claim: Emeritus communities are understaffed.
Fact: Our staffing levels are in compliance with state regulations and in some cases exceed those regulations depending on the level of care required by residents at each individual community. Our community leadership has the authority to increase staffing levels at any time to meet the needs of residents. In addition, we hire a full-time clinician at our communities to ensure oversight of care – a staffing requirement for Emeritus, which is not required by many states.
Claim: Emeritus staff is undertrained.
Fact: During the interview with Kelly Scott, our Vice President of Program Development and Implementation, A.C. Thompson asked about training for our Memory Care staff. Kelly mentioned it started with an eight-hour training course. That’s where the interview was cut off. What A.C. didn’t show was Kelly saying, “The initial 8-hour course is followed by ongoing monthly training, job shadowing, and constant mentoring from an experienced Memory Care staff.” Additionally, with the company’s significant growth over the last five years, we recognized the need for more consistent training and evaluation methods throughout our communities. That’s why we hired a National Director of Training and Development last year to design and implement very comprehensive and proactive training programs on-site and online across all our communities. We also increased our training staff to 46. By the end of 2011, our enhanced training programs were fully implemented for our 30,000 employees. We also now have better systems in place to measure its effectiveness and monitor the learning outcomes. All of these measures have been important in our mission of continuously improving quality, and our deficiencies have trended down significantly over the last five years.
Claim: Emeritus staff are told to cover up mistakes.
Fact: Emeritus has an extensive quality oversight process and employees are encouraged to provide their input and report mistakes. An important part of our quality services program is the regional oversight process. Two types of site visits are routinely conducted in our communities. These are the Comprehensive Process Review (CPR) and the Quality Services (QS) Site Visit. The CPR process is used as a framework for Continuous Quality Improvement and the QS Site visit is focused on areas related to systems implementation and ongoing compliance, which identify opportunities for improving resident care.
Claim: Emeritus employees were directed to help move in residents with higher care needs to boost revenues.
Fact: First, Emeritus does not employ any sales methods or directives intended to encourage staff to recruit residents with more acute care needs. Second, residents with higher care needs do not boost revenues in the long term. The reason Emeritus accepts people with higher care needs is because we believe all people deserve to have choice, independence, dignity and quality of life in their living arrangements.
Claim: Emeritus policy dictates that we “close the back door,” and prevent residents from leaving even if their care needs require a higher level of care.
Fact: False. “Close the back door” is a term used commonly throughout the senior living industry. Emeritus employees may use the term to highlight the importance of providing a high quality of service to residents to ensure that the residents do not choose to move out because they are dissatisfied with customer service or any aspect of their lifestyle or situation at Emeritus. We do monitor move-outs so that we can identify and correct any issues and enhance resident satisfaction.
Claim: Emeritus at Emerald Hills kept Joan Boice longer than they could care for her.
Fact: As Joan Boice’s condition declined, her healthcare team at Kaiser (including her physician, home health nurses, home health physical therapist and medical social worker/case manager) were all aware and informed of her changes. During that time, the healthcare team at Kaiser, as well as Joan Boice’s family and the staff at Emerald Hills considered and discussed the alternatives of Boice remaining at Emerald Hills on hospice care or transferring to a skilled nursing facility (both of which require an order from Boice’s physician to initiate). On December 1, Boice’s condition took a turn for the worse when she was found to have several additional areas of skin breakdown in addition to the one bunion that had been diagnosed and treated the prior month. On that day, Kaiser’s nurses assessed Mrs. Boice, the family was notified of the changes, nursing home placement was deemed necessary and additional efforts were made by Kaiser to obtain the necessary physician order. On December 4, the order was received, an available nursing home bed was identified and Mrs. Boice was transferred. In the interim, Mrs. Boice remained under the care of Kaiser’s home health team, assisted by the Emerald Hills staff.
Claim: Emeritus pressures employees to keep the facilities as close to filled as possible.
Fact: Emeritus needs to maintain a certain occupancy rate to keep the community operating successfully and the staff fully employed. As a result, we seek to achieve high occupancy by residents whose care needs match the types and levels of service we provide so that we can continue to operate efficiently and provide service of the highest quality and value to seniors and their families. However, we do not pressure employees to fill empty beds for the sole purpose of increasing occupancy.
Claim: Kathryn Locatell alleges that “nothing was done” to help Mrs. Boice during her time at Emeritus.
Fact: Dr. Locatell was hired by the plaintiff’s attorney. Although a medical doctor, Dr. Locatell is not a practicing clinician. According to her own testimony, Dr. Locatell makes her living by providing “expert” testimony and appearing as witness across the country in long-term care cases filed by plaintiff lawyers. She was compensated handsomely in this case for her time and testimony. Her forensic conclusion that “nothing was done” to help Mrs. Boice during her time at Emeritus not only contradicts testimony from other witnesses at trial who actually cared for Mrs. Boice, but is the type of testimony she is often paid to give according to lawyers around the country we have spoken to. Indeed, Emeritus’ staff was constantly working with Mrs. Boice to reposition her, keep her clean, feed her, and otherwise take care of her daily needs. It is important to note that Dr. Locatell testified that she reviewed Mrs. Boice’s medical records shortly after she moved out of the Emerald Hills community and months prior to her death. Dr. Locatell did not report any suspicions of elder abuse, even though she was professionally and legally obligated to do so if she truly believed that abuse had occurred. Instead, Dr. Locatell waited until the lawsuit was well underway to ever make a public allegation of elder abuse. Of the approximately 34 health care professionals that examined and/or treated Mrs. Boice from the time she came to Emeritus and passed, Dr. Locatell is in fact the only physician who alleged that Mrs. Boice had been a victim of abuse.
Claim: The staff at Emeritus at Emerald Hills ignored Joan Boice’s pressure wounds and her wounds were discovered at the Skilled Nursing facility. No one told the Boice family about these wounds.
Fact: Mrs. Boice had a wound on her foot which was treated by Kaiser Home Health during the month of November. On December 1, additional skin issues were identified. Emeritus worked with Kaiser’s Home Health team, who evaluated Mrs. Boice, reported them to the physician and implemented treatments. Emeritus communicated with the family to make them aware that additional wounds were developing at that time (December 2008). It was when the additional wounds developed that Emeritus initiated efforts to facilitate the move to the Skilled Nursing Facility (SNF), leading to the physician order for transfer on December 4. All of Mrs. Boice’s wounds were identified and treated by Kaiser Home Health before her transfer to the SNF.
Claim: Former Emerald Hills med tech Jenny Hitt covertly treated Joan Boice’s pressure wounds.
Fact: Ms. Hitt’s testimony that she covertly treated Joan Boice’s pressure wounds is not only improbable, but has no basis in fact. During the time period that Ms. Hitt claims to have covertly treated Ms. Boice’s wounds, Ms. Boice was seen by multiple providers, including her primary physician, Dr. Awan, Kaiser nurses, and therapists. None of them reported seeing pressure wounds when Ms. Hitt claims to have treated them. Furthermore, the dressing supplies and medications used to treat these types of wounds require a physician’s prescription; no such prescription was issued during the timeframe that Ms. Hitt claimed to have been treating Ms. Boice. We believe that Ms. Hitt’s recollection is mistaken.
Claim: Emeritus didn’t create an adequate – and consistently updated – care plan for Joan Boice.
Fact: Three care plans, initial and updated, were maintained within our database. The plan of care was developed and updated accordingly for Mrs. Boice, both manually and electronically, by a licensed nurse. Services rendered during the course of her stay were consistent based on her care needs and overall health condition as evidenced by staff interaction and collaboration with several health care professionals and health care providers.
Claim: There were no employees working on the overnight shifts at Emerald Hills during Joan Boice’s time at Emerald Hills.
Fact: This is completely untrue. The allegation that no employees were working on overnight shifts is errantly based on a lack of documentation, rather than a lack of staffing. Sworn trial testimony verifies that employees were working overnight. An Emerald Hills staff member, who was actually there, testified under oath that there were never fewer than three memory care caregivers on any night shift – two caregivers and one Med Tech.
Claim: During the time that Joan Boice was at Emerald Hills, the company did not employ enough staff at the facility.
Fact: Sworn testimony from both plaintiff and defense witnesses in this trial affirmed that at no point during this time did resident care needs go unmet.
Claim: Joan Boice should not have been admitted to Emerald Hills, given her needs.
Fact: This claim was based on statements by Catherine Ratelle, who never met Mrs. Boice and thus never made a first-hand evaluation of her condition. In fact, Mrs. Boice met all the criteria for residing at an assisted living community and that was substantiated by her treating physician, her family, the staff at her previous residence, and the assessment administered by the Emerald Hills nurse. Mr. and Mrs. Boice moved to Emeritus from another assisted living community at the request of their family because they were dissatisfied with their prior living arrangements.
Claim: The Boice family was contacted by the collections department and told it owed over $14,000 in rent for December, January and February because the family did not give sufficient notice about Mrs. Boice’s move-out in early December.
Fact: This is completely false. We did receive payments of $4625 in October and November of 2008 from the Boice family. A final balance of $4540 was written off in March of 2009. The Boice account never reached a balance of $14,000 and we did not pursue payment with a third party.
Claim: Staff who tried to express concerns to top management both at Emerald Hills and elsewhere were fired for being troublemakers.
Fact: To suggest that someone would be fired for bringing concerns to light is simply untrue. Emeritus routinely solicits feedback from its residents, their families and employees. We welcome suggestions from all of our employees on how to improve systems, procedures and care for our residents. For those uncomfortable with approaching management directly, we have Ethics First, which is a confidential and anonymous way for employees (as well as residents and family) to provide feedback. At Emeritus, all employees have a voice and it is something we encourage.
Claim: Emeritus directed employees to cut labor costs in the California division by 10 percent across the board.
Fact: This is patently untrue and has no basis in fact. Emeritus would not enact across-the-board labor cuts at the expense of our residents’ care needs. Without question, our staffing levels need to be in compliance with state regulations and, in many cases, Emeritus exceeds those regulations depending on the level of care required by residents at each individual community. At Emeritus, our “bottom line” is that every resident must have his or her care needs met. That is our top priority.
Claim: Emeritus’ lack of a staffing formula or ratio leads to understaffing.
Fact: We do not use a staffing formula because it would not account for all of the criteria that need to be considered beyond sheer numbers – such as the specific skills and experience of the staff, the number of residents we have on any given day, the level of care and services those residents require, the size and layout of the community, and the ability for our staff to meet the residents’ care needs, which ultimately determines the quality of the care provided.
Claim: During the Boice trial, Alicia Parga acknowledged that she did not know the stages of dementia while she was employed at Emerald Hills.
Fact: Despite Alicia Parga’s testimony that she did not know the formal clinical stages of dementia, she demonstrated an ability to meet the needs of the residents in the memory care neighborhood. She also demonstrated a caring attitude in her notes to the skilled nursing facility indicating how best to meet the needs of Joan Boice. Demonstrated behavior of meeting the needs of residents — rather than the ability to recite on the witness stand the clinical stages of dementia — reveals adequate training.
Claim: The Boice family says they were offered $3.3 million to settle their suit, with the condition that all company documents, depositions, and other discovery would be given to Emeritus or shredded, and that the court files would be sealed.
Fact: This question is indicative of the outrageous plaintiff’s tactics and broader legal appeal issues of the case. The fact that the plaintiff has made court-ordered confidential negotiations public is completely unethical and an attempt to insinuate that Emeritus agreed with the Boice position simply by the act of negotiating an offer.
Claim: A female resident urinated in the hallway of the memory care wing at Emeritus at Emerald Hills on a regular basis.
Fact: Dementia can cause an individual to experience incontinence or other issues involved with bowel and bladder control. The staff was extremely aware of this resident’s situation and followed procedure in addressing it. They even had a special undergarment produced for this resident that would help contain this issue and protect her dignity. Our staff is trained on how to address this common occurrence in our memory care neighborhoods. We start by trying to discover the root cause – whether it’s the inability to recognize the need to go to the bathroom, an inability to locate the restroom, an inability to recognize the toilet and understand what it is used for, or even medications they may be taking. If we discover the cause, we can often work proactively to get the resident to use the restroom before any problem occurs. However, even with the best proactive plans, someone might still urinate in a public place. If and when this happens, our response would be to first provide the resident with dignity. So, we would try to distract and remove other residents from the area to provide her privacy and not to embarrass her. Then, we would try to assist her safely – place her clothing back on, walk her to her room, for example. – all while talking to her soothingly, never scolding or correcting. Finally, we would immediately clean the area.
Claim: Regulators have cited Emeritus for “excessive bedsores,” allowing them to occur in communities in Whittier, San Diego and outside of Sacramento.
Fact: Elderly people are at greater risk for bedsores because they have thinner skin, which is more vulnerable to damage from minor pressure. Just like any other organ of the body, skin breaks down and deteriorates with age. Additionally, if an elderly person is bedridden for any length of time, they are at an increased risk of developing bedsores. This is why bedsores are common in senior residential settings.
Claim: At Villa del Rey, Emeritus played a role in a resident’s suicide.
Fact: No, we did not play a role in this resident’s death. While she was a resident at our Villa del Rey community, the resident was under the care of her personal psychiatrist. The medical chart notes indicated that she was not considered a suicide risk by her treating psychiatrist.
Claim: Emeritus at Ridgeland Pointe should never have admitted Merle Fall because her needs exceeded what Ridgeland Pointe was able to provide. After she jumped, she was left alone for 30 minutes before anyone from the community helped.
Fact: Mrs. Fall’s primary physician certified that Ms. Fall was appropriate for assisted living shortly before she took residency at the community. One of our caregivers spent hours with her during the previous night and the following morning. One caregiver testified that she observed Ms. Fall in the hall at approximately 6:50 a.m., shortly before she exited the community a little after 7:00 a.m. After her fall, she was discovered almost immediately and the staff called 911, the family, her physician and the Executive Director of the community. Several caregivers remained with Ms. Fall during the time until the paramedics arrived.
Claim: After the Ridgeland Pointe incident where a Memory Care resident went into another resident’s room, kicked out the stop lock and jumped out a window that met the prescribed building codes for Memory Care, Emeritus claimed they fixed the problem. But another Memory Care resident at Emeritus at Oceanside in California did the same thing.
Fact: A Memory Care resident forced open a locked window. The locks on the window were approved by Community Care Licensing. Two staff members risked their own lives to pull this resident off the ledge, saving his life. The resident was immediately transported to the hospital. The state found that “all allegations are unfounded” and did not issue a citation for the incident.
Claim: In 2007, workers at an Emeritus assisted living facility in Oceanside, Calif., found a resident lying beneath her window. Her family contends that the facility was aware of her behavior issues, but didn’t take action to prevent the fatal incident from occurring.
Fact: This resident was an Independent Living resident who, according to her own physician, did not need assistance. A resident’s doctor is the final authority on his or her health status and on directing the type of care that is required, including issuing the appropriate orders. Throughout this resident’s stay at the community, the staff kept physicians and her family informed about her condition, including reporting that she had some confusion in the days and hours preceding her fall from the window. The community did not receive any orders to change the resident’s care protocol during this time. Emeritus staff followed procedure and involved her physician, family and emergency contacts immediately and appropriately.
Claim: Irving Weinberg, 98, died in 2010 when his motorized wheelchair tumbled down a staircase at an Escondido, California community. The state cited the facility for not having enough staff in place to prevent the fatal accident.
Fact: The death of Irving Weinberg at Escondido was extremely tragic and unprecedented. All codes and protocols were followed, but this is a case where a resident’s actions resulted in an accident. We strongly disagree that his accident had to do with staffing levels, as no amount of staff could have prevented him from spontaneously jamming his wheelchair into reverse when he got startled at a religious service.
Claim: In 2009, a review of state inspection reports revealed that the state had cited Escondido for failing to provide adequate medical attention for a resident who died of sepsis.
Fact: This resident lived in Independent Living and her religious preference necessitated that she decline medical attention. It is these factors that led to the state acknowledging the allegations against the community were unfounded. We stand behind our care staff and their management of this situation.
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