Case 2:22-cv-02344-RBS Document 1 Filed 06/14/22 Page 1 of 140
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`UNITED STATES DISTRICT COURT
`FOR THE EASTERN DISTRICT OF PENNSYLVANIA
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`UNITED STATES OF AMERICA,
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`Plaintiff,
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`v.
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`AMERICAN HEALTH FOUNDATION,
`INC.; AHF MANAGEMENT
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`CORPORATION;
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`AHF MONTGOMERY, INC. d/b/a/
`CHELTENHAM NURSING AND
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`REHABILITATION CENTER; and
`AHF OHIO, INC. d/b/a THE
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`SANCTUARY AT WILMINGTON
`PLACE and SAMARITAN CARE
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`CENTER AND VILLA,
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`Defendants.
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`Civil Action No:
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`JURY TRIAL DEMANDED
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`THE UNITED STATES’ COMPLAINT
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`1.
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`The United States of America brings this action under the False Claims Act
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`(“FCA”), 31 U.S.C. §§ 3729-3733, and federal common law theories of payment by mistake and
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`unjust enrichment. The United States brings this case against Defendants American Health
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`Foundation, Inc. (“AHF”); AHF Management Corporation (“AHF Management”); AHF
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`Montgomery, Inc., which does business as Cheltenham Nursing and Rehabilitation Center
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`(“Cheltenham”); and AHF Ohio, Inc., which does business as The Sanctuary at Wilmington
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`Place (“Wilmington Place”) and Samaritan Care Center and Villa (“Samaritan”).
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`2.
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`This action arises from the Defendants’ provision of non-existent and grossly
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`substandard nursing home services to Medicare and Medicaid beneficiaries at Cheltenham (from
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`at least January 1, 2016, to December 31, 2018), Wilmington Place (from at least January 1,
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`2017, to December 31, 2018) and Samaritan (from at least October 1, 2016, to December 31,
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`Case 2:22-cv-02344-RBS Document 1 Filed 06/14/22 Page 2 of 140
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`2018). As a result, the Defendants caused or risked causing serious physical and emotional harm
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`to their residents, who were elderly, disabled, and otherwise highly vulnerable.
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`3.
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`Cheltenham, Wilmington Place, and Samaritan each failed to maintain adequate
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`staffing levels and repeatedly failed to follow infection control protocols.
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`4.
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`Furthermore, Cheltenham housed its residents in a filthy, pest-infested building,
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`where there was a glaring absence of activities or stimulation and residents’ personal items were
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`often lost or stolen. Cheltenham also gave its residents unnecessary drugs (including powerful
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`antipsychotics and other psychotropic medications) and subjected its residents to mockery and
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`abuse.
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`5.
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`In addition, Cheltenham repeatedly failed to provide its residents with needed
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`psychiatric care. For example, Cheltenham admitted one resident with a history of self-harm,
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`who then slashed his wrists while in the facility’s care. The resident was hospitalized, physically
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`recovered, and returned to Cheltenham—only for the nursing home to again ignore additional
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`warning signs and fail to provide him with needed psychiatric services. Tragically, mere weeks
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`after being readmitted to the facility, the resident committed suicide by hanging himself from a
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`bedsheet in one of Cheltenham’s shower rooms.
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`6.
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`Wilmington Place and Samaritan had their own serious shortcomings as well. For
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`example, Wilmington Place had repeated failures relating to resident medications, including the
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`provision of unnecessary drugs, and persistently failed to create and maintain crucial resident
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`care plans and assessments. For its part, Samaritan also had repeated failures related to resident
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`care plans and assessments, as well as a building and grounds that often were not safe and
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`sanitary.
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`7.
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`The Defendants provided this grossly substandard care despite Pennsylvania and
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`Ohio repeatedly citing Cheltenham, Wilmington Place, and Samaritan for deficiencies in surveys
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`conducted by the states’ health departments.
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`8.
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`Yet the state survey findings hardly captured the full extent of the problems at the
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`Defendant facilities. The facilities often had some sense of when a survey could occur, which
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`gave the facilities a chance to prepare for scrutiny. State health inspectors also provided notice
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`when they arrived, so facility staff knew when they needed to be on their best behavior.
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`9.
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`For example, on July 26, 2017, which was less than a week after Pennsylvania
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`had completed a survey of the facility, one Cheltenham employee sent an internal email with the
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`message: “Ain’t nobody faker than a nursing home when state is in the building . . . #Factz.”
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`Another employee replied with a picture of a person laughing and the caption, “I’m dead,”
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`indicating that she thought this was so funny she had died laughing.
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`10.
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`The state survey findings were addressed to the administrator of each facility and
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`conveyed to executives at AHF and AHF Management. But the Defendants’ knowledge of the
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`nonexistent and grossly substandard care in their facilities was far more extensive than those
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`documented deficiencies in the state surveys. Facility staff internally reported problems up to
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`facility managers, who in turn often alerted executives and key individuals at AHF and AHF
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`Management. In addition, AHF Management personnel periodically visited the facilities to
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`perform their own inspections and relay the results to facility managers and AHF and AHF
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`Management executives. Finally, external nursing home consultants hired by AHF Management
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`also visited the facilities and flagged various problems for the Defendants.
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`11.
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`Despite getting regular reports detailing the grossly substandard care provided at
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`Cheltenham, Wilmington Place, and Samaritan, the Defendants were primarily focused on their
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`finances and not on improving care quality at the nursing homes. AHF Management executives
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`regularly implored facility managers to increase the number of residents (or “census”) at the
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`nursing homes, while also simultaneously cutting costs. Meanwhile, although the facilities often
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`had difficulty attracting staff due to lower salaries than their competitors, AHF had a substantial
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`amount of funds in reserve. In December 2017, for example, this reserve fund was worth about
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`$16.5 million, and AHF planned to invest 70 percent, or about $11.55 million, in various
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`securities.
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`12.
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`Ultimately, the Defendants knowingly submitted or caused the submission of
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`false and fraudulent claims for nursing home care by (a) providing services that were either non-
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`existent or grossly substandard and (b) consistently violating the standards of care set forth in the
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`Nursing Home Reform Act and its implementing regulations, 42 U.S.C. §§ 1395i-3, 1396r et
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`seq.; and 42 C.F.R. §§ 483.1-483.95.
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`JURISDICTION AND VENUE
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`13.
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`This Court has jurisdiction over this action pursuant to 31 U.S.C. § 3732(a), 28
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`U.S.C. § 1331, and 28 U.S.C. § 1345.
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`14.
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`AHF, AHF Management, and Cheltenham transacted business and committed acts
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`proscribed by 31 U.S.C. § 3729 in this District. Therefore, venue is proper in this district under
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`31 U.S.C. § 3732 and 28 U.S.C. §§ 1391(b) and (c).
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`15.
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`Due to the date of the Defendants’ false claims and the date those claims were
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`paid by Medicare and Medicaid, the causes of action alleged in this Complaint are timely
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`brought by being within the six-year statute of limitation periods set forth at 31 U.S.C. §
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`3731(b)(1) and 28 U.S.C. § 2415(a).
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`16.
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`The Department of Justice first obtained relevant documents and materials from
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`the Defendants on October 11, 2019. Therefore, all the United States’ FCA allegations are also
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`timely brought under 31 U.S.C. § 3731(b)(2) by being within three years of when material facts
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`were known or reasonably should have been known by the Department of Justice official
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`charged with enforcing the FCA.
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`PARTIES
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`17.
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`The United States brings this action on behalf of the Department of Health and
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`Human Services (“HHS”) and one of its operating divisions, the Centers of Medicare &
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`Medicaid Services (“CMS”) for losses that the United States incurred under the Medicare and
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`Medicaid programs. During the relevant periods, the United States provided approximately 52
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`percent of the funds paid by Pennsylvania Medicaid to providers and approximately 62 percent
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`of the funds paid by Ohio Medicaid.
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`18.
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`Defendant AHF is an Ohio nonprofit corporation that is located at 5920 Venture
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`Drive, Suite 100, Dublin, Ohio 43017. Through its wholly owned subsidiaries, AHF establishes,
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`acquires, owns, supervises, monitors, and directs nursing homes in different states around the
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`country.
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`19.
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`Defendant AHF Management Corporation is an Ohio nonprofit corporation that is
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`located at 5920 Venture Drive, Suite 100, Dublin, Ohio 43017. AHF Management is a wholly
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`owned subsidiary of AHF with a common board of directors, executives, and officers. AHF
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`Management handles the day to day activities of AHF. AHF Management also oversees and
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`exerts financial control over the nursing homes owned by AHF, including the Defendant
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`facilities.
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`20.
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`Defendant AHF Montgomery is an Ohio nonprofit corporation that is located at
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`5920 Venture Drive, Suite 100, Dublin, Ohio 43017. AHF Montgomery is a wholly owned
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`subsidiary of AHF with a common board of directors, executives, and officers. AHF
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`Montgomery does business as Cheltenham Nursing & Rehabilitation Center, a 255-bed nursing
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`home facility located at 600 W Cheltenham Ave, Philadelphia, Pennsylvania. A substantial
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`majority of the revenue accrued by Cheltenham comes from Medicare or Medicaid, and a
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`substantial majority of the residents at this facility are Medicare or Medicaid beneficiaries.
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`21.
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`Defendant AHF Ohio is an Ohio nonprofit corporation that is located at 5920
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`Venture Drive, Suite 100, Dublin, Ohio 43017. AHF Ohio is a wholly owned subsidiary of AHF
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`with a common board of directors, executives, and officers. AHF Ohio does business as four
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`nursing homes, including The Sanctuary at Wilmington Place and Samaritan Care Center and
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`Villa. The Sanctuary at Wilmington Place is a 63-bed nursing home facility located at 264
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`Wilmington Avenue, Dayton, Ohio 45420. Samaritan Care Center and Villa is a 56-bed nursing
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`home facility located at 806 E Washington Street, Medina, Ohio 44256. A majority of the
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`revenue accrued by these facilities is from Medicare or Medicaid, and a majority of the residents
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`at these facilities are Medicare or Medicaid beneficiaries.
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`THE FALSE CLAIMS ACT
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`22.
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`The False Claims Act (“FCA”) establishes liability for knowingly making,
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`submitting, or causing false or fraudulent claims for federal funds. 31 U.S.C. § 3729(a)(1)(A).
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`23.
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`Under the FCA, “knowingly” means that a person has actual knowledge that
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`information is false, acts in deliberate ignorance of the truth or falsity of the information, or acts
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`in reckless disregard of the truth or falsity of the information. 31 U.S.C. § 3729(b)(1)(A).
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`24.
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`No proof of specific intent to defraud is required to show that a person acted
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`knowingly under the FCA. 31 U.S.C. § 3729(b)(1)(B).
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`25.
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`Courts have held that only “material” false claims are actionable under the FCA.
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`The FCA defines the term “material” as “having a natural tendency to influence, or be capable of
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`influencing, the payment or receipt of money or property.” 31 U.S.C. § 3729(b)(4).
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`26.
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`The FCA provides for a recovery of three times the damages sustained by the
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`United States, plus a civil penalty for each violation of the FCA. 31 U.S.C. § 3729(a)(1).
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`27.
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`The FCA states that a civil penalty for a violation is to be not less than $5,500 and
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`not more than $11,000. 31 U.S.C. § 3729(a)(1). These penalties, however, are to be adjusted in
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`accordance with the inflation adjustment procedures set forth in Section 5 of the Federal Civil
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`Penalties Inflation Adjustment Act of 1990, Public Law 101-410. See 28 C.F.R. § 85.3(a)(9).
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`For all FCA violations occurring after November 2, 2015, the minimum penalty is $12,537 and
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`the maximum penalty is $25,076.
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`28.
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`The United States may bring an action under the FCA within 6 years of the
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`violation or within 3 years of when material facts were known or reasonably should have been
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`known by the Department of Justice official charged with enforcing the FCA, whichever occurs
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`last. 31 U.S.C. § 3731(b).
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`NURSING HOME REIMBURSEMENT UNDER MEDICARE AND MEDICAID
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`29.
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`In order to participate in and receive payments under the Medicare and Medicaid
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`programs, a nursing home must execute a Health Insurance Benefit Agreement, Form CMS-
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`1561. See 42 U.S.C. § 1395cc. By doing so, a provider expressly agrees to conform with the
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`applicable code of Federal Regulations within Title 42, which includes the standard of care
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`regulations that implement the Nursing Home Reform Act, 42 U.S.C. §§ 1395i-3, 1396r et seq.
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`See 42 C.F.R. §§ 483.1-483.95.
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`30.
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`In order to bill Medicare electronically, providers must execute an Electronic Data
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`Interchange Enrollment Form, in which they agree to “be responsible for all Medicare claims
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`submitted to CMS by itself, its employees, or its agents, and to “submit claims that are accurate,
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`complete, and truthful.”
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`31.
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`The standard form for Medicare and Medicare claims submitted by nursing homes
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`is the UB-04 or CMS-1450. This form requires the submitting party to represent that the billing
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`information on the claim form is true, accurate, and complete. The submitting party further
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`certifies that it “did not knowingly or recklessly disregard or misrepresent or conceal material
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`facts.”
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`32.
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`The Medicare and Medicaid programs use a prospective payment system to pay
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`for a bundle of nursing home services that facilities provide to eligible residents. This means
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`that payments are based on a predetermined, fixed amount.
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`33.
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`To receive reimbursement from Medicare and Medicaid, facilities are required to
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`complete and submit a Minimum Data Set (“MDS”) form to CMS for all residents. 42 C.F.R. §
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`483.315. Facilities are required to complete MDS assessments for all residents upon admission
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`and then quarterly thereafter. 42 U.S.C. § 1395i-3(b)(3)(C)(i)(I); 42 U.S.C. § 1395i-
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`3(b)(3)(C)(ii). Facilities must also examine each resident once per quarter and revise the
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`resident’s MDS assessment accordingly. 42 U.S.C. § 1395i-3(b)(3)(C)(ii).
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`34.
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`In the MDS form, facilities have to provide CMS with an accurate and
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`comprehensive assessment of each resident’s functional capabilities, identify health problems,
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`and formulate a resident’s individual plan of care.
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`35.
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`Ultimately, the medical condition, nursing care needs, and other information
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`provided in the MDS form determine the Medicare and Medicaid reimbursement rate for each
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`resident.
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`36.
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`Facilities must certify that their submitted MDS information is accurate, timely,
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`and collected in accordance with applicable Medicare and Medicaid requirements. Facilities
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`must also acknowledge that they understand that (a) the MDS information is used as a basis for
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`reimbursement with federal funds, (b) their continued participation in Medicare and Medicaid is
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`conditioned on the accuracy and truthfulness of the submitted information, and (c) the
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`submission of false information can lead to substantial criminal, civil, or administrative
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`penalties.
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`MEDICARE AND MEDICAID REQUIREMENTS FOR NURSING HOMES
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`37.
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`The Medicare and Medicaid programs require nursing homes to comply with
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`rules and regulations relating to standards of care. See 42 C.F.R. § 483.1(b).
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`38.
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`These rules stem from the Nursing Home Reform Act (“NHRA”), 42 U.S.C. §§
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`1395i-3, 1396r et seq. The NHRA’s implementing regulations are set forth at 42 C.F.R. §§
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`483.1-483.95 and provide more clarity as well as additional requirements for nursing homes.
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`39.
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`The NHRA defines a nursing home or “nursing facility” as an institution that is
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`primarily engaged in providing skilled nursing care and related services, rehabilitation services,
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`or “health related care and services” to people who require care that is “available to them only
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`through institutional facilities and is not primarily for the care and treatment of mental diseases.”
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`42 U.S.C. § 1396r(a).
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`40.
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`During the relevant periods, each of the Defendant facilities fit this definition and
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`was thus covered by the NHRA.
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`41.
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`Under the NHRA, nursing homes must comply with federal and state
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`requirements relating to the provision of services, as well as applicable professional standards
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`and principles. 42 U.S.C. § 1396r(b); 42 U.S.C. § 1396r(d)(4)(A).
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`42.
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`Specifically, a nursing home “must care for its residents in such a manner and in
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`such an environment as will promote maintenance or enhancement of the quality of life of each
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`resident.” 42 U.S.C. § 1395i-3(b)(1)(A).
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`43.
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`Along these lines, a nursing home must provide nursing services and medically-
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`related social services “to attain or maintain the highest practicable physical, mental, and
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`psychosocial well-being of each resident.” 42 U.S.C. §§ 1395i-3(b)(4)(A)(i) and (ii).
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`44.
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`Nursing homes must also provide pharmaceutical, dietary, and dental services
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`sufficient “to meet the needs of each resident.” 42 U.S.C. §§ 1395i-3(b)(4)(A)(iii), (iv), and (vi).
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`Thus, facilities must help residents make dental appointments and arrange for their
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`transportation. 42 C.F.R. § 483.55(a)(4). Facilities must also provide nourishing, palatable, and
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`balanced diets that meet the individual needs of residents. 42 C.F.R. § 483.60(d).
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`45.
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`In addition, nursing homes must provide a professionally-directed activities
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`program “designed to meet the interests and the physical, mental, and psychosocial well-being of
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`each resident.” 42 U.S.C. § 1395i-3(b)(4)(A)(v).
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`46.
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`For residents with mental disorders, facilities must provide “appropriate treatment
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`and services to correct the assessed problem or to attain the highest practicable mental and
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`psychosocial well-being.” 42 C.F.R. § 483.40(b)(1); see also 42 U.S.C. § 1395i-3(b)(4)(A)(vii)
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`(requiring facilities to provide treatment and services required by mentally ill residents that is not
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`otherwise supplied by the state).
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`47.
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`In general, nursing homes must be administered in a way that uses resources
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`effectively and efficiently to attain and maintain the highest practicable well-being for residents.
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`42 C.F.R. § 483.70. This includes maintaining medical records that complete, accurate,
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`accessible, and organized. 42 C.F.R. § 483.70(i)(1).
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`48.
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`Nursing homes are required to discern the needs of each resident through
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`assessments. Facilities must conduct a comprehensive, accurate, and standardized assessment of
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`the resident that describes the resident’s functional abilities and identifies medical problems. 42
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`U.S.C. § 1395i-3(b)(3)(A). This assessment must be completed within two weeks of a resident’s
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`admission and then “promptly after a significant change in the resident’s physical or mental
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`condition.” 42 U.S.C. §§ 1395i-3(b)(3)(C)(i)(I) and (II). Even if there are no obvious significant
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`changes to a resident’s condition, the facility must still assess the resident at least once per year.
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`42 U.S.C. § 1395i-3(b)(3)(C)(i)(III). In addition to the more comprehensive annual assessment,
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`the facility must examine each resident once per quarter and revise the resident’s assessment
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`accordingly. 42 U.S.C. § 1395i-3(b)(3)(C)(ii).
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`49.
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`The NHRA further directs nursing homes to create a written care plan for each
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`resident that “describes the medical, nursing, and psychosocial needs of the resident and how
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`such needs will be met.” 42 U.S.C. § 1395i-3(b)(2)(A). Within 48 hours of a resident’s
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`admission, the facility needs to develop a “baseline care plan” that includes the minimum
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`information needed to properly care for the resident. 42 C.F.R. § 483.21(a)(1). Then, once the
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`facility has completed its initial comprehensive assessment, it must develop a corresponding
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`comprehensive care plan that includes measurable objectives and timeframes for meeting the
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`resident’s needs, as well as the services that are to be furnished to attain or maintain the
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`resident’s highest practicable well-being. 42 C.F.R. §§ 483.21(b)(1)(i) and (2)(i). The nursing
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`home must then follow the care plan and provide the relevant services and activities for each
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`resident. 42 U.S.C. § 1395i-3(b)(2)(A). These care plans must be periodically reviewed and
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`revised each time a resident is assessed. 42 U.S.C. § 1395i-3(b)(2)(C).
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`50.
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`The services provided by a nursing home must “meet professional standards of
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`quality” and be provided by qualified personnel. 42 U.S.C. §§ 1395i-3(b)(4)(A) and (b). The
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`implementing regulations set forth in more detail what this entails at 42 C.F.R. § 483.25. Some
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`of the quality of care standards are as follows:
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` Skin integrity. The facility must ensure that residents receive care to prevent pressure
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`ulcers (also referred to as pressure sores or bed sores), unless they are clinically
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`unavoidable, and receive treatment for existing pressure ulcers “to promote healing,
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`prevent infection, and prevent new ulcers from developing.” 42 C.F.R. § 483.25(b).
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` Accidents. Facilities must be “as free of accident hazards as possible” and each resident
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`must receive “adequate supervision and assistance devices to prevent accidents,” like
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`falls. 42 C.F.R. § 483.25(d).
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` Respiratory care. Facilities must ensure that residents needing respiratory care, including
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`tracheostomy care, receive the care consistent with professional standards of practice. 42
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`C.F.R. § 483.25(i).
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` Pain management. Facilities must ensure that “pain management is provided to residents
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`who require such services, consistent with professional standards of practice.” 42 C.F.R.
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`§ 483.25(k).
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`51.
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`A nursing home must provide 24-hour licensed nursing services “which is
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`sufficient to meet the nursing needs of its residents,” as well as “a registered professional nurse
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`at least 8 consecutive hours a day, 7 days a week.” 42 U.S.C. § 1395i-3(b)(4)(C)(i). This means
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`having sufficient numbers of licensed nurses and other nursing personnel “to provide nursing
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`care to all residents in accordance with resident care plans,” along with ensuring that the licensed
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`nurses “have the specific competencies and skill sets necessary to care for residents’ needs. 42
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`C.F.R. §§ 483.35(a)(1) and (3). In addition, nursing aides, which are individuals who provide
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`nursing or related services without being registered or licensed, must be trained and have
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`demonstrated their competency. 42 U.S.C. §§ 1395i-3(b)(5)(A), (C), and (F).
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`52.
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`Furthermore, the NHRA has specific provisions related to infection control. The
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`facility must have an infection control program “designed to provide a safe, sanitary, and
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`comfortable environment” and “to help prevent the development and transmission of disease and
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`infection.” 42 U.S.C. § 1395i-3(d)(2)(A). This includes having a system for identifying
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`potential outbreaks and following precautions to prevent the spread of infection and disease, such
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`as the proper handling and storage of linens. 42 C.F.R. §§ 483.80(a) and (e).
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`53.
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`Nursing homes must also provide pharmaceutical services, including prescription
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`medications, to meet the needs of each resident. 42 C.F.R. § 483.45(a). In addition, the drug
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`regimen for nursing home residents “must be free from unnecessary drugs,” which includes
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`drugs used in excessive doses, for excessive durations, without adequate monitoring, without
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`adequate indications, or with adverse consequences. 42 C.F.R. § 483.45(d). Nursing homes
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`must further ensure that its medication error rate is less than 5 percent and residents are not
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`subjected to “any significant medication errors.” 42 C.F.R. § 483.45(f). Medications must be
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`labeled with accurate and complete information and be stored safely. See 42 C.F.R. §§ 483.45(g)
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`and (h).
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`54.
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`Psychotropic drugs—including antipsychotic, antidepressant, antianxiety, and
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`hypnotic medications—have additional requirements when used in nursing homes. 42 C.F.R. §§
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`483.45(c)(3) and (e). Facilities must ensure that residents only receive psychotropic drugs when
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`“the medication is necessary to treat a specific condition” that is diagnosed and documented. 42
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`C.F.R. § 483.45(e)(1). And unless clinically contraindicated, residents who receive psychotropic
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`drugs must also receive gradual dose reductions and behavioral interventions “in an effort to
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`discontinue these drugs.” 42 C.F.R. § 483.45(e)(2).
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`55.
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`To help nursing homes employ appropriate pharmaceutical processes and
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`practices, facilities must hire or retain a licensed pharmacist to, among other tasks, consult “on
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`all aspects of the provision of pharmacy services in the facility.” 42 C.F.R. § 483.45(b)(1). A
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`licensed pharmacist must review each resident’s drug regimen at least once a month and “report
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`any irregularities to the attending physician and the facility’s medical director and director of
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`nursing.” 42 C.F.R. § 483.45(c)(4). The facility must then act upon any reports of irregularities,
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`which can include the identification of drugs that are unnecessary due to an excessive dose,
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`excessive duration, inadequate monitoring, inadequate indications for use, or adverse
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`consequences. 42 C.F.R. §§ 483.45(c)(4)(i) and (d)(4).
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`56.
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`In addition to clinical care, nursing homes must provide necessary care for each
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`resident’s “whole emotional and mental well-being,” which includes the prevention and
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`treatment for mental health disorders and substance abuse issues. 42 C.F.R. § 483.40. The
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`facilities must have “sufficient staff” with “appropriate competencies and skills,” including
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`“caring for residents with mental and psychosocial disorders” as well as “implementing non-
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`pharmacological interventions.” 42 C.F.R. § 483.40(a). Facilities must also ensure that residents
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`who display or are diagnosed with mental health issues receive “appropriate treatment and
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`services to correct the assessed problem or to attain the highest practicable mental and
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`psychosocial well-being,” and that other residents do “not display a pattern of decreased social
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`interaction and/or increased withdrawn, angry, or depressive behaviors,” unless it is clinically
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`inevitable. 42 C.F.R. § 483.40(b); see also 42 U.S.C. § 1395i-3(b)(4)(A)(vii) (requiring facilities
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`to provide treatment and services required by mentally ill residents that is not otherwise supplied
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`by the state).
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`57.
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`Relatedly, nursing homes with more than 120 beds must also have at least one full
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`time qualified social worker. 42 U.S.C. §§ 1395i-3(b)(7). And all facilities “must provide
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`medically-related social services to attain or maintain the highest practicable . . . well-being of
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`each resident.” 42 C.F.R. § 483.40(d).
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`58.
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`Along with its other provisions, the NHRA also confers various rights on nursing
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`home residents. For instance, residents have the right to choose their doctor, be fully informed,
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`and participate in their care or treatment. 42 U.S.C. § 1395i-3(c)(1)(A)(i); see also 42 C.F.R. §§
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`483.10(c) and (d). Nursing homes must also immediately inform a resident, and (if appropriate)
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`his or her representative, as well as consult with the resident’s physician when the resident is hurt
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`in an accident, undergoes a significant change in physical or mental condition, has a need for
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`significantly altered treatment, or is to be transferred or discharged from the facility. 42 C.F.R. §
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`483.10(g)(14).
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`59.
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`Nursing home residents also have the right to be free from abuse, as well as
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`physical or chemical restraints that are not required by medical symptoms and are instead
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`imposed for discipline or convenience. 42 U.S.C. § 1395i-3(c)(1)(A)(ii). As the regulations
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`further state, residents also have the right to be free of mental or verbal abuse, as well as
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`“neglect, misappropriation of resident property, and exploitation.” 42 C.F.R. § 483.12(a)(1).
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`Facilities must develop and implement policies to prohibit, prevent, promptly report, thoroughly
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`investigate, and address such misconduct. 42 C.F.R. §§ 483.12(b) and (c).
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`60.
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`Residents also have the right to a safe and orderly transfer and discharge from a
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`nursing home. 42 U.S.C. § 1395i-3(c)(2)(C). Per the implementing regulations, this right means
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`the facility “must provide and document sufficient preparation and orientation to residents to
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`ensure safe and orderly transfer or discharge from the facility.” 42 C.F.R. § 483.15(c)(7). The
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`nursing home must also “ensure that the transfer or discharge is documented in the resident’s
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`medical record and appropriate information is communicated to the receiving health care
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`institution or provider.” 42 C.F.R. § 483.15(c)(2). The receiving provider must receive, at a
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`minimum, the resident’s care plan goals, contact information for the resident’s representative,
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`and all other necessary information and documentation “to ensure a safe and effective transition
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`of care.” 42 C.F.R. § 483.15(c)(2)(iii).
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`61.
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`The implementing regulations explain that the NHRA also requires a nursing
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`home to “treat each resident with respect and dignity” and to “care for each resident in a manner
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`and in an environment that promotes the maintenance or enhancement of his or her quality of
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`life.” 42 C.F.R. § 483.10(a)(1). Accordingly, residents also have the right “to retain and use
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`personal possessions,” as long as there is sufficient space and the possessions do not endanger
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`other residents or interfere with their rights. 42 C.F.R. § 483.10(e)(2). And when residents have
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`grievances, they have the right to voice them freely and have the facility “make prompt efforts”
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`to resolve their concerns. 42 C.F.R. §§ 483.10(j)(1) and (2).
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`62.
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`The NHRA regulations further state, “Quality of life is a fundamental principle
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`that applies to all care and services provided to facility residents.” 42 C.F.R. § 483.24.
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`Therefore, nursing homes “must provide the necessary care and services to ensure that a
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`resident’s abilities in activities of daily living do not diminish” unless it is clinically unavoidable.
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`42 C.F.R. § 483.24(a). If, however, a resident is unable to perform certain activities of daily
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`living, the facility must provide “the necessary services to maintain good nutrition, grooming,
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`and personal and oral hygiene.” 42 C.F.R. § 483.24(a)(1). In addition, the facility must provide
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`activities, directed by a qualified professional, that are “designed to meet the interests” and
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`support the well-being of each resident, “encouraging both independence and interaction in the
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`community.” 42 C.F.R. § 483.24(c).
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`63.
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`Finally, the NHRA and its implementing regulations set forth requirements for the
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`nursing home building and physical environment. Under the NHRA, a nursing home must be
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`“equipped and maintained to protect the health and safety of residents, personnel, and the general
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`public.” 42 U.S.C. § 1395i-3(d)(2)(B). The implementing regulations further state that facilities
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`must provide an env