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The many extracts on this page are from copyright material. They are reproduced here for educational purposes and to stimulate public debate about the provision of health and aged care. I consider this to be "fair use" in the common interest. They should not be reproduced for commercial purposes. The material is selective and I have not included denials and explanations. I am not claiming that all of the allegations are true. The intention is to show the general thrust of corporate practices as well as the nature and extent of the allegations made.

The Provision of Care in Genesis Facilities


Genesis shows a conflict in perspective. It believes and presents itself as an innovative group dedicated to provide high quality care. It markets this image and other corporations are willing for Genesis staff to represent their concerns. Its staff represent the industry at political and other talkfests where they present the industry's views. Genesis image of itself is generally accepted.

The nurses who work in Genesis facilities caring for patients have a very different story to tell. The number of instances in which Genesis facilities are accused of unacceptable care suggests that their care does not differ from that provided by other market listed corporations. The Services Employees International Union (SEIU) have been highly critical of care in Genesis facilities. They have analysed data and presented a number of reports linking poor care to Genesis business practices. They contrast corporate claims with documented poor care and link them with an account of Genesis' business policies. I have devoted a separate web page to these reports.

The extracts in this file have been divided into sections relating to issues surrounding care. Click on the numbers to go there.

1. Genesis claims that it provided innovative care and there is evidence that it really did try to care for people.

2. A very bitter dispute with nurses and nursing unions in which the unions accuse Genesis of poor business decisions and of substandard care. Genesis responds very indignantly, not by refuting the nurses' claims but by making exaggerated claims and attacking the motives of the nurses.

3. A series of reports pointing to substandard care in Genesis homes

4. Some material describing the aged care environment and Genesis behaviour within it.

5. The way in which Genesis and its staff acted as industry spokespersons, putting the industry's position. They are not subject to fraud allegations.

6. SEIU Reports alleging deficiencies in care at Genesis facilities. This material is on a separate web page.

The Public Face of Genesis

I have seen reports describing Genesis' vision of a different and better sort of aged care. The company seems to have been founded on that vision and the belief than fulfilling that vision will bring them success. Is this the American Dream? - the belief that hard work and a good product are the secret of success. This is a vision tarnished by failure in the health and aged care marketplace.

I have included segments describing Genesis involvement with Doctor's Health on Genesis marketplace page. Doctors Health was a group, which believed that it could succeed in managed care by putting care before profit. It soon collapsed and Genesis tried to rescue it.

COMMENT:- The SEIU quotes several corporate statements setting out Genesis claims to provide a different and superior sort of care - not long-term care but "eldercare". These are on the SEIU whistle blowing page.

GHV Releases Statement on Union Claims
PR Newswire May 27, 1999

Genesis Health Ventures, Inc., a recognized innovator in the healthcare industry, was founded in 1985 to redefine how America cares for the elderly and is dedicated to helping older adults live a full life as independently as possible in their later years. The Company, which consolidated its businesses under the brand name Genesis ElderCare in 1996, has established Genesis ElderCare Networks in five regional markets in the eastern United States and currently serves more than 175,000 customers daily.

Genesis Holds Ceremony for Employee Graduates of Workplace English as a Second Language Program

PR Newswire February 3, 1999

On Friday, February 5, Genesis ElderCare (R) will hold a ceremony for 16 French-Creole and Spanish-speaking employees graduating from an innovative English as a Second Language program called "English at Work: English as a Second Language for Eldercare Workers." The employees are certified nursing assistants and dietary workers with Atlantis Center in Lantana and Sutton Place Center in Lake Worth.
"Genesis recognizes that the quality of care we provide is only as good as the quality of our employees," said Pfau. "This is one of several staff development programs that we sponsor to cultivate and refine the skills of our employees and to enable them to provide a superior level of care." This is the first time the course has been conducted. There are plans to roll out the program at other centers throughout the Genesis ElderCare network.

COMMENT:- The program below creates an intense conflict of interest. The counselors would be in a position to persuade wealthy people to admit themselves to nursing homes long before it was necessary or desirable. Other companies have not hesitated to put pressure on staff urging them to place corporate interests ahead of the patients. The temptation to do so would be strong and it is to Genesis credit that no one has come forward claiming that they did so.

Chicago Tribune July 25, 1999

Family, friends and social service agencies are usually the ones to provide help when we have trouble taking care of an elderly relative. But now a for-profit company is rolling out a nationwide program--with advice on housing matters--designed to fill the gap when others can't, or won't, give assistance.

"Twenty-five percent of all households are involved in some level of care-giving for the elderly," said Maryann Timon, senior vice president of Genesis Elder Care, a subsidiary of Genesis Health Ventures Inc., of Kennett Square, Pa.

Timon cited insurance industry studies that show about 18 hours a week are spent by care-givers providing assistance to an elder who lives in their home.
Typically, they're the ones trying to juggle kids and a career, along with an elderly mother who may have broken a hip and has to be moved.
That was the motivation behind the new care-giver's program called Full Life Services. It is currently available only in some states in the East. But Timon expects services soon to be accessible nationwide through the company's chain of 326 nursing homes, 35 assisted-living facilities and 100 pharmacies.
For starters, a Full Life Services counselor conducts an assessment of the older person's situation and then provides a written plan, which is available to all family members. The idea is to establish a long-term relationship with the counselor to provide on-going support.
A counselor can help a family decide whether the elderly person should move.
Counselors can help family members decide whether the senior should move in with them.

"We bring to the surface issues the family is struggling with but cannot articulate," said Timon.

The counselor also lists the pros and cons of the 10 most common housing options for seniors, including assisted-living facilities and continuing-care retirement communities.
What sets the program apart from many others is that it's run by a big for-profit company. Full Life Services provides pretty much the same type of help as local social service agencies, Timon said. But she believes funding for public and private agencies is not enough to accommodate the growing number of elderly.
A counselor who's there every step of the way during an elder care crisis seems like a godsend. But the cost of the service--$95 an hour--remains out of reach for many.

GHV Switches to Safety Needles An Industry First
PR Newswire October 4, 1999, Monday

Genesis Health Ventures (NYSE: GHV) announced today that in an effort to provide employees a safer working environment, Genesis ElderCare skilled nursing centers will stop using traditional syringes and switch to safety syringes over the next year.

Genesis Launches Skilled Nursing Center Report Card
PRNewswire March 1, 2000

KENNETT SQUARE, Pa., March 1 /PRNewswire/ -- Genesis Health Ventures, Inc. (NYSE: GHV) launches a comprehensive web-based report card today that contains Genesis ElderCare skilled nursing facility survey and certification data, customer satisfaction ratings and key clinical outcomes by state. The report card, which can be accessed through a hot button on or at, is a first for the long term care industry.

Michael R. Walker, chairman and chief executive officer, said, "With the increase of consumers turning to the web for health information, this site provides key information on the care given by our 333 Genesis ElderCare Centers. The report card gives consumers and referral sources access to indicators we use internally to measure quality -- state/federal survey findings, satisfaction ratings, and clinical information."

The Nurses View of Genesis

These extracts reveal the bitter dispute with the nurses --- two very different views of what it is all about. Nurses complaints about care have been correct in the past. Not only are they in the best position to tell, but the nurses come with a tradition of service before self when contrasted with the profit first philosophy of the market. In 1999 and 2000 corporations including Genesis complain bitterly that there is a shortage of nurses, that they can't afford to pay more, and that this is why care is suffering. I remind you that about one year earlier corporations were asserting that nursing homes were overstaffed (fat in the system). They were not only firing nurses but fighting a bitter conflict as they reduced the conditions of service. The deterioration in care can be dated to that time.

COMMENT:- Genesis responds publicly to a strike threat by nurses.

Genesis ElderCare Facilities Gear Up for SEIU Strike
PR Newswire February 11, 1999

Two Genesis ElderCare skilled nursing facilities in Connecticut received 10-day strike notices yesterday from District 1199 NE/Service Employees International Union which stated union employees will strike beginning 6 a.m. February 24.
"It is truly regrettable that by calling for the strike action, the SEIU is forcing its members to abandon their crucial jobs of caring for nursing home patients in order to walk the picket line," said Dick Blinn, New England President for Genesis ElderCare, a leading provider of eldercare services in the region.

The strike action is part of a statewide strategy in Connecticut to pressure the legislature into increasing the Medicaid reimbursement rate to nursing facilities. "Like the rest of the long term care providers, Genesis supports increasing Medicaid reimbursements," said Blinn. "However, we are outraged that while the SEIU claims they are concerned about patient care, they have chosen to disregard their responsibilities in caring for the elderly people of Connecticut."

Genesis has been negotiating with the SEIU and bargaining in good faith since contracts ran out this fall. Due to a network of New England facilities, Genesis is fortunate to have a large pool of dedicated workers who have volunteered to replace the strikers.
SOURCE Genesis ElderCare

COMMENT:- The next two releases are from the nursing union. The first attacks the company not only for its care but also for its business practices. The nursing union has undertaken a number of studies of Genesis conduct and circulated these. Information was put on the www (no longer available). I have only included a few extracts related to care from this SEIU press release below. There are more extracts on Genesis market page.

The second article reports an SEIU study of staffing levels, which other studies have shown are deficient across the USA but much more so in corporate homes. I have quoted extracts relevant to the market from three SEIU reports on the Market page. I have devoted a full page to the SEIU studies of the care provided in Genesis facilities.

Union Establishes Special Web Site to Track Performance of Nation's Fifth Largest Nursing Home Chain
PR Newswire April 26, 1999

"Company's Performance Doesn't Measure Up to the Hype"
"Genesis is regarded by some as representing the future of the nursing home industry in this country," said SEIU President Andrew L. Stern. "But our research shows that the company's performance doesn't measure up to the hype."
* How the company's effort to establish the "definitive brand name in eldercare services" is foundering on media reports of serious patient care problems in a number of its nursing homes. ("Genesis ElderCare Branding Strategy: Is It Working?," Vol.1 No.3)

Nursing Home Residents at Risk. Staffing Levels at Genesis ElderCare Are 14% Below Average in Sixteen States; Staffing Levels Also Fail to Meet Recommended Minimums
PR Newswire May 26, 1999

The study was conducted by the SEIU, the Service Employees International Union, the nation's largest health care union. Genesis ElderCare is the country's fifth largest nursing home chain.

"Less staff jeopardizes the quality of care received by residents in these homes," said SEIU president Andrew L. Stern. " Genesis ElderCare's strategy of cost cutting means that there are less staff to provide the hands-on care that residents need."

According to a 1996 study of nursing home care by the Institute of Medicine, "inadequate nurse aide staffing leads to increased risk of medical complications and expense, intermittent discomfort from hunger and thirst, escalated need for even more nursing care, and sensory and psychological deprivation."
The National Citizen's Coalition for Nursing Home Reform, an industry watchdog group, recommends that nursing home residents have a minimum of 4.1 nursing hours per patient day available to them. Genesis ElderCare nursing homes, on average, do not meet this minimum recommended level in any of the sixteen states.

SEIU is sending its study to several hundred regulators, legislators and hospital discharge planners in the sixteen states where Genesis ElderCare operates nursing homes. Copies of SEIU's previous reports on Genesis ElderCare can be obtained via the worldwide Web - - - - - -

Average Staffing Data from HCFA OSCAR database July 1997 to June 1998

State ....... Average Non- .... Average Genesis ... % Difference
ElderCare .. Genesis Total ...Total Nursing Staff .....Genesis
.............Nursing Staff ....... HPPD ............. Facilities

CT ............ 3.19 ............. 3.08 ......... 3% below average

DE ............ 4.75 ............. 2.90 ......... 39% below average

FL ............ 4.07 ............. 2.93 ......... 28% below average

IL ............ 3.52 ............. 3.08 ......... 13% below average

MA ............ 3.81 ............. 3.20 ......... 16% below average

MD ............ 3.92 ............. 3.01 ......... 23% below average

NC ............ 4.11 ............. 3.34 ......... 19% below average

NH ............ 3.76 ............. 3.16 ......... 16% below average

NJ ............ 3.49 ............. 3.72 ......... 8% above average

OH ............ 3.87 ............. 3.30 ......... 15% below average

PA ............ 3.96 ............. 3.31 ......... 16% below average

RI ............ 3.91 ............. 1.76 ......... 55% below average

VA ............ 3.82 ............. 3.36 ......... 12% below average

VT ............ 3.47 ............. 3.39 ......... 2% below average

WI ............ 3.29 ............. 2.88 ......... 12% below average

WV ............ 4.34 ............. 3.48 ......... 20% below average

All Genesis
Weighted Avg... 3.78 ............. 3.25 ......... 14% below average

 Total Nursing Staff Hours per Patient Day (hppd) = the average amount of time that residents have available to them from all nursing staff for charting and administering medications (licensed staff) and for feeding, dressing, bathing, ambulating, repositioning and general hands-on care (Certified Nurse Aides).

COMMENT:- Genesis responds by attacking the credibility of the nurses data and by attacking their motives. It does not address the figures by giving its own verifiable figures. This is a typical corporate response. It usually means that the figures cannot be refuted. Is it likely that they would respond without getting a copy? PR Newswire reports are on the www and Genesis uses this extensively.

GHV Releases Statement on Union Claims
PR Newswire May 27, 1999

Genesis Health Ventures (NYSE: GHV) Chairman and Chief Executive Officer Michael Walker released the following statement in response to allegations made by the SEIU yesterday: We have not seen the SEIU "study" but can tell you their news release fits the pattern of SEIU's playing fast and loose with statistics in order to paint a false impression of the care given by our dedicated employees.

Genesis has been under attack by the SEIU for over a year now. This new release is part of a corporate smear campaign. Labor unions have been largely unsuccessful in getting employees to vote for representation over the past 10 years or so. In an effort to boost membership/dues, the unions have developed another tactic -- the corporate campaign. Rather than going after single locations -- in our case nursing facilities -- and trying to get them to go union one by one, they now wage a no-holds-barred attack on the reputation of the owner of the facilities.

It is the union's intention to cause so much pain by way of damaged reputation and stock volatility that the company will unilaterally allow the SEIU to unionize all our facilities unopposed. Genesis will never do that. We strongly believe that each facility and each employee has the right to vote whether or not they want to belong to a union.

As for the allegations made about staffing -- Genesis facilities consistently meet and/or exceed staffing levels set by each state in which we provide care. The union president's statement that we had a staff cost- cutting strategy in place at all our nursing facilities is ludicrous. Even with recent cuts in Medicare funding dictated by the new prospective payment system, we have consciously reduced our corporate overhead costs while keeping staffing levels at skilled nursing centers virtually unchanged.
-- In 1998, 91 percent of current customers said we meet their needs in every way, 90 percent of customers were willing to recommend us to others while 93 percent said our employees treat them with dignity and respect.

-- The last quality component we track is more medically based -- seven clinical indicators. They are pressure ulcers -- a/k/a bedsores--, nutritional assessment, incidents and accidents involving residents, restorative nursing, continence, physical restraint use, and use of psychotropic medications.
The strongest testament to quality care in Genesis facilities is that 43% of our customers get better enough to go home -- that's nearly twice the national average of 24%.

SOURCE Genesis Health Ventures, Inc.

THE HARTFORD COURANT September 17, 1999 Friday, 4S EASTERN

A monthlong effort to organize Salmon Brook Nursing & Rehabilitation Center ended Thursday when workers voted to join District 1199 of the New England Health Care Employees Union.
Union officials contend that officials from Salmon Brook and its parent company, Genesis Health Ventures Inc. of Pennsylvania, responded with a campaign of "threats and intimidation" aimed at persuading employees to reject the union. As a result, District 1199 plans to file "multiple charges" of federal law violations with the NLRB, according to union spokesperson Deborah Charnoff. Company officials could not be reached for comment Thursday.

Danger to Resident Care Leads Workers to Reject Contract Offers at Two Genesis Nursing Homes; Fire, Scabies Outbreak Ignored by Management
PR Newswire December 6, 1999, Monday

CINNAMINSON, N.J. and PARSIPPANY, N.J., Workers at Cinnaminson Nursing Center (Cinnaminson) and Troy Hills (Parsippany), both owned by Genesis ElderCare, announced Friday that they are refusing managements' latest contract offers.

The employees of both homes, members of labor union 1115 of the Service Employees International Union, say that health and safety issues-not wages-are at the heart of the negotiating impasse.

"Right now we have no say in care, and we continue to be understaffed," said Veronica Griffith, a Certified Nurses' Aide at Troy Hills. "And Genesis continues to hire more and more temporary agency workers," she added.

Fears about inadequate staffing intensified on Friday morning, when a Cinnaminson resident set his bed ablaze to get the staff's attention. The resident, who landed in the hospital, had been buzzing for assistance for nearly an hour, but no one responded. The staff of nearly all agency workers was unprepared for the incident and did not call the fire department. Only one full-time permanent aide was working at the time of the accident.

Since Genesis began running the Cinnaminson facility, almost half the experienced, trained care givers have been replaced by temporary agency employees, undermining resident care.

Both Troy Hills and Cinnaminson have been cited for deficiencies in care by state inspectors. Since January 1998, Genesis homes in New Jersey have received $27,000 in fines from the New Jersey Department of Health and Senior Services. The inspections by the state agency that led to the fines revealed violations at the homes that were "widespread," "resulted in actual harm" to residents and posed "a serious threat to the health, safety, and welfare" of the residents at the facilities.

The outbreak and spread of Scabies, a highly contagious parasitic skin disease, is yet another example of Cinnaminson's neglect of safety issues. Not all residents and workers have been treated for the disease, endangering anyone living in or visiting the home.

Cinnaminson and Troy Hills workers want to establish Labor-Management Committees to discuss safe staffing issues and Health and Safety Committees to monitor workplace safety issues.

THE HARTFORD COURANT February 23, 2000 Wednesday,

The newly formed union at Salmon Brook Nursing and Rehabilitation Center has reached a contract agreement with the facility's parent company.

The collective bargaining agreement was reached Feb. 4 between Genesis Health Ventures and local members of the New England Health Care Employees Union, District 1199.

COMMENT:- Note the fracas below which reflects the poor relationships with staff. The company has even commenced a retaliatory law suit against some of its staff. This ort of thing does not create a good environment for humanitarian work. When the union intervened Genesis backed down.

The Boston Globe March 3, 2000, Friday ,THIRD EDITION

Seven nursing home assistants have filed complaints with the Massachusetts Commission Against Discrimination, alleging they were unfairly fired last month by Courtyard Nursing Home in Medford because of their immigrant backgrounds and their involvement with a service-employees union.

Hal Ruddick, staff director of Service Employees International Union Local 285 in Roxbury, said the workers are among 16 who were unfairly fired Feb. 10 because they are Haitian.

"These are immigrant workers who were verbally abused by supervisors at Courtyard," said Ruddick. "They were also terminated because of their involvement in the union."

A spokesman for Pennsylvania-based Genesis Health Ventures, one of three owners of Courtyard, denied the charges. "We terminated them because they left their jobs for more than an hour," said Lisa Sullivan. "They refused to do their morning routines and they ignored supervisors."

Sullivan said Genesis has filed patient-abandonment charges against all 16 workers. The other owners of the nursing home are New England Medical Center in Boston and Hallmark Health System in Malden. They have said they are not responsible for managing the Medford facility.

Fired nurses aides will return to their jobs
The Boston Globe March 21, 2000, Tuesday ,THIRD EDITION

Seventeen nurses' aides who were fired from jobs at courtyard nursing home in Medford last month will return to their jobs under an agreement hammered out by their union and the nursing home.

The company maintained the workers left their posts in violation of employment rules.

Reports Describing Care in Genesis Facilities

Regulators tell 3 nursing homes to stop accepting new admissions
The Associated Press State & Local Wire October 26, 1998

Three of Florida's 18 worst nursing homes are under orders not to accept any new residents and could lose their Medicaid contracts and be fined, as well, the state's top regulator said Monday.

Eighteen of Florida's 676 nursing homes were put on notice by the Agency for Health Care Administration in early September that they had 90 days to shape up or sell .

After reviewing all 18 cases, AHCA found three still had "several serious deficiencies," including bed sores, dirty conditions and insufficient and unresponsive staff.
The three homes with a moratorium on new admissions are - - - - Atlantis Rehabilitation and Nursing Care Facility, in Lantana; - - - - -. Atlantis, owned by Genesis Elder Care, is home to 89 people.

Condition of patients leads to federal fund cutoff for nursing home
Associated Press November 11, 1998

A South Charleston nursing home will lose federal health care funding after failing surveys that measure patient care.

Some patients at Valley Center have been dehydrated, scratched by their uncut fingernails and left in their feces for up to 24 hours, family members say.

By Dec. 10, the federal Health Care Financing Administration will end Medicare and Medicaid payments for 76 patients.
Kim Cameon, a spokeswoman for Genesis Eldercare of Kennett Square, Pa., owner of the center, confirmed that the home did "not meet the requirements to participate in Medicare and Medicaid."

South Charleston home will be re-evaluated soon Health officials try to decide if facility should get funding
Charleston Daily Mail November 13, 1998

State health officials will re-examine practices at a South Charleston nursing home to determine if it can continue to participate in federal reimbursement programs, said the nursing home's corporate spokeswoman.
If the center is not found to be in compliance as of Dec. 10, residents will have to move after Jan. 10, 1999.
Family members had complained that nursing assistants had not trimmed residents' fingernails, had not provided sufficient water and had left residents in their own feces for hours.
After finding deficiencies during separate visits in May, September and November, the federal government withdrew certification.

Without it, families would have to pay the $ 3,500 cost a month or find other placements.

Profits can come at high costs
The Tampa Tribune November 15, 1998

Corporate chains increasingly run the nursing home industry, and research shows they have a large share of problems in Florida.
Comparing care…..Nursing homes are inspected at least every 15 months and graded on compliance with federal requirements. A Tampa Tribune analysis of the latest inspections, up to April 1998, showed five of the six largest nursing home companies in Florida had a higher than average number of deficiencies when compared with all nursing homes in the state.

Total deficiencies for every 10 homes Vencor 118 * Mariner Health Group 111 Integrated Health Services 110 Beverly Enterprises 106 Genesis 95 All other homes 89 Health Care & Retirement Corp. 80

Deficiencies that caused "actual harm' for every 10 homes Each deficiency is graded to reflect its severity. Homes owned by five of the six largest companies, which are all publicly traded, had a higher than average number of deficiencies that caused "actual harm" to residents. Health Care & Retirement Corp. had three harmful deficiencies for every 10 homes, four below are the statewide average. Integrated Health Services 12 Vencor 11 * Mariner Health Group 9 Beverly Enterprises 8 Genesis 7 All other homes 7 Health Care & Retirement Corp. 3


DELAND - The granddaughter of an 89-year-old woman has filed a lawsuit, contending the older woman suffered a broken hip at an Ormond Beach nursing home and subsequently died.

Wendy Sampson of Johnson City, Tenn., is seeking more than $15,000 in damages from Genesis Health Ventures Inc., doing business as Coquina Center Nursing Home. Her grandmother, Jessie Frey of Ormond Beach, died Dec. 21, 1997, from complications from a broken hip, the lawsuit stated.
Frey fell several times, and in December 1997 fractured her hip. Nursing-home staff failed to discover, diagnose and arrange for treatment of the broken hip during a reasonable time period, the suit stated.

The Record (Bergen County, NJ) February 6, 1999

More than one in three nursing homes in New Jersey received a perfect rating under a new report card the state unveiled Friday to help consumers evaluate long-term care centers.
Seven of Morris County's 18 facilities received top scores; two nursing homes received below average scores: Spring Hill Nursing Center in Morristown, which has had new owners and management since last year, and Morris Hills Multicare Center in Morristown.

The Palm Beach Post March 12, 1999

When the Agency for Health Care Administration decried conditions in 18 Florida nursing homes in September, the state initiative was dubbed ''get up or get out.''

Thursday, a major national nursing home chain chose the second option: It announced plans to get out of suburban Lantana.

Genesis Health Ventures of Pennsylvania, which operates 450 nursing homes nationally, surprised residents, their families and even some state regulators by deciding to shut down its Atlantis Center Genesis Eldercare home after moving the 61 residents.
In September, a scathing state report ranked Atlantis among the worst nursing homes in Florida. The report cited problems such as sores on patients, improper medication and unresponsive staff.
On Thursday, Genesis executives blamed the state's ''arbitrary and capricious survey process'' for the closing. They said Atlantis was singled out unfairly and problems were corrected.

COMMENT:- Note the first response to the finding of substandard care was to file a lawsuit against the AHCA. Lawsuits filed by wealthy corporations against underfunded government departments act as a deterent which prevents them from acting in the interests of citizens. Fear of costly lawsuits by Tenet/NME, a company with a budget probably greater than Australian state budgets exerted a strong restraining influence in Australia between 1991 and 1995. Australian state health departments and even the Australian Medical association were constrained when they wanted to act in the interests of citizens. This legal thre4at is one of the reasons why surveillance is so often ineffective.

Sun-Sentinel (Fort Lauderdale, FL) March 12, 1999

The Atlantis Rehabilitation and Nursing Care Facility, west of Lantana, has started to inform patients' families of a plan to shut the home, all of whose 120 beds are licensed to serve Medicaid clients.
The agency, which is responsible for nursing home inspections, had cited the Atlantis Center for an inadequate nursing staff, improper administration of medication, failure by employees to answer call bells and the appearance of bedsores on patients.
Earlier this month, Genesis filed a six-count lawsuit against the agency, claiming that the Atlantis Center was "wrongfully and falsely held out by AHCA as being a substandard facility and was wrongfully included on AHCA's target list of the worst nursing homes in Florida."

The Palm Beach Post March 18, 1999

I read with unrestrained joy last week about the closing of Atlantis Center Genesis Eldercare in Lantana. I visited my sister and a new friend at Atlantis daily. They were generally uncomfortable because their health needs were ignored. In addition, the nursing home was filthy.

After visiting many times, I concluded that making it out of there would be a milestone in one's life.

Lake Worth

COMMENT:- Note the comment about the impact of staff relations on care given in Vencor. Genesis is not doing well in its relationship with staff.

Nursing homes in staff crunch; Worker shortage called threat to patient care
Milwaukee Journal Sentinel March 21, 1999

A serious shortage of health care workers is bringing patient neglect and frustration to a growing number of Wisconsin nursing homes and is threatening access to home care for the elderly and disabled.

Short-staffing citations against nursing homes from Milwaukee to Marshfield have tripled in two years, and the problems have led to harmed residents, burnout among front-line aides and licensed nurses, and widespread use of temporary workers, the Journal Sentinel found. Some understaffed homes are rejecting patients.
The staffing squeeze, fueled by high turnover, is more pronounced at for-profit nursing homes and in the Milwaukee metro area compared with outstate, state figures show. Even temporary help nursing agencies, so-called pools, are running short of workers. They generally pay around $2 more per hour than nursing homes but offer lesser or no benefits.
Documenting short staffing is tricky. State-set minimum staffing levels are very low, so citations usually are based instead on federal standards for care. Proving a link between poor care and short staffing is a challenge for inspectors.
During a period of short staffing at Marshfield Center nursing home, state inspectors alleged that a diabetic woman died after being neglected last June. A spokeswoman for the owners, Genesis ElderCare, a large Pennsylvania-based nursing home chain, said the death was not linked to low staffing.
The state's top health official acknowledged the nursing home industry's staffing challenge but said the tight labor market wasn't the whole story. Health and Family Services Secretary Joseph Leean faulted Vencor for fueling an exodus of nurse aides at Mount Carmel through poor labor relations.

Hanging on to staff For -profit nursing homes have the most dificulty retaining nursing staff compared with their competitors, the latest figures show Nursing turnover is linked to quality of care.

One-year retention rates:


Licensed practical nurses..98%............81%..............83%
Nurse aides................90%............66%..............70%

2 nursing home employees charged with neglect
THE BALTIMORE SUN November 4, 1999, Thursday ,FINAL

The former administrator of a Parkville nursing home and a nurse at the facility have been charged with reckless endangerment and neglect in a case stemming from the death of a patient who died shortly after her release from the home in October 1998.

The former employees of the Cromwell Center Nursing Home were indicted after an investigation by the state Attorney General's Office that was sparked by testimony before a congressional committee this year.

Frank Mann, spokesman for Maryland Attorney General J. Joseph Curran Jr., said yesterday that Wesley E. Street, the former administrator, and Robin L. Kelly, a nurse formerly employed at the facility, were charged in indictments --unsealed Tuesday -- with reckless endangerment, Medicaid fraud and neglect of a vulnerable person. The charges stem from the case of Elsie Wagner, who was a patient at Cromwell, which is owned by Genesis Eldercare, a Pennsylvania-based nursing home chain.

Wagner's granddaughter testified about the care provided to her late grandmother before the Special Committee on Aging, which held hearings in Washington last year on how well states responded to complaints of poor patient care. Maryland was one of the states criticized in a report released at the hearing.

Gloria Cruz, the granddaughter, told the committee that when she filed a complaint about what happened to her grandmother, she was told by a state official, "We deal with the live patients before we deal with the dead ones."
In a written statement, Lisa Salaman, a Genesis spokeswoman, said the company did not believe criminal charges were warranted.

"The center provided excellent care to Mrs. Wagner up until the time of her discharge to another facility. - - - - -

COMMENT:- The explanation given for settling this case is often offered. It allows the corporation to go on claiming that it was not at fault.

Nursing home, state settle discharge death suit; $50,000 'ridiculous, ' says patient's kin
THE BALTIMORE SUN January 19, 2000, Wednesday

A Parkville nursing home has agreed to pay $50,000 to settle charges brought by the state Attorney General alleging that its workers failed to follow proper procedures in discharging a critically ill patient who died eight days later.

The settlement announced yesterday stems from the case of Elsie Wagner, who was a patient at the 147-bed Cromwell Center at 8710 Emge Road from Nov. 30, 1995, until her discharge on Oct. 9, 1998. Released from Cromwell with critically low levels of sodium, Wagner died Oct. 16.

Gloria Cruz, Wagner's granddaughter, who testified before a congressional committee last year about the case, called the settlement " ridiculous."
The nursing home, part of the Pennsylvania-based Genesis ElderCare chain, will pay the $50,000 fee in return for the state's agreement to drop any further civil or criminal action related to the patient's discharge.

The agreement will not affect the criminal charges against two former Cromwell employees, who were indicted last year on charges of reckless endangerment and neglect.
Wagner's release from Cromwell came after her family had arranged to move her to Delaware where she would be closer to relatives, including Cruz.
The information not transmitted to the family or the Delaware facility included "panic level" blood test results which showed Wagner's sodium levels were critically low. Other information not sent out to the family included the fact that Wagner was experiencing significant chest congestion and that the patient had recently fractured her arm, "leaving her with persistent pain."

In a company statement, Genesis spokeswoman Lisa Salaman said, "The center chose to settle unfounded claims brought by the Attorney General's office, without admitting any such violation, to eliminate the diversion of time and resources from providing care and supporting former center employees who were unjustly charged in this case."

The two former employees, Wesley E. Street, former administrator, and Robin L. Kelly, a nurse, were charged with reckless endangerment and neglect in an indictment announced Nov. 3. The two are no longer employed at Cromwell.

Genesis has promised to help defend the two former employees.

COMMENT:- The next article which is primarily a review of staffing problems describes the voluntary closure of a below average Genesis nursing home. The article also discloses that by 2000 there was an excess of nursing home beds in some states. One of the reasons for this may have been that the "demand" for post-acute care and a variety of therapies has disappeared now that therapy is an expense rather than a profit. The net result is that patients are shuttled about to meet the demands of the marketplace.

Worcester nursing home to close; 76 being displaced at Lincoln Center
TELEGRAM & GAZETTE March 08, 2000

- Lincoln Center, a 130-bed nursing home at 299 Lincoln St. owned and operated since 1991 by Genesis ElderCare, will close.

Seventy-six residents will move to other facilities.

In a letter to the state Department of Public Health filed with its voluntary closure plan, Genesis ElderCare said it was no longer financially viable to continue to operate Lincoln Center.''

Genesis ElderCare spokeswoman Lisa J. Salamon said yesterday that the nursing home was losing money and having difficulty hiring staff and attracting residents because of an overabundance'' of nursing home beds in the area.
Staffing difficulties and too many beds are common problems, he said. A 1999 survey of federation members showed more than one in 10 nursing positions is vacant, leading nursing homes to enact or consider admission restrictions.

Statewide there are 4,000 to 5,000 empty beds, as elders find other options for care, such as assisted living, and nursing home stays become shorter, he said. But if they were filled, we would have a horrendous problem,'' because of staffing, Mr. Plumb said.
Lincoln Center's report card score continues to be below the statewide average. Its score is 104, compared with the statewide average of 122 and a maximum possible score of 132.

Aid cuts create nursing home ills; Low wages, rivalry add to woes

Several major national chains have declared bankruptcy. Other big chains, such as Genesis ElderCare of Pennsylvania -- which closed a 130-bed nursing home in Worcester last month -- have restructured, resulting in closed facilities and displacement of residents.

COMMENT:- The following comes from a web site run anonymously by nurses and concerned citizens who fear victimisation. It claims that it has already been closed down once by corporations. It publishes information about standards of care without disclosing sources. It is produced to illustrate the depth of anger about the aged care marketplace. I cannot vouch for its accuracy.


The following are nursing homes in our area and what the nurses and residents have to say about them. We provide this list to aid those who are shopping for a nursing home bed for their loved ones. We believe no one else is standing up to provide this service. The staff writing this Web Site are not affiliated with any of these nursing homes, and are not all nursing home professionals. Included are RN’s, LPN’s, EMT’s, ministers, nursing home volunteers, family members, nursing home residents, and social workers. We must publish this site anonymously so that we can protect our jobs against certain corporate retaliation.

The corporate interests tried without success to ban our site, having it removed the first day we put it online! But we are back and will soon have a permanent site outside the USA.

Genesis operates a rather large number of nursing homes in this area, and we had no shortage of stories that were easy to check out! They operate Heritage Hall(s) in Agawam, Chapin Center in Springfield, Governors House in Westfield, Kimberly Hall(s) in Windsor, Salmon Brook in Glastonbury, Fox Hill in Vernon and others.

Genesis is now in Chapter 11 bankruptcy. The one thing the nurses from Genesis never stop saying is how short staffed the place is. Treatments and medications fail to arrive on time. Supplies are always at a premium. Managers turn over by the week. Unlike Vencor you will see lots of pool at any Genesis facility we looked at.  The stress is so bad that staff and managers are turning on each other like a shark tank at feeding time.

The pay is low, and they force staff to punch out for lunch even though they must work during lunch to avoid discipline. Overtime is subject to discipline too.

Nursing home violations rise; Life-threatening problems at some long- term centers worry state officials
Milwaukee Journal Sentinel April 8, 2001 Sunday FINAL EDITION
STEVEN WALTERS of the Journal Sentinel staff

COMMENT:- One of the cases used to illustrate this was a Genesis home.

Still, on some days in some homes in the last few months, the frayed safety net of nursing home care has failed completely.

Stevens Point: Care given to four residents of the River Pines Center in Stevens Point -- who all died between Dec. 23, 2000, and Jan. 29, 2001 -- was criticized by state inspectors in a 167-page report.
Alleged care lapses at that home were "sobering," Schroeder said. "I am not aware, in talking with the staff, that there had ever been a case like this before."

River Pines is owned by Genesis Health Ventures, which owns several Wisconsin nursing homes, including two in Madison. The chain's homes are part of the estimated 14% of nursing homes in the state that are operating under bankruptcy protections.

Genesis spokeswoman Lisa Salamon said company officials reacted with "shock and disbelief" at the allegations of poor care at River Pines and "assembled a team of clinical care experts" to investigate.

"We have done root-cause analysis of all four cases and have met with the state to informally dispute their findings and conclusions," said Salamon, who said the state report " distorts circumstances and causes" surrounding the four deaths.

The Record (Bergen County, NJ) April 8, 2001
PAUL H. JOHNSON, Staff Writer

Comment:- The unions exposed poor standards in Genesis homes publicly. Genesis has not taken the message to heart. It is still victimising union members who protest.

More than 100 union workers rallied Saturday afternoon in front of the Ridgewood Center nursing home to protest stalled contract talks and the firing of three workers for joining a picket line.
Crawford joined the strike on March 13 to highlight the fact that center workers did not have a contract. Two days later, he was told a permanent replacement was taking his job as a housekeeper.

Local politicians and union activists from New York and New Jersey joined the protest, saying that Genesis Health Ventures, the nationwide corporation that runs Ridgewood Center, should not have dismissed the employees for joining a strike.

"You don't fire workers for going on a picket line," said Assemblywoman Loretta Weinberg, D-Fort Lee."These are the people who take care of the most frail in our society. If we can't pay them decent wages and protect their future, then we are not upholding our part of the contract with society."
Salamon (for Genesis) said the three workers who lost their jobs were warned before the strike that if they walked the picket line before a contract was signed, they could be replaced."We told them if they went on strike without finishing negotiating a contract we would hire permanent replacements," she said.

Ormond Beach nursing home sued for accidental death
The Associated Press State & Local Wire April 11, 2001

An Ormond Beach nursing home where a resident accidentally strangled himself two years ago is being sued over the death.

THE HARTFORD COURANT May 18, 2001 Friday,

The union representing striking health care workers Thursday reached agreements with five more nursing homes for employees to return to their jobs, but workers at more than half of the original 39 homes affected by the strike remained out of work.

Among the homes where union members will be able to return to their jobs were two facilities owned by Genesis Healthcare, which had hired permanent replacements during the strike. The issue of replacement workers has become a key sticking point in resolving the impasse.

Genesis in the Aged Care Environment

Federal Pay Rules Hit Nursing Homes :::: Market Slams Publicly Traded Firms Squeezed by Reimbursement Rules
The Daily Record (Baltimore, MD.) May 3, 1999
Bob Keaveney; Daily Record Business Writer

PPS applies only to the patients whose services are paid through Medicare, which covers only about 8 percent of nursing home costs. Some 70 percent is paid via Medicaid, with the rest covered by private health plans or long-term care insurance.

Still, because Medicare is the primary payer of ancillary services, providers say they must cut back or even eliminate many of those services.

Nursing homes feel the pinch of federal Medicare changes
The Associated Press State & Local Wire May 19, 1999

The possibility her nursing home will run out of money keeps Ruth Baron awake at night.

"I'm an early-to-bedder," Baron told a visitor Tuesday. "They don't have enough help. ... I'm ready to go to bed and there's just nobody to put me in bed. I just can't do it on my own."

Baron, 77, lives at Harris Hill Center, a nursing home owned by Pennsylvania-based Genesis Health Ventures Inc. Genesis is one of five national chains that together own 29 of New Hampshire's 95 nursing homes.

Genesis and at least two other companies have taken a financial beating recently, largely because of a new payment system for Medicare, federal health insurance for the elderly.
Shumway says the state is keeping close tabs on homes owned by the chains to ensure patient care doesn't suffer.

Nursing Home Industry's Financial Crisis Threatens Patient Care
The Washington Post June 19, 1999

Much of the nation's nursing home industry is in such dire financial straits that regulators and other observers are worried about the care elderly residents will receive.
"Basically they've been expanding much too fast . . . and it sort of backfired on them," bond analyst Frank Bianco of McMahan Securities said of nursing home chains. "I'd say that had they not expanded to the extent they did they'd probably still be in good shape now," Bianco said.
Under the new system, the government is moving toward standardized daily payments. The transition began last July for some companies and in January for others. For companies such as Vencor and Genesis Health Ventures Inc., the average daily payment for a Medicare patient declined by more than 20 percent during the first quarter of 1999, compared with a year earlier. For Genesis, the average sank from $ 393 to $ 312.
"We are receiving more complaints from staff themselves about facility conditions and the quality of care than we have in the past, a significant increase," said Mark Miller, Virginia's long-term-care ombudsman, an advocate for nursing home patients.

"If a facility's in trouble financially they're much more likely to make up the costs in the care they provide, which means less services, less staffing, and that all equates to a poor quality of care," Miller said. "People just aren't going to get the services that they need."

In District of Columbia nursing homes, "we've got quite a few cases of just not enough staff on duty to do the things that residents need," though that isn't a new problem, said Anne Hart, who until recently was the ombudsman for the District.

In Maryland, "I think that the quality of care in nursing homes has probably deteriorated in the last 12 to 18 months," said Carol Benner, director of licensing and certification.
Five Maryland nursing homes were dropped from Medicare and Medicaid during the fiscal year that began Oct. 1, compared with none during the previous fiscal year. The increase may partly reflect stricter government standards and heightened enforcement, Benner said.

COMMENT:- Genesis is unhappy that Florida authorities are only monitoring stock-driven companies. The authorities are well aware of the pressures on these companies and their poor track record.

State scrutinizes finances of nursing homes
Business Journal February 25, 2000

State regulators are closely monitoring 12 area nursing homes because of concerns about their financial health.

Northeast Florida nursing homes being scrutinized by the state Agency for Health Care Administration are owned by four companies. Three of the companies filed for Chapter 11 bankruptcy protection last year.

Those companies are:

* Sun Healthcare Group (OTC-BB: SHGE) of Albuquerque, N.M.
* Mariner Post-Acute Network (OTCBB; MPANE.OB) of Atlanta.
* Integrated Health Services (OTCBB: IHSVQ.OB) of Baltimore.

The fourth company is Genesis Health Ventures (NYSE: GHV) of Kennett Square, Pa.
* Genesis Health Ventures, owner of Lake Forrest Health Center in Jacksonville, is the only company on the state's monitoring list that has not filed for Chapter 11.

"Genesis has not filed bankruptcy and does not intend to," said Marilyn Wood, president of the southern region for Genesis Eldercare.

However, the company's financial situation has been a concern on Wall Street. On Feb. 6, Genesis' stock hit a new 52-week low of $1.43.
Genesis' Wood says she is concerned that the state agency is looking only at proprietary or for-profit companies.

"Their justification is that they're primarily looking at stock-driven companies," she said. "We all know that long term care is having some difficulty."

Wood also is unhappy with some of the questions Health Care Administration asked employees at the Genesis-owned Riverwood Center.

"They asked if they were receiving pay checks and if they bounced," Wood said. "We felt that it wasn't appropriate, and that has subsided." The Riverwood staff also has been asked about inventory, supplies, food and their general satisfaction with the facility

COMMENT:- Note the comment by an Ombudsman which is very critical of the working conditions created by the market based companies.

The Ailing NH NURSING Homes Industry
Business NH Magazine March 1, 2000

Many New Hampshire nursing homes are facing uncertain financial futures.

Griffin and her small team work with residents, their families and the facilities to resolve disputes, and she says she has seen marked increase in the number of complaints" over the past three years - from 674 in 1997 to 1,146 in 1998, and the same again in 1999. The complaints "cover a full range of concerns," she says.

Asked to what she attributes the increase in complaints, Griffin answers that "it's not possible to attribute what we are seeing to one factor." Certainly, the trend towards acquisitions and the building of multi-state chains is part of it. "It's a matter of public record," Griffin says, "that we have chains that made huge acquisitions and overextended themselves."

Rusin says the "atmosphere" changes when privately-owned nursing facilities are purchased. "It used to be that you'd talk to the administrator, and it would be the owner. ... Now they have to call a corporate office ... chains have templates on how to do things," and cannot always react quickly to correct problems.

In some parts of the state, the nursing homes aren't competing with each other for employees; they're competing with Target and Wal-Mart.

In other areas, there is almost a bidding war going on for nursing home workers, with $1,000 signing bonuses paid to leave one facility for another, Rusin says.

The lack of continuity of caregivers is a big issue for residents, says ombudsman Griffin (Ombudsman). "Survey after survey shows that what residents value most is their relationships with staff ... it's the interpersonal connection. And if the faces are changing all the time, that's not there. Facilities try to provide continuity, even with (temporary) staffing agency personnel."

Her solution? "Nursing homes need to be a place where people want to work. It's not all about money and benefits. The industry needs to pay attention to the work environment. Caregivers want to feel that what they have to offer is valued and respected. Money needs to be invested in the culture of the nursing home, paying attention to why people want to work where they work. That's a long-term solution."

Genesis Speaks for the Industry

The industry has bitterly opposed any increase in salaries, claiming that they can't provide care if their expenses are increased. What they are really saying is that they can't provide care and pay off their loans.

Minimum Wage Hike Proposed
AP Online October 07, 1999; Thursday 17:23 Eastern Time

The minimum wage would rise $1 over three years and businesses would get $35 billion in tax cuts under bipartisan legislation circulating Thursday in the House.

Republicans and Democrats acknowledge that an increase in the $5.15-an-hour wage is all but inevitable, but many are looking for a way to offset the estimated $16 billion cost to businesses.
Meanwhile, a House committee heard dueling testimony Thursday regarding how a minimum wage increase would affect the number of people on welfare.

A $1 increase would force entry-level wages higher across the board, increase employer costs, reduce the number of jobs and lure badly needed workers away from nursing homes to better paying jobs elsewhere, said Deborah Rowe, director of staffing services for Genesis ElderCare.

An increase ''will reduce our already limited ability to hire and train new employees, and thus will have a negative impact on hiring of public assistance recipients,'' she told the House Education and the Workforce Committee.

Federal News Service OCTOBER 7, 1999, THURSDAY

Thank you Chairman Goodling and members of the Committee for the opportunity to speak to you today. My name is Debbie Rowe. I am the Director of Staffing Services for Genesis ElderCare. I am here today on behalf of the American Health Care Association - a federation of 50 affiliated associations representing over 12,000 non-profit and for- profit assisted living, nursing facility, and subacute care providers nationwide. I'd like to use this opportunity to discuss with you the significant effects that increases in the minimum wage have on the long term care community, and the impact such increases have on our ability to provide employment and career opportunities to economically disadvantaged people.
In conclusion, nursing home providers are in a bind. We are dependant on federal and state governments for payments for nearly 80% of our residents. These payments often do not meet the cost of providing care. A minimum wage increase will increase those costs, thereby stifling our ability to do the outreach, training, and provide the special services required to continue our success in the moving people from welfare to work in our communities.

Recommendations There are many steps that could be taken to save long term care providers from the staffing and caregiving crisis we are currently facing. Among these steps are:

  • Expand the concept of a minimum wage to create a higher nursing home wage with requirements for state & federal governments to pay for that wage through fair Medicaid & Medicare reimbursement.
  • Recognize our responsibility to care for residents and enact payment standards that are adequate to meet the costs of providing care.
  • Extend the Work Opportunity Tax Credit for a longer term with inflation updates to the credit.
  • Allow struggling companies to deduct the WOTC credit from the Alternative Minimum Tax (AMT).
  • Enact a special training tax credit for employers that provide a recognized program leading to a certification such as a CNA.
  • Pass BBA "fixes" to restore dramatic reductions to Medicare payments for skilled nursing facilities (SNF) and repeal the arbitrary therapy caps.
  • Dedicate future hearings to the specific problems of recruitment and retention of caregivers in this tight labor market.
  • Enact enhanced visas to lift caregiver immigration restrictions and
  • provide a labor pool for much needed caregivers.
  • Enact upward mobility scholarships to fund additional training toward advanced certifications in nursing and other critical care functions.

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