CMS Regulations and Monitoring Long Term Care Facilities

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This is the Nursing Home Abuse Podcast. This show examines the latest legal topics and news facing families whose loved ones have been injured in a nursing home. It is hosted by lawyers Rob Schenk and Schenk Firm of Schenk Smith LLC, a personal injury law firm based in Atlanta, Georgia. Welcome to the show.

Schenk: Welcome to episode 63 of the Nursing Home Abuse Podcast. My name is Rob Schenk.

Smith: And I’m Schenk Firm.

Schenk: And we are your co-hosts and we also happen to be nursing home abuse trial lawyers operating out of the state of Georgia. As this episode goes to air, it is April 9^th, 2018, very close, in fact, on Friday, it will be the birthday of our third President, Thomas Jefferson.

Smith: Awesome.

Schenk: Well I only say that because I’m already prepared. I have this sheet ready.

Smith: Okay.

Schenk: It’s that while in fact Thomas Jefferson was the third president, during his presidency, I should say, the Seventh Amendment was ratified. And without looking at this paper, being an attorney for however many years going through law school, Will, can you tell me what the Seventh Amendment is?

Smith: It’s the right to a trial by jury in civil cases over $20.

Schenk: That’s right. In suits at common law, suits by a trial by jury shall be preserved, and no fact tried by jury shall be otherwise re-examined by any court in the United States.

Smith: I wonder has there every been an appellate decision or something like that involving a case where somebody sued for less than $20 and they were told you can’t do that?

Schenk: I don’t know but aren’t there appellate cases – it’s a shame that I don’t know this, but hasn’t that increased just through the common law, like the $20 component?

Smith: I don’t think it has.

Schenk: I don’t know. I feel like the Seventh Amendment would have to be the least litigated of the amendments, because with the exception of the quartering of troops.

Smith: Oh right, right, right. The Third Amendment. It doesn’t matter. Our current dean, Dean Timmons, I’ll never forget…

Schenk: At Georgia State University.

Smith: At Georgia State University. Her husband would go to parties and tell people he was a professor at Georgia State and he taught the Third Amendment, and people would be like, “Oh, that’s really interesting.” He’d be like, “Oh yeah, lots of crazy stuff happening with the Third Amendment nowadays, you know what I’m talking about?”

Schenk: This guy knows what I’m talking about. Very quickly for anybody that’s interested in the Seventh Amendment, the Seventh Amendment was a response to what? The injustices of the English Crown. King George abolished trial by jury just prior to the revolution. Still before, trials were often unfairly decided by judges loyal to the king, so the Founders sought to ensure citizens could bring their grievances before their peers who would then impartially evaluate their claims. Now that judge only determines that law to be applied and leaves the jury alone to determine how that law applies to the facts.

And Thomas Jefferson viewed the Seventh Amendment as essential for democracy, and there’s a famous quote – most all trial lawyers have this in their email signature, but it is by Thomas Jefferson – quote – “I consider trial by jury as the only anchor ever imagined by man by which a government can be held at principle of its Constitution,” – end quote.

Smith: And you’ve got to think like what was really going on with the Founding Fathers in the decision to include the right to a trial by jury is probably that rich landowners weren’t getting their way all the time and so they were sick and tired of having to deal with royalty making decisions and they wanted the other rich landowners, their peers, to be able to make decisions in cases of controversy.

Schenk: I’ll have to say lucky that they did want to control…

Smith: Oh, I’m sure.

Schenk: …for us, down the line.

Smith: Oh, absolutely.

Schenk: Speaking of the line, we’re going to be having somebody on the telephone line here in the next couple minutes. In other words, we have another guest. Our guests are becoming more common on this program.

Smith: Yeah.

Schenk: People – I don’t know. Word’s getting out about the show. Anyway, who is the guest for today, Will?

Smith: Well it is Richard Mollot who I had the pleasure of meeting at the Consumer Voice, which is a long-term care advocacy group. I met him at the conference back in November. He is the executive director of the Long-Term Care Community Coalition or LTCCC, a nonprofit organization dedicated to improving care for seniors and the disabled through legal and policy research, advocacy and education.

Richard has served on a number of state and national consumer and government advisory boards relating to such issues as dementia, nursing home and assisted living standards, mandatory managed long-term care and nursing home financing and quality improvement.

He has written and presented trainings on a variety of long-term care issues including nursing home laws and regulatory standards, assisted living law and policy, dementia care, the use of antipsychotic drugs, caring and planning for an aging person with disabilities and the Affordable Care Act – what seniors need to know about long-term care and elder justice.

Richard is a graduate of Howard University School of Law and is a member of the Maryland Bar. When I went to the conference and met him, he was actually presenting on the new changes on what people needed to know about the new regulatory changes that went into effect last November for CMS.

Schenk: Ah, okay.

Smith: So it will be interesting to talk to him about those changes and how they have not been enforced.

Schenk: How they have not been enforced. But at any rate, we’ve got him on the line. Richard, welcome to the show.

Richard: Hi. Well thank you very much for letting me on. I appreciate it.

Smith: So Richard, we met last fall at the Consumer Voice conference. I really enjoyed your presentation on the new changes on what surveyors and advocates of long-term care residents need to know. But first, just kind of give us an overview of what your organization is.

Richard: Sure. So we’re a nonprofit organization. We’re actually pretty small. And we focus on improving care and quality of life for residents in nursing homes and assisted living primarily. So most of my work, I would say, is on nursing home issues.

Smith: Okay.

Richard: So we also are entirely dedicated to the resident’s perspective, so we don’t – occasionally we’ll do trainings and give information to nursing home providers, but we are entirely focused, entirely dedicated on the resident and family perspective.

Smith: And you guys are located in New York, is that correct?

Richard: That’s correct, but if I may mention our website, NursingHome411.org, we have resources for residents and families and advocates who will work with them around the country. We put data out in easy-to-use format for people to find out about staffing levels in the nursing home, find out about citations about the nursing home, find out things like antipsychotic drug use in the nursing home, and we have a lot of materials, including what we’re going to be talking about today that are applicable nationwide.

Smith: That’s an extremely helpful website and we’re going to make sure that goes up on the screen here because one of the things that happens a lot of the times is we get all types of calls, not just for individuals looking to make a legal claim, but also people that just have questions, like, “Hey, is this a good nursing home?” or “Where should I put my loved one?” So any information like this, Nursing Home 411, I think people are going to really appreciate.

Richard: Great, great. Thanks. And obviously I agree with this for all the work that we do, but especially now as a lot of things are changing in the nursing home system and frankly over the past year we’re seeing a lot of the basic protections being undermined that it’s really important for people to know what their rights are and the people that work with them, the families, attorneys, advocates, etc., to know exactly what a resident’s rights are in terms of certain care requirements and have an advocate for them.

Smith: Right, so I want to get into that too, and before I do, I just want to let our listeners know that before 1987, it was kind of like the Wild West. I know at the conference, I was talking to a very old school ombudsman who remembers nursing home because the Omnibus Reconciliation Act of ’87, which included the Nursing Home Reform Act, and she said it was “One Flew Over the Cuckoo’s Nest.”

And now we have these new rules and it is getting better for residents, but tell us what’s going on now because when you and I met in November, we were right on the cusp of the second phase of three phases. Can you explain what was going on with that?

Richard: Sure. Obviously being respectful of time, but a brief background might be helpful. So any nursing home that takes any amount of money from Medicaid or Medicare is required to abide by the Nursing Home Reform Law from 1987. And the regulation came out about five years after the Reform Law was passed in 1987 and they had not been changed until 2016. So a lot of the work that we have been focused on is a result of that change as we mentioned.

But as I said, every nursing home is required to meet those standards. Every nursing home that’s licensed is required to meeting those standards for every single resident in the facility whether it’s private pay, whether the care is paid through Medicare, Medicaid, their Uncle Jack, it doesn’t matter. These rules that we talk about apply to everyone in the facility.

So what happened is that over 25 from 1992 to 2015-16, things obviously changed. We have a better understanding of what people want when they get older, what they have a right to when they get older. We have a better understanding of dementia and the lives that people with dementia, what makes that good or bad, appropriate care, etc.

Now CMS, the Centers for Medicare and Medicaid Services, they developed changes over the course of that 25 years through what we call S&C memos. So over time there have been little tweaks to the regulations. What CMS did in 2015-16 is that they completely revised the regulations.

So a couple of important points here. They have implemented those regulations over a three-year period, so the first phase is 2015, November 2015. The second phase, as you mentioned, was just this past November. And then the third phase is in another two years.

But I tell people, and I think it’s really important for families and residents and everyone who works with them to understand that that Nursing Home Reform Law that you mentioned, that 1987 Omnibus Reconciliation Act, that has not changed. The basic standards that we talk about have not changed, so if some of the language changed, some of the expectations, like I said, with dementia care, etc., the guidelines of that have changed. The understanding of what our expectations are have changed, but basic standards have remained the same.

And the reason why I think that’s so important is because we were afraid that with these changes going on with the survey system, which we’ll talk about today and that was a subject, of course, in my presentations, but also that the changes to the regulations would be public advisors don’t know what to do any longer, surveyors, the inspectors, don’t know what to do any longer, that the nursing homes could use as an excuse that things have changed and we don’t know. And it’s important for people to understand that no, those basic rights have not changed. Basic standards have not changed at all.

Smith: So what was the impetus for the change, then?

Richard: You know, the advocates that I worked with, we were not happy that they were making these changes. I think that part of it was that they did have these memos over the course of the years that did put in different guidelines and language to the regulations so that they wanted to rework that all over again in a sense. But I mean, I personally don’t think it was the best idea. A lot of what we see, to be honest, in terms of the changes that go on over the years with nursing homes and with nursing home payments and reimbursement for care, etc., is frankly, unfortunately we have a lot of bad nursing home operators out there, and that is why we have always strongly supported attorneys and the right of people to go to court when they or their loved one is the subject of abuse and neglect. But the – sorry, I lost my train of thought.

Smith: You guys didn’t like the changes. I know there was a lot of grumbling about the changes in the F-tags.

Richard: About that, that’s right. So essentially all these changes were implemented. The standards essentially remain the same and we were just so concerned and are still concerned that this is going to lead to a lot of confusion.

Smith: Sure.

Richard: Now you mentioned F-tags. So essentially we have the nursing home law, Nursing Reform Law, and that has not changed. That’s from 1987. And many of the regulations – and the regulations were essentially revived, but again, they’re all based on the same standards. So for instance, a resident has a right to receive care and the expectation is that they will not develop a pressure ulcer unless it was absolutely unavoidable.

Smith: Right.

Richard: That’s been a law since 1987 and it’s been a regulation since 1991, and it continues to be in the revised regulation. So the difference could be in terms of what the expectation is for the nursing home to be self-assessing whether or not it has the staff training and the sufficient staff to meet those needs. That is something, that quality assurance component, is something that’s new in the new regulations, but again, that standard has existed. I know it’s still a serious problem. In fact, that’s one of the issues that we have data for every nursing home that we publish periodically when the data is updated, so you can see what are the pressure ulcer rates in the nursing homes in my community, the nursing homes I’m thinking about, etc. So that I think is a very good example, that and antipsychotic drugs is another good example of that. Seven years ago, the U.S. Inspector General found out that one out of four nursing home residents were being given antipsychotic drugs, which carry a black box warning against use on elderly people with dementia.

Smith: And black box – for our viewers, what does black box mean?

Richard: So the FDA reviews medications, etc. A black box warning is its highest possible warning.

Smith: Right.

Richard: And essentially what they say in a black box warning is that these drugs in particular have a high risk of death. They also have a high risk of stroke and heart attacks, falls, Parkinsonism, which is not Parkinson’s disease, but Parkinson’s symptoms. And attorneys I know, two of them I’ve spoke to over the years said they have clients who are on these drugs who developed shakes and the other Parkinson’s-like symptoms, and even when they were taken off the drugs, the shaking didn’t go away.

Smith: Yeah.

Richard: So those are some of the reasons why there is a black box warning against the use of these drugs. So what CMS essentially did is they, I would say, beefed up a little bit the requirements in 2016 by requiring that the pharmacist review medical records of anyone who is taking these drugs, at least on a monthly basis. But again, that’s because we have, even though this is prohibited in 1991, that we have, 20 years later, 22 years later, we still have 25 percent of residents receiving these drugs. I’m not a clinician, but I know how to read and went only and I looked at the CDC website, I looked at a scientific journal – 1.5 percent of the entire population will ever have a diagnosis that CMS uses when it risk adjusts for appropriate use of these drugs.

Smith: And just to explain to our listeners, what’s going on here is, and I think we’ve had an episode about this before, is antipsychotics can be used as a form of chemical restraint. So you’ve got Mr. Johnson who’s roaming the halls and he’s getting into other residents rooms and he’s an annoyance to the staff or he’s maybe a little aggressive but he’s not really a harm to himself or others, it is easy for them to sedate him and give him some sort of sedative or psychotropic or antipsychotic, and that’s against his rights as a resident.

Richard: Correct. And in so many ways, there’s a prohibition against the use of chemical restraints, as you mentioned. There is a prohibition against the use of drugs that are not necessary to treat specific clinical conditions with the use of antipsychotic drugs. If someone is put on an antipsychotic because say they’ve become very agitated and are a danger to themselves and others, there are protocol requirements that two things happen – one, that there is gradual dose reduction, that the facility is looking to ensure that the dosage of that drug goes down, down, down.

And the other thing is non-pharmacological approaches that the facility is also looking to see what is going on with this person – how can we treat it? Because we know all dementia-related behaviors as they’re called, the scratching, spitting, crying, whatever that might be, they are all an expression of something that is going on with the resident, and too often, the nursing home staff don’t understand that and they take something personally or they will go off and engage with the resident in a negative. But it’s very important for families and everyone who works with them to know that those so-called behaviors, they’re an expression – something is going on with me. I’m scared or I’m bored or I have a backache or I’m constipated or whatever, and I can’t say, because I have dementia, I can’t say, “Look, my tummy hurts,” or “Look, you scared me when you grabbed me from behind.” So those are really, really critical for people to understand because so much of what we come across in poor care, unfortunately a substantial amount is lack of training and especially for people with dementia, a lack of training, understanding of care for a resident with dementia.

And that, just to circle back, that is a really good example because those requirements, again, were always there in the 1987 law and the 1991 regulations. And again, that no chemical restraint, no inappropriate use of drugs, etc.

Smith: Okay. So this is a very basic overview and question, but when we talk about these regulations, who is it that’s enforcing? The state surveyors, yeah.

Richard: Yeah, the Centers for Medicare and Medicaid Services, that is the federal agency that operates under the President of the United States, and they are responsible for two things – paying nursing homes for the care they provide and overseeing nursing homes and ensuring they’re providing good care to residents 24 hours a day, seven days a week, 52 weeks out of the year. They contract with state survey agencies, and usually it’s the Department of Health, the Department of Public Health in this case. And those states pay the nursing homes and they are responsible for overseeing the nursing homes. They do that –

I think it’s important to note in two basic ways – one is that they are responsible to responding to complaints from residents, staff, families, workers, etc., and two, and most importantly, is that they have to conduct essentially an annual survey. The survey can be between nine and 15-month period, but it’s supposed to be a surprise survey and state is required to have an annual survey. They are not in compliance with their contract, and this is something that I’ve studied a lot over the years is that there is what’s called a state operation manual that details, and that’s the reason I wanted to mention that is because too often, frankly, our researchers, government researchers found that states do not do a good job identifying when there is non-compliance with minimum standards when there is abuse and neglect, and even when they do identify those problems, they often don’t cite the facility, they don’t penalize the facility, and if they don’t penalize the facility, then they don’t make change, and that again gets back to why we’ve always been so supportive of the role of the attorney because oftentimes that’s the only place, the only area in which a resident and a family can get some kind of – have their voices heard and get some kind of justice.

Schenk: What’s your understanding as to why? What’s your opinion as to why the regulatory bodies are not able to execute and effectuate regulations appropriately in your opinion?

Richard: The nursing home industry is extremely powerful, and as an aside, the pharmaceutical industry is also extremely powerful, probably even for more so because they’re such a money vendor in our society. So that’s why we have the issue with antipsychotic drugs in short. But in terms of oversight, the nursing home industry is very powerful both on the federal level and on the state level.

So I don’t want to get too far ahead, but one of the issues about which we’re very concerned for residents and families right now is that as soon as the last presidential election, the nursing home industry wrote letters to President-elect Trump, then the President Trump and then to the head of CMS saying, “Oh, we need to have less regulations. We need to have even lower enforcement.” So these have been such significant issues for residents over the years and people who never go to a nursing home and the nursing home is not very good and then they still might find a three-star or four-star or five-star facility that the system does not adequately address problems in nursing homes. And I know you didn’t invite me on to speak about lawyers, but that’s why we have always been so supportive of the private bar because that’s oftentimes the only place we can get someone justice.

Smith: And/or on occasion the ombudsmen. I had a chance to have lunch with Melanie McNeill, who is the head of the ombudsmen here in Georgia, but the problem there is they’re super under-funded and often neglected.

Schenk: Yeah, they’re going in a thousand different directions.

Smith: Yeah, there are a 155 counties in Georgia and she may have a staff of, I don’t know, 60 people. It’s just impossible for her to deal with.

Richard: Yeah, and thank you for mentioning this. There are advocacy organizations. My organization, we’re an advocacy organization, but we focus on systemic issues.

Smith: Absolutely.

Schenk: Sure.

Richard: The areas of our expertise, there are grassroots organizations that do help people who are aging or people with disabilities that they can go to, and also there is the long-term care ombudsman program, so the ombudsman program, just very briefly, under the Older Americans Act, every single state is required to have a long-term care ombudsman program, and those ombudsman programs, there are actually new regulations out as of about three years ago. The ombudsman program operated since the ‘70s without any regulation in terms of that was expected. You spoke about speaking to Melanie in Georgia, so they would – the state was required to have an ombudsman like Melanie, and she was required to then be doing monitoring, helping residents, etc., within the nursing home and assisted living and other residential care facilities, but there were no other instructions for what they were supposed to do.

So part of the strength of the ombudsman program is that they are entitled to go into every facility. The facilities can’t say, “No, we don’t want you here.” They are entitled and responsible for helping residents and families resolve problems. They also help residents and families develop resident and family councils, which make a huge difference. Studies have shown that having a family council, for instance, improves the care for all residents in the facilities, so that’s something we also highly recommend.

The problem with the ombudsmen, quite often as you were saying, they tend to be very underfunded. They do not have regulatory authority, so again, it’s only that CMS, Department of Health nexus that can penalize a facility when they’re found to be out of compliance, so it’s a little bit different. And also because there is historically the lack of requirements for the ombudsman program and the underfunding, they tend to be even more – and this is generally speaking, not for every state, but they tend to be more politicized than the state survey agencies or the Departments of Health.

Smith: Well speaking of which, do you think the new administration is affecting CMS negatively?

Richard: I do.

Smith: Go ahead. We do too. We’ve talked about it many times on this program.

Richard: Okay, no, I’m glad. That could certainly be something that certainly can be a focus of its own program.

Smith: Yeah.

Richard: It’s something which people should certainly be aware of. As I mentioned before, when we’re talking about the power of the industry, nursing home residents, think about it, they have an ombudsman volunteer usually who may come in weekly, sometimes may only come in quarterly or not at all into the facility. They don’t have lobbyists that I know of – I don’t know anywhere that has its own lobbyists. The nursing home industry, the nursing home providers have two major lobby associations, and in addition to that, there are a lot of lobbying law firms at both the state and federal level that lobby on behalf on the interest of nursing homes, not on behalf of the interests of the residents.

Smith: Is there anybody that does that?

Richard: Just to circle back quickly to the current administration though, we are, again, a nonprofit organization. We are neither Republican nor Democrat. We don’t get involved in those things. But the truth is the lobby associations immediately, as I said before, wrote to President-Elect Trump, wrote to President Trump and to his administration at CMS and said, “We need you to reduce these regulations.” They literally said in one of their letters, “We love caring for elderly Americans but the regulations are just too hard for us to abide by.” So we’re seeing a lot of these regulations are being cut, cut, cut, and the enforcement, which has always been pretty poor nationwide also we’re seeing it cut, cut, cut as well, and that has had a lot of impact already and the threat is much larger going forward. We expect that they will have a wholesale change to the nursing home regulations starting this summer. It’s published on the federal registry website.

Smith: And just so our listeners understand this, when Richard’s talking about the special interests of the nursing home industry, this is a healthcare industry that has billions of dollars, so they have a lot of money. Who is on your side? Who is on Consumer Voice side, on the ombudsman side? Are there any special interest group out there? How do you get money?

Richard: Well there’s no lobby group. We go to – for instance, we’ve been going to visit Congress, especially since we’ve seen implementation of a lot of these industry lobbyist requests, the delayed enforcement, the delayed implementation of a lot of important standards related to the use of antibiotics and caring for residents when they come into a facility, etc. They’ve managed, very briefly, to put off implementation of some of those very basic standards. So when we go to what we call Capitol Hill, usually it’s with a representative from Consumer Voice, someone from the Center of Medicare Advocacy, my organization, Justice in Aging – so there are small organizations, relatively small organizations compared to the industry lobbyists who do work on these issues, but I’m not a lobbyist. I run a small organization. I develop the materials that we talk about. I do education, etc., but I’m not a lobbyist the way that Leading Aids, which is one of the lobbyist associations or the American Healthcare Association, they have teams of paid lobbyists, and in addition, there are very high-priced law firms on both the state and the federal level that are in the halls of your legislature all the time and in the halls of Congress all the time.

Smith: And they’ve got money too, so at the end of the day, you need money for your campaign, whatever, when you have money, money talks. I mean it’s the best thing.

So let’s talk about some of these changes though, You mentioned these changes are not being implemented. What’s going on with that?

Richard: Sure. Well as we said, the regulations, the basic standards have existed since 1987. The regulations implementing them have changed a bit over the past – and are changing over the past couple – this year, last year and 2019, excuse me, but what is going on is a couple things. One is that the nursing home lobbyists have pinpointed some of these standards that they either don’t want to go into effect, that did go into effect and they want to backpedal on, and also they’ve been changing to how these standards are implemented through penalty.

So very quickly, for instance, the industry asked for a one-year delay in some of the regulations that were coming out in last November, November of 2017. Those include what’s called antibiotic stewardship, so as some members of your audience know, the misuse of antibiotics is a very serious problem across settings, including at home, that antibiotics are becoming less effective because they’ve been overused so much. So the way CMS addressed it is to make sure that nursing homes have what’s called an antibiotic stewardship program, and that went into effect in November of 2017.

Another issue, as I mentioned, is dealing with people with dementia. Now nursing homes have always had a large percentage of residents who have dementia, and whenever a nursing home takes in a resident, they are guaranteeing they have the skills necessary to meet the needs of those residents. What CMS did in 2016 is they said, “Look, we want you to make sure that you have a program in place to care for these so-called behavioral symptoms of dementia.” So that’s one of the rules the industry said, “Well can you delay it for a year because we need more training?” which to me is frankly ridiculous because this is something that people with dementia have been going to nursing homes for decades, generations, obviously. That’s often why people wind up in a nursing home. So to say that you need more training to defies credulity.

So CMS did, those are a couple of examples, what CMS did was they actually took the industry’s request for a one-year delay and they came out with an 18-month delay. So there are about a half-dozen regulatory standards including anti-biotic stewardship, including management of behavioral symptoms, including having a baseline care plan for residents when they enter a facility, that CMS is saying, “We’re not changing right now the regulations, but we’re not going to enforce.”

Schenk: Yeah, which we’ve said in previous episodes that the Trump administration is in the pocket of the nursing home lobby.

Smith: Oh, absolutely.

Schenk: But Richard, we would love to have you on again. We’re reaching the end of this particular episode, but if we could get you back next week to continue talking about this subject and what you do at the Long-Term Care Community Coalition, but as of right now, for our listeners, can you tell them, direct them how they can get information for your website, your Twitter feed, all that kind of stuff.

Richard: Sure. So website again is NursingHome411.org, NursingHome411.org, and we’re on Facebook at Facebook.com/LTCCC and on Twitter, our Twitter handle is @LTCConsumer – LTC and then Consumer spelled out. There are no dashes or dots or anything else, so L-T-C-C-O-N-S-U-M-E-R. On Twitter and on Facebook, we post news reports, action alerts, things that people should know about, what we think people should know about what’s going, also some of our programs, etc. Everything on our website is absolutely free. We’re really happy for people, including ombudsman programs, etc., to copy and use these materials in their training. I do occasional webinars and they’re also all on our YouTube channel which is accessible through the website.

And I think it’s just so important that as all these changes are taking place and now we’re seeing some issues with the Trump administration to try and remove some of these basic standards that people know what their rights are and they know what questions to ask, whether they’re talking to their caregiver in a nursing home, whether they’re talking to an attorney that they called up, whether they’re talking to an ombudsman, it is so helpful for families and residents to know basically what their rights are, and we have a lot of good materials. We give fact sheets on resident rights that we think are and have identified as important, so a two-pager that people can copy and use to identify what is going on, try to understand what is going on with their resident and what their rights are.

Schenk: Yeah, the site is fantastic. Will and I have gone onto it several times. There’s a wealth of information. We appreciate all the work that you’re doing and we appreciate you coming on the podcast and we can’t wait – we look forward to having you on again, Richard.

Richard: Great, thanks. With so much going on, I hope this came across, because there are so many things changing between the new regulations and of course what’s going on with the Trump administration and the changes with survey, which we didn’t even get to, but whatever we could do to make people aware, we certainly appreciate you’re doing this as a public service and thank you again for inviting me.

Schenk: You’re very welcome. Thanks a lot, Richard.

Smith: Absolutely.

Schenk: Man, Richard, he’s on it. He really is fighting the good fight.

Smith: And this is what I like about him, because I had mentioned before that the Consumer Voice conference was largely ombudsmen and other advocates for long-term care residents, is that these people are not doing it for the money. This is not what you go into hoping to make bank. I mean these aren’t lobbyists on K Street. These aren’t people at huge law firms. These are passionate advocates who are working at nonprofits. And without them, there would be no one, no one on the side of nursing home residents in Washington, and fortunately we have them, so that’s amazing.

Schenk: Speaking of on the side, I’m surprised that we’ve gone this entire episode without Will making a comment on what’s on the side of the table we’re sitting at, which is, in answer to that question, a GoPro camera.

Smith: Oh yeah.

Schenk: So Jean, I don’t know like if Jean bikes, motorbikes or goes downhill skiing or whatever, but he is lending to this show a GoPro camera to maybe make this a two-camera show. So there’s a red blinking light so something’s going on with the camera. Whether it’s capturing anything, I don’t know.

Smith: So essentially if it has captured, then what Jean’s going to do is this video, this podcast, if you watch the video, you should be able to capture it from multiple different angles.

Schenk: Multipe angles and like a behind-the-scenes angle, because it looks like the GoPro, you can see some of the mixing board.

Smith: Yeah.

Schenk: In case you wanted to get closer up to Will’s face. Anyways, this concludes episode number 63 of the Nursing Home Abuse Podcast. We are certainly happy that you have made it this far. As always, new episodes are available on Monday mornings for download on Stitcher, iTunes, Spotify, Pod Happy, whatever the podcast app of your liking is.

Smith: Yeah, there’s PocketPod, I don’t know. There are a hundred of them.

Schenk: And then of course you can always watch this, and again, we encourage you to watch it because now there’s possible two different points of view that you can watch us from on our YouTube channel or our website, which is NursingHomePodcast.com. And with that, we will see you next time.

Smith: See you next time.

Thanks for tuning into the Nursing Home Abuse Podcast. Please be sure to subscribe to this podcast on iTunes or Stitcher and feel free to leave us some feedback. And for more information on the topics discussed on this episode, check out the show website – NursingHomeAbusePodcast.com. That’s NursingHomeAbusePodcast.com. See you next time.