Leading the Charge Against Nursing Home Abuse, with James Morgan

0:03 So, in long-term care facilities across California, there are seniors suffering from all kinds of preventable falls, bed sores, medical issues. We haven't been one of those facilities, you only understand, I think, the challenges people face there. And more importantly, the families don't see the signs right in front of them, and when they do, which is not often enough, they don't know what to do about it. We're really excited today. I'm excited today to have attorneys who have focused on leading the charge against nursing home abuse, Jim Morgan, James Morgan from Lanzone Morgan law firm. Jim, thank you so much for joining us today.

0:35 Yeah, thanks for having me, Bill. So, you know, what is the most common case that people call you? I know that people call me and say, you know, I think my mom this, I think my dad that, I think this is going on. Yet, not all of them are lawsuits, not all of them are legal matters, and not all of them are actionable. What's the most common case that you get that you're able to really to right the wrong or help things move in the right direction?

0:58 The two most common cases that we have are bed sore cases, or pressure sore cases, also called decubitus ulcers, and fall fractures. So, in nursing homes, elderly people fall, right? They fall in nursing homes and not in nursing homes. But in nursing homes, when somebody calls us and tells us, "Hey, you know, Grandma fell in a nursing home and fractured her hip, or hit her head and has a subdural hematoma," then we start asking questions and find out, "Well, you know, was Grandma ambulatory? Was she able to walk around the facility on her own? You know, physically fine? Or was she a fall risk? And did she have falls prior to that?" So, we look at the risk for falls prior to the fall that injured him or her. And then for bed sores, I say bed sores or pressure sores because the you know, people will call us and say oh my mom had sores all over her body. that's not necessarily a case. that could be due to a medical condition, skin condition. but the bed sores that we're looking at that tend to lead to cases happen at pressure points. That's why they're we call them pressure sores.

2:25 And the pressure points are your coccyx and your heels. And those are where the people who get bad bed sores get them and they're the deadliest ones that can lead to sepsis and infections and death.

2:45 I would think that those places also are indicative of not being moved around. Having just recently had a family member in the hospital for you four five weeks. Had a great hospital, Cedars-Sinai, with great care. They were very conscious to keep the patient moving, turning over, out of the bed, sitting in a chair, going for a walk. And I asked and they were always checking her heels and I think in her coccyx they would turn her over. But it just seems that they're very aware the need to keep them moving. Whereas in a nursing home I can imagine you have budgetary issues and you have staffing issues, management issues. If you're not paying attention, I can see that patients, you know, they're tired, they're not feeling well, they're not going to get up on their own and they're not going to get the care they need to get out. Is that Is that what the issue is with it? It's it's a indication of poor care?

3:35 It is. and a lot of times what happens is I think the awareness is there. I think pretty much everybody who works in a nursing home or who has worked in a nursing home for any length of time knows that if somebody's in bed all the time they're at risk for getting a bed sore or a pressure sore. They The general rule of thumb is that they need to be turned and repositioned at least every 2 hours if they're bed bound, and if they can't get them up and get them into a wheelchair. So, turning them and repositioning them every 2 hours is a is a good general rule, but the problem is in the nursing homes, they are so chronically understaffed

4:19 Right. that the I don't think it's a matter of the people not wanting to turn and reposition them. It's just that they just don't have time. They have too many patients who need too many things, and if anything can slide, it's going to be the turning and repositioning. And so, they may go into somebody's room and say, "Okay, it's time for me to turn you to your left side or put a wedge pillow behind you so you're not on your coccyx for 10 hours straight." And the And the patient may just, you know, grumble and say, "I'm sleeping." or "I don't want to be turned." or, you know, just kind of a reactionary comment by the patient, and the overworked CNA will just say, "Okay, forget it then. You know, I've got plenty of other things to do than to, you know, fight with you about trying to prevent a bed sore." and that's what will happen is and people will just literally sit in their same position in their bed for 24 hours a day. And that and that bone will just push through the skin eventually, but the tissue, the fat, the muscle, and then it breaks open in the skin, and causes terrible bed sores.

5:38 Now, I've been to nursing homes, several different ones. I'm pretty good at math. I came from a contracting for an company training where you learned how to look around and assess things and count numbers and it's kind of a habit at this point. I've never seen a nursing home that had enough staff and enough people in process to turn people every 2 hours. I mean, I don't mean you know, to call every nursing home in the Southern California a liar, but I can do math and if you're turning one every 2 hours and you have 50 patients, that means you're turning [clears throat] over one every couple minutes. That means nobody's leaving the area. They're turning people over non-stop and that doesn't happen. I've never seen that anything close to that. And so it is very expensive. Nursing homes in California are you know, very expensive. The ones that are taxpayer funded are overused cuz we can get into the politics of it, but there's all that going on. The private ones are also very expensive and even they don't have that kind of manpower. So it just seemed like this is just a non-stop problem and we now have a solution which is just keep suing these companies? Like what Where is the end game in this process? What I appreciate it's good business and I appreciate your you're forcing these entities to reform. But is there any sign that the industry is making progress towards this or is it just something that's going to continue and it's kind of cost of business is paying attorneys when they lose lawsuits?

7:06 I think the I think the solution is to staff the facilities sufficiently. And I can tell you there are facili- I've been doing this 26 years here in LA, all over California. This specific type of law for 26 years. And I can tell you there are facilities that we have never sued for bed sores. So it can be done. Okay? And those facilities that we've never sued typically tend to be the smaller facilities, maybe family-owned facilities, not these giant corporate facilities that are doing everything based on numbers. but facilities where maybe the owner is on the ground. And the owner's in there seeing what's happening. And they don't have 100% turnover every year.

8:02 Right. You would you would be surprised at how many nursing homes in the state of California have 50 or 75% or even [unclear]% or more turnover every year. When you have that kind of turnover, there's no consistency with the care.

8:20 Okay. But when you have a mom-and-pop facility, the owners are on the ground, they care, they know the families, you know, those are the ones that I sue the least. And like I said, I drive by a nursing home every day. I drive by several around my office, but there's one I drive by almost every day, and I've never sued them for a bed sore. And I and I just think this is a facility that's doing something right. So, I know it can be done. it's just a matter of staffing.

8:56 I do know you're right, the metric is the turnover. I know I One thing is I just have a habit to always ask people how long they've been with the company. you know, I mean, it's literally at my doctor's office today, and at USC Keck, and what I do notice is at the finer facilities, and the finer departments of the finer facilities, people have been there for years, multiple years, some decades. the middle-class ones, you know, years, 5 years, 7 years, 3 years. the nursing home There were one or two that were nightmares that we I visited, cuz that's where the people were that I had to go visit. You can just tell, they're just they're working three different places. They get, you know, they're like job shopped out, and they're just they know they're over-understaffed, and they're just doing the best they can. And the And the workers are I mean, they have hearts of gold, and they're working themselves to bone. It's not their fault. But, I could say it's the management that has a track record of not attracting, and developing, and keeping quality staff to do the job properly.

9:51 Yeah, that that's exactly right. in most of the cases that we have, it's not the CNAs who, you know, are just mean people. Or the Or the LVNs or the RNs. It's really just a matter of they just don't have time to do it.

10:10 Yeah. I mean, you don't work in that kind of facility generally if you don't like elderly people. Right. You know? Because it takes a big heart. It takes a lot of patience to work in a facility like that.

10:23 Right. But, if you're given, you know, a number of patients to care for every day, and they need baths, and they need help eating, and they need help drinking, and they need their clothes changed, and they need diapers changed.

10:37 They make a mistake, and you have to run to not humiliate the patient, and I tell people, you know, just think about this. If you're If your If your job is washing cars, and you have You're going to work from 8:00 until 8:00 a.m. until noon, and you're going to wash cars, if you have two or three cars to wash, you're going to do a great job. Cuz you've got 4 hours, you've only got three cars, you're going to pay attention to detail. But, if you have 12 cars to wash, you're going to have to cut some corners.

11:12 Yeah. Okay. Not everybody's going to get the best car wash. Right. And the care in the facility is the same. Okay. If you have 10 patients, you're going to be able to give them a lot more care than if you have 25 patients. It's just as simple as that. And that's when accidents happen. And by the way, while I'm on this topic, I can tell you that we get a lot of phone calls right after major holidays. And that's because people are taking off. Right? The facilities, the people aren't going home. The all the beds are still filled on Thanksgiving, Christmas, New Year's Day, the 4th of July. The beds are all filled, but the staff, they want to go home and spend time with their families.

12:04 Right. So, they these facilities tend to be understaffed during the holidays. Yes. And it's not uncommon for us to get phone calls a day or 2 days or a week or 2 weeks after holidays because that's when accidents are happening and that's when neglect is happening.

12:24 Now, [unclear], everybody else you hear of news stories in nursing home of, you know, terrible abuse of cases, right? People who are sadistic, people who are, you know, doing terrible cruel things. And while those exist, that's not your bread and butter. It sounds to me like these are more I mean, I don't mean to put your the practice down, but more mundane, more operational deficiencies than actual malice, I would think, that you're really talking about. At what point does a particular case does a person feel their case is strong enough to give you a call? Meaning, they're going to think it's just my mom who's not getting the service that she needs. You're going to know, "No, if your mom's not getting service, probably it's the facility and you probably know the facility cuz you've been there before." So, what does that look like? Somebody calls you and says, "Mom has bed sores. Mom's not getting attention. Mom's not getting her walker or her medicines." Is that Is that who's calling you to start the process or how's the process start?

13:18 Yeah, I'd say the first thing you were talking about is is, you know, somebody who's just a malicious person, right? Less than 10% of our cases are somebody who's just actually physically abusing the resident. [snorts] 90 plus percent of our cases are just lack of care. And frankly, I think the maliciousness is is there sometimes, not necessarily by the staff, but by the owners who are saying, "Hey, we want to make as much money as possible and staff is our biggest expense. So, we're going to get by with as little staff as possible so that we can make as much money as possible." And trust me, there is big money in nursing homes.

14:09 Seems like a reason why large corporations and billionaires own dozens and dozens of nursing homes in the state of California. They are making money. They're not buying nursing homes and operating nursing homes because they're losing money. Now, back to your question. So, somebody calls us and you know, a fall fracture is a is a simple reason for somebody to call us. Or a fall, maybe subdural hematoma, they hit their head, they get a brain bleed, possibly a death along with that. but and then the bed sores, too. Sometimes but you know, we'll get a call and somebody will say, "Oh my gosh, my mom has the worst bed sore you've ever seen. I'm going to email you a picture. You better be sitting down to look at this." And it's a stage one or stage two. And it looks horrible to the family because this is their loved one.

15:07 Right. Right? But it's not doesn't rise to the level of a case. Okay? So, we ask, you know, what does it look like? Do you have a picture of it? Is it stage Did anybody stage it? Did they say it's stage one or two three or four or unstageable? You know, we have to we have to ask those questions. But it's not just the bed sores and the falls and fractures. We get calls, you know, even this week we get calls. Elopement cases are big. Okay, where somebody has dementia, they're supposed to be in a locked unit for their own safety, and they wander out on the street and they get hit by a car. I mean that that we get a lot of elopement cases. We'll We'll get cases or we'll get calls I mean, we take we take about 3% of the cases that call us or the people who call us. About 30% of those are cases. So, a lot of people are calling us with legitimate complaints. Mom's a diabetic and she's not getting a diabetic diet. Mom's not getting her meds on time. She's supposed to get them at a very specific time or they're not going to be effective and they're just not doing it. Mom is sitting in soiled sheets for hours. Every time I go in there, she's in dirty diapers and I mean, these are legitimate complaints.

16:29 If it's something that doesn't rise to the level of litigation, then we tell them what to do. We tell them how they can get a response from the nursing home themselves, how to complain, where to complain, who to complain to. And if and if we think it's there's enough there, we direct them to make a complaint either to the Department of Public Health if it's a nursing home, and ask for a complaint investigation. Or if it's an assisted living facility, they make their complaints to the Department of Social Services and ask for a complaint investigation. And that usually gets the attention of the of the operators of the facility because they don't want DPH or DSS snooping around, asking questions. And that can be a very effective way of getting a nursing home to make a change in the care they're providing to their loved one.

17:24 I just go back to something you said from a business point. You said you take about 3% or let's say 1 in 33 incoming we have a problem. And there might be a problem, it's just not litigation level or legal.

17:36 Right. So, as a real estate agent or as a you know, whatever professional business that comes across a couple of these, if I call your office once and it doesn't amount to anything, I shouldn't be discouraged because odds are it takes a number of these to maybe create a pattern or create a history that you can that you can move forward on. So, I think one of the things that I'm getting is if I call if I call you know, often you call an attorney and it doesn't fit their standards, you feel like, "Ugh, I'm sorry I bothered the guy." And the answer should be, "No, it's not a bother." Same with me, I'm listing property. You can call me all day long about property you want to sell. I may not be able to help you, but you can call me all day long, I'll take those calls and try to help you with other solutions. And I think you gave me the other part of that, which is if you can't help, you have some other information that can help people, so therefore you become a good point of contact for what to do with it.

18:27 Yeah, and that and that's what I tell people who do what you do, Bill. I say, "Look, don't think, 'Oh, I don't want to waste, you know, Jim Morgan's time by sending this to him because I don't know if it's a case.'" I tell them, you know, "I don't expect you to know if it's a case because there's so many nuances and so many factors that go into it. But if you have a client complaining about a nursing home, you know, give them our name and say, "Contact this guy. I don't know if he can help you, but if he can't help you, hopefully he's going to point you in the right direction."

19:02 That's good. And because we're happy to help people, you know, we tell people sometimes when we say, "Hey, there's not enough for litigation here, but you know, that's good news. That means, you know, mom didn't get hurt like some of the other people that we've had to file lawsuits for.

19:21 Right. Okay? And you came to us and you talked to us at the right time before that happens to mom. Right. So, let's talk about how this we can prevent this from happening to mom in the future. And we're happy and it's not just me. I mean, I talked to these people. We have staff who have a lot of experience with taking these calls, talking to clients, and they're very experienced at helping them. I mean, we get calls just, you know, "Hey, they're they're billing me inappropriately." I mean, that I'm not going to file a suit over that. It might be a few hundred dollars, but it's important to them because these people are on a limited budget.

20:01 Right. so, you know, we tell them what to do about that. Right. Well, I think that's a point that it probably speaks to your success because I think as business people, even though you're an attorney, most attorneys might think of themselves as attorneys and not business people, but our job is to help people and we can't just take the case we get paid on and leave people worse off when they call us that we can't help. We need [clears throat] to try to help everybody we can and at least move them forward to some degree. So, I really appreciate you laying that out for us. And again, our goal here today, this is Probate Weekly, but we talk to these families unfortunately circumstances my you know, clients and conservatorships are often in nursing homes, heirs are often in nursing homes and some of these passed. and so, these are important issues for us to be able to address. specifically your case, what areas do you serve? What areas should somebody feel comfortable calling you about a nursing home? You don't cover You're not a national firm. You're California and you're Southern California based, I believe.

20:55 [snorts] We are based in Southern California. We have an office in Oakland, but we do cases all over California. Top to bottom. I'm licensed in Nevada and Arizona as well. So, I'll look at cases in Nevada and Arizona. And if I don't take those cases, I'll, you know, if it's good enough, I'll I'll refer them to somebody in Nevada or Arizona that I work closely with who is experienced handling these cases. But now, you know, especially since COVID, you know, almost all depositions now are taken by Zoom. And so, we're not having to travel to, you know, Redding or Sacramento, you know, or San Diego, you know, just to take a deposition. We're sitting at our desk taking depositions of people who are all over the state.

21:48 Right. and then and then there's there's court calls. So, we're going to court hearings, you know, by Zoom, as well. So, a lot of times, the only time that we have to go to the specific venue, no matter where it is in California, is if we're going to try the case. And that's less than 5% of the cases we file go to trial.

22:09 The gift of COVID for all the pain, suffering, the terrible and all that, which is true, don't overlook that. But the positive was our my business the same way. I can list property anywhere. I deal with customers online, e-signing documents. I remember when it started to get an elderly person to e-sign was impossible. Once COVID hit, everybody learned how to e-sign.

22:28 Right. Right. That's And there's a room with their iPads signing documents for me. It's just amazing how all that changed. So, Well, look, you know, I really appreciate you walking through again. I think the biggest challenge we have is we don't get these cases very often, but these are people who are important to us. And who do we call? And obviously, throughout California, Nevada, Arizona, you're a person we should be calling or your friend your at least your office to at least vet and see if this is a problem. So, I appreciate you laying it out for us today. For anybody who wants more information, the website is lanzonemorgan.com [spelled out on air] is the website. And then his contact information I have down below in the banner. Phone number [phone number shown on screen]. And if you're driving or can't write this down, feel free to reach out to me. I'd be honored to pass on. I saw I think it was a landmark case you had that somebody posted about and that's what caused me to reach out to you initially. And so I know I know you'd be one of the leaders in this industry. I think you're doing some really good work in a very difficult area. I guess if you do enough of it you get good at it at some point in time. After some time. Thank you so much for being on Probate Weekly with us today.

23:39 Yeah, you're welcome Bill. Anytime. And for the rest of you, this is Probate Weekly we get together every week and talk about how we can better serve our customers in probate. Usually with probate attorneys, litigation, trust and estate attorneys. In this case some of some of our customers and or heirs are in nursing homes or you know in conservatorships and so on. So I thought it was really a great opportunity to speak with a leading attorney in that area. If you have a client who has a problem feel free to reach out to Jim at lanzonemorgan.com or reach out to me if I can help. In any way if I can help I'd love to get your comments, feedback. Was this interesting? It's a little off the normal path but I thought it was really high quality. Let me know though. I'd love to hear your feedback. I'm at Bill Gross Probate on social media. As always make today your best day ever. That's