JoCo nursing home aims to oust Parkinson’s patient: ‘Over my dead body,’ daughter says
Fourteen hundred miles away from her sick dad, Aliza Katz can barely eat. Her mind’s not fully on her work. She doesn’t sleep because of how worried she is over what’s happening to her father inside Village Shalom’s nursing facility in Overland Park.
“When I actually go to sleep, I’m having horrible dreams,” said Katz, 53, a native of Overland Park living in Bonita Springs, Florida.
The crux of her concern: a letter that blindsided Katz in November telling her that her father, 80-year-old Norman Bresel — ill with Parkinson’s disease, halting in his speech and movements and reliant on a wheelchair — had 30 days before he would be booted from the place he has called home for five years.
In official terms, Bresel was being “involuntarily discharged” for what Village Shalom wrote was necessary for Bresel’s own “welfare” because he had needs that “cannot be met at Village Shalom.” In a statement to The Star, the organization’s president and CEO, Matthew Lewis, said that although privacy laws prevented him from talking about Bresel, the move was in the best interest of the entire Village Shalom community.
But Katz, together with officials from two Kansas state agencies who have since investigated the matter, don’t understand that stance at all, or Village Shalom’s insistence to move forward with his removal. They have grown convinced that something more is afoot.
“I told them,” Katz said of Village Shalom, “‘Over my dead body are you going to kick my father out like some kind of dog.’”
Bresel recently sat in his room at Village Shalom, his speech quiet and labored. He has cried in confusion over the prospect of being forced from his home, his daughter said.
“It’s pretty difficult to understand why, all of a sudden, I’ve become a target,” Bresel said. “I just want to live my life.”
What Bresel didn’t know, what his daughter has only recently discovered, is that involuntary discharges — getting ousted or sent to another nursing facility on only 30 days’ notice — are the leading complaint against nursing homes nationwide.
‘Patient dumping’
Complaints, made to the nation’s Long-Term Care Ombudsman Program, a network of advocates for nursing home patients, are only rising — up from 5.9% of 150,000 complaints in 2011 to 7.3% in 2018, the most recent year for data.
In its extreme form, it is called “patient dumping.” Nursing home residents considered too difficult or costly to care for, or who may pay less on Medicaid as opposed to private-pay residents, are removed and left at bus stops — often and illegally with little or no prior notice — or sent to emergency rooms for evaluations, and then never readmitted.
“It’s an enormous, tragic problem,” said Kelly Bagby, a vice president of AARP Foundation, where she is a senior attorney in Washington, D.C., for the organization’s litigation unit. “People are dumped into nowhere, into motels, hotels, homeless shelters, but also hospitals all the time.”
Since 2017, AARP has continued to fight a California nursing home, Pioneer House of Sacramento, after it sent an 82-year-old woman, Gloria Single, to be evaluated at an emergency room and, then, without warning, refused to take her back.
Single, who was on Medicaid, had dementia, lung disease and other problems. She lived at the nursing home for five years with her 93-year-old husband, Bill. The nursing home maintained that they sent her to an ER after she became upset and started throwing plastic utensils. Single, they claimed, had mental health issues and needed to be placed somewhere else.
The nursing home was ordered by the state to take Single back, but it refused. Single’s health deteriorated until, in 2019, she died.
“Her husband and her both died waiting for us to be able to force the facility to take her back,” Bagby said. “That’s the side story here. It’s very debilitating to be dumped. It’s not just about your rights, or your not being with your friends or living in your home. It’s very traumatizing.”
The litigation is ongoing.
“We are determined,” Bagby said. “Our client died. We’re going to figure out a way to impose consequences. This can’t be allowed to stand.”
‘The most disturbing situation’
Katz is fighting her dad’s proposed removal as well.
A former pharmacist and well-regarded figure in Kansas City’s Jewish community, Bresel has lived in Village Shalom’s nursing units since 2015. Located at 5500 W. 123rd St., it is a vast continuing-care complex of homes, apartments and rooms for independent living, assisted living, nursing and memory care. Although it now serves all people and faiths, the nonprofit’s roots date to 1902 and the Michael Appleman Home for Aged Jews, then in Kansas City.
Bresel has been happy at Village Shalom, which means “peace” in Hebrew. He came not long after his wife of 54 years, Barbara, died in 2014 while caring for him.
“My mom — completely out of the blue, unexpectedly, hadn’t been sick — literally didn’t come up to bed one night,” said Katz, who also has a younger brother, Scott. “My dad came down to find out where she was, and she had passed away watching ‘Dancing With the Stars.’”
Bresel lived for a few months in Florida near his daughter before he insisted on returning home to Kansas City. At Village Shalom, he likes his nurses, caretakers and friends. He appreciates that it honors the Jewish faith and traditions that have sustained him. White and black yarmulkes lie on his nightstand. He attends Jewish services regularly in his wheelchair.
“All in all, we were very happy,” said Katz, who said that she did not think anything was amiss at Village Shalom until July.
Prior to that, Bresel’s sister in Overland Park had had authority of Bresel’s financial and other legal matters as his power of attorney. But because of illnesses and other matters in her own family, she had to hand off the role.
Katz last summer was given power of attorney. As the new point person looking after her father’s care, she was invited by Village Shalom to take part, over the phone from Florida, in one of his regular care conferences, an update on how everything is going.
“And in that conversation for the first time, I heard the most disturbing situation,” Katz said.
She was told that there was a report that her father had possibly acted in a sexually inappropriate way around a staff member. The accusation was vague. Katz was shocked.
“They kept telling me, ‘Don’t worry. Don’t worry. It’s extremely common,’” Katz said.
Indeed, the American Parkinson’s Disease Association notes that impulse control disorders, ranging from gambling to hypersexuality, are well-known side effects associated with some of the medications used to treat Parkinson’s disease. Up to 5% of people with Parkinson’s seen in clinics have exhibited the behavior. So-called ISB, inappropriate sexual behavior, is common to 7 to 25% of people with dementia. The higher rate is seen among patients in skilled nursing units.
Katz still was concerned. “My dad is such a perfect gentleman,” she said.
If her father had acted inappropriately with anyone — and Katz was not given enough detail to be convinced that he had — it was the polar opposite of his character and how he’d ever behave. She wondered if whatever occurred was a mistake or a possible side effect of his mixture of medications:
The sedative Klonopin, the antipsychotic Seroquel, hydrocodone, levodopa for Parkinson’s, the antidepressant Remeron. All told, he could be taking as many as 20.
Kansas in 2016 led the nation in the overuse of antipsychotic medications in nursing homes. The rate of use across the country has since dropped. In 2018, the most recent year of data compiled by the federal Center for Medicare and Medicaid Services, Kansas still ranked 12th.
Katz pushed for the nursing home to get her father to a neurologist and psychiatrist. Advocating for his health, she said, “I began to make waves.” A stack of emails shows that Village Shalom seemed to be working to accommodate her.
“I just thought, we’ve got to get him in to see some specialists and get this taken care of,” Katz said.
Then the letter arrived, giving 30 days’ notice and saying Bresel would be sent to a different nursing home.
“As I was trying desperately to help my dad, they advised us they were kicking him out,” Katz said.
Bresel himself called the allegation that he was dangerous to others “nonsense.”
‘The absurdity of the allegation’
Patient advocates say that few nursing home residents or their relatives are aware that they possess both the legal right and ability to fight involuntary discharges. The Nursing Home Reform Act of 1987, strengthened in 2016, guarantees it.
Katz decided to fight. The law spells out six reasons that a nursing home can discharge a patient involuntarily:
▪ Nursing home cannot provide adequate care for the resident.
▪ Resident’s health has improved so much he or she no longer needs nursing home care.
▪ Safety of other residents or staff are at risk.
▪ Health of other residents or staff is in danger.
▪ The resident, after being given reasonable notice, has failed to pay for care.
▪ The facility closes.
The reasons for discharge must be documented in the resident’s clinical record. A nursing home can’t just say that it no longer can provide needed care. It has to document why it can’t and why another facility, the one it is transferring the patient to, can do what it cannot. Family, or the legal guardian, must also be notified in writing, and informed of their right to appeal.
Katz asked for just that, an appeal hearing before a Kansas administrative law judge, now scheduled for March. She called the Kansas Office of the Long-Term Care Ombudsman, part of the state’s Department of Administration, which sent out an investigator.
Christine Mozingo, the ombudsman for Johnson, Wyandotte and Leavenworth counties, visited Village Shalom. She talked to Bresel, examined his medical records.
She found nothing. “It is our position that there is no documented reason — and I was not given any documentation, nor was I told anything — that would support one of the reasons to be discharged,” Mozingo told The Star.
She looked in his medical records regarding the allegations of inappropriate sexual conduct. There was no mention. “It was not in his record,” she said.
Mozingo also talked to staff about the allegation. “I was told that nothing like that had occurred,” she told The Star. Her recommendation to Village Shalom was to stop proceeding with the discharge.
Once she met Bresel, she thought any notion that he could be a threat to staff or others, or that he posed a problem that Shalom could not handle, was ludicrous.
“When you see him and meet him, you’ll get a better sense of the absurdity of the allegation,” Mozingo said. “I mean, he certainly has some mobility, but it’s somewhat limited. It would be very easy for staff to step away.”
The Kansas Department of Aging and Disability Services, which oversees nursing homes, sent out an investigator, too. In its report, the investigator noted that one individual on Village Shalom’s administrative staff stated that Bresel “would touch staff inappropriately and try to get staff to come into his room.” And that it had been going on for a while.
But there was no documentation in his medical records. No documentation to suggest he endangered anyone. And no care staff the investigator spoke to backed up the allegation. The investigator’s written conclusion in November:
“The facility inappropriately issued a 30-Day discharge notice to (Bresel).”
Investigations notwithstanding, Village Shalom has not backed off. Katz called in character references for Bresel, who for years ran the Foxhill Pharmacy at 109th Street and Roe Avenue. Four rabbis wrote to Village Shalom’s leadership, including to Lewis, its president and chief operating officer.
“Dear Matt,” David Glickman, the senior rabbi at Congregation Beth Shalom in Overland Park, wrote in December. “I am writing to you out of pastoral concern for Norman Bresel. I have never tried to intercede on behalf of a Village Shalom client, but I am concerned about his potential removal. . .
“The very foundation of VS is to be a safe haven for the most vulnerable members of our Jewish community. If there is anything I can do to help this situation, and find a way for Norm to remain a part of VS family and community, I would be happy to be a resource. Surely, there must be some additional avenues that have not yet been explored to try to create a safe environment for all.”
Rabbis Moshe Grussgott and Herbert Mandl of Kehilath Israel Synagogue called Bresel in their joint letter “a beloved member of the Jewish community.”
“We accordingly feel that it would be the proper and ethical course of action for you to try and explore every avenue of possibility for Mr. Bresel to be able to stay there,” they wrote
A rabbi from Fairfax, Virginia, David Kalender, wrote to appeal for Bresel.
“My mother was a resident of Village Shalom, living out her final years in the villa,” he wrote, extolling the staff’s kindness and care. “Regarding Norman, I implore you to offer him the same.”
‘I don’t want to leave’
Typically, nursing homes will back down, stop a discharge or transfer, once the long-term care ombudsman or other agencies determine there is no documented foundation for discharge. Village Shalom has not.
“I’ve never seen an incident,” said Mozingo, the regional ombudsman, ”where our office and KDADS (Department of Aging and Disability Services) are saying there is no reason for this notice, but they are continuing with it.”
The Star requested an interview with Village Shalom’s leadership. In response, Lewis replied that privacy laws prevented the organization from addressing Bresel directly.
“Village Shalom cannot comment on any situation involving a resident, except to confirm that there exists an ongoing proceeding before a Kansas Administrative Law Judge appointed by the Kansas Department for Aging and Disability Services,” Lewis wrote. “We understand that the resident’s family opposes this action, but Village Shalom will take action in the best interests of our entire community and all of our residents and staff.”
He went on, ”It is the policy of Village Shalom, and in accordance with federal regulations, that no resident will involuntarily leave Village Shalom without assurance of relocation to a safe home that meets the resident’s needs.”
Legal papers filed in advance of the hearing identify two caretakers who apparently will testify about Bresel’s “inappropriate behavior.” Advocates for nursing home patients said that even if the behavior can be proven, the nursing home must document all it tried to do to rectify the problem.
If it could not rectify the problem, it cannot just pass it along to another nursing facility. It must show how and why another facility is better able to care for the patient.
“When you accept someone into your nursing facility, you’re accepting them and creating a home for them,” said Bagby of the AARP. “It’s a commitment you’re making. And unless his needs have changed so dramatically that they can no longer meet his needs, then they have an obligation to keep him.
“There are circumstances where being a danger to themselves or others is a real thing. They have to document that. They can’t just say it. They have to show in the medical record what they were doing to address what the danger is. The first step can’t be kicking him out.”
Bresel, in his room, was adamant. “I don’t want to leave.”
Although he is a retired pharmacist, Bresel had too little money to afford to privately pay for long-term nursing care at Village Shalom. His illness and care drained his finances. He ultimately spent down what assets he still had to qualify for Medicaid.
Speaking in general, Bagby and other advocates said that for far too many nursing homes, money and maximizing profits are at the root of many involuntary discharges of Medicaid patients.
The amount that Medicaid reimburses for daily care is often significantly less than what most nursing facilities get from those paying privately.
“If you have a lot of people who are on Medicaid and want to change what’s called your ‘case mix,’” Bagby said, “you have to get rid of some of the Medicaid people.”
Kansas state records report that Village Shalom’s private pay rate for nursing care is $353 per day. Medicaid, meantime, pays $239 per day — a difference of $114 daily or about $3,400 per month
Medicaid patients like Bresel are providing nearly $42,000 less per year than patients paying privately.
Bresel believes that money is the prime reason Village Shalom wants him out. “I can only assume it’s because of my financial situation with the company,” he said.
When the letter of discharge arrived, Katz said she told her father that he was welcome to come live in Florida. Why be in a place that doesn’t want you?
“And he said, ‘No, I want to stay here. This is my home,’” Katz said. “When these nursing homes do this to the residents, it’s not just the resident that suffers. It’s the whole family.
“I had too many people tell me if they get away with what they’re doing to your dad, he will die. He’s just going to die. He doesn’t have anything else. And to me, I wasn’t going to just let that happen.”
Resources
Organizations to contact if you think you’ve been wronged by a nursing home:
▪ The National Consumer Voice for Quality Long-term Care: theconsumervoice.org/get_help. Click on individual states for more information. Or call 202-332-2275.
In Missouri:
▪ Missouri Ombudsman Program: health.mo.gov/seniors/ombudsman
▪ Missouri Coalition for Quality Care: mcqc.com
In Kansas:
▪ Kansas Long-term Care Ombudsman: ombudsman.ks.gov/home
▪ Kansas Advocates for Better Care: kabc.org
