Ailing Grandmother Neglected In NJ Nursing Home, Family Says

Editor's note: Patch reached out to CareOne repeatedly for comment before publication and was ignored. Six days after the story was published, the company sent a point by point response to some of allegations. Those points have added to the story.

PARSIPPANY, NJ - She was left alone for hours in a chair, in a soiled diaper, in unspeakable pain and not provided fresh water. Trying to recover from a bad fall and COVID-19 for 86-year-old Filomena Iuliano was a daunting task. According to her granddaughter Valerie Frye, Care One at Morris made a horrible situation worse.

"The unfathomable treatment and care of my grandmother and family has weighed heavy on my heart," Frye told Patch.

The current COVID-19 crisis has placed a spotlight on many nursing homes in the Garden State and even facilities with previously clean records haven't been immune. A report about a Warren County facility revealed a woman who fought to save her father from what she says was mismanagement of his care for one.

Infamously, Andover Rehabilitation and Subacute Care set up a "makeshift morgue" to deal with an overflow of bodies over Easter weekend. The facility, which had numerous complaints and penalties levied at it in the past was recently fined $220,000 and is now being sued by families of patients.

As of June 3, Care One at Morris had 124 reported resident infections and 33 among staff. The facility has lost 36 patients and no staff members.

What follows is Iuliano's story as relayed by her granddaughter, who says she spoke out in the hopes of helping others. Patch attempted to contact Care One to discuss the specific claims made by Iuliano's family before the story was published for more than two weeks but received no reply beyond a response via email saying that the messages were received.

Iuliano's odyssey began in Queens, NY, where she has lived independently for decades until the outbreak of the pandemic had her moving in with Frye's mother, Maria Fonovic in Sparta.

On April 7, Iuliano took a fall and was admitted to Newton Medical Center and after having surgery on a fractured hip and receiving a COVID-19 diagnosis, she was discharged to Care One at Morris for rehab on April 17.

"Throughout the day, multiple family members called over to the facility and left messages. They were concerned that no one was answering and just wanted to receive confirmation that Filomena had arrived safely," Frye said.

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After 9 p.m., the family received a phone call from the director of nursing that provided a room number and a direct line to Iuliano’s room.

According to a CareOne spokesperson, Iuliano was admitted april 17 around 6:30 p.m. and the Director of Nursing informed the family of her arrival that evening "which supports adequate and timely communication."

The spokesperson also said that daughter Maria reported to the Director of Nursing on May 12 via phone call that she was extremely frustrated because no one from Newton Medical Center informed her of her mother’s transfers and in fact that lack of communication was not from Care One but from Newton Medical Center.

Frye also said that the director assured Maria that she would hear from someone by April 20, with an intake evaluation and treatment plan and no one ever called.

The facility spokesperson said that daughter Maria Fonovic was identified as the emergency contact #1 in the resident medical records and that she was contacted on April 21 to review plan of care and complete intake evaluation. In addition to this initial update the center Case Manager provided an update to Maria on April 23, April 24, April 28, April 29 and May 4.

The Medicare.gov Nursing Home Compare results shows that over the last three years, overall rating of the facility is average, the staffing is average, the health inspections are below average and the quality measures are above average. Their health citation issues totaled five, which is above the average in New Jersey but below the average in the country.

In February 2018, the facility was fined $5,000.

In their most recent survey cycle ending in Match 2019, there were five health violations listed and none were the results of complaints. According to the March 25, 2019, report Care One at Morris failed to:

• Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
• Provide care and assistance to perform activities of daily living for any resident who is unable.
• Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.
• Implement gradual dose reductions (GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications
• Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Despite some issues in their history, there was nothing to hint at the trouble Frye's family would face. After three days in the facility, Iuliano spoke to her daughters April 20 and complained that she was not being attended to and was left to sit in a chair for over three hours.

"At no time during the residents stay at the center did the resident or family member report that Ms. Iuliano was left in a soiled diaper and unspeakable pain," the CareOne spokesperson said. " A review of the medical records resident Ms. Iuliano reported a pain level of 0 out of 10 every shift to the nurses since admission and the day prior to discharge except one incident whereas she reported a pain level of 5 and was given Tylenol for relief. Ms. Iuliano had an order for as needed Percocet however was not used during her stay at the center. "

In addition to her hip fractures, Frye said her grandmother also had multiple fractures in her lower back from a previous fall. That day, Frye's aunt called the doctor and the family received no response until a week after Iuliano was admitted. The doctor they spoke to said the facility was unaware of the fractures despite it being in the chart, Frye said.

A spokesperson for CareOne said according to the review of the centers medical record, Dr. Kenneth Adessa documented in the resident history and physical on April 19 two days post admission “89 year old female with left sided hip fractures from a fall and COVID 19 positive pneumonia.”In addition that medical records provided to Care One from Newton has no documentation of multiple lower back fractures as granddaughter claims, the spokesperson said.

Every day Iuliano’s daughters and granddaughters checked in, and day after day the complaints were the same. She was being left alone for hours, sitting in soiled diapers, and not being provided with fresh water.

Fonovic voiced her concerns and the complaints from her mother to the social worker in the facility as well.

"The social worker offered no apologies or resolutions, instead she told Maria that her mother was being 'nasty' to the staff. This was surprising to hear," Frye said. "As a senior, Filomena has had multiple extended stays in hospitals and rehabilitation centers in Queens. Never have we heard this complaint. In fact, we have witnessed quite the opposite. Filomena often joking with nurses and aids and referring to them with terms of endearment."

A spokesperson for Care One said that according to a witness statement by the social worker, "care plans put in place that day for confabulation regarding not receiving care; nursing documented behavior of being rude specifically toward African American staff members and using racial slurs and derogatory words."

"There is supporting documentation of these behaviors on April 21 and twice on April 25," the spokesperson said. "These behavior notes from nursing: two regarding confabulation, patient telling family that she was not being changed and not having water, when staff went to check, patient was dry and clean and water was available within reach; and one regarding rude and derogatory behavior toward staff."

Another Fall

Later that day, not feeling satisfied with the response of the social worker, the family made contact with a case manager who said that she would be making a call to the director of nursing to let them know of the continuous complaints, Frye noted.

"The following day a staff member entered my grandmother’s room and said something along the lines of, 'since you had to go ahead and complain, here is your water.'" Frye said. "Filomena then called her daughters and asked them to please stop complaining on her behalf in fear of retaliation from the nurses and aides."

On May 4, Iuliano was very upset and told her daughter that she had sat in a soiled diaper for hours. About a half an hour after they spoke, she was changed and defecated again. She called a nurse in and that person refused to change her.

"He said that he had just changed her an hour ago, and she would have to wait. Again, calls and complaint were made to the case manager by her daughters," Frye said. "The next day, tired of not being changed and washed, Iuliano attempted to get out of bed and go to the bathroom on her own. Not having the strength to carry out that task, she fell."

According to the CareOne spokesperson, a nurse responded to hearing a resident yelling out. The call light in her room was not activated nor was the resident found to have had an incontinent episode, the spokesperson said. The aide documented she was last with the resident 40 minutes prior to the incident, the spokesperson said.

"The resident was found sitting on the floor next to the bed with walker in front of her. The patient herself reported 'I was going to the bathroom when I lost my balance falling to the floor.'" the spokesperson said. "A review of medical record indicates that initially Ms. Iuliano was incontinent likely due to her immobility however its documented that as she physically improved Ms. Iuliano was actually continent and would have not soiled or defecated on herself as she was using the toilet for elimination needs."

Frye said the family doesn't know how she got out of bed as she was a fall risk and wore a bracelet.

"We assumed all the proper precautions were put in place," Frye said. "So, how did this happen?"

Care One contacted the family after the fall to inform them Iuliano was being transferred to the Morristown Medical Center. There, the doctor’s evaluation revealed that Iuliano had fractured three ribs because of the fall, and they also discovered her stitches from her hip surgery almost a month ago had never been removed.

"After speaking with the surgeon who performed the surgery, he informed them that he had instructed Care One to transfer Filomena to his office for removal of the stitches and to have a repeat chest x-ray two weeks after her arrival at the facility," Frye said. "On top of all of Filomena’s struggles she had also developed pneumonia in her previous hospital stay."

According to Frye, Care One had told the surgeon that they were equipped to perform those tasks and that a record of the x-ray and removal of the stitches would be sent to his office.

"The CXR confirms adequate communication with the surgeon’s office and compliance with his/her recommendations," the Care One spokerperson said.

"The case manager also told Maria that the stitches had in fact been removed. The receptionist at the surgeon’s office said that she had tried for over two weeks to get in touch with Care One, they never answered their phone, and never returned any of her messages," Frye said. "They never received the records to confirm that those procedures were done."

Care One said this was not the case.

" A fax communication addressed to the center case manager was received on April 20 by Premier Health Associates group which verifies that in fact the surgeon office had prior communication with the orthopedic group. In addition this fax does not give orders for the Care One Staff to remove the sutures and give orders for x-ray of hip, two views which was completed on May 1," a spokesperson said. " In addition as stated above a CXR was ordered so verbal communication exchange did in fact occur between the orthopedic group and the Care One Staff."

Communication Restored

During her week-long stay in Morristown, Frye said there was much improved communication.

"Every single day there was communication between the nurses, doctors, and Filomena’s daughters. This was extremely comforting to the family and a sharp contrast front the communication at Care One," Frye said. "Upon discussion of her discharge plans, the decision that needed to be made was clear. Filomena would never return to the Care One of Morris or any of their other locations. The social worker from the hospital arranged for a bed to be delivered to Maria’s house and for scheduled visits from a nurse and a physical therapist for further rehabilitation."

While her Grandmother is now home and safe, Frye said she has lingering concern for others which has prompted her to speak out.

"What about all the other patients at that Care One at Morris? The patients who are not verbal or who may not have any family to advocate for them. We understand that amidst the pandemic, frontline workers need to follow guidelines for their own protection," Frye said. "However, inadequate resident monitoring, delay or failure of necessary care, and a complete disregard for family communication is completely unacceptable."

A Care One spokesperson said that a review of the medical records disproves that as Iulianoreceived care that support an overall improvement in her physical mobility.

"Initially she required extensive with care needs and upon discharge she required minimal assist with care and in addition was walking up to 30 feet. There is no evidence of any negative outcomes such as dehydration, or skin breakdown, facility acquired infection that would support Granddaughters claim of failure to provide necessary care," the spokesperson said. "In fact the center was monitor her hemoglobin closely and when it drop below her baseline IV Venfor was implemented and the insertion of a peripheral inserted central line to manage her Anemia. Prior to discharge Ms. Iuliano was fully recovered from COVID-19 as documented by the ID."

Care One did note Iuliano did fall at the center and sustained a suspected left posterior acute fracture of 8th through 10th rib and possible 12th rib fracture.

"Post fall she was sent to the ER at MMH, was admitted and was discharged home," the spokesperson said. " This resident has a history of falls with fractures and did not use the call bell to request assistance and was attended to last by her aide 40 minutes prior to the incident."

For her part, Frye said she hoped that her family's experience will encourage officials and administration to take a closer look into the conduct and competency of all the employees.

"I want to ensure that all patients are being treated with the care and compassion they deserve during this very frightening time," she said.

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