Aging Joyfully, Inc.

The following is in response to a consumer complaint against Aging Joyfully, which was assigned an ID of [redacted]. The complainant is the daughter of a previous resident at Aging Joyfully. I.E. (the resident in discussion) moved into Aging Joyfully on June 03, 2016. At 1605 on June 03, 2016, I...

, (the Advanced Practice RN/Owner) had just completed a 45-minute admission intake/physical assessment with I.E. I.E. was then left at the table viewing a magazine; I walked to another location (within 20 feet of the resident and with ability to see I.E.) to finish documenting the assessment; and within 5 minutes, a crash was heard and I.E. had fallen to the floor. A Certified Nursing Assistant was also present and within 15 feet of I.E. Due to physical limitations I.E. would have been unable to brace the fall and therefore landed full weight on his left side. He sustained a superficial left-sided head abrasion with minimal bleeding and subsequent bruising along his left side. Following the fall assessment the complainant was immediately called at 1620. The complainant was grateful I had called in a timely manner. The communication prior to admission did involve a discussion with the complainant that I.E. was considered a moderate fall risk (versus a high fall risk which would require continuous observation). The issue of communication will be discussed further at a later point. On one occasions following the fall, I.E. and the complainant were on the patio with no AJ staff. After a period of time, an AJ staff member saw I.E. was left unattended by the complainant - there had been no notification from complainant about her leaving I.E. on the patio alone. The complainant also insisted on a TV in I.E.'s room for him to view, "if he needed to be in a quiet place." For both these situations the complainant needed to be reminded by AJ staff of I.E.'s fall risk and that being left in an inadequately supervised area was not acceptable. This and other events completely contradict the accusations/tone of the complaints submitted. Beginning June 04, 2016, following the fall additional staff was added to the schedule to ensure the safety of I.E. This offered I.E. a 2:1 care ration at no added cost to the family. The EZ stand mobility device was utilized for transfers following the development of left sided discomfort related to the fall. On June 02, 2016 I met with the complainant to discuss and complete the required admission paper work. On page 4, paragraph 6 of the Resident Rental Agreement the Terms of the Agreement related to payment are completely outlined. The admission agreement states that the first 30 days payment is required on admission and that this first 30-day payment is not refundable. The daily rate is $250.00 / day, therefore the total admission fee is $7500.00. The complainant insisted paying only through the end of the month, which was 28 days ($7000.00). The complainant also, more than once, adamantly requested a change to the agreement allowing for only a 10-day non-refundable period (a strange request with no reason provided). The $7000.00 admission fee was granted, but the 30-day non-refundable time frame was not negotiable. As required the complainant initialed each page of the contract after questions were addressed. During the June 02nd discussion, the date of admission was also discussed. The complainant was informed that I would be attending a family reunion the afternoon of June 10, 2016 through the afternoon of June 12th and would be unable to complete an admission during this period of time. She was also informed that an on-call RN would be available for emergencies such as changes in resident conditions, falls, and/or issues requiring close observation/monitoring. An abundance of communication and background information was available from the complainant. I expressed gratitude for most of the information offered such as REM sleep literature, diet concerns, and particulars of care. Within a period of 2-3 days the information offered via frequent texts, e-mails, and phone calls became belittling and overwhelming. A 3-ring binder was also presented outlining a number of verbatim (quotation outlined) conversations to use when caring for I.E. The complainant was informed that I was not comfortable with expecting my certified, dementia-trained staff using scripted dialogue with residents. I.E.'s other family members were not allowed to be an active part of I.E's care due to estranged relationships with the complainant. There were "friends" present requesting direct observation of cares and assessments and sending texts out of the facility. The complainant was informed that this behavior was a breach of the HIPAA regulations and would not be allowed at Aging Joyfully. The allegation of I.E. having suffered an ulcerated buttocks while at Aging Joyfully is false. When the complainant mentioned this concern the resident's buttocks/groin area was assessed by myself and 4 other certified staff members and each would state this allegation is not true. This complaint is not the complainant's first allegations against care providers on behalf of I.E. There are multiple allegations/actions by the complainant in the recent past, resulting infrequent disruptions to I.E.'s care. These disruptions can be devastating, confusing and result in unusual/assertive behavior for frail, elderly patients. I have discussed my concerns for I.E. with his other family members and with the State Office of Ombudsman for Older Minnesotans. In discussions with our area's Ombudsman's representative, he confirmed he did not state many of the things the complainant previously documented as being statements from him. I.E. is a vulnerable adult and he needs and deserves a caring, proper advocate. thank you for accepting my response to the Revdex.com,Joy [redacted] APRN

I am rejecting this response because:
I am rejecting this response from Aging Joyfully for many reasons related to Joy's breach of contract,  lack of nursing/owner competency, and violation of tenant/resident rights:1. Contrary to Joy's comment: The sores on IE's butt and tear in his crack was documented by his day program on the day he got a shower, Tuesday, June 7th. IE had complained of butt pain to our family friend on a visit on Monday, June 6th. IE asked the family friend to look at his butt as it hurt and he knew he had some kind of sore. The AJ staff said she was not allowed to look at his butt, even though, she'd been IE's primary caregiver for all doctor and dental appointments doing bathroom duty with him for several years. She was capable of single handedly transferirng IE at her 130 pound weight, whereas, it took Aging Joyfully three staff to yank him off a chair in pain for transfers. (There is no such thing as a safe three person transfer, which we all witnessed.)  I asked Joy to look at his butt on Monday (June 6th) afternoon.  She said she would, and she "was competent to do a skin check." Yet, she did not call me back. So, I contacted IE's Day Program, and asked them to do a skin check on Tuesday when he was scheduled for a shower. The nurse at his Day Program reported "IE had three scratches and a tear in his butt crack. Very painful." That fact is confirmed in the email already presented to the Revdex.com in the original Email copy/complaint. Again, Joy never called back to say she had indeed conducted a skin check or to report the very painful area his Day Program had documented. Joy is in violation of IE's contract by not reporting this harm to family, and by not providing a safe place with competent staff for [redacted] to live - rules she is required to run her business by.2. Head Injury - First day at Aging Joyfully. Joy did call me to report the head injury. She went on to tell me she stepped out of the room, heard a loud thump, went back in to find him on the floor. She told me she had no idea how the fall happened. Joy knew IE was a high fall risk. If she and a staff person really were there, and within 15-20 feet  each (which is 5-6 steps), how is it that two "qualified persons" in such close proximity could not keep this fall from happening? My husband took care of my Dad for 11 months in our home, on daily average at least two trips to the bathroom, up and down a chair lift, to and from the dinner table, to bed etc., IE was stronger and faster when he lived with us in 2014/2015. And yet by himself, my husband managed to not let a single fall happen.  While at Aging Joyfully, Joy "The Advance Practice/RN/Owner,"  and the "Certified Nursing Assistant" were incapable of preventing a frail 91 year old man from a fall that resulted in a head injury. Joy DID NOT report any torso or arm bruising in her phone call to me, or in the days following. I asked Joy that night if IE should be taken in for wound care/head xray, because she reported a very large egg on his head from the fall.The swollen egg was still bleeding into the night when I arrived and then stayed overnight. There was blood on IE's pillow case. Joy said no, they would not take him in for Urgent Care. Instead she said, staff would ice it and take vitals. Joy is required to report bruising to family, any change of condition is required reporting. So, while I was grateful she reported in a timely manner, she did NOT report any details of the fall, did NOT report She or staff were in the room, and again was not forthcoming about the bruising. Again, Joy did not adhere to her responsibilities as owner/nurse in her own contract with IE because when there is a change in condition, she is required to report that change to family. Both of these incidences would most likely have also been reported in detail to authorities, as self-reporting is a sign that a senior facility is honest and forthright.  The story she tells the Revdex.com is not what she told us, that, she "stepped out of the room, heard a loud thump, and found [redacted] on the floor, not knowing what happened."3.  When a family member visited their loved one at Aging Joyfully, the staff disappeared. Twice, while on the patio, I left my Dad to tell staff that other residents on the patio had been outside long enough and wanted to come in. There was no staff on the patio. One man in a green fishing hat was  very overheated. He sat in front of the glass door for 15 minutes waiting for someone to come get him. So, I got went inside to get him help. I was told that when residents were on the patio, the cook and her son, a kitchen helper, were keeping an eye on the residents. The window to the kitchen on the outside patio wall was also open so the cook could see and hear residents. Having said that, Joy often sent her caregivers on break two at a time. In one incidence when I left my Dad to come in to get help for a resident in the sun on the patio, Joy said the person would have to wait until the caregivers got off break to go assist him. Made no sense to me. Joy told us the caregiver ratio of three staff would always be on the day shift except for the two person night shift, that she would be at the facility a lot, as she lived close by (when in fact she went on vacation with no nurse onsite for day to day cares or caregiver oversight), two kitchen staff daily, and an activity person three afternoons a week. There were only six residents, so that is plenty of staff for them to be doing appropriate oversight. So, when Joy said in her report to the Revdex.com that she added staff just to keep IE safe, that was news to us. To us, she was adhering to the promise she made that there would be three caregivers on staff. Just as a note: When a family member is visiting a resident at ANY SENIOR FACILITY, and while on the premises, THE CAREGIVERS ARE STILL ON THE CLOCK TO WATCH AND ASSIST RESIDENTS. Our presence as a family member is not their time to take a break, making us responsible for residents. In the end, IE never fell while we visited.4.  Payment: The Omsbudsman I worked with in 2010 (first head injury at a senior facility) informed me that the state frowns upon 30 day notices/commitments required by seniors at facilities. My request wasn't odd. It was based on professional guidance from an Omsbudsman, who objects to holding residents' money hostage if the resident passes away or moves out due to poor care for 30 days. So, yes. I do negotiate a shorter time for giving notice, because the beds are often filled soon after a resident leaves giving the nurse/owner a chance to double dip into funds for the resident who is gone and the one who is coming in. And, of course, I wasn't willing to pay the full $7500.00.  IE didn't move in until June 3rd. At $250.00 for the two days he didn't live at Aging Joyfully, rent totals, $7,000.00, what I paid on IE's behalf: $7,500 (month's rent) minus $500.00 (days not living there) = $7,000.00 for the actual days he was there. No one has every charged us at a senior facility for the days PRIOR TO HIS ARRIVAL/IE living there. Ridiculous. IE should get his money back for the whole month. Joy violated the contract. She is required to provide care, have a plan in place, protect a resident from neglect, abuse and maltreatment, adhere to privacy regulations, provide adequate care with nurse oversight, and adhere to the patient bill of rights. IE had a head injury the first day, a documented butt crack tear and three scratches, horrendous bruising all over the torso and on both arms (never reported to family), and was taken to the Emergency Room, unable to move due to the extensive bruising, rib fractures and an ulcerated sore on his bottom. Joy said she hadn't gotten him an xray because she "was waiting to see if he needed one." He complained of pain and by June 17th, IE COULDN'T MOVE! What was she waiting for? IE told my visiting friend on the 17th, he didn't want to be transferred he had, "pain on his left side, left arm and left leg. I called the N. Clinic on call doctor; he insisted that since IE had had a head injury recently, he needed to be seen!  Joy didn't adhere to her contract from day one. IE was only there 14 days and had all of these harms done to him, and I had to assure the hospital, the Special Investigator with the Office of Facility Complaints, and the Eden Prairie Police Department (which launched a criminal investigation against Aging Joyfully on IE AND on another resident's behalf - "substantiated"), that, of course, IE WOULD NOT be returning to the place that had harmed him. Joy violated her own contract, not providing cares. Aging Joyful thinks they can require a no return policy on a 30 day fee, but the agreement is a two way street: for those 30 days, they are required to meet their obligations to the resident, which they did not do.5.  I have been IE's caregiver for 20 years. While AJ is trying to spin this as me disrupting IE's care, in fact, it's me providing oversight when there is a lack of care. That is my job as POA and HC Director for my Dad, a vulnerable adult with traumatic brain injury, stroke and dementia. Yes, IE has been harmed in the past. Both of his head injuries happened at senior facilities (2010 and 2013), just as the  third head injury happened at Aging Joyfully. Sadly, at IE's prior residence, an incidence was spelled out in detail in a DHS  Report. It was simply time for that facility to be surveyed, and there was my Dad (with a client number), highlighted as being a maltreated resident in that facility. 6. If Joy was only gone for 2 days in June, I don't know why she didn't respond to my requests that whole weekend and during the week to investigate rough treatment my husband and I observed by untrained staff on the night shift, unskilled transfers during the day by untrained staff, and my request to investigate the bruising on the arms we were starting to see. Joy didn't respond to me for five days! And I finally had to text her to say, "CALL ME." And yes, Joy was very irritated to receive any information.Very odd behavior from a nurse taking in a brand new resident. I do not have a three ring notebook with any verbatim dialogue.  Joy declined to take the notebook I offered to her with IE's medical information, medication list, dietary prescriptions, etc., As I initially reported to the Revdex.com, when I asked if I could bring her the notebook that we used to train  caregivers when they came to care for IE in our home, Joy said, "No." At the point that my Dad was in so much pain with the butt sores, and the caregiver family friend offered to help. Joy was angry and said they wouldn't accept any advice or information. Her "CNA's found the comments demeaning." Anyone who really cares about a senior wants that kind of information; seniors have a right to an individualized plan of care that is signed off on by the Representative. In the absence of this plan, I had information to offer Aging Joyfully. There were not interested. This was a red flag. Joy is in violation of the contract by not providing adequate care. We weren't renting a room from her. Aging Joyfully's license is Housing WITH SERVICES. Joy said her philosophy is to NOT accept any information about residents from outsiders because she wants her staff to be the "go to" person for the resident. Well, that was never going to happen with my Dad: The ever appearing bruises, scratches, head injury, and rough three person transfers indicated to him they couldn't be trusted, were not safe caregivers for him in their lack of skills. With fractured ribs and that amount of bruising, the EZ Stand was a painful, poor transfer decision.  We've been told many stories of loved ones whose parents have choked to death, and been in harm's way because of this archaic philosophy that all knowledge of the resident (i.e., food has to be cut, pureed, no seeds or nuts etc.,) by way of family support is cut off. In the senior industry, these kinds of senior facilities are likened to "breaking a horse's spirit." This was the cruel relationship that revealed itself to us in those two weeks at Aging Joyfully, the way staff treated residents, like they had to let residents know who was in control - AJ staff.7. North Memorial Hospital treated IE for five days for the ulcerated butt sore. This is documented. IE arrived in ER all black and blue. Treated for rib fractures. An ambulance picked up IE at Aging Joyfully, delivering him to the Emergency room where all this was witnessed and documented. (bruise photos in original complaint)8. Joy had phone numbers and names of all IE's offspring. IE's other offspring choose not to be involved in IE's care. They do not want to know medical details, do not want to see Depends, only want to visit when it meets their scheduling needs. Caregiving is not for everyone, and I accept that. Having said that, I want my siblings to spend with IE. I don't keep my siblings from IE, from any facility, or from any information at the facility; all of their names are on the contact list so they can get updates and information directly from the nurse. 9. I'm the person who told Joy that IE is a high fall risk. IE doesn't have a TV. Nor did I get one for him there. Nor did I order cable services. Three people moved IE's belongings out of his room at Aging Joyfully. They can all report: IE did NOT have a TV in his room. IE has not had a TV in his room since 2013, for safety reasons, cannot be left alone as a high fall risk. IE even lived with us for one year, and was never left alone in his bedroom. The caregiver family friend can also attest to the last two places [redacted] lived: he did not have a TV in his bedroom. AJ is confusing a couple of questions I had about cable TV that never came to be because it was clear: AJ's lack of oversight in public areas demonstrated their inability to monitor private areas.11. I don't have an Omsbudsman assigned to IE's case regarding Aging Joyfully. So, I'm not aware of any statements from the Omsbudsman that IE  never had...!! I was notified by the Special Investigator , MN Dept of Health, Office of Facility Complaints,  that a printed report on the Aging Joyfully investigation representing IE will be coming in 2-3 months, but that the preliminary conclusions I'm made aware of against Joy and Aging Joyfully on behalf of my Dad determined (as read to me over the phone by the Special Investigator):1. Violation of two Bill of Rights: "to be served by people that are competent and to be free of maltreatment"2. There was not a competent Assessment completed by Joy, the Nurse/Owner3. There was no proper monitoring by Joy, The Nurse/Owner4. There was no required Service/Care Plan, no implementation or revision.5. Tasks were not specific to resident needs6. No proper orders were in place for individualized treatment and therapy7. Lack of supervision of staff as is required under the Comprehensive Housing with Services License8. Lack of visits with staff to ensure completed tasksIE's case is also being investigated by the  Eden Prairie Police Department as a Criminal Investigation; it is being conducted in parallel with another Aging Joyfully resident who was also harmed. I am told that I will find out the outcome of my father's investigation when both criminal investigations are completed.  The investigation by the Special Investigator by the Office of Facility Complaints for the other Aging Joyfully resident has been resolved and IS concluded as a "Substantiated Claim" against Aging Joyfully. My Dad was not the only person harmed there.Aging Joyfully needs to refund IE's $7,000.00. Aging Joyfully did not fulfill the contract. IE did not receive safe, appropriate, compliant care and could not return there.Aging Joyfully should pay IE's related medical bills (not yet received), which required a five day observation status, two ambulance/transportation rides and misc costs.I provided photos of bruising, email confirming butt tear and scratches, and correspondence with AJ in the original complaint filed with the Revdex.com. If you are missing any of this information, let me know.I would ask that the IE encryption be changed to different initials to better protect privacy of my Dad and my name be removed, if possible.Thank you for your time and consideration. If you have any questions, let me know. Most Gratefully,B

The following is in response to a consumer complaint against Aging Joyfully, which was assigned an ID of [redacted]. The complainant is the daughter of a previous resident at Aging Joyfully. 
I.E. (the resident in discussion) moved into Aging Joyfully on June 03, 2016. At 1605 on June...

03, 2016, I , (the Advanced Practice RN/Owner) had just completed a 45-minute admission intake/physical assessment with I.E. I.E. was then left at the table viewing a magazine; I walked to another location (within 20 feet of the resident and with ability to see I.E.) to finish documenting the assessment; and within 5 minutes, a crash was heard and I.E. had fallen to the floor. A Certified Nursing Assistant was also present and within 15 feet of I.E. Due to physical limitations I.E. would have been unable to brace the fall and therefore landed full weight on his left side. He sustained a superficial left-sided head abrasion with minimal bleeding and subsequent bruising along his left side. Following the fall assessment the complainant was immediately called at 1620. The complainant was grateful I had called in a timely manner. The communication prior to admission did involve a discussion with the complainant that I.E. was considered a moderate fall risk (versus a high fall risk which would require continuous observation). The issue of communication will be discussed further at a later point. 
On one occasions following the fall, I.E. and the complainant were on the patio with no AJ staff. After a period of time, an AJ staff member saw I.E. was left unattended by the complainant - there had been no notification from complainant about her leaving I.E. on the patio alone. The complainant also insisted on a TV in I.E.'s room for him to view, "if he needed to be in a quiet place." For both these situations the complainant needed to be reminded by AJ staff of I.E.'s fall risk and that being left in an inadequately supervised area was not acceptable. This and other events completely contradict the accusations/tone of the complaints submitted.
Beginning June 04, 2016, following the fall additional staff was added to the schedule to ensure the safety of I.E. This offered I.E. a 2:1 care ration at no added cost to the family. The EZ stand mobility device was utilized for transfers following the development of left sided discomfort related to the fall. 
On June 02, 2016 I met with the complainant to discuss and complete the required admission paper work. On page 4, paragraph 6 of the Resident Rental Agreement the Terms of the Agreement related to payment are completely outlined. The admission agreement states that the first 30 days payment is required on admission and that this first 30-day payment is not refundable. The daily rate is $250.00 / day, therefore the total admission fee is $7500.00. The complainant insisted paying only through the end of the month, which was 28 days ($7000.00). The complainant also, more than once, adamantly requested a change to the agreement allowing for only a 10-day non-refundable period (a strange request with no reason provided). The $7000.00 admission fee was granted, but the 30-day non-refundable time frame was not negotiable. As required the complainant initialed each page of the contract after questions were addressed. 
During the June 02nd discussion, the date of admission was also discussed. The complainant was informed that I would be attending a family reunion the afternoon of June 10, 2016 through the afternoon of June 12th and would be unable to complete an admission during this period of time. She was also informed that an on-call RN would be available for emergencies such as changes in resident conditions, falls, and/or issues requiring close observation/monitoring. 
An abundance of communication and background information was available from the complainant. I expressed gratitude for most of the information offered such as REM sleep literature, diet concerns, and particulars of care. Within a period of 2-3 days the information offered via frequent texts, e-mails, and phone calls became belittling and overwhelming. A 3-ring binder was also presented outlining a number of verbatim (quotation outlined) conversations to use when caring for I.E. The complainant was informed that I was not comfortable with expecting my certified, dementia-trained staff using scripted dialogue with residents. 
I.E.'s other family members were not allowed to be an active part of I.E's care due to estranged relationships with the complainant. There were "friends" present requesting direct observation of cares and assessments and sending texts out of the facility. The complainant was informed that this behavior was a breach of the HIPAA regulations and would not be allowed at Aging Joyfully. 
The allegation of I.E. having suffered an ulcerated buttocks while at Aging Joyfully is false. When the complainant mentioned this concern the resident's buttocks/groin area was assessed by myself and 4 other certified staff members and each would state this allegation is not true. 
This complaint is not the complainant's first allegations against care providers on behalf of I.E. There are multiple allegations/actions by the complainant in the recent past, resulting infrequent disruptions to I.E.'s care. These disruptions can be devastating, confusing and result in unusual/assertive behavior for frail, elderly patients. 
I have discussed my concerns for I.E. with his other family members and with the State Office of Ombudsman for Older Minnesotans. In discussions with our area's Ombudsman's representative, he confirmed he did not state many of the things the complainant previously documented as being statements from him. I.E. is a vulnerable adult and he needs and deserves a caring, proper advocate. 
thank you for accepting my response to the Revdex.com,
Joy [redacted] APRN