Black eyes, bruises and a busted lip are not what most of us associate with a nursing home. When one North Texas family suspected abuse, they did not turn to regulators but technology.
Statistics show about one in three homes nationwide have been cited for abuse. FOX4 found more and more families fed up with the system, are fighting back with their own secret weapon.
"She started having babies when she was 14," said Shirley Ballard, talking about her grandmother, Minnie Graham.
At 98 years old, Graham was a cherished woman.
"She has great, great grandchildren," said Ballard.
Graham was adored by a large extended family and granddaughters who could not stand by when they started noticing bruises.
"She kept telling us people were hitting her," said Teri Hardin, another granddaughter.
Her granddaughters say the Winters Park Nursing and Rehabilitation Center in Garland told them Graham fell out of her wheelchair. They didn't buy it so they installed a hidden camera in her room.
Brenna Tiller is the hospice worker who was assigned to Graham. The video shows Tiller pulling Graham up by the arm. Graham later falls back onto the bed and cries out.
"Somebody help me," you can hear Graham say on the tape.
When Graham begins slapping at Tiller, Tiller slaps her more than once.
"When my grandmother is screaming in pain, it is completely disregarded," said Teri Hardin.
Tiller uses language we cannot print. She calls Graham ugly and retarded. She mocks her. She also sticks out her tongue at Graham, sprays water in her face as she brushes her hair and puts a towel in her mouth she just used on Graham's body.
"I just don't know how people can be so heartless and careless," said Ballard. "Clearly it hurt when they pulled on her arm. Clearly it hurts when you yank someone by the hair on their head."
And it is not just Tiller. Iwuchukwu Ekechukwu, who goes by the name Louis, is extremely rough with the frail 98 year old. He can be seen on the tape hitting Graham.
"No compassion at all, no compassion," said Hardin.
Graham's family filed a complaint with Garland Police and a Dallas County Grand Jury indicted both aides last summer for Felony Injury to the Elderly. But nothing happened. The months ticked by. Records show police arrested Ekechukwu but the criminal court continued his case 13 times waiting for Tiller's arrest.
"They kept telling us, we can't find her, we cannot pick her up," said Hardin.
But FOX4 had no problem finding Tiller.
"Have you seen the video?" Becky Oliver asked Tiller outside her home in North Texas.
"I don't want to, I don't want to, too many memories," said Tiller.
"You are seen hitting her, cussing at her," Oliver said.
"No, she was pulling on me and slapping me," said Tiller. "I have never had a patient who was verbally aggressive like that."
Tiller was wearing a uniform and confirmed she still works as a nurse aide at another home. The Texas Nurse Aide Registry shows her registration is valid and she's employable. The registry shows the same information for Ekechukwu. Graham's family filed a complaint with the Texas Department of Aging and Disability or DADS and showed the tape to an investigator.
"She said, well I did see what they did to her and I am really sorry about that but the nursing home did not know they were doing that so there is not a lot we can do to the nursing home," said Ballard.
The state substantiated the complaint but DADS did not cite the home for any deficiencies and issued no fines.
That is not unusual for the state of Texas. Medicare shows Texas pays some of the lowest fines on average in the country, just under $7,000 per fine. In Washington, the average fine is about $90,000, Tennessee it is $64,000 and in Kentucky and South Carolina the average fine is just under $40,000.
And in Texas, if a nursing home agrees to pay a fine and not fight it, 35% is automatically knocked off the fine.
"DADS completely let me down. They kept making excuses," said Glen Frausto. Frausto and other families say they are so fed up with the state they are turning to the courts.
In a lawsuit, Frausto says his mother suffered from bedsores on her heel and backside and Pennsylvania Rehabilitation in Fort Worth failed to provide the proper medical care.
"The bedsores were horrendous. They were as big as a plate," said Frausto.
Frausto says it was not until after his mother died, the state finally paid the home a visit.
"How come you couldn't have done this when my mom was alive?" Frausto asked.
After his mom's death, state inspectors found Pennsylvania Rehabilitation failed to maintain an infection control program. Records show 16 deficiencies in the past 3 years and one $1,625 fine. The home had no comment.
"It just left me appalled," said Cornelius Kasey, a lawyer representing another family suing Duncanville Healthcare and Rehabilitation Center.
Connie Horsley's family is suing Duncanville Healthcare claiming a worker dropped Horsley and he hit his head. It says the home should have used two workers to move the 75 year old paraplegic.
"You are taking about 5 falls in 8 months, that's a lot of falls," said Kasey.
After Horsley's death, the state found Duncanville was providing "substandard" quality of care. The home had no comment.
"It is just not right for people to go through what I went through," said Frankie Ross, Horsley's daughter. "Somebody needs to say something."
And that is exactly what families across North Texas are doing.
When Mynez Carter's family grew suspicious of her bruises, they placed a hidden camera in her room at Heritage Oaks in Arlington. The video shows a nurse aide pulling Carter's hair, pushing her and pinching her leg.
"My heart started racing and I was horrified," said Freddie Johnson, Carter's daughter. "I was more mad than anything just to know this was going on with my mother."
After FOX4 aired the video, police arrested Maria Acosta. She is facing Felony Injury to an Elderly. The state investigated, substantiated the complaint and issued a $137,000 fine. Heritage Oaks paid $90,000 to settle with the state.
Heritage Oaks released this statement to FOX4.
"Everyone associated with our facility continues to be committed to providing the highest level of compassion and care for our residents every day. The health, safety and well-being of our residents remains a top priority. As soon as we were aware of the incident involving Ms. Carter, we immediately notified law enforcement and took steps to protect our residents, including removing the offending employee from the facility. We remained in close contact with the officers assigned to this matter and provided full cooperation in their investigation."
The day after FOX4 talked to Brenna Tiller on camera, police arrested her and took her to jail.
Winter's Park Nursing and Rehabilitation released this statement to FOX4.
"Providing the highest quality of care for Winters Park Nursing and Rehabilitation Center is our top priority. The facility is fully cooperating with all appropriate parties regarding allegations of misconduct by a hospice aide, who was employed by an unaffiliated company and provided hospice care at Winters Park. Once we became aware of an allegation of misconduct by a Winters Park aide, we responded in a timely way, and after careful review, that employee was terminated. Due to an ongoing investigation, we are not able to provide additional information. We do want our patients and their families to know that the aides in question are no longer employed with TRISUN and the hospice company respectively."
Graham's family says one of the more disturbing aspects of the tape involves the male aide. When Graham tells him he will be sorry for the way he's treated her, he does not say anything, he gestures his response with his middle finger, then leaves the room. Graham died about a month later.
"I think it definitely affected her will to live," said Teri Hardin.
"I think she just gave up because of the condition," said Shirley Ballard.
The family thinks all nursing home residents should be electronically monitored. They visited their grandmother every single day.
Earlier this month, the Oklahoma Governor signed legislation that allows all nursing home residents to install cameras in their rooms. Families can pay for monitoring and the nursing home cannot remove or tamper with the device or refuse to admit a resident who requests monitoring.
For more information about nursing homes in Texas, you can find information on these web sites.
To verify a Certified Nurse Aide Registration
To research a specific nursing home facility in Texas and view their inspection reports go to: www.dads.state.tx.us
To file a complaint with DADS go to the complaint information page and view the options available.
Mail to the
Texas Department of Aging and Disability
Consumer Rights and Services
Complaint Intake Unit
PO Box 149030
Austin, Texas 78714-9030
To see information and ratings the Center for Medicare and Medicaid Services has given a specific facility in the state of Texas or nationwide go to:
To view extensive on-line information for nursing homes nationwide and Texas go to: http://www.propublica.org/nursing-homes
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