Study Concludes Nursing Home Patients With Dementia Are Far More Likely To Suffer An Injurious Fall When Taking Common Antidepressants

Posted by Jonathan Rosenfeld on January 27, 2012

elderly lady with caneIt's no secret that falls in the elderly nursing home population remain one of the largest threats to patients safety and overall well-being.  Recognizing this threat, nursing homes must assess each patient for their potential fall-risk and create a plan of care to reduce the incidence of falls during their stay at the facility. 

While fall precautions may including common sense precautions such as: staff assistance, walkers or modification of bed heights--- new research suggests that nursing homes need to begin evaluate patient's use of common antidepressants known as selective serotonin reuptake inhibitors (SSRI's) which dramatically increase a patient's risk of falling.

A recently published study in the British Journal of Pharmacology conducted by clinicians in the Netherlands followed a group of 248 nursing home patients diagnosed with dementia over a two-year period. 

While nearly all of the patients experienced some type of fall during the course of the study, the study concluded that patients taking SSRI's had a notably higher incidence of falls compared with their peers who were not taking the drug.  Even more alarming, was that fact that researchers determined that patients taking SSRi's (common drugs include: Paxil, Zoloft and Prozac) were three time more likely to suffer a fall-related injury such as a hip fracture, leg fracture, bruise or wound.

Though not the primary focus of the study, an incidental finding was that patients taking SSRI's combined with sedatives and hypnotic drugs-- commonly given to patients to aid with sleep--- resulted in an ever further elevated rate of fall-related injuries.

While the this similar studies will no doubt need to be completed on a broader scale, mounting evidence suggests that all medications prescribed to nursing home patients should be evaluated to determine their necessity.  Further, given the suggestive data from this recent SSRI study, nursing homes need to heighten their focus on patients' medications when tailoring a fall-prevention protocol.

Related:

Study Links Medication Use With Falls

Half Of Nursing Home Residents Wrongly Drugged

Antidepressants may raise fall risk in nursing homes USA Today

Falls in older people: epidemiology, risk factors and strategies for prevention (PDF) LAURENCE Z. RUBENSTEIN Age and Ageing 2006; 35-S2: ii37–ii41 doi:10.1093/ageing/afl084

Illinois To Receive Big Bucks To Improve Nursing Home Safety. Will It Help?

Posted by Jonathan Rosenfeld on January 27, 2012

Many Illinois Nursing Homes may soon be stepping upon some new wealth under a recently devised tax-plan that that is intended to provide for an increase in the number of state nursing home surveyors and increased staff at troubled facilities.  By taking advantage of a Federal Government matching-fund program, the program is expected to provide $145 million in new funding for nursing homes in Illinois.

According to a report on the program in The Republic, Illinois officials have allocated $20 million for purposes of hiring 160 new nursing home surveyors and the balance of the funds will be put towards the state's Medicaid program for indigent nursing home patients.

Because much of the funding provided the program is derived from taxes on daily nursing home rates paid by non-Medicare patients, some critics view the program as little more than a tax on the wealthy to distribute funds to facilities that primarily care for the poor. 

As a nursing home lawyer, I can certainly appreciate these the re-allocation-of-funds arguments as directed to the increase in funds allotted to Medicaid facilities.  However, I think that the substantial boost in the number of nursing home surveyors across the state will be beneficial for all nursing home patients in Illinois.  Hopefully, the influx of nursing home surveyors will allow incidents involving patient injury and abuse to be properly investigated in a timely manner so the responsible parties can be properly identified.

Related Nursing Homes Abuse Blog Entries:

Ohio Nursing Homes Forced to Shed 2,800 Jobs; Gov't Budget Cuts to Blame

Will Steep Reimbursement Cuts To Nursing Homes Jeopardize Patient Care?

It's Time To Yank Federal Funding From Dangerous Nursing Homes

Study Demonstrates Nursing Home Workers Earn Less Than Minimum Wage

10 Resources To Help Families Transition Their Loved One To A Nursing Home

Posted by Jonathan Rosenfeld on January 26, 2012

The transition to a life in a nursing home or assisted living facility usually a difficult process for both the individual involved as well as their family.  Even the most well laid plans for transition to a skilled nursing facility are usually accompanied by many questions that may never have presented themselves until the family has had time to appreciate the change in circumstance.

While transitions such as this will never be easy, there are many different resources to assist with all different aspects as people begin new aspects of their lives.  Below are 10 resources that many of our clients have found to be especially helpful for them as they take on new endeavors.

1) Caregiver list 

http://www.caregiverlist.com/blog/Julie/Default.aspx

This blog gives updates on important health care information for the elderly. It helps those who are caregivers properly care for the elderly.

2) ElderLaw Answers 

http://www.elderlawanswers.com/

This gives an array of answers to some of the legal questions that are faced by the elderly population in the United States. It also gives people information on elder law attorneys across the nation.

3) Silver Innings – Blog for Senior Citizens 

http://silverinnings.blogspot.com

This is a universal blog about the elderly, family and caregivers that show what the elderly community around the world is like.

4) Nurse Virginia Blog by Virginia Garderding, R.N.

http://www.nursevirginiablog.com

Virginia talks about elderly care and what the caregivers should expect and how the caregivers should treat those they are caring for. Through her blog and book, Virginia shows how to care for the elderly with dignity.

5) Hospice and Nursing Homes Blog by Frances Shani Parker

http://hospiceandnursinghomes.blogspot.com/

Frances writes about anything associated with elder care, hospice, palliative care, nursing homes, dementia, caregiving and seniors. She keeps topics up to date.

6) Hospice and Caregiving Blog 

http://blog.hospicefoundation.org/

This blog describes level of care and options for the caregiver during hospice and the end of life experience.

7) Boca Home Care Services

http://www.bocahomecareservices.com/blog/understanding-medicare-home-care-benefits/

Boca Home Care Services provides different levels and types of care for the elderly in the Boca Area. They tailor their staff to meet specific needs of patients.

8) Vida, Inc. Senior Resource 

http://www.vidaseniorresource.com/

Vida Inc. Helps connect seniors with senior care specialists who help in caring for specific needs. They provide home care, assisted living and senior care resources.

9) Care Trak – Home Care LLC 

http://www.caretrakhc.com/elder-care-blog-caretrak-home-care/

Care Trak helps people in their own homes. They provide safety and foster independence.

10) Skilled Nursing Facilities.org 

http://www.skillednursingfacilities.org/blog/

This blog incorporates many realms of elder care and needs. This is a nationwide directory that provides quality ratings to facilities across the United States.

Lots Of Information On Nursing Homes Is Out There--- It Frequently Is A Matter Of Knowing Where To Look

Posted by Jonathan Rosenfeld on January 25, 2012

One of the most common questions I receive is, 'What do you know about this facility?" While I am familiar with some of the "frequent fliers" and certainly don't mind sharing my experiences, there really is a tremendous amount of information on facilities that can be easily obtained via the internet and via states' department of health websites and through Medicare's Nursing Home Compare site.

While much of the information and nursing home survey findings can make for some dull reading, there really is quite a bit of material that can be accessed on individual facilities.  A the Nursing Homes Abuse Blog, I try to condense much of this information into a digestible piece for readers.  Below are some facilities that we have highlighted in our nursing home spotlight series. 

The IDPH quarterly report on Nursing Home Care Act violations includes a $30,000 fine for violations relating to the area of nursing. Fox River Pavilion is a large 121 bed facility in Aurora, IL.

Medicare gave the facility an overall rating of two out of five stars (below average rating) with only one out of five stars (much below average rating) for health inspections. Between July 2009 and September 2010, the facility had 15 health deficiencies, which is seven more than the Illinois and U.S. average.

On August 20, 2010 the Illinois Department of Health issued a 'Type A' violation and $10,000 fine against Ambassador Nursing & Rehab Center located in Chicago, IL. The sanctions are in response to the conditions documented in July 1, 2010 survey completed at the facility that identified several problems related to patient safety and well-being.

The most troubling aspect of the survey is the fact that the facility failed to properly respond to an abusive staff member at the facility. An unidentified CNA admitted to physically abusing a paraplegic patient at the facility. In addition to the admission from the employee, the May 16, 2010 event was also witnessed by another patient and visor where they corroborated the fact that the nurse slapped and choked the patient after complaining about the way she was transferred to her wheelchair.

Three surveys; one very negligent nursing home. At least that’s what it looks like after analyzing recent Illinois Health Department data about the Northwoods Care Centre in Belvidere, IL.

The surveys, conducted in late 2010, and June 2011, highlight several areas in which the home was consistently negligent. Key among them was the failure to distribute medications on time, failure to keep residents properly fed, and failure to develop proper care plans.

Multiple surveys of the Virgil Calvert Nursing Home (also recently called “Nathan Health Care Center”) in East St. Louis, IL paint a truly dismal picture of an unsafe and unsanitary facility.

Among the most troubling aspects of the surveys are numerous accounts of roach sightings in kitchen areas. A surveyor in January 2011 spotted several dead roaches lining the shelves of the food pantry, which at the time contained residents’ nutritional supplements and tube feeding supplies.

Despite claims on its Web site that its “philosophy is one of compassion,” the Waterfront Terrace Nursing Home in Chicago appeared quite differently to recent health department surveyors.

  • Disposable razors in residents’ rooms
  • Exposed wiring in bathrooms
  • A large hole in the vending room ceiling
  • A bag of expired medications from 2007, stored alongside current medications

In a survey conducted in mid-March, inspectors found several alarming deficiencies. One of the most serious was the home’s repeated failure to effectively screen residents for severe mental illness. At least three patients had severe schizo-affective disorders, the report said, which put all 98 residents at risk.

A 90-page survey filed in September 2010 by the Illinois Health Department depicts Plaza Nursing & Rehab Center in Midlothian, IL as a chaotic place with little regard for residents’ safety and quality of life [Plaza Nursing and Rehab Center (pdf)] . In particular, Plaza failed to make shower and toilet areas safe for residents, which led to many unsupervised and life-threatening falls. According to the survey, at least nine residents suffered injurious falls.

In addition to violating patients’ right to a safe and supervised environment, Plaza staff were also guilty of:

  • Keeping water temperatures in bathrooms scalding hot
  • Accepting money from patients who asked to do them “favors”
  • Closing the patient smoking room without first notifying patients, and without providing an alternative spot
  • Failing to clean up dangerous pooling water adjacent to bathtubs
  • Serving food in an unsanitary environment, with flies
  • Administering injections without first pulling patients’ privacy curtains

The influx of felons into main-stream nursing homes. It may be legal, but does it pose a threat to granny?

Posted by Jonathan Rosenfeld on January 24, 2012

In California, the never ending quest to chop money from state budgets has taken a new turn as state prison officials have initiated a new medical parole program which allows medically incapacitated felons to utilize the services of private nursing homes. 

Starting in 2010, the California Correctional system placed 29 inmates--- not parolees or people whom have already served their time--- but real, hardened criminals--- whom have suffered form some type of medical incapacity that they now require medical care; into the hands of skilled nursing facilities throughout the state.

Under a medical parole policy chronicled recently in a New York Times' article, "When the Nursing Home Resident in the Next Room is a Convicted Criminal", a state board determines if the patient is indeed medically incapacitated and eligible for placement at facility in the state. Once placed, the inmate is treated just like any other patient at the facility and can go about his daily activities without the supervision of any of the security detail offered in a jail.

While most of the inmates placed in skilled nursing facilities outwardly appear incapable of perpetrating any of the violent acts that may have caused them their original problems, the Times article highlights how the subjectivity involved in determining an inmates disability has resulted in several situations where some inmates may still be capable of physically or psychologically imposed themselves on other patients or staff.

While the medical parole plan, saves the state more than $19 million annually, the other real winners in this situation are the facilities where these inmates are placed.  Rather than being completely reliant on government stipends, the medical parole program explicitly allows the state to pay a 30% premium over standard Medicare rates as a method of enticing facilities to participate.

As a lawyer who has seen the devastation firsthand when violent people are permitted access to exceptionally vulnerable nursing home patients, I am somewhat skeptical about the long-term viability of this program.  While in theory many of these inmates may be completely incapacitated, what happens in the exceptional case when the patients makes a significant recovery and is able to physically or psychologically bully another patient or staff.  Worse yet, without any ongoing monitoring, what's to keep the inmates 'friends' or 'associates' from paying a visit?

Time will tell, but my guess is that this program's duration is limited.

Related Nursing Homes Abuse Blog Entries:

Registered Sex Offender Attacks Fellow Resident in Iowa Nursing Home

Where Will Criminals Go When They Need Skilled Nursing Care?

What Can Nursing Homes Do To Protect Patients From Violence Within Facilities

Is Assisted Living Facility To Blame For Murder Of Patient?

Metolazone? Methimazole? What's the difference? For nursing home patients, a lot!

Posted by Jonathan Rosenfeld on January 23, 2012

prescriptionThe reported settlement of a nursing home negligence case in involving a medication mix-up caught my attention because of my perceived increase in the frequency with which medication errors are occurring at nursing homes across the country. 

Like many nursing home patients, the patient involved in this incident was a frail, elderly woman, who was dependent on the staff at the skilled nursing facility to provide her with the medications prescribed by her physician.

Also, similar to other errors involving nursing homes injuries-- such as deadful bed sores, the errors related to this incident are reflective of mistakes made by several employees providing care to the same patient. 

In this case, the original error was made by a pharmacy who mistakenly filled the physicians prescription with the wrong drug--- albeit similar in name. However, the error was then compounded when multiple nursing home employees administered the wrong medication to the patient over a course of 18 days.

Arguably, medication errors aside, the nursing home staff continued to provide inferior care when they failed to notice a rapid deterioration of the patient's strength. During the time that the wrong medication was administered, the woman lost a significant amount of weight and became visibly dehydrated.

Like other types of nursing home injuries, this medication error was not divulged until an autopsy was performed which indeed concluded that medication error contributed to existing kidney problems which eventually claimed the woman's life.

In response to a nursing home negligence lawsuit initiated by the deceased woman's family, both the nursing home and pharmacy involved in this sad course of events have agreed to contribute to a settlement.

My take:

As a lawyer who is regularly involved in the prosecution of nursing home negligence matters, I find episodes of injuries and deaths of patients resulting from compounded errors made by multiple staff members far too frequently.   Of course, the original pharmacy error is inexcusable as pharmacists have a duty to dispense proper medications.  However, the fact that different nursing home employees continued to administer the wrong medication over the span of 18 days is sickening--- particularly in light of the fact that the woman's body was obviously given indications that something was not right.

I truly hope the administration at this facility recognize the universal incompetence of their staff and implement a training program to help identify errors as their arise as opposed to simply paying out another settlement in the aftermath.

Related Nursing Homes Abuse Blog Entries:

Pharmacy Error Blamed For Death Of Nursing Home Patient After She Receives Incorrect Medication

'Significant Medication Errors' Discovered In Nursing Home Following Investigation Related To Patient Injury & Death

Wrongful Death Lawsuit Claims Nursing Home Negligently Administered Allergy Inducing Drugs To Patient

Who Should Manage Administration Of Medication?

Nursing Home Injury Laws: Iowa

Posted by Jonathan Rosenfeld on January 22, 2012

Number of nursing homes in Iowa: 445

Patients living in Iowa nursing homes: 25,676

Occupancy rates of Iowa nursing homes: 80.3%

Average number of deficiencies at each Iowa nursing home: 9.0

Percent of Iowa nursing homes with serious deficiencies for actual harm to patient: 20.9%

Most common deficiencies at Iowa nursing homes: Professional Standards, Accident Environment, Food Sanitation

Distribution of ownership of Iowa nursing homes:  53% for profit,  43% non profit, 4 % government

Most populated cities in Iowa: Des Moines, Cedar Rapids, Deavenport, Sioux City, Iowa City

Staffing levels at Iowa nursing homes (daily hours):Above average,  3.5 total staff,  1.3 licensed nurse

Visit Nursing Home Injury Laws to learn more about Iowa nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Failure To Provide Blood Thinning Medication Results In Stroke & Subsequent Death Of Nursing Home Patient

Posted by Jonathan Rosenfeld on January 20, 2012

Like many nursing home patients, Milton Aucoin was a sick man who was reliant on a nursing home to attend to medical needs.  In particular, he needed the nursing home staff to properly administer necessary medications that were prescribed by his physicians. 

As part of his rehabilitation from a stroke, Mr. Aucoin was to receive blood thinning medications to prevent another episode. 

Despite physicians’ orders for blood thinners and other necessary medications, a news report concerning a recently filed wrongful death lawsuit alleges that the staff at Chateau De Notre Dame (Louisiana nursing home) ignored the orders by withholding the medications for two days following his initial admission.  As a result of the lack of proper medication, Mr. Aucoin suffered a subsequent stroke which contributed to his death.

Apparently medication errors were not a new issue for Chateau De Notre Dame as the facility had been cited by surveyors from the Department of Health and Human Services found higher than average medication error rates at the facility over an extended period.

Despite their reputation as facilities that care for the elderly on a long-term basis, nursing homes are medical facilities that provide skilled nursing for patients with both long-term and acute care needs.  Regardless of the underlying reason for admission, nursing homes have a responsibility to follow the orders of the patients attending physicians.

A medication plan remains one of the most primary responsibilities that skilled nursing facilities are responsible for complying with.  In addition to providing patients with the specific medications (and dosage), facilities must comply with the schedule for each medication. Unfortunately, when the accurate administration of medications is not made a priority we can see the devastating results.

Related Nursing Homes Abuse Blog Entries:

Common Medications Used By The Elderly Must Be Properly Monitored To Keep Patients Safe

Nursing Home Patient Dies After Receiving 'Toxic' Medication Overdose

State Surveyors Discover Medications Continually Withheld At Conn. Nursing Home

Medication Errors To Blame For Death Of Nursing Home Patient

Illinois Officials Begin Examination of Nursing Home Procedures Following Elopement Of Alzheimer's Patient

Posted by Jonathan Rosenfeld on January 19, 2012

winterThe Chicago area has been struck by a snap of arctic weather lately.  It’s the kind of weather that quickly brings a chill to every part of your body regardless of how quickly you can do what needs to be done and get back to a warm area. 

When I read news clippings about a downstate nursing home patient who wandered from a facility into these cruel temperatures, I couldn't help but cringe as I knew more bad news would follow.

Sadly, I was correct. 

The body of the 75-year-old nursing home patient, identified as Aubrey Giles, was found in a creek located just a block away from Midwest Rehabilitation and Respiratory Care in Belleville, IL.  The elements were simply too much for that man to bear, and a medical examiner has ruled Mr. Giles died from exposure-related hypothermia.

In response to this unfortunate incident, officials from the Illinois Department of Heath have descended upon the Southern Illinois Nursing Home to begin an investigation into matter.  Much of the investigation will focus upon Mr. Giles' care plan created by the facility to best serve the his needs. 

Because many Alzheimer’s and dementia patients are considered to be elopement risks, I presume the state’s investigation will closely review what type of safeguards were ordered under the care plan for this patient vs. the safeguards (such as door alarms, wanderguards and gps tracking bracelets) that were actually in place at the time Mr. Giles wandered from the facility.  In  addition to safeguards, I would anticipate most of the staff on duty at the time of Mr. Giles incident would be questioned about their knowledge of his past behavior in addition to the circumstances of the day in question.

While wandering safeguards will indeed be reviewed, according to news reports surrounding this incident, the timeliness of the facilities notification of officials following the known departure of Mr. Giles’ departure from the facility appears to be within the boundries of the law.  Amazingly, while officials from Midwest Rehabilitation discovered Mr. Giles missing at three in the afternoon--- it was not until 7:30 that evening that the facility notified Department of Health officials.  Yet, this scheduling is completely legal.

Moreover, despite the fact that nursing home workers knew their patient with diminished capacities went into the frigid elements, no local police departments were contacted to help in the search for this missing patient-- again completely legal under the present laws.

Situations such as this shout the need for state lawmakers to begin to reevaluate the nursing home laws applicable to the tens of thousands vulnerable patients in Illinois whom are completely reliant on facilities for every part of their subsistence.  I find that fact that a nursing  home can use their own methods to locate a missing patient for 23-hours after they go missing downright shocking.  If a similar incident were to occur with a child leaving his home, I have little doubt the the public outcry over such an incident would be deafening. 

Related Nursing Homes Abuse Blog Entries:

Investigation Initiated After Suspicious Nursing Home Death, Involving Patient Wandering and Drowning

Too Little, Too Late. Nursing Home Submits Corrective Plan After Disabled Patient Wanders From Facility To His Death

State Fines Nursing Home Where Patients Drowns In Puddle In Front Of Facility

Lack Of Door Alarms Allows Assisted Living Patient To Wander To Her Death

Nursing Home Blamed For Un-checked Urinary Tract Infection

Posted by Jonathan Rosenfeld on January 18, 2012

One of the more common nursing home injuries that I see commonly involves the development of a urinary tract infection during an admission to a facility.  Commonly referred to as a UTI, a urinary tract infection can involve any of the part of the urinary system comprised of the kidneys, ureters, bladder, and urethra.  

Most UTI's are caused by bacteria from the colon that gets introduced to the urinary tract.  However, particular patients with catheters, may develop UTI's when bacteria is introduced from other sources such as poor sanitation by staff at a skilled nursing facility.

Women are significantly more susceptible to developing UTI's due to anatomical differences that allow outside bacteria a more direct path to the urinary system.  

Most UTI's can be identified by the following characteristics:

  • Discolored or cloudy urine
  • Pungent smell in urine
  • Blood in urine
  • Frequent urges to urinate
  • Fever
  • Bloated abdomen

When diagnosed at an early onset(with a urinalysis), a UTI can be readily treated with antibiotics.  If the UTI has progressed--- and infected other systems in the body--- the patient may required hospitalization for intravenous antibiotics.  If not timely identified and treated UTI's can cause a systemic infection known as sepsis or even death.

I was once again reminded of the devastation that a UTI can bring to an elderly nursing home patient when I read about a recently filed lawsuit against an Illinois Nursing Home.  The lawsuit, filed in Madison County, by the family of a deceased woman who was under the care of Edwardsville Health Care Center alleges that the facilities delay in implementing treatment for a UTI contributed to the patient's death preceded by a painful series of complications including:

  • Sepsis
  • Metabolic acidosis
  • Acute Kidney Failure
  • Dehydration
  • Malnutrition

Related:

Urinary Tract Infection Medicine.net

Urinary Tract Infections In Long-Term-Care Facility Residents (pdf)

Dehydration Prevention: Facilities Must Monitor Intake & Output

Nursing Home Fined After Investigation Determines That Urinary Tract Infection Was Related To Poor Care

Untreated Urinary Tract Infections In Nursing Home Patients May Result In Urosepsis

Never Event #4: Catheter Associated Urinary Tract Infections

About Jonathan Rosenfeld

Photo of Jonathan Rosenfeld

Jonathan Rosenfeld is a lawyer who represents people injured in nursing homes and long-term care facilities.   Jonathan has represented...

Read More

Subscribe

Add this blog to your feeds or subscribe by email using the form below

Concerned about a loved one? Talk with an attorney today.

Bed Sore FAQs

Frequently asked questions on bed sore prevention, treatment and legal rights of those who have been neglected.

View FAQs