Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Bloomberg reported that more than 90 percent of U.S. nursing homes in each of the past three years were cited for violating federal standards, according to a government report.  The article substantiates that many nursing homes are simply not doing an adequate job caring for our nations elderly population.  According to the inspector general's report for the Department of Health and Human Services:

• For-profit facilities had a higher percentage of violations than other nursing homes-94% of for-profit nursing homes surveyed were cited for deficiencies, compared to 88% of not-for- profit and 91% of government nursing homes
• The most common violations related to improper storage and distribution of food, accident hazards and lack of services necessary for residents' mental and physical well-being

• The rate of violations differed by state, with every nursing facility surveyed in Alaska, the District of Columbia, Wyoming and Idaho reporting citations compared with a low of 76% in Rhode Island.

There are 1.5 million people living in 16,000 nursing homes in the United States.  The facilities are reliant on government payments for the vast majority of their operating budget.  In order for the facilities to be reimbursed by Medicare and Medicaid, the nursing homes must be certified as meeting certain federal standards.

According to Susan Feeney, a spokeswoman for the American Health Care Association, a Washington advocacy group for 9,000 nursing homes, nursing home inspections are too subjective.  ``We're looking to work with Congress and the administration to implement a process that's less subjective and has incentives for quality improvement,'' Feeney said.

Federal and state regulation of nursing homes provides essential guidelines for the safety and well-being of nursing home residents.  In order to provide the safest environment for nursing home residents, all aspects of the facilities need to be properly monitored.  Any efforts on the part of the nursing home industry to relax or eliminate the standards should be considered self-serving.

A former employee at the Crown Healthcare Nursing Home in Mobile, Alabama recently plead guilty to first-degree theft.  The former nursing home worker used the nursing home's credit card to buy $14,373 in personal purchases from Sam's Wholesale Club.  From June, 2005 through May, 2007 the nursing home worker bought gas, tires, a washing machine and groceries for personal use as though the were purchased for the benefit of the nursing home. The employee was sentenced to two years, which was suspended, placed on probation for five years, ordered to pay full restitution and fined $500.  Learn more about the theft from an Alabama nursing home here.  I hope the residents of Crown Healthcare have double checked their bank accounts....

We recently discussed how the Metron Nursing Home in Allegan was losing its Medicare and Medicaid funding due to multiple violations in patient care.  Now, more information has come to light about the the Michigan Attorney General's investigation and the forced sale of the facility.  Two nursing home residents at Metron of Allegan died after nursing home workers failed to administer oxygen. 

The incidents follow a similar 2005 incident when, Sarah Comer died at the Metron of Big Rapids. The death of Comer lead to a lawsuit against the nursing home.  In the course of litigation, allegations of nursing home workers covering up Ms. Comer's death began to surface.  The workers were alleged to have conceived of a story to suggest that Ms. Comer died from caused unrelated to the negligent administration of oxygen.

The facility was recently found to be in violation of 11 safety violations partially consisting of:

• Failure to provide oxygen, resulting in two deaths.
• Failing to prevent resident-on-resident physical and sexual abuse.
• Failing to investigate a resident who eloped from the facility.
• Failing to provide pain medications prescribed by doctors.

Prior to losing its Medicare and Medicaid funding, Metron has has ample warning to correct the consistently poor care served to its residents: Metron has been under state oversight for two years, fined over $300,000.00 for heathcare citations and had its facility in Kalamazoo closed when inspectors found serious violations relating to patient care.  It seems that for the good of all residents at Metron facilities, they should be shut-down for good.

The Justice Department is investigating the quality of care at the Minneapolis Veterans Home in Minnesota.  "Essentially they want to know if the civil rights of residents mights have been violated by not getting the care they should have," said Gil Acevedo, deputy commissioner of the Minnesota Department of Veterans affairs, that operates the facility.

What started this investigation is unknown.  However, this veterans nursing home has had many problems in the past.  Since 2005, the facility has 66 state rule violations, $42,300 in fines and was required to hire a consultant and monitor to look over it.  Of the many state rule violations, medical errors at the facility have been associated with the deaths of three residents.

The Justice Department has been investigating the VA nursing home for several months.  As a preliminary step in the investigation, the Justice Department has asked the facility to hand over two years of medical records from veterans and their spouses.  The state has refused to comply with the request stating violations of state and federal privacy laws (HIPPA).  However, the state has disclosed information regarding the number of falls, injuries and deaths at the facility since 2006.

The Special Investigations Section of the Justice Department is conducting this investigation under the Civil Rights of Institutionalized Persons Act.  The Act was intended to protect people in prisons and other institutions, but has recently been used by the Justice Department to investigate suspect VA nursing homes.  The Justice Department cited the State of Tennessee earlier this year for improper care at two veterans homes.  Read more about this investigation here.

Getting the Justice Department involved in nursing home quality is a good thing.  VA nursing home are subject to the same rules and regulations as privately operated facilities.  If the Justice Departments involvement helps raise the level of patient care even everyone involved, including state officials, should be happy.  Obviously, with the number of violations and injuries at this veterans nursing home, people are not doing their job and patient safety is not getting the attention it deserves.

Dr. Laura Mosqueda, Director of Geriatrics and recipient of the Ronald Reagan Endowed Chair at UC Irvine, presents detailed analysis of the forensic signs of elder abuse. Dr. Mosqueda explores how to discern the difference between natural signs of aging and evidence of abuse in this vulnerable population.

Nursing home visits are great for both residents and their friends and families.  Everyone is usually happy to see each other and discuss current world topics, the weather, baseball or food.  However, don't let the smiles distract you from what should be a secondary reason for visiting friends and family members in nursing home--doing a mini inspection. 

I'm not talking about getting up on the roof of the nursing home and looking at the quality of the shingles or heading down to the basement to look at the hot water heater.  Rather, when visiting don't be shy about prodding around both the facility itself and on your loved one.  Look at the: cleanliness of the facility, look at the food, pay attention to the temperature of the room, look for familiar faces, look at the schedule of activities, chat with the staff--keeping track of all the small parts of your loved one's environment is the best it can be.

If your family member is bed-bound, pull the sheets back and peek under the robe.  Is everything clean?  Are their any dry or cracked areas of skin?  Is there any unpleasant smell?  Does everything look ok?  Even the sharpest elderly may lack sensation in areas of their bodies to detect skin irregularities.  If something looks wrong-- it probably is.  Early detection of potentially deadly conditions, such as pressure sores, may save your loved one from pain and embarrassment down the road.  You're not being a pest, you're being a caring friend or family member looking out for your loved one's best interest.

The Legal Medicine Blog written the Dan Frith and Lauren Ellerman commented on a recent incident involving a Colorado nursing home's failure to provide assistance to a nursing home resident using the the bathroom.  Firth and Ellerman get at the meat of the issue with respect to many nursing home falls and scores of nursing home injuries--not enough nurses.

Sure shiny, pretty facilities are nice, but when evaluating facilities, the most important criteria in the selection of the facility is if the facility has enough staff.  Not just nurses, but also nurses aides, physical therapists, maintenance personnel and even cafeteria workers are all important to the providing quality patient care.  Adequate staffing provides ample manpower to properly look after nursing home residents. 

A nursing home staff member must provide assistance, not only in skilled nursing care, but also in looking after residents basic needs goes far in prevention of incidents which may harm residents and eventually cost the facility in litigation expenses.  As the Legal Medicine Blog points out you should ask to see staffing polices when selecting a nursing home and don't be shy about speaking to the residents about their experience.  If the facility will not let you speak to residents, thank them for their time and leave right away.

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The above description is of a person in Clinton, Iowa police are searching for.  The woman called the Alverno Health Care Facility and tricked an employee of the facility into giving her the names of several nursing home patients with Fentanyl patches.  The woman then went into the facility to visit the patients whose names she was given.  The woman tore the Fentanyl patches off the patients bodies and fled the facility.  Read more about this incident involving stolen medication here.

Obviously, this facility is responsible for this incident.  How and why they would release the names of residents is not only a safety concern but also violate all concepts of privacy.  Then the facility physically let this woman into the facility to see these residents whom she had no relationship with is also disturbing and a nursing home safety violation.

Fentanyl is an extremely strong pain reliever that is absorbed through the skin. Fentanyl acts upon specific receptors in your brain and spinal cord to decrease the feeling of pain and to reduce your emotional response to pain. Fentanyl is used to manage moderate to severe pain, usually in people who have chronic pain. Fentanyl is often used when your other pain medicines no longer work.

Few relationships have such an alignment of interests as an attorney / client contingency fee payment plan.  Simply put, a contingency payment is a payment based on a recovery for the injured person.  In a contingency fee arrangement, the attorney receives no payment until the lawsuit is tried to verdict or settled.  After all the work has been done, the attorney receives a percentage of the recovery. 

The percentage of the recovery a lawyer charges is dependent on the type of case and the complexity of the matter.  Nonetheless, the exact percentage should be agreed upon in writing soon after the retention of the lawyer. 

In all cases there is a chance there will be no recovery--the case may not have merit or the defendant goes bankrupt, ect..  Under a contingency fee contract, if the lawyer does not win the case then the client will not be required to pay a fee. The client is not responsible for paying the lawyer for any of the time he spent on the case.

The ability to collect a percentage of the settlement or judgment provides a solid incentive for a lawyer to best serve a client. This is another reason why contingency plans are very popular with clients. After all, the potential financial reward of getting the highest settlement benefits the attorney and the client equally. So, the attorney will not perform at anything less than his or her best because there is a huge incentive for successfully litigating the case.

I began to think about this following my recent post on the Fairness In Nursing Home Arbitration Act and reading Donald Vanarelli's Blog on elder law.  The reality of the matter is that trials are becoming less common with both parties frequently opting to either settle their disputes amongst themselves, agree to binding arbitration or use mediation to help them resolve their dispute.  Nonetheless, trials will remain the ultimate way of deciding disputes.

According to The Center for Justice  & Democracy and Bureau of Justice:

• Trials in Federal Court have declined by 80% from 1985 to 2003
• Of the 98,786 tort-related cases in Federal Court only 1,647 or 1.7% went to trial
• There has been a 23% decrease in State Court trials from 1992 to 2001
• A mere 0.5 to 1% of civil lawsuits filed in State Court around the country actually go to trial

My guess is that cases involving nursing home abuse and neglect are consistent with the statistics cited above.  In nursing home litigation there are other factors to consider when evaluating if a case should be taken to trial including:

• The injured parties age- can he or she wait for a trial which may occur years down the road
• Health of the injured party- can they physically be present for the duration of a trail
• Family concerns- does the family want to relive a dark chapter in their lives
  
• Economic- Many nursing homes have 'eroding policies.'  Eroding policies usually have a maximum pay out that includes both defense attorney fees and money paid towards settlement of the injury or death.  In other words, the longer the defense lawyers get paid, the less potential recovery there may be for the injured victim.

I wholeheartedly agree with Vanarelli, that each case should be prepared as if it was going to trial--even if the reality is that it will get resolved through an alternative such as mediation.  Here is Vanarelli's list of how lawyers should prepare for mediation:

   1. You greatly increase the chances of success in mediation when you make the mental transition from thinking like an advocate in pursuit of a “win” to thinking like a counselor seeking to create value for both parties.

   2. Determine what basic information you need from the other party, if any. Think about what the other party will need from your client. Then, make a timely exchange of basic documents and information prior to the mediation.

   3. Prepare your client for mediation. The client should understand ahead of time the general nature of the mediation process: what role the mediator plays, what role the lawyer plays and that confidential information may be disclosed because it is protected in the mediation. In addition, the client should have the benefit of the lawyer’s evaluation of the case, including case weaknesses. Most importantly, the client should understand that there is a real opportunity to resolve the case in the mediation.

   4. Help the client identify his/her real interests by asking the client to tell you what he or she wants to achieve, listening to the answers and examining each goal identified by asking “Why”? “Why do you want to achieve that goal?” Find out what really motivates the client. Asking questions to uncover interests is like peeling the layers of an onion.

   5. Listen closely to the other party during the mediation. When the other party states his/her position, they are giving you valuable information about what they want. Invite them to tell you more by asking: “Why do you want that?” “What is the problem?” “What are your concerns?”

   6. Explore the possible resolutions to the dispute. Assess your client’s BATNA (Best Alternative to a Negotiated Agreement). Your BATNA is the reality your client will face if you reach no deal in the mediation. After analyzing your BATNA, calculate your reservation value, or the lowest offer you would be willing to accept.

   7. Assess the other party’s BATNA. Think through the alternatives that the other party will face if no deal is reached. Using that information, calculate the other party’s reservation value.

   8. Evaluate the ZOPA (Zone of Possible Agreement), or the range of all possible settlements which would be acceptable to both parties. The ZOPA falls between the reservation values of both parties.

   9. Prepare a mediation game plan in advance. Decide whether you should make the first offer, how you will respond to offers made by the other side, and how you will use the joint sessions.

  10. Use the mediator to educate your client about the strength and weaknesses of his/her case. If your client has unrealistic expectations, let the mediator deflate them. If your client is absolutely convinced of an outcome, let the mediator undercut that conviction. Help the mediator to conduct a similar educational process with your opponent. It might be a good idea to submit a summary of the facts and legal issues in the case to the mediator in advance.

I came across this news video about a New Mexico nursing home that took it upon itself to improve patient care.  After losing Medicare and Medicaid funding, this facility has received a clean bill of health and is now providing quality care to New Mexico's elderly.



Nursing Home Injury Laws: New Mexico

How would you feel if someone told you to go live in a new place where you know no one and have never seen the facility before?  You probably would be sad, upset and I'll be pretty stressed. 

I came across this article written by Dr. Michael Camardi appearing the the Ranoake Times who put together a nice list of things to do when selecting a nursing home for a loved one.  I am particularly fond of his idea of including the actual resident when selecting the facility.  Even if extraordinary steps need to be taken to physically bring the person to visit the nursing home via ambulance or medical transport, it is time and money well spent.  If the person is completely bed-bound, take photos of the various facilities to help them in making this important decision.

Below is Dr. Camardi's list of steps to take when selecting a nursing home:

1. Geography. Try to find a home within a 20-minute driving distance (no longer than a half-hour) so as to make the journey easily as there will be frequent trips to visit, bring various items, attend meetings with the staff, etc. When there's an emergency, time is important.

2. Use your phone sense. Call prospective homes and gauge how well the staff handles your questions and arranges an appointment for you to take a tour of the facility. You can tell a lot about the stress level of the site by the way a phone inquiry is handled.

3. Go the state health department Web site (www.vdh.state.va.us/OLC/longtermcare/) for a copy of the last three state surveys. Seeing the last one is not enough. What you want to see is if the site has a tradition of excellence in caring for the elderly.

4. Use your instinct. Recall how your senses were alerted when you went to look at a prospective house for sale? Think of what you looked for: Was it clean or dusty? Was it bright and cheerful or dull and depressing? Did it smell fresh or was there an odor? Apply those same standards when looking for a place to live for your loved one.

5. Make a list of the specific issues that pertain to your loved one and pose those questions. These can run the gamut from dietary concerns to newspaper delivery to types of TV/radio sets to pictures on the wall. Does the facility make every effort to make the nursing home your loved one's home or do they put barriers in the way?

6. When you get to the site, how are you received? Do you get eye-to-eye contact. Are you given an information package detailing the key features of the facility. Do they offer refreshments while you're on tour. In short, are they happy to do their best so as to have you entrust them with your loved one?

7. Look closely at the other residents. Don't see many? There may be a reason. Do the patients who seem most impaired look clean and well-kept? Those are the most challenging ones for the staff and can be a good insight into the level and quality of nursing care. Look down the halls and see how long it takes for a call bell to be answered.

8. Look at the staff. Are they busy and engaged with the residents? Are there relationships there or is everyone just going through the motions?

9. Come back on the evening shift unannounced. This is very, very important on many levels, and if the impression you received during your tour is confirmed during your evening visit, then you have a serious candidate.

10. Talk to people about your findings and seek affirmation. Friends who have placed loved ones in nursing homes, social workers who place patients in nursing homes and doctors who care for patients in nursing homes. These are the people at the tip of the spear.

11. Make the decision about the final placement together. Leave nobody out even if they are not directly involved. Don't be second-guessed. This is the time to bring up the issue of appointing someone as having power of attorney. It is a great responsibility and the one who is chosen must have good judgment, sound reasoning and have known the patient very well over the years.

The Senate Finance Committee passed the Patient Safety and Abuse Prevention Act, S. 2838 which notably abolishes mandatory arbitration clauses and establishes a nationwide system of background checks to stop convicted felons from working in nursing homes and other long-term care facilities.

The bill is now going before the full Senate.  The legislation puts in place a system of background checks and encourages federal and state coordination. It will utilize the FBI’s national database and state police records in order to effectively screen potential care-givers for criminal history. The criminal background checks will prevent common incidents involving: sex abuse, physical abuse and neglect. 

Nursing home arbitration clauses have been a sneaky secret inserted into admission documents for unsuspecting nursing home residents and their families.  The arbitration clauses attempt to force cases involving nursing home injury or death to be resolved before an arbitrator as opposed to being able to have their case heard in court.  In many circumstances the arbitrators are actually paid by the nursing homes--hardly impartial.

The Watchdog Blog and specifically blog authors, David Arkush and Christine Hines did a nice job describing how the nursing home industry did its best to misrepresent the importance of a right to jury trial for nursing home cases.  Arkush and Hines sum it up best when describing the intentions of nursing home owners attempts to continue with mandatory arbitration, 'We're corporate lobbyists fighting for the right to neglect or abuse elderly nursing home residents with impunity.  Our corporate clients want to make millions in profits without worrying about being held accountable if they hurt people.'

Call your senator and tell him or her to vote to support the Fairness In Nursing Home Arbitration Act.

Felony sexual assault charges have been dropped against a Wisconsin man for having intercourse with his comatose wife.  Prosecutors' case against the man relied on videotapes evidence of the man engaging in intercourse during visits at the Divine Savior Nursing Home in Portage, Wisconsin. However, the Fourth District Court of Appeals ruled that the videotapes are inadmissible in the case. The court found that the man's  Fourth Amendment rights against unreasonable searches were violated when police installed a hidden camera in the wife's nursing home room.  

According to reports, the couple was married in 1988 and had no children.  Read more about this case involving felonious sexual assault here.

In addition to constitutional issues, this case also demonstrates the need for nursing homes to install video cameras in their facilities.  Regardless of how you feel about the Appellate Court's ruling, video cameras placed in comatose patients' rooms provide an additional layer of security currently not in place to protect this particularly susceptible group.  What if the incident above involved an intruder or nursing home employee?  How would the prosecutors be able to make their case?

Bad nursing homes generally have a pattern of poor care.  There will always be isolated incidents at even the most well staffed facilities.  However, when repeated incidents occur within a brief period of time there are usually deeper problem with the facility. 

Case in point, two recent lawsuits were filed against the Devon Gables Health Care Center.  The first lawsuit involves, Elfriedel Sitzman, a female resident who was not give adequate care following a stroke.  The lawsuit claims that Sitzman fell and broke her arm in a fall during her stay at the facility from November through December, 2007.

Keeping criminals out of the nursing home industry is the intent of the Patient Safety and Abuse Prevention Act (S. 1577). The act became one step closer to becoming law this week when the Senate Finance Committee unanimously passed the aft this week. The Act would establish a nationwide system of background checks for potential nursing home and long-term care employees.

If passed by the Senate, the bill would allow nursing homes to weed out potentially abusive caregivers from the hiring pool. Bill sponsors Sens. Herb Kohl (D-WI) and Pete Domenici (R-NM) in a statement called the bill an important step toward protecting seniors from mistreatment by those who care for them.

Background checks work.  Earlier this year, the Senate Special Committee on Aging, which Kohl chairs, announced that a three-year, seven-state background check pilot program had prevented thousands of potentially abusive candidates from gaining employment in the long-term care field. Read more about Patient Safety and Abuse Prevention Act here.

Illinois has a similar law on the books when the Governor signed HB 2531 into law.

I came across this post in Bill Jackson's Elder Abuse Blog regarding the selection of a nursing home.  We are so connected to the internet and its resources for checking on people and facilities that we have become disconnected with actually going out and getting our hands dirty when investigating nursing homes for a loved one.  Preliminary research may be effectively done on a computer, but as Bill Jackson recently wrote in is blog, nothing can take the place of your senses.

A visit with the following in mind will give you the best idea of how your loved one will live on a daily basis at each facility.

Look

Look at the residents and staff.  Do they seem rushed and frantic?  Are the residents alert or do they seem glassy eyed?  Are people smiling?

Listen

What do you hear?  Is it resident's yelling in pain?  Worse yest do you hear staff speaking to the residents in a harsh tone?  Is the tv blaring in a room where a resident is sleeping?  Are call bells continually going off? 

Smell

Does the facility smell clean?  Go into the cafeteria, does it smell like food?  Is the smell of urine, vomit or feces anywhere?  If so, your on site inspection is done.

The Green Meadows Health Care Center in Louisville, Kentucky has lost its Medicare and Medicaid funding after repeatedly putting their residents at risk for danger and not investigating resident injuries.  No specific act of wrong doing is cited in the denial of government funding.  Rather, the nursing home  has received numerous type 'A' citations.  Type 'A' are the most serious and are dealt out when a nursing home resident's safety is endangered. 

Nursing homes rely almost completely on government payment to operate.  Once Medicare and Medicaid funding is lost, most nursing homes must close their doors.  Most nursing homes rely on government funding for 80-90% of their budget.

The situation at Green Meadows demonstrates the importance of making complaints regarding dangerous nursing home care.  Making a complaint with your state regulatory agency not only helps with determining the cause of nursing home abuse or neglect, but it also creates a record for future use  in screening facilities by others. 

Facilities that receive ongoing complaints are subject to having their licenses pulled and government funding withheld.  If you believe that a nursing home in your area is putting the safety of residents at risk, look at the link here to learn to file a complaint against the facility using your state's nursing home ombudsman and investigators.

Nursing Home Injury Laws: Kentucky

I have used the term 'wrongful death' in many posts and was asked recently: What exactly does wrongful death consist of?   'Wrongful death' is usually associated with a legal cause of action on behalf of the person who died but also on behalf of the people close to the deceased who depended on the person both economically and emotionally.  A 'wrongful death' lawsuit is usually brought by a family member or person close to the deceased.  Many states have statutes on point as to who may bring a wrongful death lawsuit.  The Wrongful Death Act in Illinois is codified at 740 ILCS 180.

How much are you going to sue for?

Is a question frequently asked by clients in filing a wrongful death lawsuit.  The question of course goes to the damages sought in the lawsuit, and the answer is usually anything but straightforward.  Most states, such as Illinois, require the lawsuit to seek damages in excess of the jurisdictional minimum.  In other words we do not ask for a specific amount when filing most lawsuits.  We ask a jury or judge to actually determine the amount of damages based on the evidence we present.  In wrongful death cases damages usually consist of: medical bills, burial expenses, lost wages and pain and suffering experienced by the survivors.  Expert testimony is typically required to help establish damages in wrongful death cases.

How long do I have to bring my case?

A statute of limitations is the time allotted to bring a cause of action.  Each state has different statute of limitations for different causes of action.  In Illinois, generally have 2 years from the date of the incident to file a lawsuit.  This statute applies to both nursing home negligence and wrongful death cases.  If you do not bring a lawsuit within the prescribed time requirements, you forgo your right to recover forever.  

If you believe that you have a wrongful death lawsuit or nursing home negligence case, feel free to contact me to discuss the matter.  The consultation is free and is kept in strict confidence.

Resource:

Nursing Home Injury Laws

Ever go into a nursing home in the middle of the day?  While the rest if the world busy about their business, many nursing home residents are sound asleep or staring blankly at the ceiling.  Even may of the residents who appear to be awake have a dulled look in their eyes.

A new British Study suggests that many of the nursing home residents who appear to be in trances may be improperly medicated.  In a study of 22 nursing homes, 51% of residents were give inappropriate drugs including anti-psychotics, antidepressants and painkillers.  Frequently, anti-psychotic drugs are used to treat dementia and Alzheimer's patients even though the drugs were not intended for those residents.

The use of medications is not only inappropriate it may be downright dangerous.  Recently, evidence has come forward linking popular anti-psychotic medications such as: Clozaril, Risperdal, Abilify, Seroquil and Zyprexa to an increased risk of stroke.

At too many nursing homes and long-term care facilities over-medication of residents has become such an accepted part of the facilities culture that there may be little incentive to consider reducing or eliminating the medication all together.  Further, some facilities wish to keep their residents medication level high to reduce the amount of work the nursing home staff needs to do with the residents.  It may be easier to dish out pills than it is to interact with residents who may suffer from dementia or psychiatric problems.

If you believe your family member is inappropriately medicated or is over-medicated ask to speak with his or her physician.  Do not take it upon yourself to reduce medication without the input of medical expertise.

Read more about the over medication of nursing home residents here.

A woman was killed in a fire at the Lebanon Manner Village assisted living complex in Indiana when a fire broke out in her apartment. The other buildings in the complex were evacuated. It took firefighters more than an hour to put out the flames according to Lebanon firefighter Wheat. Thirteen apartments were damaged by flames and almost the entire building sustained some kind of damage, Wheat said.  Most of the residents at the assisted living facility will remain out of their apartments due to smoke and water damage.  Officials did not release a cause of the fire, but friends said the victim smoked and was on oxygen.

If the operators of this facility knew that this woman had a tendency to smoke and use oxygen they should be ashamed of themselves.  Not only did they literally set this woman up to die they also put all of the other residents at this facility in jeopardy.  Nursing homes and assisted-living facilities must ensure their residents' safety during fires, this includes: conducting drills, having a fire safety plane in effect and in my humble opinion not permitting people to smoke around oxygen tanks.

Read more about this Indiana assisted living facility fire here.

The case of a nurse intentionally giving a lethal doses of morphine to a resident at a Chicago- area nursing home raises many concerns surrounding patient care, but one that jumps out at me is: who is looking after the medication stash in nursing homes?  Are most facilities so short staffed that no person is assigned to monitor the quantity of medications distributed?  Are potentially lethal medications treated with no more controls than a glass of water?

I recently came across this article regarding drug abuse amongst medical professionals in South Carolina and it seems as though many nursing home run a self-serve medication administration plan for their employees.  How widespread is prescription drug abuse (this includes stealing medication):

• More than 1 our of 100 nurses has been disciplined for a drug-related offense- most involve stealing medications
• 1.3% of licensed practical nursed (LPN) has faced discipline for: stealing drugs, forging prescriptions, failing drug screens and showing up to work impaired
• The percentage of medical professionals addicted to drugs is higher than the general population
• According to the DEA, 7 million American abuse prescription drugs
• the most commonly abused drugs amongst the nurses involved in disciplinary cases are: morphine, Demerol and hydrocodone
• nurses also tended to abuse pain killers such as: Dillaudid, Stadol, OxyContin, phenobarital and Duragesic patches

Obviously, an impaired nurse puts patient care in jeopardy because the nurse may not be able to tend to the patient's needs.  Also, an impaired nurse may be so desperate for his or her fix that they withhold necessary medication from the patient and use it for themselves.  There are reported instances where nurses have: removed Duragesic patches for nursing home residents, replace Oxycontin with similarly colored pills and replaced liquid medications with water.

While I sympathize with the nurses who may have addition problems, the real victims here are the nursing home residents who have medication withheld or improperly administered.  Nursing home owners must take responsibility for controlling access to highly addictive medications and implement programs to assure residents are receiving not only the proper dosages of medications, but also that there is real medication administered in the first place. 

 Who really likes to think about sputum or mucus?  Well, Thomas Sharon, R.N. at legalnurseconsultanttom.com points out that sputum color is an important factor to look at when evaluating the quality of breathing tube care.  Breathing tubes such as tracheostomies and ventilators are a common medical medical conditions for nurisng home and long-term care residents.  

Obviously, these medical condions require ongoing nursing care which is beyond the common knowledge of many nursing home residents and their families.  As nurse Tom discusses in his recent post, nurses must reposition and clean the breathing tube in order to prevent infection and medical complications.  There are many preventable medical complications in respiratory patients that may be easily identified by a family member or friend with common sense.  

Nurse Tom points out that the color and consistency of the sputum is frequently indicative of the quality of nursing care and may be used to identify potiential medical complications such as infection or suffocation.  Futher, the breathing noises are important to pay attention to as well, as congested raspy breathing noises usually demand immediate nursing attention.  

Below is the chart from Nurse Tom's site, demonstrating how to identify respiratory problems from the color and consistency of secretions.

Following my recent post on the frequency of hip fractures in nursing homes, I received several responses from blog readers who asked me about the effectiveness of hip pads in preventing injury and hip fractures to nursing home residents.  For those that don't know, hip pads are usually similar to underwear with built in plastic and foam pads.  The overwhelming evidence suggests that hip pads do little to prevent hip fractures amongst the elderly.  In fact, a recent study of 1,000 nursing home residents was terminated because the hip pads were so ineffective in preventing fracture.

According to the study's author, Dr. Douglas Kiel, of Harvard Medical School, 'In the United States, nearly 340,000 hip fractures occur per year, more than 90 percet of which are assiciated with falls, and the number of hip fractures may double or triple by the middle of this century.' Further, 'The highest incidence rates of hip fractures have been reported in nursing home residents, where 50 percent of residents fall each year.' 

So the question remains, why do nursing homes and facities use hip pads in the first place?  I really con not think of any reason other than the fact that some nursing homes would rather use a device to take the place of staff involvement and supervision of their residents.  The only effective way to prevent nursing home falls is to identify people who may be prone to falls and to provide adequate assistance to residents throughout their daily living activites.

Read more about hip pads in nursing homes here.

Cincinnati City Council members are requesting that the city get out of the nursing home inspection business following the discovery of 'crack house' conditions at Westside Health Center and Terrace Assisted Living Facility.  The council members suggest the investigatory responsibilities be turned over to the Ohio Department of Public Health to improve the quality of resident care at the facilities.  Safety concerns were discovered at the facilities during a police raid on March 13th.

About time!! Nursing home inspectors have an important job to protect the safety and welfare of the facilities residents.  If the the inspectors fail to discover safety violations at these facilities, then who will?  Passing the torch on safety inspections to a state group of inspectors is similar to the inspection system used in Illinois Nursing Homes.  Read more about the proposal to remove Cincinnati Nursing Home Inspectors here.

For more information on the 'crack house' conditions found at Westside Health Center and Terrace Assisted Living Facility look here and here.

A nursing home resident in England died after receiving 5 times the normal dosage by a nurse at the nursing home where she resided.  The woman who had Parkinson's was unable to communicate her physical needs or her insulin dosage to the nursing home employees.

An insulin overdose results in low blood sugar levels, or hypoglycemia. Symptoms of hypoglycemia include:

• Anxiety
• Confusion
• Extreme hunger
• Fatigue
• Irritability
• Sweating or clammy skin
• Trembling hands

If sugar levels continue to fall during an insulin overdose, serious medical complications and even death.  Low blood sugar is defined as less than 70 mg/dL. Hypoglycemia is defined as a low blood sugar which leads to symptoms.

Nursing homes must properly monitor diabetics blood sugar levels.  Moreover, nursing homes must dispense medication in their proper dosage and at the proper times.  If a nursing home makes errors with respect to medication dosage they are guilty of nursing home neglect. 

Read more about this incident involving medication errors here.

The crash of a medical helicopter in Indiana is a reminder of the potential dangers to nursing home residents during transport.  This recent helicopter crash occurred in rural Indiana with a Air Evac Lifeteam.  Three people died in the helicopter crash including a flight nurse, flight paramedic and base manager.  No patients were on board.  The FAA is investigating the cause of this tragedy.

Heparin is a commonly used blood thinner that has come under scrutiny for possible contamination.  The FDA has recommended restricting the use of high doses of Heparin, or generally known as Bolus dosing in an attempt to limit the severity of adverse reactions to the drug. Bolus dosing is used to quickly thin blood in some patients. 

The following people should be particularly aware of the Heparin contamination: hemodialysis patients, cardiovascular patients who have had surgery, photopheresis patients, plasapheresis patients and people who have had blood clots in their arteries.

There have been more than 350 complaints of adverse reactions to Heparin.  The adverse  reactions have been reported with the Heparin Sodium Injection multiple dose vials, 10 ml and 30 ml vials, 5000 units/ml, 10 ml vials and 10,000 units/ml, 4 ml vials.  The following reactions have been reported shortly following the administration of Heparin:

• Severe allergic reactions
• Death
• Severe nausea
• Vomiting
• Disphoresis
• Difficulty breathing
• Low blood pressure

If you were administered Heparin and experienced any of the above conditions, contact an attorney to learn your rights both individually and as part of a class action lawsuit today.

See the FDA recall of Heparin here.