Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Rarely do nursing homes have isolated problems.  Rather, problems with patient care usually stem from a culture of poor staff training and under-staffing.  Case in point-- The Summerville at Potomac nursing facility in Maryland.  Following a routine inspection, state and county nursing home surveyors discovered numerous violations governing patient care in nursing homes.  Among the violations, the surveyors discovered: improperly care for pressure ulcers, mismanaged patients' medication, lack of fall precautions for patients prone to falling and patients with excessive weight gain and loss.  

According to Wendy Kronmiller, director of the Maryland Department of Health and Mental Hygiene's Office of Health Care Quality, many of the reported problems can be attributed to a lack of coordination of care.  The survey found that Summerville lacked a delegating nurse to monitor care of each resident. Despite state laws that require a delegating nurse to visit the facility every 45 days, no delegating nurse had visited the facility for months.

In addition to receiving a $10,000 fine and a ban on admission of new patients, the facility was ordered to complete a six-point 'directed plan of correction'.  The plan includes the following mandates:

• Appointment of a full-time registered nurse
• Conduct an examination of each patients skin
• Hire a wound care specialist to address pressure ulcers
• Hire a monitor to report conditions to officials
• Notify residents families about the conditions found in the survey

Obviously the nursing home's decision to provide a 'bare bones' staffing of the facility had a drastically negative impact on patient care.  Nonetheless, a $10,000 fine still seems like little more than a slap on the wrist to a publicly traded corporation that owns the facility. The Summerville at Potomac is owned by Emeritus Corporation.  Emeritus owns and operates 289 nursing homes in 37 states.  Read more about this Maryland Nursing Home here.

Just 20 days after entering the Golden Living Center, 71-year-old Dean Cole lost 20 pounds due to malnutrition and dehydration.  According to Mark Wandersee of the Eldercare Rights Alliance, the nursing home staff is to blame for his rapid deterioration. "He wasn't getting the care he needed for food and water," said Wandersee.

A wrongful death lawsuit was filed against the nursing home alleging Cole's dehydration caused kidney failure and brain damage and ultimately his death.

Notes in Cole's medical chart verify that the nursing home staff was aware he was not eating.  The nursing home staff wrote:

• Resident picks at food
• Needed to be fed for supper
• Not eating well
• Resident refusing to eat

Despite the multiple notations of Cole's inability to eat while unsupervised, his records indicate that he ate the majority of his meals when engaged in mealtime conversation with nurses.  My guess is that this nursing home was seriously understaffed to care for residents such as Mr. Cole.

Here is a video of the news story related to this episode of dehydration and malnutrition.

Another completely preventable nursing home death recently made the headlines as reported in STLtoday.  Employees at the Northgate Park Nursing Home left 95-year-old Fannie Mae Rooks in her wheelchair in an outdoor smoking area at the facility last week. Rooks reportedly died from exposure to the elements as she sat unattended in the cold weather.  Local police investigators are trying to determine how Ms. Rooks made her way into the smoking area and how nursing home employees failed to keep track of her whereabouts.  

Once again, I am amazed how nursing homes continually fail to provide even the most basic level of care to their residents.  In this case, it is likely several nursing home employees were in a position where they should have seen this elderly lady sitting outside and brought her safety.  Until nursing home owners are held responsible for the preventable injuries and deaths of their residents, situations involving nursing home neglect will continue to be an ongoing problem facing nursing home residents.

Three nurses at New Park House, an English Nursing Home, were fired following the posting of patient photos on their Facebook accounts.  The incident highlights the importance of patient privacy in a world where confidential patient information can be distributed with the click of a mouse.  

Nursing home residents have a right to privacy.  In the U.S. patient privacy is protect by the Health Portability and Accountability Act of 1996 (HIPPA- Federal Register, 164.508).  The Act specifies that patients' medical charts can only be distributed to authorized individuals with the written authority of the individual.  Further, the request can be withdrawn at any time.

Join the Nursing Homes Abuse Blog's group on Facebook for in depth discussion of issues relating to residents and their families. 

21 Chicago Nursing Homes have received a 'one star' rating by the Centers for Medicare and Medicaid Services.  The facilities were selected for this dubious honor according to objective criteria: results from annual inspections, level of staffing at the nursing home and performance of 10 key quality measures related to patient care.  The poorly rated Chicago Nursing Homes also share other similarities in that they are all 'for-profit' facilities and all have been frequently named in lawsuits in Cook County, Illinois. Among the under-achievers:

• Alden Northmoor Rehab
• Alden Princeton Rehab
• Ambassador Nursing & Rehab Center
• Avenue Care Center
• Belhaven Nursing & Rehab Center
• Boulevard Care Center
• Bronzeville Park Nursing & Living Center
• Center Home Hispanic Elderly North
• Continental Nursing & Rehab Center
• International Village
• Jackson Square Nursing & Rehab Center
• Lakeview Nursing & Rehab Center
• Renaissance At Midway
• Renaissance At South Shore
• Renaissance Park South
• Sheridan Shore Rehab Center
• South Shore Nursing & Rehab Center
• Southview Manor
• St. Agnes Healthcare and Rehab Center
• Washington Heights Nursing Home
• Waterfront Terrace

By the time a pressure ulcer has progressed to Stage 4, the wound is deep the muscle and bone in the area is involved--usually decayed.   Frequently, infection can develop in the dead tissue impeding the healing process.

Advanced stage pressure ulcers need to be free of dead or damaged tissue in order to heal. Even with the most attentive medical care, some pressure ulcer's require surgical intervention.  Surgical Debridement is when a surgeon uses a scalpel to remove the dead tissue, bone and fluid from the area around the pressure ulcer. 

Debridement of the pressure ulcer may be accompanied by 'flap reconstruction'.  Flap reconstruction is when tissue is harvested from the persons body to cover the open wound.  The goal of the reconstruction is to improve the hygiene and appearance of the wound and and reducing the risk of further infection.

Surgical treatment of pressure ulcers has one of the highest complication rate of any surgical procedure.  Recovery from the procedure is time intensive and painful.  Therefore, the use of surgical intervention to treat pressure ulcers is usually considered to be a last resort.

Pressure ulcers are preventable.  If your loved one has developed a pressure ulcer while a resident of a nursing home, hospital or assisted living facility, contact the the team at Rosenfeld Injury Lawyers.  We can  help determine what parties may be at fault and advise you of your rights.

Resources For Pressure Ulcer Treatment

Emedicine: Pressure Ulcers, Surgical Treatment and Principles

Mayo Clinic: Bedsores. Treatments and Drugs

Related Bed Sore FAQ Entries:

What is mechanical debridement of bed sores?

What is chemical debridement of bed sores?

What is biological debridement of bed sores?

What is surgical debridement of bed sores?

The report of staff at the Edgewood Vista Assisted Living Facility, incorrectly telling the family of a resident she was dead gave me chills.  For six hours the family mourned the loss of their loved one--no reason to second guess the grim message.  An afternoon-shift nurse at the facility caught the mistake while making medication rounds and realized the facility had mistakenly switched the roommates identities-- and realized the 'deceased' resident was very much alive.  Officials at the assisted living facility, acknowledge the mistake happened because the roommates charts were 'mixed up' and because the death occurred early in the morning when 'employees working that shift weren't familiar with the two roommates.'

The 'mix-up' in identity also resulted the assisted living facility to failing to see a DNR order in the deceased's chart.  Consequently, the facility attempted to resuscitate the woman and ignored her wishes to go to a specific funeral home.

How long had this 'mix up'  been in place?  I imagine there are countless 'mix ups' with roommates taking place everyday throughout nursing homes, assisted living facilities and hospitals. Nonetheless, mistakes impacting to patient care are inexcusable.  Facilities need to take all necessary steps to assure residents and their families that they are actually providing the specified care to the person it is prescribed for.

This article from Hutchinson News Online, details the high rate of nursing home staff turnover at most facilities.  Most nursing homes have annual staff turnover rates that exceed 100%.  The lack of continuity of care is problematic for both the nursing home and residents.  For the nursing home it means an exertion of time and money to train and attract new employees.  For nursing home residents,  high staff likely has a direct impact on the quality of their care.  According to a 2006 University of Kansas study on nursing homes, employee turnover is "the most important factor in predicting nursing home deficiency scores."

In our nursing home liability practice, it is common to see cases involving medication errors, dietary errors and general medical mistakes occurring at a disproportionate rate among new nursing home staff.  In a pending matter, a CNA at a Chicago Nursing Home mistakenly served a resident a steak dinner when the resident was on a strict 'soft foods' diet.  The resident chocked on the steak and suffered a brain injury from lack of oxygen.  Barely 24-hours on the job, the nurse was unaware of the resident's dietary restrictions. 

I just got an email from Wes Bledsoe, founder of A Perfect Cause, regarding the Minnesota State's Attorney's indecisiveness in bringing felony charges against the young women who allegedly abused Alzheimer's patients at the Good Samaritan Society - Albert Lea Nursing Home.

Here is a copy of the email.  I encourage everyone to forward this email, as this really is an issue that deserves to be in the headlines.

Here’s your call to action!

Please call Craig Nelson… the Freeborn County Attorney in Albert Lea, MN… as soon as possible today. Please send this appeal to ALL on your email lists… plus ask family, friends, associates, and co-workers to call.

Nelson’s office number is 507.377.5192.

You can even fax him at 507.377.5196. I do not have his email address but anyone who does have it, please send it to me and I will circulate that too.

We invited Nelson to attend the town hall meeting last night. He declined, saying he’d “wait to see what happened in the media and hear from the court of public opinion.”

So… here’s your chance to be the “court of public opinion.”

What do we want?

1.       Felony Charges filed against the alleged assailants

2.       If convicted, the assailants should be required to register as sex offenders

3.       If he chooses not to file felony charges, he should immediately recuse himself and turn the case over to the MN Attorney General’s Office due to a conflict of interest

Why?

 1.       The families of the Good Samaritan Society – Albert Lea (nursing home) victims and many citizens of Albert Lea have asked us for our help.

2.       Nelson has

a.       Charged the alleged assailants of these victims with only class five misdemeanors

b.      Stated the assailants will "most likely will face suspended jail sentences and probation, so they'd have the threat of jail hanging over them if they get in more trouble”

c.       A conflict of interest due to a reported relationship with at least one of the alleged assailant’s families (he therefore should recuse himself and his office from the case)

3.       The alleged assailants are smarter than the County Attorney, as reported the alleged         assailants targeted victims who could not tell on them and if they did, that no one would       believe them

a.       Nelson’s office states the victims are not reliable witnesses

4.       Failure to prosecute physical and sexual battery committed against vulnerable adults by caregivers sends a loud and clear message that it is open season on any long-term care             residents in the future

5.       The alleged criminal acts committed against these elderly and vulnerable adults should be considered as “Hate Crimes”

Background on the case

Larson – Complaint - http://stmedia.startribune.com/documents/2albertlea.pdf?elr=KArks:DCiUHc3E7_V_nDaycUiacyKUU

Broitzman – Complaint - http://stmedia.startribune.com/documents/1albertlea.pdf?elr=KArks:DCiUHc3E7_V_nDaycUiacyKUU

Minnesota Department of Health – Investigative Report - http://www.health.state.mn.us/divs/fpc/directory/surveyapp/ohfcfindings/h5441019.pdf

More to Come

Yes, I am upset about the State of Minnesota and CMS’ policy to cite ZERO deficiencies if facilities “self-report” and “offer an acceptable plan of correction.” These agencies will be our next target, but I want to give them an opportunity to talk and modify this policy before we move on them.

Yesterday was an incredible experience. We met with two families… had seven television interviews throughout the day… two print media interviews… met with an ally who is funneling information to us… plus the town hall meeting.

Here’s what the media had to say about…

Last Night’s TOWN HALL MEETING

Star Tribune

Families sound off on abuse at Albert Lea nursing home

http://www.startribune.com/local/36022444.html?elr=KArksUUUU

Albert Lea Tribune

http://www.albertleatribune.com/news/2008/dec/12/residents-respond-alleged-abuse-case/

Advocate stirs debate on elder case

KIMT

Good Samaritan Abuse Charges Get National Attention

http://www.kimt.com/news/local/36024879.html

FOX 9

Town Hall Meeting Addresses Albert Lea Nursing Home Abuse

http://www.myfoxtwincities.com/myfox/pages/News/Detail?contentId=8054920&version=4&locale=EN-US&layoutCode=TSTY&pageId=3.2.1

KXMC

Minn. nursing home hit hard by abuse allegations

http://www.kxmc.com/News/308028.asp

WCCO

Nursing Home Hit Hard By Abuse Allegations

http://wcco.com/health/nursing.home.abuse.2.885548.html

KSTP

Minn. nursing home hit hard by abuse allegations

http://kstp.com/article/stories/S702828.shtml?cat=1

KAAL

Family Members Speak Out on Nursing Home Abuse

http://kaaltv.com/article/stories/S702744.shtml?cat=10151

KTTC

Family member appalled over nursing home charges

http://www.kttc.com/global/story.asp?s=9508954

KARE 11

Albert Lea community speaks out about nursing home allegations

http://www.kare11.com/news/news_article.aspx?storyid=531759&catid=14

Yes… we can… and together… we are… making a difference!

Many thanks for all!

Wes

Wes Bledsoe

Citizens’ Advocate & Founder

A Perfect Cause

1501 N. Broadway Blvd., Bldg B

Oklahoma City, OK 73103

C – 405.308.3858

C – 405.802.2903

Wes@APerfectCause.org

www.APerfectCause.org

Our Mission - To End Needless Suffering & Preventable Deaths

 "A Perfect Cause must produce a perfect effect."

Science of Mind, Dr. Ernest Holmes

Minnesotans have a reputation for being kind, compassionate people.  However, several employees in Minnesota nursing homes are doing a fine job trashing the state's reputation.  After, the reports of abusive teenagers at Good Samaritan Nursing Home, a new report of nursing home abuse by a nurses aide has emerged from a different Minnesota Nursing Home.  

The allegations involve one nurses aide who reportedly abused six nursing home residents afflicted with dementia, over the course of several months earlier this year.  According to the Minnesota Health Department, the nurses aide reportedly:

• Stuck a finger in the cancerous vulva of a resident until she screamed
• Intentionally dropped a resident from four feet
• Tossed stuffed toys on the floor in front of a resident who thought the toys were her children
• Gave lap dances to two male residents 
• Slapped a female resident in the face after the woman called her an offensive name

The nursing home abuse was witnessed by another nurses aid at the facility for several months before the abuse was reported to the administrators.  Minnesota, like many states, has a vulnerable-adult law that requires nursing home workers to report suspected maltreatment to the nursing home administration where they work. Obviously, this nursing home needs to re-educate its employees as to their legal responsibilities to their residents.

Read more about this brutal case of nursing home abuse here.

On the heels of the Nursing Homes Abuse Blog's recent discussion regarding an increase in hospital-related pressure sore cases, the Agency for Healthcare Research and Quality released a report further confirming the problem.  Perhaps most the most startling finding from the agency's report is that hospitalizations for bed sores (also called decubitus ulcers, pressure ulcers, pressure sores) have increased by more than 80% from 1993 to 2006.  This increase includes people who were admitted to the hospital because of pressure sores or developed them while being treated for another condition in the hospital.

Among the more disturbing 'highlights' in the report are:

• In 2006, there were 503,300 hospital stays with pressure ulcers noted as a diagnosis--an increase of nearly 80% since 1993.  The pressure ulcer stays totaled $11 billion in hospital costs.
• More than 90% of the pressure ulcer-related hospitalizations were intended to be for medical conditions unrelated to pressure ulcer treatment.
• Compared to stays for all other medical conditions, hospital stays related to pressure ulcers were more often discharged to and long-term care facility and more likely to result in death.
• 72% of adults hospitalized with a secondary pressure sore diagnosis were 65 or older.  In comparison 56.5% of adult patients had a principal diagnosis of pressure ulcers were 65 or older.
• Medicare was the biggest payer for hospital stays related to pressure ulcers- Medicare paid the bills for 3 out of 4 pressure ulcer stays.
• Paralysis and spinal cord injury were common co-existing conditions among younger adults hospitalized principally for pressure ulcers.

Don't let hospitals continue to provide inadequate treatment. Prevention of pressure sores needs to be a priority for hospitals.  If you or a family member developed a bed sore during a hospitalization, we can help.  Rosenfeld Injury Lawyers has successfully prosecuted bed sore cases for more than 30 years.

In an effort to identify instances of nursing home abuse and neglect, the Illinois Department of Public Health has implemented a death reporting program in ten counties in Illinois.  The pilot program requires nursing homes to immediately report nursing home deaths to the county coroner.  Once reported, it is up to the county coroner to investigate the facts surrounding the death and determine if the death was related to nursing home abuse or neglect.

From July 1, 2007 through June 30, 2008, 8 suspicious deaths were attributed to mistreatment in nursing homes out of a reported 3,669 total nursing home deaths.  The pilot program empowered coroners to investigate deaths by phone, fax, or in person each and assess if abuse or neglect might have contributed to a resident's death.   The pilot program ran in the Illinois counties of Champaign, Effingham, Kane, Kankakee, Lake, LaSalle, Lee, McLean, McHenry and Morgan. 

Of the eight deaths that were attributed to improper nursing care, several fines were imposed against the facilities by state and federal authorities.  In Champaign County, the coroner's tip-off resulted in federal officials imposing a fine against the Champaign County Nursing Home of $13,600 for the death of a 94-year-old woman who died from a pulmonary embolism shortly after fracturing her leg during a transfer out of bed.  Also in Champaign County, the coroner's tip-off lead to a $52,500 state fine was imposed against Pleasant Meadows Christian Village Nursing Home for improper treatment of a resident's bedsore that had advanced to sepsis and ultimate death.

Richard Dees, Chief of Public Health's Bureau of Long-term Care, says it appears the project failed to show that a state law requiring nursing home death reporting and investigations would have a 'conclusive' benefit.  Pointing to the relatively small number of suspicious deaths reported by local coroners.

Arkansas and Missouri are currently the only states that require nursing homes to report all nursing home deaths to local coroners.  In Illinois, it is left to the coroner's discretion as to investigate the death.  Most coroners and medical examiners only investigate nursing home deaths if the family requests they do so or if criminal activity is suspected.  Sadly, the failure of the state to implement any laws mandating the report of nursing home deaths will result in countless cases of improper nursing home care--especially cases of nursing home neglect-- that will forever go undetected. 

Read more about this pilot program for Illinois Nursing Homes here.

Recent national headlines regarding abusive nursing home workers appear almost surreal.  Abusive people caring for the most vulnerable seems commonplace.  Nonetheless, I was particularly disturbed to hear the report of nursing home abuse involving nurses at a Mississippi Nursing Home.  Clarionledger.com reports, two employees of Graceland Care Center have been arrested for crimes involving abuse of vulnerable adults.  According to the Mississippi Attorney General, Jim Hood, the arrests of the nurses were made following indictments by a Mississippi grand jury.

Cynthia Hunt, a 46-year-old LPN was charged with two felony counts of abuse of a vulnerable adult for an alleged incident where she poured aftershave on the genitals of a nursing home patient and administering medication that caused pain.  If convicted, Ms. Hunt faces up to 40 years in jail and $20,000 in fines.  The other LPN, Kathy Brooks, is accused of stealing a nursing home patients' pain medication, hyrocodone.  If convicted Ms. Brooks, faces one to five years in jail.

How many other nursing home residents were victimized by these abusive nursing home employees before they were caught?

The Chicago Tribune reported that Morris Lee Brinkley, a 73-year-old home care nurse, has had her nursing license suspended.  According to Illinois Department of Financial and Professional Regulation, Ms. Brinkley's nursing license was suspended for, "failing to adequately treat bedsores and other signs of neglect on a 13 year-old home health care patient who subsequently died and for failure to report suspected child abuse or neglect as required by the Abused and Neglect Child Reporting Act."  

The 13-year-old boy the Department of Professional Regulation is referring to is Jaylen Brown.  Due to cerebral palsy, mental retardation and severe scoliosis, Jaylen relied on his home care nurses for all of his daily living needs.  

The nurses did not do their job.  In March, Jaylen's mother brought him to  the University of Chicago's Comer Children's Hospital with dangerous medical conditions.  According to reports, Jaylen was presented to the hospital he had pressure ulcers on his shoulder, ear, legs and hand.  A pressure ulcer on his back had advanced so far, that the his bones were visible.  In May, 2008 Jaylen died from sepsis.  His death has been ruled a homicide.

Home health care nurses are commonly used to provide medical treatment to home-bound people of all ages.  In addition to providing medical treatment, home care professionals must report instances of suspected abuse or neglect back to authorities.  Amazingly, Morris Brinkley had more than 20 year nursing experience.

With the holidays upon us, many of us will be visiting friends and relatives in nursing homes. In order to make the visit rewarding, for you and your loved one, some advanced thought should be put into your visit.  I came across this valuable list of recommendations for nursing home visits compiled by Jennifer Davis, on staff at Hebrew Senior Life. 

For residents that are alert the following is recommended:

• Keep them connected to the outside world with news about neighbors, family, friends and current events. Talk in a quiet place. Try to be at eye level with the person and speak slowly and clearly.
• Encourage reminiscing. Bring photos or objects to share. Stimulate conversation about past achievements. If your loved one always tells you the same story, accept this. It’s your listening that shows that you still care.
• Sometimes it’s enough to sit and just hold hands.
• Empathize with a relative’s feeling of distress. Don’t try to deny its existence or argue with the resident who may be confused. It only gets the resident more agitated, and causes further loss in self-esteem.
• Don’t use visits to give advice, scold or argue with the resident.

When a relative is too ill to talk:

• Hold hands; provide touch by rubbing the person’s back.
• Sing songs or play tapes of the person’s favorite music.
• If you can, just sit and share being there without feeling like you have to do or say something.
• Get to know staff, other residents and families to make the visit more pleasurable.

The family of a 90-year-old nun who died from complications related to a fractured skull has filed a wrongful death lawsuit against the Summit Park Hospital and Nursing Care Center.  The New York nursing home allegedly failed to secure unsteady dressers, within residents rooms, to the wall.  Apparently, when the nun attempted to get some belongings from the dresser, the furniture collapsed on her.  The nursing home became aware of dangerous problems with the dressers when a similar incident occurred within weeks prior to the nuns death. Read more about this lawsuit against a New York nursing home here.

Here is the Nursing Home Abuse Blog's earlier report of this nursing home death.

Unsatisfied with the nursing home's explanation for the dozens of bruises on their 84-year-old grandmother, the family of Armeda Thomas, an 84-year-old resident at Madison Manor Nursing Home decided to place a video camera in the disabled woman's room.  The video tape confirmed that Thomas was the victim of physical and verbal abuse from the staff at the facility.  The video revealed the following evidence of abusive behavior on the part of nursing home staff:

• Failed to bathe Thomas
• Failed to feed Thomas. 
• Taunting and mocking the disabled woman
• Pulled residents out of bed by their neck
• Let Thomas lay on the floor for an hour before any aid was provided

Following the discovery of the videotaped abuse, the Attorney General began a criminal investigation which revealed the nursing home failed to investigate injuries of 'unknown origin' to 17 cognitively impaired residents at the facility.  Kentucky nursing home investigators issued a Type-A citation to the nursing home determining the conditions at the facility posed immediate danger to the residents. 

According to Kentucky nursing home records, the facility has corrected the violations posing immediate jeopardy to residents and is working to correct the less serious violations.  Madison Manor is part of the Richmond Health and Rehabilitation Complex and is owned by Extendicare, a national nursing home operator.

Although the nursing home employees behavior is inexcusable, blame for this barbaric treatment also falls on Extendicare.  The fact that there are multiple episodes of abusive behavior can only mean that Extendicare has failed to provide adequate training and supervision for its employees.