Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Peanut butter tainted with salmonella has claimed the life of a 72-year-old resident at a Minnesota Nursing Home.  Consequently, the family of Shirley Mae Almer, have filed a food poisoning lawsuit against the manufacturer and distributer of the peanut butter in Hennepin District County in Minneapolis for her death.

The lawsuit names Peanut Corporation of America and King Nut Companies as the defendants in the matter.  Peanut Corporation manufactured the contaminated peanut butter over the past six months and King Nut distributed the peanut butter to institutions--including Almer's nursing home.

The lawsuit alleges that Almer died on December 21, 2008, during a temporary stay in a Brainard, Minnesota Nursing Home. The peanut butter lawsuit alleges that her death was caused by eating peanut butter contaminated with Salmonella typhimurium, the same strain of bacteria that has been connected to other illnesses and deaths after ingesting the peanut butter.

According to the complaint, the defendants failed to manufacture, package and transport their products safely, failed to supervise and train their employees effectively, did not maintain hygienic conditions for production of peanut butter, failed to test their final products before distributing them and did not take steps to prevent cross-contamination at the plant.

The Minnesota Department of Health found salmonella bacteria in an open 5 pound tub of peanut butter served at the Minnesota nursing home where Almer was residing, and other sealed containers of peanut butter manufactured by Peanut Corporation of America have been found to be contaminated with the same strain of bacteria, tracing the contamination back to the processing plant where the containers are sealed.

According to reports released on January 27, 2009, subsequent inspections by federal health officials have found evidence of Salmonella typhimurium at the plant, together with two other strains found on the floor of the facility and another strain in a different container of peanut butter produced by Peanut Corporation of America.

King Nut Companies distributed large tubs of peanut butter manufactured by Peanut Corp. to nursing homes, schools and other food service institutions in several states.

Peanut Corp. also sold peanut paste to nearly 100 different manufacturers of peanut butter crackers, cookies, ice cream, nutrition bars and other products containing peanut butter. To date, almost 400 products have been recalled that are believed to contain the contaminated peanut butter.

If you or a loved one have contracted salmonella after eating peanut butter served in a nursing home or institution, you may be entitled to a claim for damages against the peanut butter manufacturer and distributer of the products.  Also, depending on when the peanut butter was served, you may also have a claim against the nursing home or institution where the peanut butter was served.

You can read more abut the FDA's recall of contaminated peanut butter in nursing homes and other institutions here.

Pressure ulcers (also called bedsores or pressure sores) are preventable with proper nursing care.  In fact, CMS (Centers for Medicare and Medicaid) has deemed the development of pressure ulcers to be so preventable in both acute and long-term care settings that it has stopped reimbursing for medical charges related to treatment of the ulcers.  This is useful video on the this topic.

The failure of a Pennsylvania hospital to take basic steps to protect its patients may have cost a dementia patient her life.  89-year-old Rose Lee Diggs was admitted to UPMC Montefiore for multiple deficiencies during the investigation of her death.  Although Diggs was transferred from a nursing home that warned the hospital of her propensity to wander, staff at the hospital failed to take any preventative measures to assure Diggs safety in their facility.

Five days after Diggs admission to UPMC she was found dead on the hospital roof in her hospital gown and slippers in 20-degree temperatures.  The Pennsylvania Department of Health determined Diggs was able to access the rooftop through a mechanical room with a broken lock.  The last recorded sighting of Diggs by hospital staff was more than 13 hours before her body was discovered. 

The health department's investigation into the death determined the hospital acted improperly when it:

• Failed to assess patients safe care needs
• Failed to take any steps to address wandering behavior- despite the nursing home advised them of this tendency
• Failed to maintain a safe hospital environment

Following the health department's report, the hospital developed a plan of correction to address the deficiencies.  Among the new programs initiated: a 'Condition L' plan that causes all hospital employees to help in a coordinated search for missing residents, geriatric or psychiatric nurses are to conduct specific assessments of each patients propensity to wander and a policy to inspect doors leading to outside areas.

The family of Diggs is planning to pursue a civil case against the hospital for their negligent care that caused or contributed to her death.  This matter highlights the importance of investigations by health departments into situations involving negligent care in hospitals and nursing homes.  Frequently, the information obtained by investigators can be helpful in the course of litigation as witness statements and other valuable information is captured shortly after the incident took place.

Related article

State cites UPMC for patient's death on roof

My office was recently retained by the family of a woman who developed pressure sores on her buttocks and vagina in a Chicago nursing home.  When asked, the family was unsure if their loved one was technically 'incontinent'.  After reviewing the woman's chart, it was obvious that the woman was incontinent and the nursing home failed to provide properly adequate cleaning and timely changes for this elderly nursing home resident. 

By some accounts, more that 50% of the people living in nursing homes or assisted living facilities may have some type of bladder or bowl control problems.  Although widely used, incontinence can be defined as the uncontrolled elimination of urine or fecal material from the body. 

Incontinence Is Not A Normal Part Of Aging

Despite its prevalence, incontinence is often treatable.  Any resident who has been deemed incontinent should be evaluated by a physician to determine if the cause of the incontinence is physical or psychological.  Once the cause is identified a combination of behavior modification and staff assistance may be of some help.  In other cases, medication or surgery may also help alleviate the incontinence issues.  Diapers or similar undergarments should only be used as a last resort.

Incontinent nursing home residents have an increased vulnerability for developing pressure sores (also called: pressure ulcers, bed sores or decubitus ulcers) for several reasons:

Nursing Home Residents In Denial Of Their Incontinence

Let's face it, there is perhaps nothing more humiliating to a senior than to admit to nursing home worker, whom he or she may not know, that they have lost their ability to control their bladder or bowels.  Consequently, some nursing home residents are hesitant to notify the staff to their situation and may wind up literally sitting in their own waste.

Inadequate Staffing To Properly Monitor And Change Incontinent Residents

All too frequently, nursing home staff try to implement a 'one size fits all' program for incontinent nursing home residents.  This approach is simply not acceptable.  Nursing homes must have a program in effect to monitor each residents changing needs and have staff available to change soiled residents.  Additionally, adequate levels of staffing should be in place to encourage residents who are able to use the toilet.

When urine or fecal material is held against the skin the damp, acidic nature of the wastes cause the skin to become weakened and susceptible to cracking and peeling--literally eroding the bodies natural defenses.  Proper maintenance of the skin, requires the skin to be kept dray and sanitized.  To minimize development of pressure sores, incontinent nursing home residents should:

• Be cleaned regularly with mild soap and lukewarm water
• Be moisturized daily
• Encourage the use of barrier products lotions
• Use proper turning techniques to minimize time spent in one location
• Use positioning devices to alive pressure from bony areas
• Keep the bed elevation as low as possible- this reduces pressure on the sacrum
• Keep residents clean and dry

For more information on incontinence and pressure sores in the nursing home setting:

Overview of Pressure Ulcer Management: An Expert Interview With Carol A. White MS, RN, ANPC, GNPC, DNP(c)

Incontinence in the Elderly: What a Caregiver Should Know

More than 460 people have been diagnosed with salmonella that can be traced to peanut butter used in institutions.  It is estimated that the salmonella outbreak has caused more than 100 of the people to seek hospital treatment.  Salmonella can be especially serious in elderly people with weakened immune systems.  If not quickly identified and treated, salmonella may cause death.

If you are concerned about potentially having peanut butter that may be contaminated with salmonella, check out the FDA website.

As we recently discussed, Winchester Centre for Health and Rehabilitation may lose its Medicare and Medicaid funding if it fails to correct the dangerous conditions inspectors have recently found at the facility.  The federal Centers for Medicare and Medicaid Services have given the facility a February deadline to correct the problems or federal aide will be pulled and daily fines will be imposed.

The Lexington Herald-Leader, ran an article detailing the deficiencies documented in recent inspections of the facility obtained via the Open Records Act.  Among the more disturbing situations detailed in the report:

• A resident lost 87 pounds during a 19 day admission to the facility
• Staff repeatedly failing to notify physicians for deterioration of residents physical condition
• Administering the wrong dosage of an anti-seizure medication for 40 days to a resident.  The resident was prescribed 450 milligrams of extended release capsules by mouth, but the nursing home staff gave the resident 400 milligrams by feeding tube, which altered its effectiveness.  Consequently, the patient suffered a seizure.
• Staff failed to follow doctors orders for patients with serious medical conditions
• Problems with cleanliness, equipment disrepair, and temperature of food served to residents

What is particularly disturbing about these findings, is that the nursing home staff acknowledges the poor conditions- yet was ineffective in doing their job to stop them from occurring in the first place.  When questioned by a state inspector about the precipitous weight loss of a resident, the medical director of the facility stated, "It was not a good experience during his three-week stay, and I think he suffered for it."

Malnutrition In Nursing Homes

Poor nutrition and dehydration are common in nursing home residents and are associated with many adverse clinical outcomes. OBRA (Omnibus Budget Reconciliation Act) guidelines require nursing homes to provide adequate nutrition to their resident.

Despite facilities obligation to provide proper nutrition to its residents, two out of five nursing home residents suffer from malnutrition, and dehydration. Malnutrition in nursing home residents can occur for a variety of reasons, including the resident's inability to process food and ill-fitting dentures. Dehydration can occur for a variety of reasons as well, including diarrhea and the effects of medication. Unfortunately, malnutrition and dehydration can also occur due to a nursing home's negligence in a variety of situations, including:

• Failure of the nursing home to employ adequate staff, which results in the staff's inability to properly feed the residents
• Failure of the staff members to pay adequate attention to those residents needing assistance with eating
• Failure of the nursing home to properly educate the staff on nutrition and feeding methods
• Failure of the nursing home to provide proper supervision over those who provide nutritional services
• Reliance on liquid supplements as opposed to making sure each resident eats enough food to get necessary vitamins, minerals, protein, and calories

If you notice that your loved one has signs of malnutrition or dehydration or if you think that they are not getting enough food or fluids at the nursing home, you should immediately notify the nursing staff and the physician to prevent potentially serious, life-threatening consequences.

The California Department of Pubic Health has imposed the maximum fine permitted under the law against Casa Bonita Convalescent Hospital in connection with the death of a ventilator dependent resident.  State regulators issued three citations against the facility for the 2007 death of the 90-year-old resident.  An investigation in the incident by state authorities determined poor care led to the woman's death when staff at the facility intentionally disconnected the woman from a ventilator and shut-off a remote alarm to notify staff of problems with the machine.  Read more abut this California nursing home here.

The Enquirer-Herald had a really interesting article regarding younger people in nursing homes.  Increasingly, nursing home are becoming a place for people of all ages.  Over the past 20 years, the number of residents at nursing homes has surged.  Today, people under 65 comprise almost 10% of the nursing home population. 

At Orchards Rehabilitation and Care Canter, an Idaho nursing home, four out of five people are under 55.  According to administrator Mindy Shepard, a lack of alternatives is the real reason for younger people are entering facilities once deemed only for the aged.  "It's not that uncommon because we have a gap in the health care system between the hospital and the nursing home," says Sheppard.

One of the reasons for the increase in younger residents is the increase in poorly controlled chronic disease.  Manny younger nursing home residents suffer from:

• Obesity
• Diabetes
• Multiple Sclerosis
• Side effects of stroke
• Side effects of heart attack
• Chronic asthma
• Pulmonary disease

Another reason for the increase in younger nursing home residents is likely due to the progress made in medical care over the past 20 years.  Younger people may be surviving chronic conditions as well as traumatic injury such as automobile accidents due to medical treatment previously unavailable.

Medical needs aside, younger people frequently have difficulty adjusting to a nursing home setting due to generational differences.  "They don't want Lawrence Welk," says Judy Wood, the activity director at Orchards Rehabilitation for more than 20 years. "The younger residents have different interests in music, technology .  It's challenging.  I try to gear activities to their interests and give them group opportunities to express their feelings about being in a long-term care facility."

Nursing home staff must not assume younger residents are automatically better able to care for themselves. Younger nursing home residents frequently require the same assistance with daily living tasks as older nursing home residents.  Staff should follow the the specific procedures set forth in younger residents 'care plans' to avoid confusion and injury causing situations such as falls, pressure sores or medication errors.

A Michigan Court has stricken an 'arbitration clause' from a pending wrongful death lawsuit against a Michigan nursing home.  In the case of High v. Capital Senior Living Properties, a nursing home resident's son filed a wrongful death lawsuit against the facility for failing to properly supervise his mother. Among the claims made in the lawsuit, the Plaintiff, Sidney High, claims the facility was negligent in allowing his mother (who had Alzheimer's) to wander from the facility and freeze to death. 

After filing the wrongful death lawsuit, Capital Senior Living filed a motion to dismiss and attempted to force the claims made in the lawsuit to proceed under arbitration.  The facility claimed they were entitled to have any claims made against them in a private, arbitration setting per the terms of their admission documents. 

In siding with son of the deceased nursing home resident, the Federal Court reasoned that there were multiple factors that weighed in favor of striking the arbitration clause in the nursing home admission contract.  Among the factors the court looked at in determining the arbitration clauses invalidity was that the clause was never signed by the resident herself and the woman did not have the mental capacity at the time of her admission to reasonably comprehend the significance of the contract.

Arbitration Clauses 

In an effort to avoid litigation and keep information regarding the quality of care provided in nursing homes private, many nursing homes have inserted arbitration agreements into nursing home admission documents.  Unlike most personal injury lawsuits, where a jury determines the amount of compensation due to an injured person, an binding arbitration (as most arbitration clauses specify) allow one person to determine the damages to be awarded to an individual or family.  Moreover, many nursing home arbitration clauses allow the nursing facility to appoint the arbitrator themselves-- hardly an independent trier of fact.

Many states have stricken arbitration clauses from nursing home injury and death cases and have allowed the matters to be heard by a judge or jury.  Last session, Congress introduced the Fairness in Nursing Home Arbitration Act, which would effectively invalidate all arbitration clauses.  We will keep blog readers updated as to the status of this important development in nursing home legislation as the new Congress convenes.

Read the full case of High v. Capital Senior Living Properties here.

Too often we report on the poor conduct of nursing home staff.  This video should be a reminder to the quality people working hard in nursing homes across the country to provide compassionate care to residents. Thank you.

I was reviewing the AARPBulletintoday, and they ran a story about Kentucky nursing home that was cited for reports of alleged nursing home abuse and neglect by nursing state nursing home inspectors.  Winchester Centre for Health and Rehabilitation received a Type A citation- the most serious nursing home citation a state can give-- for problems related to 'medical errors' and consequently the federal government will terminate its Medicare / Medicaid funding.

According to Kathy Gannoe, executive director of the Nursing Home Ombudsman Agency of the Bluegrass, prior to issuance of the Type A citation, the Winchester received 31 resident complaints in the past three months, and that 86% of the complaints had apparently been resolved.

Winchester is a 183-bed facility that has received 1 out of 5 stars from according to Medicare ratings, putting the facility in the 'much below average' category.  Winchester Centre for Health and Rehabilitation is owned by Kindred Healthcare.  To those who may not be familiar with Kindred, it is a multi-service health care conglomerate that owns and operates hospitals, nursing centers, rehabilitation centers, and long-term care facilities throughout the country.

As of February 7th, when the Medicare contract with Kindred officially terminates, Winchester will no longer be certified to provide care to government aid recipients.  Consequently, the Medicare recipients at Winchester will have to relocate to other Medicare approved facilities.

But where will the residents go? The closure of facility deemed to have safety violations may seem like a good idea, but the closure of a Medicare-funded facility really just puts additional strain other other facilities forced to pick up the slack.  In Kentucky, more than 400 nursing home beds allocated for Medicaid recipients have been lost over the past year.  According to Gannoe, the closing of another facility would be "a very serious problem for consumers," and "a disaster for Central Kentucky."

About Medicare / Medicaid Funding Of Nursing Homes

Medicare provides an essential service for both residents and facilities.  For residents, Medicare (and Medicaid) provide not only the the funding for their stay at the facility, but the government's involvement also assures residents that the facility meets the standards set forth by the federal government.  Federal Regulations control all aspects of nursing homes from the type of nursing care provided to residents to the temperature of the food the kitchen prepares. The bottom line is that the regulation is in place to protect the well being of each resident.

In exchange for meeting the standards set forth by the government, nursing homes are paid a daily rate for providing quality care to its residents.  In most cases, government funding comprises close to 90% of a nursing homes stream of revenue.

Authorities are looking for Jacqueline Anne Lumpkin, a certified nursing assistant at an Alabama Nursing Home, who is accused of stealing an elderly resident's identity to fraudulently buy goods and services valued at more than $5,000.  Warrants for Lumpkin's arrest were issued on December 4, 2008 and she is being charged with: elder abuse / neglect, financial exploitation, identity theft and fraudulent use of a credit card.  Each count caries a $15,000 bond.  Authorities are still attempting to learn if there are more residents that Ms. Lumpkin has taken advantage of.  Read more about this case of financial exploitation of the elderly here.

A janitor at the Normandy Nursing Center, a St. Louis, Missouri nursing home, was arrested and charged with raping a resident at the facility.  The victim is a 36-year-old woman suffering from Cerebal Palsy and seizure disorder.  The alleged incident took place on December 21st when the janitor attacked the woman in a stairwell and raped her.  The alleged perpetrator is being held in the St. Louis County Jail on $200,000 cash only bond.  According to the administrator at Normandy Nursing Center, the alleged perpetrator has worked at the facility for a year and a half and passed a background check. Read more about this nursing home rape here.

Normandy Nursing Center received 2 out of 5 starts as a total rating for the facility according to Medicare's Nursing Home Compare website.  The for-profit facility is capable for 116 residents.  When it comes to staffing levels at the facility, Normandy rated poorly receiving just 1 out of 5 stars.  Normandy's staffing levels were significantly below the staffing levels for both national and Missouri nursing home averages.  Dare I say that had Normandy provided more staff to look after residents, this nursing home rape may have been prevented?

New York Nursing Home inspectors were recently called to investigate, Hilltop Nursing Home, following two incidents where nurses at the facility gave insulin to non-diabetic residents.  The residents went into shock and were hospitalized.  According to a report from the  New York Department of Public Health, the two incidents were investigated following tips made on the telephone hot line.  One of the insulin errors involved an LPN who admitted to being under the influence of narcotic medications not prescribed to her. 

During the recent health department investigations, investigators also determined that nurses at the facility signed out narcotic medications for resident use, but there was no documentation that the medications were actually administered.  Upon discovering this situation, the findings were turned over to the Bureau of Narcotics Enforcement.

Hilltop Nursing Home is a short-term sub-acute facility certified for 110 residents and has a staff of 200.  It specializes in treatment of traumatic brain injury and pediatric care. Hilltop Nursing Home has been part of the government's nursing home watch list or "Special Focus Facility" since 2006 when an 11-month-old boy stopped breathing for 20 minutes following the displacement of his breathing tube.  The boy suffered brain damage from the incident.  An inspection of the incident confirmed the boy received improper medical care and the staff failed to timely respond to alarms signaling a problem.

The 'special focus facility' designation cases nursing home inspectors to visit the facility more frequently.  Nursing homes remain part of the 'special focus facility' watch list until they pass two consecutive surveys without major violations.  Well, after these incidents involving medication errors, Hilltop will remain on nursing home inspectors short list.

Read more about this medication error at a New York Nursing Home here.

The North Carolina Department of Health and Human Services has issued a report very critical of the nursing care provided to an Alzheimer's patient who recently died from injuries she sustained from a fall.  The report follows an extensive investigation of the nursing practices at Five Oaks Manor Nursing Home.  The resident at issue is 87-year-old Annie Bell Scarboro who died from head injuries related to a fall from a loading dock off the kitchen.

The state's report indicates that on December 18th, Scarboro managed to wheel herself in her 'merry walker' through three sets of unlocked doors to the outside area without the staff's knowledge.  The report also indicates there were no door alarms on any doors-- including the one leading to the outside area where Scarboro died.

This incident follows similar wandering episodes Scarboro had while a resident at the facility.  On May 22, 2008, managed to escape through the exact same doors she managed to navigate through prior to her death.

The state's report into this nursing home death, concluded the facility failed to comply with 483.25(h) Accidents and Supervision, the facility failed to "ensure that the resident environment remains free from accident hazards as is possible; and each resident receives adequate supervision and assistance devices to prevent accidents."

Among the 'assistance devices' ordered to be implemented at the nursing home, by state authorities is the installation of a Mag-Lock and Accutech alarm system.  The Mag-Lock / Accutech system automatically locks doors as an Alzheimer's resident approaches the area with a special bracelet that activates the system. 

While a sophisticated alarm system would have prevented this nursing home death.  The sad reality is that this incident should have been prevented. Had the facility followed basic safety measures for Alzheimer's patients-- staff supervision and locks on doors-- there is little doubt this death could have been prevented.

Read more about this report of nursing home negligence here.

View a complete copy of the investigative report of this incident here.

Related: Nursing Home Injury Laws: North Carolina

The Washington Post had an article on the growing diabetic population in nursing homes.  Despite the fact that up to 25% of nursing home residents have diabetes, a study published in Diabetes Care determined many diabetic nursing home residents are not getting appropriate care according to the standards proposed by the American Diabetic Association.  The study revealed while 98% of diabetic nursing home residents had their blood glucose monitored, only 38% met their short-term glucose goals.  

One of the problems facing nursing home residents with diabetes is the lack of specific guidelines set forth to care for elderly people with diabetes.  According to Helaine Resnick, director of research at the Institute for the Future of Aging Services for the American Association of Homes and Services for the Aging, most of the glucose control standards are intended for younger people and the needs of an elderly nursing home resident with a cognitive impairment may be substantially different.

"Diabetes medications are designed to lower glucose levels, which can prevent complications from developing in diabetic people,  But, when you take medicines to lower blood glucose, it can go too low, which can be extremely dangerous, especially for older adults,"  Resnick said.  It's difficult to find "the appropriate balance between keeping sugars low with the risk of keeping it too low," she added.

Both Resnick and Paul Strumph, M.D., Chief Medical Officer of the Juvenile Diabetes Research Foundation, recommend active family involvement  when developing an individualized care plan for diabetic seniors. "Families have to be very involved, and the communication needs to be ongoing because people's values can change," added Resnick.

Related Posts From The Nursing Homes Abuse Blog:

Poorly controlled blood sugar in nursing homes.

Residents of the River Park Nursing Home in Nashville, Tennessee will be forced to find a new place to live within the next  30 days.  Medicare has pulled its funding for the facility following state inspections that revealed safety violations that threatened the health of the residents.  Although the facility could continue to operate with private funding, the fact that most of its current residents rely on Medicare / Medicaid support will effectively force the facility to close its doors. 

Many of the safety violations relate to deficiencies surrounding the behavior of residents according to Joe Garafola, the facilities administrator.  "They felt like we didn't adequately assess and take care of those behaviors," he said.

According to state inspection records, River Park allowed residents with behavior problems to check themselves in and out of the home. Those residents then returned with alcohol and gave it to other patients. Some of those patients were alcoholics and were taking medication that would cause serious reactions to the alcohol.

River Park will be required to find new housing for all of its 36 residents who range in age from 19-55 within the next 30 days.  There are also state provided monitors at the facility to ensure the moving process goes smoothly. In the past three years, there have been six Tennessee nursing homes that have lost federal funding; five in 2007. In 2008, no nursing homes were terminated from the program and River Park is the first nursing home this year to lose funding.

This is the last chapter in this troubled nursing home's history of providing poor care.  In June, 2008 the facility was fined and ordered to halt new resident admissions following a surveyor's report of violations relating to; resident protection, administration, nursing services, performance improvement, resident rights and quality of care standards

I applaud the steps taken by government officials to improve nursing home care.  We will keep blog readers updated to the steps taken by federal and state officials to close the doors on dangerous nursing homes. Read more about this Tennessee Nursing Home losing its federal funding here.

The Brownsville Herald had an article on nursing homes inability to care an increasingly large portion of the nursing home population-- the morbidly obese.  Under-staffing is particularly problematic for large nursing home residents.  Obese nursing home residents require special equipment and additional staffing in order for their needs to be met.  Read more about the special needs of obese nursing home residents here.