Nursing Homes Abuse Blog - By Jonathan Rosenfeld

The results from a five-year study addressing the ability of care-givers and family to perceive pain in nursing home patients has revealed both parties fail to accurately assess chronic pain levels. In reaching this conclusion, researchers in the Netherlands studied 174 nursing home patients with and without cognitive impairments.  The study also concluded that family members were better at accurately assessing pain levels in their loved ones compared with nursing home staff.

Perhaps most disturbing, the study concluded most nursing home patients suffer from pain-- even while resting.  When researchers questioned resting patients, most scored their pain as four out of 10, compared with a median pain assessment of zero by family and caregivers.

Study author, Dr. Rhodee van Herk summarizes the findings well,

"Our study shows that nurses and relative find it hard to accurately assess pain in nursing home residents, especially if the resident has a cognitive impairment, such as dementia or is unable to speak. Pain seemed to differ, not only on an individual basis but also in different daily situations.  It is clear that pain at rest is a particular issue that needs addressing as residents rated this much higher than caregivers and relatives.  Using a simple pain intensity scale, like the zero to ten scale employed in our study, is clearly not enough.  We would like to see nurses use a combination of the existing pain scale, together with multidimensional pain observational scales to judge how much discomfort a patient is experiencing."

Nursing Homes Duty To Provide Pain Relief

Nursing homes have an obligation to provide pain relieving measures to their patients. While certain medical conditions such as bed sores (decubitus ulcers, pressure ulcers or pressure sores) may cause staff to implement pain relieving measures, staff must be diligent to look for signs of distress in patients with less visible condition that require pain relief.  

In particular with disabled nursing homes patients, staff should take note of patients facial expressions, involuntary motor actions, moans and changes in behavior as potential indicators that the patient may indeed be suffering and contact a staff physician.

Pain relief is required pursuant to federal regulation of nursing homes.  F-Tag 309 (Quality of Care) requires nursing homes to provide 'necessary care and services to attain or maintain the highest practical physical, mental and psychological well being, in accordance with the comprehensive assessment and plan of care.'

Although the term 'highest level of practicable care' is fairly vague, proposed interpretive guidelines to F-Tag 309 provide more specific guidance for providing pain relief.

Recognition and Management of Pain

In order to help a resident attain or maintain his or her highest practicable level of well-being and to prevent or manage pain, to the extent possible, the facility:

• Recognizes when the resident is experiencing pain and identifies circumstances when pain can be anticipated;
• Evaluates the existing pain the cause(s), to the extent possible; and 
• Manages or prevents pain to the extent possible, consistent with with the resident's goals, the comprehensive assessment and plan of care, and current clinical standards of practice.

As a nursing home attorney, I consistently see facilities that fail to provide compassionate pain relief. Many times I will see a written description of an obviously painful medical condition, yet the Medication Administration Record indicates the staff failed to notify the attending physician and no pain relief was provided. 

Source:

van Herk et al, Assessment of pain: can caregivers or relatives rates pain in nursing home residents? Journal of Clinical Nursing, 2009; 18 (17): 2478 DOI:

Related Posts:

Nursing Home Patient With Broken Hip Sits In Pain. Why Federal Law Requires Staff To Administer Pain Medication

Fentanyl Overdose Leads To 1.6M Nursing Home Settlement

Woman Poses As Nurse To Steal Medication From Nursing Home Residents 

Continue Reading

Police arrested Brian Dillman, a CNA at Good Samaritan Home and Rehabilitation, and charged him with battery after he allegedly choked, punched and scratched an elderly woman who asked for assistance with bathing.  According to reports, the the disabled woman has bruises and scratches from when Dillman grabbed her from behind and attempted to choke her.  Dillman remains out on bail.  No word as to his employment status at the nursing home.

Can the nursing home be held responsible for this abuse?

Maybe, it all depends on the circumstances and what-- if any-- knowledge the facility had of Mr. Dillman's violent tendencies.  The fact a violent event took place at the hands of an employee is generally not enough to impose liability on the part of a facility.

When caring for disabled patients, nursing homes must take maximum precautions to ensure their well being. Relatively, simple preventative measures on the part of the facility can ensure a safe environment for patients. Nursing homes should:

• Conduct a pre-employment background check of all employees
• Conduct regular criminal record checks on all employees
• Investigate all allegations and signs of physical and psychological abuse
• Adequately staff facilities in order to ensure multiple employees are present to look after each other
• Alert law enforcement to any suspected criminal activity
• Remove employees who stand accused of abuse from the facility during the course of the investigation

Source:

"CNA arrested in nursing home attack" Princeton Daily Clarion, September 24, 2009

It only is a matter of time before another nursing home fire claims the life of another patient.  While less publicized, hundreds of elderly people receive burns every year during their admission to skilled nursing facilities. Anyway you look at the situation, fires in nursing homes remain a real-- yet under-appreciated threat to nursing home patient safety.

According to the Government Accountability Office (GAO), from 1994 to 1999 approximately 2,300 nursing homes reported some type of fire at their facility each year.    Equally alarming is that the GAO has found the number of severe fire deficiencies in nursing home has increased steadily from 2004 through 2007.

In response to this safety threat, Centers for Medicare & Medicaid Services (CMS) now requires a smoke detector in every patient room and in public areas.  Additionally, automatic fire sprinkler systems must not be installed in new facilities and retrofit in existing facilities over the next four years.

While compliance with CMS regulations may help reduce the chance of fires in skilled nursing facilities, owners and administrators should evaluate all activities and determine what policies may be implemented to further promote patient safety.

Step #1: Eliminate Smoking In Nursing Homes

Smoking in nursing homes can at best be considered counter-productive to patient health.  Perhaps more accurately, smoking in nursing homes is threat to all patients and staff. Even when monitored, there is an increased risk of fire in nursing facilities that permit smoking compared with those that do not allow it.  Therefore, I propose nursing homes force patients to toss out their cigarettes or seek alternative facilities.

In addition to safety concerns related to fire, allowing patients to smoke in a nursing home diverts staff resources to the supervision of patients who choose to smoke and away from the task of providing skilled nursing care. 

According to The National Fire Protection Association, elderly people are more than three times more likely to suffer a smoking-related injury than their younger counterparts.  One need not look far to see examples of smoking accidents in nursing home and assisted living facilities:

• Dallas, Texas- Woman dies in a fire at an assisted living facility.  The fire inspector determined the fire started due to 'improper use of smoking material'
• Chicago, Illinois- Two patients died at Hampton Plaza Nursing Home from smoke inhalation. The fire department concluded that the fire was started by smoking materials stored in a patient's closet.
• Whittier, California- A nursing home patient with dementia ignited himself while attempting to light his cigarette.  A investigation into the matter revealed the staff was unaware that the man was even outside of the facility.
• Lebanon, Indiana- An oxygen dependent patient started a fire at an assisted living complex when the oxygen tank exploded as she smoked.  

I doubt we will nursing homes flocking to change their policies to 'smoke free' overnight.  In the meantime, facilities should take steps to develop a smoking policy that is both realistic to implement and enhances patient safety.  Here are some suggestions for developing a smoking policy:

• Designate a smoking area for patients that is supervised and well ventilated.
• Ban all smoking in patient rooms.  Studies have shown that the risk of fire increases when people smoke in bed.
• Establish an evacuation policy in case of a fire or emergency.  Similarly, inform all staff and patients as to the location of fire extinguishers and teach them how to use it.
• Keep all smoking materials including lighters and matches in possession of staff and locked at all times.
• Provide ashtrays and smoking aprons (outerwear made from fire-proof material that reduces the chance of a stray ash igniting a patients clothing) 
• Develop a smoking cessation program.
• Make sure your facility has smoke detectors and a sprinkler system
• Allow patients to smoke only when supervised by staff members.
• Develop a set of consequences for patients who fail to follow the policy.
• Write down your facilities smoking policy and give a copy to all patients and their families.

While the above guidelines may reduce the chance of fires in nursing homes, eliminating smoking remains one of the easiest ways to improve the overall living conditions for all patients and nursing home staff.

Resource:

GAO Report, Fire Safety In Nursing Homes- Recent Fires Highlight Weaknesses in Federal Standards and Oversight, July, 2004

Nursing Home Compare-  See how your facility measures up with respect to fire safety

Related Nursing Homes Abuse Blog Entries

Maximum Fine Levied Against Nursing Home For Failing To Supervise Resident While Smoking

Resident Who Smoked & Used Oxygen Suspected Of Causing Fire At Assisted Living Facility

Unsupervised Nursing Home Resident Dies From Burns

In addition to monitoring food and liquid intake of nursing home patients, staff need to pay attention to the elimination of the wastes.   When urine and feces are not produced on a regular basis, nursing home staff must bring these problems to the attention of physicians.

One of the more obvious cases of nursing home neglect my office is working on involves a patient who went at least 10 days without a bowel movement.  Shift after shift of nursing home staff tended to our client-- yet no one cared enough to look at his medical chart to see when the last bowel movement occurred.  It was not until the man was taken to a local hospital, was it determined that the man's bowel had become impacted with feces.  Within 24-hours of his admission to the hospital, the man died from complications related to sepsis.

What is an impacted bowel?

An impacted bowel is the condition where feces are trapped in the lower part of the large intestine, causing a waste obstruction. The stool collects in the bowel and becomes hardened. This hard stool can irritate the rectum, resulting in the production of mucus and fluid which can leak, causing fecal incontinence. 

One of the most common symptoms is lack of appetite, caused by pressure on the abdomen. Hemorrhoids (a mass of dilated veins in swollen tissue around the anus) are a common sign of impacted bowels because it is more difficult to rid your body of fecal matter. Other symptoms include: a constant feeling of fullness; diarrhea; hardened feces; cramping and pain; vomiting; constipation; bad breathe; and bloating. If left untreated, the waste obstruction can cause a rectal infection that can lead to sepsis (also referred to as: severe sepsis, sepsis infection, septic shock, severe sepsis, septicemia) or death. 

The most common cause of impacted bowel symptoms is Crohn’s disease.  In a nursing home setting, causes of impacted bowel include: not drinking enough water; not eating a diet with adequate fiber; lack of activity; certain prescription medications and generally unhealthy diet with high fat and processed foods.

When timely identified, impacted bowels can be treated with a higher fiber diet, increased hydration, exercise, laxatives, enemas, suppositories, or manually removing the hardened feces.

Unfortunately, many nursing home patients are highly susceptible to impacted bowels due to a combination of inattentive staff and an unhealthy lifestyle.  In order to minimize the chances of impacted bowels among patients, nursing homes should:  

• Provide the residents with proper nutrition (sufficient fiber, water, and healthy foods), the residents can suffer from painful constipation. 
• Provide as much physical activity as feasible for patients.
• Monitor each patients bowel movements (time, quantity, consistency)  
• Pay special attention to patients complaining of stomach pain or cramping

Resources:

Article Click - Fecal Impaction vs. Constipation

The association of fecal impaction and urinary retention in elderly nursing home patients

Annals of Internal Medicine – Incontinence in the Nursing Home

"What is an advance directive and should I have one?"

-Shirley C.- Aurora, Illinois

An Advance Directive is a written statement about how you want medical decisions to be made in the future if you can no longer make them yourself. Federal law requires that you be told of your right to make an advance directive when you are admitted to a health care facility.

Many states, such as Illinois have three advance directives:

• Health care power of attorney
• Living will
• Mental health treatment preference declaration

The health care power of attorney allows you to choose someone to make your future health care decisions if you are no longer able to make them yourself. This power only takes effect if you are no longer able to make health care decisions and lasts until your death unless you cancel it or include time limits. 

The agent you choose cannot be your health care professional or health care provider. You can use the Illinois Statutory Short Form: Power of Attorney for Health Care or write your own. Your agent is required to follow any specific instructions you give regarding care you want provided or with held. 

A living will is a declaration telling your health care provider whether you want life extending measures taken and are you are unable to state your wishes. Unlike a health care power of attorney, it only applies if you have a terminal condition (incurable and irreversible condition such that death is imminent and the application of any death-delaying procedure serves only to prolong the dying process). 

You can use a standard living will form or write your own, with any specific directions about what type of life-extending medical procedures you do or do not want. You can cancel your living will at any time. 

A mental health treatment declaration allows you to specify whether you want electroconvulsive treatment (ETC) or psychotropic medicine when you have a mental illness and are unable to make these decisions for yourself. You can choose someone to make your mental health decisions for you, use a declaration for mental health treatment form, or write out your wishes. Your mental treatment preference declaration expires three years from the date you sign it, and you can cancel your declaration in writing prior to its expiration so long as you are not receiving mental health treatment at time of cancellation.

A Do-Not-Resuscitate Order (DNR order) is a medical treatment order saying that you do not want cardiopulmonary resuscitation (CPR) if your heart and or breathing stops. You or your legal representative must consent to the DNR order before it may be entered into your medical record. 

If you do not have an advance directive and you cannot make health care decisions for yourself, a health care “surrogate” may be assigned under Illinois law. This surrogate will be one of the following (in order of priority): guardian of the person, spouse, any adult children, either parent, any brother or sister, any adult grandchildren, a close friend, or a guardian of the estate. The surrogate can make all health care decisions with certain exceptions (withdraw or withhold life-sustaining treatment unless you have a terminal condition, permanent unconsciousness, or an incurable or reversible condition). A surrogate, other than a court-appointed guardian, cannot consent to certain mental health treatments including electroconvulsive therapy, psychotropic medication, or admission to a mental health facility. 

Under the Illinois Nursing Home Care Act, all nursing home facilities must establish a policy for the implementation of physician orders limiting resuscitation, such as those commonly referred to as “Do-Not-Resuscitate” or DNR orders. Any orders under this policy must b e honored by the facility. Also, the Department of Public Health Uniform DNR Advance Directive or a copy of that Advance Directive shall be honored by the facility. (210 ILCS 45/2-104.2) 

Resources:

IDPH: Illinois advance directives

Statement of Illinois Law on Advance Directives

Living Will Declaration Form

Declaration for Mental Health Treatment Form

Power of Attorney for Health Care, Illinois Statutory Short Form 

IDPH Uniform Do Not Resuscitate (DNR) Advance Directive 

IDPH Uniform Advance Directive – Guidance for Individuals

IDPH Uniform DNR Advance Directive – Guidance for Health-Care Providers and Professionals

"No, we don't divulge that to family members."

Was the response given by Laura Holbrook, a social worker at Lake Worth Nursing Home, when questioned about the facilities decision to keep the facilities new patient, Boyd Mullens-- a convicted sex offender-- unannounced to patients and their families. Mullens will live freely amongst the other patients at Lake Worth after being transferred there due to medical problems from a halfway house.  

60-year-old Mullens was convicted of sexually molesting teenage boys and has been identified by authorities as a sexually violent predator.  Despite his age and fragile health, experts believe offenders, such as Mullens are capable of committing another sex offense.  "If I said there was no danger, I would be lying," said counselor Ezio Leite.  "Anytime a civil commitment client is in a facility then everyone would be aware of who they are and the danger."

Sexual Offenders Living In Freely In Nursing Homes

Hundreds of convicted sex offenders are freely living in nursing homes around the country-- most of the time without the knowledge of other patients, families or staff.  The admission of the sexual deviants is perhaps of the most extreme example of nursing home owners quest to keep their facilities full and maximize profit.

Despite an outward appearance that many of these people are incapable of harming others, we continually learn that their criminal tendencies are not mellowed by age.  Nursing home patients have a right to live in a safe environment-- free from all types of abuse.  Patients and their families should demand to know if the facility they trust is home to sex offenders.  Most states maintain sex offender databases where the physical address of the nursing home can be input as a search factor to verify patient safety.

Related Nursing Homes Abuse Blog Entries

Should Criminal Background Checks Be Required At All Nursing Homes?

94-Year-Old Charged With Raping Co-Resident In Oklahoma Nursing Home

New Nursing Home To Be Built For Sex Offenders

Murderers, Rapists, And Other Violent Criminals Living With The Elderly

Some politicians have thrown 'tort reform' into the mix of President Obama's new health care plan under the guise of saving money.  Several states already have full-fledged tort reform measures in place where the state legislature has set caps on the amount of money an injured person can recover.  

Years after many of these damage caps have been put into place, neither physician malpractice premiums nor individual health insurance rates have declined.

Nonetheless, rather than debate the philosophical aspects of imposing limits on recovery, here are some facts regarding tort reform:

• Medical malpractice has no place in the healthcare debate. Healthcare reform is about making sure that every American has access to quality, low-cost healthcare, not about limiting the legal rights of innocent patients harmed by medical negligence.
      
• Tort reform does not improve the quality of our healthcare system or produce cost savings. Forty-eight states have already enacted at least one medical malpractice tort reform measure. Yet, these legal restrictions have done nothing to improve our health care system—forty seven million Americans still have no health care, costs are still escalating and 98,000 Americans still die each year from preventable medical errors. Limiting the legal rights of injured patients will do nothing to fix these problems.
   
• Medical malpractice is about real people, with real injuries. The Institute of Medicine estimates that 98,000 people die each year in the US from preventable medical errors.  And, this number does not even include the countless other people who are injured by medical errors. Rather than reforming the legal system that provides protections to these injured patients, we must focus on reforming the medical system in this country to prevent these errors from ever happening in the first place.
   
• There is no medical malpractice crisis. In 2008, medical malpractice payments accounted to 0.2 percent of all health costs – the lowest level on record. Furthermore, researchers at the Harvard University School of Public Health have found that nearly all medical negligence claims are meritorious, with 97 percent of claims involving medical injury and 80 percent involving physical injuries resulting in major disability or death.
   
• Americans should not have to give up rights, in order to gain the right to healthcare. President Obama has repeatedly stated that in America, healthcare is a right.  Likewise, Americans should not have to relinquish their constitutionally protected 7th Amendment rights in order to gain access to quality healthcare.  
   
• Lawmakers should focus on the key issues. Achieving consensus on the health reform is an extremely delicate balance. Lawmakers must not unnecessarily insert extraneous, controversial issues such as tort reform into an already complicated issue. 
     
• Health courts would be an expensive, bureaucratic nightmare. They would exchange a patient’s constitutional right to a jury trial for a schedule of pre-determined outcomes that would be handed out by judges more interested in appeasing special interests than rendering justice to the injured patients standing before them. And health courts would not protect patients from wrongdoers, but instead, would shield doctors and hospitals from accountability for their careless, harmful acts. Health courts truly are an unfair proposition for patients.  

For more information, go to www.peopleoverprofits.org

Related Nursing Homes Abuse Blog Entry

Who Benefits From Damage Caps In Nursing Home Lawsuits?

As nursing home lawyers, one of the situations we commonly encounter involve relatively healthy people who enter nursing homes for rehabilitation due to an orthopedic or cardiac conditions--- only to encounter more problems during their admission to a facility.  In some of these situations, nursing home staff wrongfully assume that many of the prevention programs used for more disabled patients are not necessary.

What makes these type of cases particularly sad is to hear a family member describe the rapid decline in a loved ones physical and psychological condition within a short period of time.  In rehab admissions, no one ever suspects that ever suspects that their family member is potentially at risk for injury or illness due to the brief admission.

The New York Daily News reported on one of these situations where serious complications developed with a healthy patient who was admitted to a New York nursing home during a rehab stint.  In 2005 Vera Henry was admitted to Sutton Park Center For Nursing and Rehabilitation for therapy for her arm that she injured in a fall.  The admission was to last no longer than one month.

Apparently the Sutton Park staff failed to provide Ms. Henry with the therapy she was intended to receive.  During her stay Ms. Henry developed an advanced bed sore that ultimately became infected and caused her death.

Not only did the facility fail to provide the physical therapy and bed sore prevention programs, the facility failed to alert Ms. Henry's family or her physicians of the development of the wound.  The bed sore was not discovered until Ms. Henry's daughter, Patricia Henry, went to change her mother's clothes and noticed that an advanced bed sore had developed on her mother's tailbone.

"You could put your whole hand down in her back ," said Patricia Henry.  "You could see the bones and spinal cord.  It was like raw meat.  Mommy screamed until she could scream no more," she added.

Ms. Henry's family has filed a wrongful death lawsuit against Sutton Park Center for Nursing and Rehabilitation and its sister facility South Shore Medical Center.  The case is pending in Bronx Supreme Court.

Read more about this lawsuit against a New York nursing home here.

Related Nursing Homes Abuse Blog Entries

Nursing Home Owner Leave Resident On Bedpan for 24-Hours, Now Faces Jail Time

"The Nursing Home Says My Dad's Bedsores Were Unpreventable..."

In For Rehab. Out With Bedsores.

A Graphic Example Of Nursing Home Negligence: Amputation Of A Leg Due To Untreated Bed Sores

One of the trends in nursing home litigation has been the inclusion of mandatory arbitration agreements in admission paperwork.  By signing an arbitration agreement (usually unknowingly), nursing home patients may surrender their opportunity to recover money for an injury via a traditional jury trial.  Alternatively, injured parties must present their grievances before an individual or group of arbitrators.    

The arbitration agreements set forth the terms of the arbitration and how many arbitrators will hear the matter.  Generally, in the case of a single arbitrator, the individual is selected by the nursing home.  In the case of an arbitration panel (usually three people) both the nursing home and the injured party may choose an arbitrator, with a third arbitrator selected by the appointed arbitrators.

Because the ability to award money for an injury or wrongful death is taken out of the hands of jurors and into the power of individuals who may be influenced by industry power-- mandatory arbitrations are usually vigorously fought by injured parties. 

Until recently, it was universally believed that an injured person stood little chance of receiving a fair recovery in an arbitration setting because many of the arbitrators had allegiance to large nursing home operators and other appointed arbitrators may be unfamiliar with issues that frequently arise in nursing home injury matters.

That was then, this is now.

Recently, a three-person arbitration panel recently awarded over $2.7 million in damages to the family of Voncil Sherrod who died in March, 2005 from complications related to gangrene and advanced pressure sores that developed during her admission to High Point Health Care and Rehabilitation Center in Tennessee.

In addition to High Point, damages were also sought from Mariner Health Care (the parent company), Mariner Health Care Management (the management company) and National Heritage Realty Company (the licensee).  Ms. Sherrod's estate claimed that all entities were guilty of: negligence, violation of the Tennessee Adult Protection Act (TAPA) and medical malpractice.

In making this substantial award, the arbitration panel obviously sent a message to the various nursing entities that they can no longer assume that taking a nursing home negligence matter away from a jury will protect them from liability.  Also, notable was the large award for punitive damages against the facilities especially in light of the more modest awards for other claims.

The arbitration award is comprised of the following:

• $250,000 for TAPA violations
• $400,000 in attorneys fees for intentional, malicious or fraudulent misconduct resulting in TAPA violations
• $626,396.32 for medical malpractice 
• $1,500,000 punitive damages

Related Nursing Homes Abuse Blog Entries:

A Legal Victory For Nursing Home Residents. State Laws Can Supersede Federal Arbitration Act

AARP Joins Fight To Preserve Right To Jury Trial

Are Trials Really That Important? 

A Call To Abolish Arbitration Clauses 

Bed Sore Resources

A study by Canadian researchers reported that non-profit nursing homes provide better care than for-profit nursing homes.  The study reviewed the results from 82 studies from Canada and the United States conducted from 1965 through 2003. 

Forty of these studies revealed that the non-profit facilities provided better care, while three studies revealed that for-profit homes provided better care.  The rest of the studies had mixed results.  The study estimated that U.S. nursing home residents would receive 50,000 more hours of nursing care a day and Canadian residents would receive 42,000 more hours of nursing care a day if all nursing homes were non-profit.  

The non-profit nursing homes were ranked better than for-profit facilities in four areas:

• Low or higher-quality staffing
• Lower pressure sore rates
• Less use of physical restraints
• Fewer deficiencies cited by regulators

It is important to determine how to best provide the necessary level of care to one of society’s most vulnerable populations, the elderly.  More research is necessary in order to learn more about the connection between the for-profit status and quality of care.

Resources:

Fierce Healthcare - Study: Not-For Profit Nursing Homes Offer Higher Quality Than For-Profits

HealthDay – Not-For-Profit Nursing Homes Fare Better In Studies

Glendale Uptown Home is a large 240 bed nursing home facility located in Philadelphia, Pennsylvania.  On June 30, 2009 there was a small fire that occurred across the hall from the room of Selma Kirk, an 82 year-old resident.  The fire resulted in some damage to the room, but no charring, and all the residents in the wing who had been evacuated were returned to their rooms. 

Ms. Kirk’s daughter, Susan Margoles, went to the facility after the fire to check on her mother and take photographs of the fire damage.  Ms. Margoles reported that the administrators got upset and banned her from her mother’s room for taking these photographs.  A Philadelphia Daily News Columnist, Ronnie Polaneczky, was able to get into Ms. Kirk’s room on three separate occasions just by signing in at the front desk.  The facility’s executive director would not comment about the situation, citing patient-privacy laws. 

Ms. Margoles told the reporter that there was caution tape over the doorway to the wing where the fire occurred.  On this visit, she used her camera to take pictures of the damaged room.  A facility administrator witnessed Ms. Margoles taking the photographs and accused her of trespassing, telling her that she had to delete the photos or she would be arrested.  Ms. Margoles said that she finally just gave her camera to an administrator who deleted the photos.  Then, when she came back to visit her elderly mother to deliver clean clothes, the administration told her that she would be arrested if she went past the lobby and was indefinitely banned from her mother’s room. 

Ms. Margoles filed an emergency petition in Common Pleas Court for court-ordered access to her mother’s room.  Then, on July 9, 2009, the Pennsylvania Department of Health visited Glendale Uptown to investigate Ms. Margoles’ complaints.  Investigators did not find any nursing home deficiencies and described Ms. Margoles’ mother (Ms. Kirk) as congenial.  However, later that day, the nursing home called to say that Ms. Kirk had suffered a change in mental status and was being admitted to the hospital.  The day after Ms. Kirk’s hospitalization, Glendale’s executive director wrote to Ms. Margoles, stating that her mother was not welcome back.  Ms. Margoles found a new nursing home for her mother at Manor Care Huntington Valley.

According to the Medicare website, the Glendale Uptown Home received one out of five stars, which is a much below average rating.  The facility received only two out of five starts for health inspections, which is a below average rating.  In the past year, the nursing home had six health deficiencies, which is equal to the average number of health deficiencies in Pennsylvania, and two less than the average number of health deficiencies in the United States. 

Resources:

She took pix, nursing home booted her mom, Philadelphia Daily News, August 4, 2009

Just Do It. Photograph Everything, Nursing Homes Abuse Blog, June 13, 2008

Videotape Confirms Resident Murdered By Peer At North Carolina Facility, Nursing Homes Abuse Blog, June 7, 2009

NHC Healthcare is a, 120 bed nursing home located in Bristol, Virginia.  According to the government’s Medicare website, the facility received only one out of five stars, which is a much below average rating.  In the past year, the nursing home had sixteen health deficiencies, which is eight more than the average number of health deficiencies in Virginia and eight more than in the United States.  The number of health deficiencies has increased steadily over the past two years, especially in the area of qualify care. 

"Are nursing home patients protected under federal law?"

                                                                -Tom, Edina, Minnesota

Although many nursing home patients frequently feel trapped within the situation they are currently in, nursing home patients actually have many rights granted to them under federal law.  Federal law empowers nursing home patients to make decisions with respect to their medical treatment and personal care.

Federal law guarantees the following:

1. The right to participate in your care planning along with the right to refuse particular treatments.

A customized care plan must be developed for every nursing home patient.  Nursing home patients (or their representatives) may participate in developing this important part of patient care.

2. The right to privacy and to be treated with dignity and respect.

Nursing home patients are free to communicate any person they wish.  This includes: friends, family, attorneys and patient advocates.  Nursing home patients are entitled to privacy when speaking with visitors.

Unless requested otherwise, nursing home patients are entitled to open their own mail.

Nursing home staff should take steps to ensure privacy during bathing, toileting, and providing medical treatments by using curtains or private areas when necessary.

3. The right to have your own physician and/or pharmacy.

Despite the fact that many nursing homes are set up for a 'one size fits all' approach to care, YOU ARE entitled to select your own physician and pharmacy.

4. The right to be free from restraints.

Physical and pharmacutial restraints may only be used if ordered by a physician and agreed to by the patient or their caretaker.  Moreover, restraints should be used only when they are necessary to protect the individual or other patients from harm or injury.

5. The right to be informed of nursing home policies and procedures.

Policies and procedures regarding patient care and patient expectations must be written out by each nursing home.  When requested, a facility should present you with a copy of such policies.

6. The right to know about all medical care and conditions.

Nursing homes must tell each patient or their caregiver as to their medical condition and the treatment to be provided.  When and if there is a change in care, nursing homes must alert all the decision makers.

7. The right to know of the services the facility provides and the exact charges for such services.  

Nursing home must inform all patients as to the specific services provided and what the accompanying charge is for such service.

8. The right to privacy when it comes to your medical records.

Federal law prohibits disclosure of personal medical records to any person or entity without the written permission of the patient or their authorized representative. 

9. The right to use your own clothing and possessions.

Despite the fact that many nursing homes freely distribute generic clothing and effects, patients are entitled to use their own clothing and possessions if they desire.

10. The right to manage personal finances.

Many nursing homes mange their patients' finances for them.  This is legal.  In some circumstances this is done as a convenience for patients and to help expedite payment of bills.  If you do choose to allow a nursing home to manage your finances, you are entitled to: a) see an itemization as to where you money is; 2) received a written accounting for each account and expenditure; 3) get a receipt for all money  spent on your behalf; and 4) have access to your funds if you desire.

11. The right to be free from abuse in any form including: physical, sexual, neglect or isolation.

Nursing homes must provide the highest feasible level of care.  Obviously, this entitles patients to live comfortably and free from physical and emotional abuse in any form.

12. The right to stay at a nursing home as long as the facility is capable of attending to medical needs, payment is timely made and the facility continues to operate.

In other words, nursing homes CAN NOT simply discharge patients without cause.  In order for nursing homes to properly discharge patients, they must provide a reason for discharge or transfer. If you disagree with the nursing homes reasoning, patients have a right to appeal the facilities decision.

13. The right to speak freely about poor care.

Nursing home can not take any retaliatory action against a patient for making a complaint regarding care or treatment.

14. The right to have visitors.

Nursing homes are 'homes' for the patients who live there either on a temporary or permanent basis. Consequently, nursing homes must:

a) Allow patients to receive any visitor of their choosing.

b) All patients to refuse any visitor of their choosing.

c) Provide at least 8 hours per day of scheduled visiting hours.

d) Allow patient advocates and / or patient attorneys access to the facility during visiting hours.

e) Provide an area for confidential communications between patient and visitors if and when requested.

f) Patients may speak freely to visitors regarding rights and benefits.

The above rights are undeniable.  Additionally, many states have enacted laws to further protect nursing home residents.  If a nursing home is not meeting its obligations, you should contact your state or local nursing home ombudsman.