Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Good nursing homes do exist.  In fact, there are many dedicated facilities throughout the country dedicated to the compassionate care of the elderly. 

In an era where we are bombarded with horrific descriptions of nursing home abuse and neglect, it was a pleasure to come across Jane Brody's personal accounting of the Miami Jewish Health System-- one of largest nursing homes in Florida. Ms. Brody's article, 'Nursing Homes That Belie the Bad Image' appeared in the New York Times and may be viewed here.

The Miami Jewish Health system is a huge, 20-acre complex in Southern Florida that cares for a variety of young and elderly patients with a diverse range of medical needs.  In fact, the facility is designed to provide such a broad range of medical treatments, that the patients truly never need to leave the facility confines.

Unlike, many 'generalized' nursing homes, Miami Jewish Health Care Systems offers:

• An acute care hospital
• Short and long-term skilled nursing care
• Rehabilitation services
• A dementia clinic
• Psychiatric clinic
• Pain care center
• Recreational activities
• Respite care
• Religious services
• Assisted living services
• Hospice care
• Care for children with cerebral palsy

Although the lack of specializations may appear to be a bad idea, a recent article in the Journal of the American Medical Association concluded that continuity of care- where the same physician oversaw medical care both in and out of a hospital setting; speeded recovery, cut costs and reduced re-admissions to hospitals in the elderly population.

Amazingly, 85% of the patients at the 492-bed-facility, are recipients of the Florida Medicaid program which reimburses the facility $205 per day.  To cover the difference between what Medicaid reimburses and the 'actual cost' of care, the facility raises money through contributions and grants.

Finding A Good Nursing Home In Your Area

Weather you are looking for a nursing home in Florida or across the country, Ms. Brody's article cites some useful advice proposed by Jeanne M. Hannah in her book 'Taking Charge: Good Medical Care for the Elderly and How to Get It".  As the daughter of a victim of nursing home neglect, Ms. Hannah's suggestions are particularly well taken.

• Investigate Nursing Home Deficiencies: Check to see if the nursing home has violated federal nursing home standards at the Nursing Home Compare Website. (I also suggest checking on the facility via your state's department of health's website as well)
• Choose Quality Over Location: Avoid the temptation to place a loved one in a facility simply due for convenience sake.
• Monitor the Care: Be vigilant in checking on your loved one as frequently as possible.  Vary your schedule to make sure they are being cared for even on weekends and holidays.
• Assist At Meals: One of the best ways to assure your loved one stays healthy is to make sure they eat and drink.  It they need assistance hire an assistant to help them eat.  All Many nursing home patients are susceptible to dehydration and malnutrition.
• Hire a Geriatric Care Manager: Sure it may seem like a luxury, but if you can not personally look after your loved one, a care manager can act as a patient advocate and liaison between the nursing home and family.  The National Association of Professional Geriatric Care Managers has a searchable directory by location.

Related:

High Staff Turnover Rates Plague Most Nursing Homes

Eden Or A Warehouse? You Choose.

Nurses Admit To Problems At Nursing Homes

Criminal charges have been filed against Barbara Currin, the owner of Ometta Vent Care Services. The criminal charges come after a patient Currin was responsible for caring for, tipped off state officials she was not receiving the medical care that the state was paying for.  

The tip initiated an investigation by the Minnesota Department of Health and the Minnesota Attorney General.  Both agencies concluded that Ometta was not keeping up its end of the bargain in proving skilled nursing services for vent patients.

According to Attorney General Lori Swanson said, "The nursing facility deprived patients who are very in need of health care of which they were entitled and then number two bilked tax payer of the a lot of money."

State investigators further determined that Ometta was proving poor care to their patients.  A June, 2008 investigation revealed 9 licensing violations relating to inadequate training and supervision.

Related:

Staff Must Be Diligent In Order To Avoid Clogged Breathing Tubes Amongst Nursing Home Patients

Nursing Home Fined For Negligent Care Of Resident On Ventilator

Sputum Color As Indicator Of The Quality Of Nursing Care

I was recently emailed a news story involving a 78-year-old patient at Lakeshore Nursing Home in Nashville, TN who died when the ambulance in which she was a passenger, collided with a truck parked on the shoulder of the road.  

The victim identified as Sue Bly, was being transported back to her nursing home in the back of a Rural / Metro ambulance from dialysis treatment.

In addition to the death of Ms. Bly, the ambulance driver also died in the accident.  Apparently, the ambulance driver drove into a Tennessee Department of Transportation (TDOT) truck that was parked on the should of the road.  

As a personal injury lawyer, it would certainly appear that Ms. Bly's family is entitled to bring a wrongful death lawsuit against the ambulance company and/or the TDOT due to keeping an improper lookout or negligently parking the truck.  If evidence proves that both parties were at fault, a jury could apportion damages based on the degree of culpability.

Ambulance Responsibility

Due to the fact that many nursing home patients suffer physical impairments, they are frequently reliant upon ambulance services to transport them to and from appointments outside of their facilities.  These patients should expect that these services with provide them with safe transportation.

Many nursing homes have contracts with private ambulance services that may not adequately train their staff to assist with medical complications encountered by the elderly.  In addition to inadequate training, some private ambulance services use off-duty public fire-fighters or paramedics.  Many times these people are simply over-worked to safely do their jobs.

In addition to driving safely and avoiding accidents, ambulance companies my also be responsible for the following situations commonly involving nursing home patients:

• Dropping patients
• Improperly securing patients in beds and wheelchairs
• Providing wrong medications
• Sex / physical abuse
• Failing to provide assistance during transfers to and from bed
• Failing to monitor patients' vital signs
• Failing to follow physician orders

If you believe that a family member or friend died or suffered an injury due to negligent care of an ambulance driver or attendant, we would be honored to discuss the matter with you.  All attorney consultations are free kept in the strictest confidence. (888) 424-5757

Related:

Ambulance Stolen From Chicago Nursing Home Results In Multiple Injuries

Transportation In & Out Of Nursing Homes: Ambulance Responsibility. 

Continue Reading

Nursing home lawyer, Jonathan Rosenfeld, was recently interviewed for an article on preventing patient wandering.  The article 'Prevent Wandering Patient Tragedies' appeared in the on-line edition of Healthcare Technologies Online, can be viewed here.

Wandering Nursing Home Patients

Many nursing home patients with dementia and Alzheimer's are prone to wander from the facility. Once out of the safety of the nursing home, these vulnerable people are particularly susceptible to injury.  

Simple preventative measures implemented by a facility could literally be the difference between life and death for nursing home patients. There is no excuse for a nursing home's failure to keep residents who are prone to wandering from leaving the premises of the facility.

Nursing homes that care for patients who are prone to wander or elope should have the following safeguards in place:

• Door alarms
• Window locks
• Door locks
• Bracelets that track each resident's location
• Hire adequate staff to look after residents
• Have contingent plan in case a resident does wander from the facility

Related:

Alzheimer's Patient Wanders From Texas Nursing Home To Her Death

What Can Nursing Homes Learn From Jails?

Family Sues Florida Nursing Home For Death Of Wandering Resident

Clostridium difficile (also called C. difficile or C. diff) associated disease (“CDAD”) is a bacterial infection that can cause diarrhea and serious intestinal conditions (such as colitis - inflammation of the colon). CDAD is responsible for about three million cases of diarrhea and colitis annually in the United States.

C. difficile is naturally found in the environment and even in a small number (fewer than 3%) of healthy people’s large intestine. Most people in good health do not usually get sick from C. difficile because of the millions of intestinal bacteria that help protect the body from infection.

When people-- particularly the elderly-- take antibiotics to treat infections (such as floroquinolones, cephalosporins, clindamycin, and penicillins), the antibiotics can kill some of the healthy bacteria along with the bacteria causing the infection. This allows C. difficile to grow out of control leading to a C. difficile infection. 

After a C. difficile infection sets in, it can produce toxins that attack the lining of the intestine, killing cells and causing patches or plaques of inflammatory cells. The toxins can also decay cellular debris inside the colon. 

A more recent strain of C. difficile is even more aggressive, producing much more of the harmful toxins than previous strains. This new strain is also more resistant to medications and has even affected people who have not spent time in the hospital or taken antibiotics. 

Signs and symptoms of mild to moderate CDAD cases:

• Watery diarrhea three or more times a day for two or more days
• Mild abdominal cramping and tenderness
• Low-grade fever

More severe cases of CDAD can cause the colon to become inflamed (colitis) or form patches of raw tissue that can bleed or pus (pseudomembranous colitis). Signs and symptoms of more severe C. difficile cases:

• Watery diarrhea ten to fifteen times a day
• Severe abdominal pain and tenderness
• High fever
• Blood or pus in stool
• Nausea
• Dehydration
• Loss of appetite
• Weight loss

CDAD incidence has doubled in recent years and is responsible for about three million cases of diarrhea and colitis annually in the United States. A much higher percentage of people carry the bacteria in nursing homes, hospitals and other healthcare facilities. 

The bacteria are passed through the feces of an infected person and can spread to food, surfaces, and objects when infected people do not wash their hands thoroughly. The bacteria creates spores (nonactive form of the bacteria) can live in a room for weeks or even months; when ingested, they transform into the active, infectious form of the bacteria. 

Most cases occur in healthcare settings because germs are spread easily, there is increased use of antibiotics, and there are people more vulnerable to infection. CDAD commonly affects the elderly, with persons 65 years of age or older being ten times more likely to become infected with C. difficile than younger people. Infections are also more common after antibiotic use.

There are several risk factors for C. difficile infections:

• Currently taking or having recently taken antibiotics (C. difficile accounts for 15-20% of antibiotic-related diarrhea and most cases of pseudomembranous colitis)
• Advanced age (65 years of age and older)
• Recent hospitalization, especially for an extended period of time (10% of hospital patients will develop an infection after a stay of only two days)
• Living in a nursing home or long-term care facility
• Serious underlying illness or weakened immune system
• Abdominal surgery or gastrointestinal procedure
• Colon disease (IBS or colorectal cancer)
• Previous C. difficile infections

Dangerous complications can occur with C. difficile infections. These include:

• Dehydration and electrolyte deficiencies
• Kidney failure
• Bowel perforation (hole in the large intestine)
• Toxic megacolon (colon becomes very distended and can even rupture)
• Death (mortality rate is 1 to 2.5 percent and is higher in older adults)

There are several tests that can be performed to determine if a person has a C. difficile infection:

• Stool tests (enzyme immunoassay, PCR, tissue culture assay)
• Colon examination (flexible sigmoidscopy)
• Imaging tests (CT scan)

While mild illness caused by CDAD may improve after stopping antibiotics (requiring only correction of dehydration and electrolyte deficiencies), more severe symptoms might require treatment with a different antibiotic (metronidazole for mild to moderate illness and vancomycin for more severe symptoms). Probiotics (organisms such as bacteria and yeast) can be used to help prevent recurrent C. difficile infections. 

In severe cases, surgery might be necessary to remove diseased portions of the colon. Recurrent C. difficile infections occur in about twenty-five percent of people with C. difficile infections. Treatment for recurrent infection includes: antibiotics, Probiotics, and stool transplants to help restore healthy intestinal bacteria. A doctor should be consulted if a person has symptoms lasting more than three days, a fever, severe pain or cramping, blood in the stool, or more than three bowel movements a day. 

C. difficile is considered the most common cause of diarrhea in nursing homes. Because many elderly nursing home patients are more susceptible to C. difficile infections and its accompanying complications, nursing home staff must closely monitor the bowel movements of residents in order to quickly diagnose a possible C. difficile infection. 

Many nursing home residents are already weak or suffer from other illnesses; therefore, it is important that nursing home staff provide proper treatment for diarrhea (fluids and good nutrition) in order to maintain resident health. 

In addition, nursing homes should take extra precautions to prevent the spread of C. difficile through: thorough hand washing, contact precautions (keeping residents with infections separate from healthy residents), thorough cleaning of all surfaces and equipment, and avoiding unnecessary use of antibiotics. 

We have successfully prosecuted cases involving individuals who died due to untreated or undiagnosed C. difficile.  We always welcome the opportunity to speak with you regarding a potential cause of action against a nursing home or hospital.  Our services are always free if there is no recovery for you.  (888) 424-5757

Special thanks to Heather Keil, J.D. for her diligent work researching this important topic.

Sources:

Mayo Clinic: C. difficile

CDC: Clostridium difficile

Geriatric Nursing: Clostridium difficile: An emerging epidemic in nursing homes

Today, the Illinois Nursing Home Task Force will hold its second meeting regarding patient safety. The task force will hear testimony from: patients, elder care advocates and senior service providers with the goal of re-evaluating current nursing home policies, improving coordination between state agencies and to consider nursing home alternatives for people with special needs.

The task force was recently formed in response to a Chicago Tribune series of articles chronicling the safety problems in Illinois nursing homes.   The series detailed how many seniors in nursing homes suffer serious injury or death from an un-regulated group of younger patients with psychiatric conditions and criminal records.

The task force is headed by Michael Gelder, an adviser to Governor Pat Quinn.  "All of us have a role to play in ensuring the safety and well-being of nursing home residents, and we urge the public to join us in this critical work," added Gelder.

The meeting will be held today at 10 a.m. in Room 16-503 at the Thompson Center, 100 W. Randolph Street, Chicago.  The meeting will be broadcast on the Internet here.  Lastly, you may leave comments and recommendations regarding Illinois Nursing Homes at the newly formed Nursing Home Safety website.

The group is scheduled to complete a report by January 31, 2010.

Read more about this nursing home meeting here.

Related:

At least 50 Convicted Sex-Offenders Living Freely In Illinois Nursing Homes

Young, Mentally Ill Residents Pose Significant Threat To Nursing Home Residents

Murder At All Faith Pavilion

Autopsy Confirms Man Was Murdered In Chicago Nursing Home

A home-care nurse has been charged with criminal mistreatment after she failed to seek medical attention for an elderly woman with severe bed sores that ultimately claimed her life.  Prosecutors filed the charges against, Virginia Munger after an investigation revealed that although Munger was aware of advanced bed sores (also referred to as: decubitus ulcers, pressure ulcers or pressure sores) for six months, she took no medical intervention.  Munger was employed as a CNA by Homewell Senior Care, a home-care nursing company.

Read more about this case of senior neglect here.

Home Care Services

Many seniors are turning to home-care services as a way of living independently for longer.  Many of these companies offer senior a variety of medical and non-medical services and provide staffing on as 'as needed' basis.  Unlike nursing homes, home-care services are loosely regulated by federal and state officials. 

Officials at home care service companies should conduct an assessment to determine what the patient's needs are and determine if the company can indeed provide those services.  Once the needs are assessed and services are provided, the company should provide supervision of its employees to make sure those services are properly provided and the patient's needs are continually met.

In the case above, the elderly woman's family may have a cause of action against the home service company-- not necessarily for the criminal conduct of its CNA, but for failing to provide adequate supervision.  Additionally, if the company was made aware of the woman's bed sores-- yet failed to take any action they may similarly be liable for her treatment and death.

Related Nursing Homes Abuse Blog Entries

Home Care Nurse Gets Probation For Ignoring Bedsores On Child

Home Care Nurse Has License Suspended In Connection To Death Of Disabled Boy

Bed Sore Resources

As reported by WBBM 780 Radio, a female patient was punched by another male patient at South Shore Nursing & Rehab on Sunday evening.  Staff at the Chicago nursing home called police after the man allegedly attacked the woman from behind and began punching her in the face.

The woman was treated at nearby Mt. Sinai Hospital for bruising and swelling around her eye. Although the woman was released from Mt. Sinai, it is unknown if she returned to South Shore.

Read more about this violence at a Chicago nursing home here.

About South Shore Nursing & Rehab

South Shore Nursing & rehab Center was rated one out of five stars according to governmental ratings on overall care.  South Shore Nursing & Rehab is a large nursing home with 240 skilled nursing beds. The for-profit facility provides skilled nursing care for patients who have a variety of medical needs including: blood disorders, Alzheimer's, circulatory and respiratory disorders.

Related Nursing Homes Abuse Blog Entries:

Chicago Nursing Homes Not Making The Grade

Blacks Receive Inferior Care At Most Nursing Homes

When Bruises Can't Speak For Themselves: The Difficulty Proving Abuse Of Disabled Nursing Home Residents

Illinois Nursing Homes With Second Quarter 2010 Violations

The California Department of Health has issued a "AA" citation and a $90,000 fine to Fallbrook Hospital District Skilled Nursing Facility after a patient fell and subsequently died at the San Diego, CA nursing home.  According to director of public health director, Dr. Mark Horton, a state investigation determined that the facility failed to implement a plan of care to prevent the patient's injury.

The California Department of Heath has the statutory authority to impose fines against nursing facilities it licenses as part of enforcement remedies for poor care. State citations that require a civil monetary penalty be imposed are categorized as Class B, A or AA. The associated fines range from $100 to $1,000 for Class B, $2,000 to $20,000 for Class A and $25,000 to $100,000 for Class AA. The citation class and amount of the fine depend upon the significance and severity of the substantiated violation, as prescribed and defined in California law.

Nursing Home Falls

More than 1,800 people die each year in nursing home falls. All health care professionals in the nursing home setting must work together to help encourage nursing home safety. Nursing homes are required to conduct a fall-risk assessment for every resident to determine who may be at risk for falls. This puts the staff on notice as to who may need special attention and sets forth what accommodations should be in place for each resident.

Additionally, staff should always be on the lookout for residents who may require assistance getting about. If residents have a history of falls, the facility should consider using alarms on chairs or beds to notify the staff when the person attempts to walk on their own.

Falls in nursing homes occur for a variety of reasons. Some of the more common causes for falls are:

• Muscle weakness and walking or gait problems
• Hazards in the nursing home- wet floors, poor lighting, improper be heights, improperly maintained wheelchairs, equipment left out of place
• Medications- Drugs that effect the central nervous system, such as sedatives and anti-anxiety drugs (psychoactive drugs)
• Improperly fitting shoes or incorrect walking aids
• Frequent use of restraints
• Inadequate staffing levels that fail to provide sufficient assistance to residents

Here is is the California Department of Health survey regarding this fall-related incident

A report issued by the Minnesota Department of Heath has cited White Community Hospital and Nursing Home (Minnesota) for errors made by a nursing assistant during the transfer of a patient out of her bed.  

The incident occurred when the CNA attempted to transfer a disabled patient from their bed to a wheelchair using a sling. During the transfer, the patient was dropped.  The patient suffered a broken arm and leg which contributed to their death two days later.

Specifically, the department of Minnesota health report and the facilities own investigators determined that the CNA's errors caused the patient's injuries and subsequent death.  In particular, the CNA  and nursing home failed to:

• Use two-person lifting technique
• Properly train staff
• Develop and follow a comprehensive 'care plan' for the patient

Laura Ackman, the nursing home's CEO called the patient's death, "an unfortunate accident, and we regret it very much."  According to Ackman, the facility took immediate corrective action, including staff training and the purchase of new equipment.

Certainly, from the information we know about this incident, it appears that the family of this nursing home patient would have a strong case against the nursing home should they wish to pursue a wrongful death case against them.  

I applaud the facility for taking corrective measures following this incident. Nonetheless, it sounds as though the root of the problem is related to under-staffing.  

Despite federal regulations that require nursing homes to have certain 'minimum staffing levels', many facilities simply do not have adequate numbers of staff to provide quality care for their patients.  In the situation discussed above, I am certain that a closer examination of the situation would reveal that there simply was inadequate staff around to assist him or her with lifting the patient.

At a minimum, federal law requires nursing homes to have: at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day.

Resource:

N. Minn. nursing home contributed to death of resident, report says, Statrtribune.com, October 9, 2009

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

Nurses Admit To Problems At Nursing Homes

Minimum Nurse Staffing Ratios

If you've been reading recent Nursing Homes Abuse Blog headlines, this will not come as a surprise, but some of the worst nursing homes in the country are right here in my backyard-- Illinois.

According to a report from the General Accounting Office (GAO), Illinois ranks has some of the worst nursing homes in the country.  After analyzing factors such as: staffing levels, prevention of bed sores (also called: pressure sores, pressure ulcers or decubitus ulcers) and prevention of abuse, the GAO report determined that 47 Illinois Nursing Homes are among the group of facilities categorized as 'most poorly' performing.

The GAO report makes several suggestions to improve nursing home care:

Expand the federal program monitoring nursing homes. 

Currently, there are 136 nursing homes across the country labeled as Special Focus Facilities (that are subject to increased inspections), the list would be substantially expanded to 580 nursing homes.

Use a national comparison for nursing homes. 

A national comparison of nursing homes would allow authorities to more accurately track troubled facilities-- regardless of their location.  The current system uses a state-by-state comparison that does not accurately reflect states with disproportionally bad nursing homes such as Illinois.

My take

I'm all for making the selection of a nursing home easier for families.  Of course, families will still need to do their homework when selecting facilities for their loved ones, but by identifying these poorly performing facilities, families can at least learn of a facilities troubles before placing a loved one there.

Compared with 'average' nursing homes, patients at poorly performing facilities were 46% more likely to harmed as a result of serious deficiencies compared with their peers at more successful facilities.

For the facilities, hopefully being publicly branded as a 'poorly performing facility' will motivate them to make changes and improve their facilities.

Lastly, it is important to look at the similarities amongst the facilities on 'most poorly' performing list.  These similarities are not mere coincidences.  As more people become aware of these trends they will be able to make better choices in selecting a facility for their loved ones.  Troubled facilities tend to:

• Be larger, more than 102 patients per nursing home
• Run as 'for-profit' entities
• Part of large corporate chains
• Have lower staffing ratios than their peers

Resources:

Special Focus Facility Initiative and List - updated September 22, 2009

Illinois ranks high on bad nursing home report, Crains, September 29, 2009

Related Nursing Homes Abuse Blog Entries:

The Worst Nursing Homes In America

Extendicare Nursing Home Added To Government 'Watch List' Following Abuse Of Resident 

A Recipe For Danger: Nursing Shortage Could Reach 1M By 2020

Aggravated battery charges have been filed against 49-year-old Sidney Mitchell, after he allegedly 'touched' a 79-year-old Alzheimer's patient at Emporia Manor Nursing Home.  An employee of the nursing home witnessed Mitchell approach the Alzheimer's patient in a TV-room when he began to inappropriately touch her.

Police were called to the Virginia nursing home immediately after the incident occurred and a warrant was soon issued for Mitchell's arrest.  

According to news reports, Sidney Mitchell is a convicted felon with prior larceny charges.  Mr. Mitchell is scheduled for a preliminary hearing on November 4, 2009.  

My Take:

First of all, why is a 49-year-old living freely amongst elderly patients with Alzheimer's?  Regardless, of Mr. Mitchell's criminal history, it generally is a prescription for trouble when facilities co-mingle patients with significant age disparities at the same facility.

Secondly, why to facilities consistently fail to check public records on their patients?  Sure, reporters are eager to get information on their stories, but isn't a quick check of public records justified especially in a cases of a 49-year-old who is living in a nursing home?

Related Nursing Homes Abuse Blog Entries

Failure To Conduct Adequate Pre-Employment Criminal Background Search Costs Assisted Living Facility $750,000

$29 Million Sought From Nursing Home In Case Involving Molestation Of Comatose Resident

In Wake Of Sexual Assault Of Elderly Woman, Chicago Nursing Home & Administrator Named In Civil Lawsuit

Young, Mentally Ill Residents Pose Significant Threat To Nursing Home Residents

Last month was our busiest month in terms of visitors to our site.  Thank you for taking the time to visit, ask a question or leave a comment.  Your suggestions allow us to continually improve our site and make the Nursing Homes Abuse Blog an important Internet destination.  Many suggestions have turned into great ideas blog posts.

As always, I make it a point to answer each question personally. 

Below are last month's five most popular entries:

Failure To Monitor Bowel Movements In Nursing Home Patients Can Lead To Impacted Bowels

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.

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

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.

Smoking-Related Fires Are A Real Threat To Nursing Home Patients. Is It Time To Put Out The Fire?

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.

Nursing Home Negligence Lawsuit Claims New York Facility Allowed Advanced Bed Sore To Develop In Rehab Patient

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.

Illinois Nursing Home That Turned 'Blind Eye' To Sexual Assaults Now Faces Fines

The LaSalle County Nursing Home is a medium-sized 99 bed nursing home facility in Ottawa, Illinois.  On June 6, 2009, the Illinois Department of Public Health (“IDPH”) released a report following an investigation, revealing that a male resident at LaSalle County had molested ten female residents.

Nursing home residents suffering from diabetes face increased risk for a variety of health problems and complications, requiring additional caution and care.  However, there are no specific guidelines for providing proper care for nursing home residents suffering from diabetes.   Therefore, each facility must carefully determine the unique needs of each patient are successfully accommedated.

As the Baby Boomer generation ages, nursing homes will have to deal with increased numbers of residents and increased numbers of residents suffering from type 2 diabetes.  The 2004 National Nursing Home Survey revealed that 24.6% of nursing home residents had diabetes as a primary admission and/or current diagnosis, and one in four nursing home residents age 65 and older suffer from diabetes. 

A study, Diabetes Care in Extended-Care Facilities: Appropriate intensity of care?, published in the American Diabetes Association Journal, revealed that the care of elderly patients with type 1 insulin dependent and type 2 diabetes in extended care facilities fails to meet ADA Standards of Care. 

While 98% have their blood glucose monitored, only 38% meeting their short-term glucose goals.  While many nursing homes seem capable of regularly monitoring blood sugar, they may lack resources or knowledge for how to deal with the individual needs of diabetic residents.  This is especially true when dealing with elderly residents who might be unable to communicate to staff about low blood glucose levels or other dangerous conditions. 

A study conducted in a New York nursing home revealed that nursing home residents with diabetes are four times more likely to suffer from a dangerous fall than residents who are not diabetic.  This suggests that nursing home staff should consider diabetes as a risk factor for falls and take steps to reduce the risk for diabetic residents.  Diabetes can cause complications including a drop in blood pressure upon standing (orthostatic hypotension) and visual impairments; yet, researchers found that neither of these complications explained the increased risk of falling. 

One potential explanation for the increased risk of falls is that diabetics can experience problems with the peripheral nerves in their feet (peripheral neuropathy), which can affect sensation and cause pain and numbness. 

Peripheral neuropathy can cause additional complications for diabetic residents because they may be less likely to feel when their feet have become injured or are developing a pressure sore because of numbness.  Therefore, it is important for nursing home staff to regularly check the feet of diabetic patients so that minor injuries can be treated before they become infected.  This is especially important because diabetics tend to heal more slowly. 

The slower healing rate of diabetic residents is also concerning for residents who are recovering from pressure sores, injuries, or surgery.  Because of the prolonged recovery period, diabetic residents are more susceptible to infection.  Therefore, nursing home staff must take extra precautions to check on the injury or site that is healing to watch for infection or complications. 

Sources:

Diabetes Health: Nursing Home Care for People With Diabetes A Mixed Bag

MayoClinic: Type 2 Diabetes

CDC: National Nursing Home Survey (NNHS)

The Medical News: Study Shows That Nursing Homes Should Consider Diabetes A Significant Risk Factor For Falling

The Journals of Gerontology: Diabetes Mellitus Is Associated With An Increased Risk Of Falls In Elderly Residents Of A Long-Term Care Facility

Diabetes Care: Diabetes in Nursing Homes: United States 2004

Nursing Homes Abuse Blog: Nursing Homes Not Prepared To Handle Diabetic Residents