Nursing Homes Abuse Blog - By Jonathan Rosenfeld

This is the first in a series of interviews I have done with professionals in the medical, legal and caregiving communities related to the current state of nursing homes in the United States.  I am always in favor of getting different perspectives from professionals as to their perceptions and suggestions.  I hope you find these interviews as informative as I do.

Who are you and what type of work do you do? 

Angela Morrow, RN, BSN, CHPN.  I'm a registered nurse with a specialty in hospice and palliative care.  I care for patients and their loved ones at the end of life.  I'm also a writer and the Guide to Palliative Care for About.com.  As the Guide to Palliative Care, I write articles about hospice, palliative care, end of life concerns, the dying process, and grief and mourning.  I hope that my articles, blog, and community forum help patients who are trying to make informed decisions about end of life care and supports their loved ones.

What are some positive trends (if any) in the nursing home industry?

I'm finding that nursing homes are becoming more proactive in end-of-life/comfort care.  They are working hard to build relationships with hospice agencies to provide comprehensive end-of-life care to their patients.  Nursing homes are also trying hard to create a home-like environment for their residents rather than a hospital-like environment for "patients".

What are some negative trends (if any) in the nursing home industry?

Profits have always been important but especially during this time of proposed healthcare reform and drastic Medicare cuts, nursing homes want to maximize their bottom dollar.  Unfortunately, this often means cuts to staffing levels and important programs.

What correlation do you see with respect to the national trends in the nursing
home industry and the impact on patient care?

I see patients on hospice care receiving top-notch care, above and beyond what "skilled" or "custodial" patients are receiving.  Families notice the extra care hospice patients receive and are requesting hospice care sooner for their loved one.   This is a positive trend for patients that qualify for hospice but it is unfortunate for those who do not.  Current staffing levels in nursing homes mean many patients have to wait a long time to get needs met, or may not get their needs met at all.

How would you compare the nursing homes of today vs. those of 20 years ago?

Nursing homes today recognize the importance of focusing on the "person" not just the "patient".  As such, they provide important activities to promote exercise, socialization, and general well-being, whereas nursing homes 20 years ago were simply infirmaries for the elderly and disabled.  

What suggestions do you have for families when it comes to selecting a
facility for their loved ones?

Choose a facility that feels like home.  It should be warm and inviting and include activities that will stimulate and entertain your loved one.  The staff should be attentive and caring - notice how long call lights stay on before they are answered and how residents are treated in the hallways and common areas.  The nursing home should also have a good relationship with hospice agencies so when your loved one is nearing the end of life, you can rest assured they are receiving maximum care.

Three words to describe nursing homes:

Necessary, Understaffed, Underappreciated

Many thanks to Angela for her insights.  You can read more about Angela's work at her Guide to Palliative Care.

Group homes for children are supposed to offer safe homes for children with disabilities or children who have suffered abuse or neglect. Unfortunately, some children in group homes continue to suffer from abuse at the hands of their caregivers. Children in these homes are vulnerable to abuse and neglect and are often unable to report abuse or feel powerless to improve their situation.

Group Homes

Group homes are small, private homes in place to serve children or adults with various disabilities. Most group homes are small, with six or fewer occupants, and have round-the-clock trained caregivers. 

Group homes are also in place to serve “troubled teens” and children who are victims of abuse or neglect; most group homes of this type offer temporary housing for children while alternative housing is being secured either with a family member or in a foster home. 

Residential Treatment Centers (RTCs) offer housing for children suffering from mental illness or behavioral problems. The number of children in RTCs is increasing. In the United States, over 50,000 children are living in RTCs. Many children are placed in RTCs because there are not adequate community-based and in-home resources available. RTCs should only be used for children who display dangerous behavior that can only be controlled in a secure setting. However, the lack of resources forces many families and social workers to place children in RTCs even though they might not offer the best environment. 

Abuse of Children in Group Homes

Physical abuse can include sexual abuse, physical abuse, emotional abuse, and neglect. Common sources of abuse at RTCs include: physical and sexual abuse, improper use of restrains, over-medication, and overly severe punishments. There are two definitional standards for abuse. The first is the harm standard, which means that behavior is considered abusive if it results in actual harm or injuries. The second is the endangerment standard, which means that physical assault by a parent or caregiver that constitutes a substantial risk of physical injury is considered abuse. 

The most dangerous aspect of child abuse is that it “thrives in the shadows of privacy and secrecy . . . it lives by inattention” (Bakan – Slaughter of the Innocents: A Study of the Battered Child Phenomenon). Identification and reporting of child abuse is the first step in reducing the incidence of child abuse and improving the lives of all children in group homes. Children in group homes need to have access to an array of supportive adults including teachers, physicians, therapists, social workers, family friends, and their own friends. Having this network makes it easier for a child to report abuse. 

It is very difficult for many children to open up and report abuse. They might be threatened, intimidated, scared, or ashamed to openly discuss abuse. This is especially true for children who have a history of abuse before being a resident of a group home. Some children may think abusive behavior is normal and accept abuse as a reality of life, which should never be the case. 

Children are more likely to report abuse to an adult with whom they have a trusting relationship. Caregivers at group homes are supposed to be trustworthy adults who are in place to protect the children from abuse, but sometimes, these caregivers are the sources of abuse. This makes it even more difficult for their victims to report abuse. 

Children suffering from disabilities including mental retardation and developmental disabilities are also at serious risk for abuse and neglect because they often have difficulty communicating, which limits their ability to report abuse. These children are vulnerable to abuse because they might not be able to understand or process abuse. Because of this, it is important that caregivers and other authority figures (doctors, nurses, and social workers) pay special attention to notice indicators of abuse. 

People who interact with children in group homes, especially children suffering from disabilities, must be properly trained to recognize signs and symptoms of abuse. Training must not only cover physical indicators; it must also include behavioral changes including withdrawn behavior, bedwetting, uncommunicative behavior, depression, violence, running away, self-destructive behavior, and acting out. 

Every state has mandatory child abuse reporting laws in order to qualify for funding under the Child Abuse Prevention and Treatment Act (CAPTA), but each state differs in the application of these laws. Despite the prevalence of abuse and neglect in group homes, children continue to suffer because of inadequate monitoring. RTCs (Residential Treatment Centers) are largely unregulated. 

They are only required to report major unusual incidents (MUIs), and some RTCs fail to do even this. To compound this problem, many children are placed in RTCs that are far away from their families, so family members are unable to properly monitor their children in order to ensure proper treatment. 

Affect of Abuse on Children

Abuse of any person is a horrible and traumatizing experience. However, abused children often continue to suffer from problems later in life, after the abuse has ended. Some children are released from these group homes when they reach 18 years of age. They often leave the home ill-equipped to cope with life outside the group home and face the risk of homelessness, substance abuse, depression, and crime. 

Sources:

Child Trauma Academy: Physical Abuse of Children

Protect: National Association to Protect Children

The Pennsylvania Journal on Positive Approaches: Beyond Abuse, Treatment Approaches for People with Disabilities

Therapistunlimited.com: Group Homes for Teens

eHow: Information on Group Homes for Children

Well if you ask Jennifer Johnson at Nurse Practitioner Schools, there are many reasons-- 100 to be exact-- why people should consider a career in nursing.  I hope people may read this list and realize that nursing career can be mutually beneficial for both the nurse and patients.  Well done Jennifer!

Related:

Nursing Home Cuts Jobs Of 14 Nurses

The Keystone Of The Nursing Home: Nurses

High Staff Turnover Rates Plague Most Nursing Homes

As a nursing home lawyer who has been involved in many cases where where 'sepsis' is listed as a cause of death, I can attest to the devastating effects this complication has on patients with bed sores (similarly called: pressure sores, pressure ulcers or decubitus ulcers) and other medical conditions. 

To those unfamiliar with sepsis, it is a severe infection that effects the complete body.

The wide-reaching effects of sepsis surprised even me.  According to statistical analysis of septic hospital patients:

• Sepsis is the 10th leading cause of death in the U.S.
• 1/3 of people who develop sepsis will die
• Sepsis results in more than $17 billion in medical expenses every year

The fight against sepsis has now begun!

The Banner Desert Medical Center (Arizona), is now the first medical center in the country to implement a sepsis detection program to help improve the survival rate of patients.  The hospital uses a scientific formula to detect warning signs that are indicative of sepsis including:

• changes in body temperature
• increases in heart rate
• changes in respiratory rate
• white blood cell count

Once the early signs of sepsis are identified, the hospital is able to administer treatment quickly-- and greatly improve the patients survival rate.  At Banner Medical Center, the hospital credits the new program with the early detection of sepsis in 60 patients within the first two-month period that traditional detection techniques were unable to spot.  Read more about this important development in sepsis detection here.

My hope is that the sepsis detection instruments used at this hospital become common practice-- not just amongst hospital patients-- but nursing home patients as well who frequently receive delayed medical treatment because nursing home staff do not have the tools to make a diagnosis of sepsis.

Related:

Is sepsis related to bed sores? BedsoreFAQ.com

Despite Their Avoidability, Bed Sores Continue To Plague Nursing Home & Hospital Patients In All Demographics

Lawsuit Alleges: One Week In The Nursing Home Results In Significant Deterioration Of Pressure Sores & Sepsis

Bed Sore Resources

Bed Sore Treatment Specialists

This year, more than 80,000 episodes of sexual abuse involving children will be reported to authorities. Take a deep breath....  

Because the actual number of instances sexual abuse in children is believed to be far greater, due to the fact that only a fraction of the childhood sexual abuse cases get reported to authorities.

While the sexual abuse may occur both inside the home-- at the hands of friends or family, research tells us that the incidence of sexual abuse in children increases outside the home.  

While thankfully, far from a commonplace occurrence, children in a day care, group home or institutional setting are at an increased risk of becoming victims of sexual abuse compared with their peers in a more traditional settings.

The impact of sexual abuse amongst children varies greatly dependent upon individual factors such as: the child's personality, their age and their living situation.  Similarly, victims of childhood sexual abuse manifest the effects of their abuse at different times of their lives.  In some cases, the sexual abuse victims may not even become aware of the full effects of their abuse until later in life-- when they begin to experience difficulties with relationships and intimacy.

Common manifestations of sexual abuse in children include:

• Sudden behavior changes
• Difficulty sleeping
• Withdrawal from friends and family
• Toileting accidents
• Behavioral problems
• Inappropriate sexual behavior
• Aggressiveness

Despite the obvious level of discomfort that accompanies sexual abuse topics, experts agree that some of the most productive part of sexual abuse treatment involves an open discussion of the incident itself and acknowledgment of related feelings.

Treatment for victims of sexual abuse usually incorporates various aspects of individual and group therapy.  Because family members may experience feelings of guilt and embarrassment, it is also important that counselors work with the family unit as well as the child. 

Pursuing A Childhood Sexual Abuse Case Against A Facility

In order to recover damages against a facility where sexual abuse have occurred, it may be important to establish that the management was in a position to prevent the act from occurring.  In some cases this means the facilities failure to screen its employees, while in other situations it may be necessary to establish that the facility failed to intervene when it should have known when the alleged conduct occurred.

As attorneys who are devoted to representing victims of sexual abuse and assault, we have developed contacts with medical and psychological professionals across the country to both assist our clients with the recovery process as well as assure that the full extent of their trauma gets conveyed in a compassionate, yet effective way to decision makers such as defense lawyers, insurance companies or to a court.  

At all times, we are mindful of the best interests of out clients and frequently work hard to resolve matters prior to litigation and before the individual is forced to re-live their trauma before a jury.  

You can always talk with an attorney experienced with representing victims of sexual abuse free of charge.  All contacts are kept in the strictest confidence. (888) 424-5757

Resources:

Responding To Child Sexual Abuse, American Academy of Child & Adolescent Psychiatry

Alleged sexual abuse at a day care center: impact on parents.

The spectrum of sexual abuse in daycare: An exploratory study, Journal of Family Violence 3 (4): 283-298.

Child Injury Laws Blog

Related:

Children In Nursing Homes: Truly The Most Vulnerable

Children In Day Care Are Susceptible To Many Of The Same Problems Our Elderly Nursing Home Patients Encounter

Are Group Homes A Viable Alternative To Nursing Homes?

Victim Of Sexual Abuse To Receive $3.2 Million From Chicago Archdiocese

A Philadelphia jury awarded $5 million in punitive damages to the widow of a man who died from bed sores he developed during a hospitalization and then worsened during a subsequent nursing home admission.  

The case, believed to be the first of its kind in terms of awarding punitive damages against a nursing home in Philadelphia courts, was allocated: $1.5 million against Jeanes Hospital and $3.5 million against Hillcrest Convalescent Home. 

According to widow's lawyer, Steven R. Maher, Jeans Hospital failed to diagnose the man's urinary tract infection that contributed to the development of bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) and then the man was transferred to Hillcrest Nursing Home where the bed sores worsened.  Despite his wife's best efforts to care for her husband at home, the man succumbed to the bed sores approximately two years after he developed them.

This punitive damage award is in addition to a $1 million compensatory damage award a jury had previously awarded in the case.   Incidentally, Jeanes Hospital is part of the Temple University Health System and Hillcrest is owned by Genesis HealthCare Corp., a large nursing home operator in the Northeast.

While punitive damages are rare due to the high threshold an injured party must prove, in this case 'outrageous and reckless conduct', it doesn't surprise me that these type of damages were awarded in a bed sore case.

Obviously, the plaintiff's lawyers did a great job presenting their case, but when jurors hear and see how devastating a bed sore can be, it most definitely evokes feelings of rage-- when they see how a medical facilities neglect resulted in such devastating injuries such as advanced bed sores.

Related:

Unusual damages set in Phila, bedsores case, Philly.com, March 17, 2010

Over 500,000 Adults Suffer From Bed Sores In Hospitals

New York Jury Punishes Nursing Home Where Man Develops More Than 20 Bed Sores

If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?

Bed Sore Pictures, Bed Sore FAQ

Bed Sore Resources

Bed Sore Treatment Specialists

To many, the use of bed rails on a hospital bed provides an added level of safety  to prevent falls for patients who may be in a weakened physical state.  While use the of bed rails may be appropriate in certain situations, research tells us that bed rails are still significantly overused and can endanger patients by allowing them to become entrapped in a gaps created between the rail and the side of the mattress.  The entrapment risk can quickly kill a patient within minutes.

The New York Times recently reported on potential dangers associated with the unnecessary use of bed rails in the nursing home setting.  The Time article cites Steven Miles, a geriatrician and bioethicist at the University of Minnesota who has studied the usage of bed rails amongst the elderly.

"Rails decrease your risk of falling by 10 to 15 percent, but they increase the risk of injury by about 20 percent because they change the geometry of the fall," Miles notes.

Information regarding the dangers of bed rails has lead to a reduction of their usage-- now, less than 10% of nursing home patients have beds with bed rails.  Nonetheless, the lack of manufacturing guidelines when it comes to gaps between the mattress and the rails, continues to expose patients to an unnecessary risk.

I continue to see safety problems involving the use of mismatched mattresses and bed frames in some nursing homes and hospitals.  I recently worked on a case involving the asphyxiation of a patient where a new mattress was used on a bed frame more than 20 years old-- creating a gap of more than 8 inches between the mattress and the railing.  Rather than replace the entire bedding set-up, the nursing home had apparently tried to save some money and replace the mattress alone.

Related Nursing Homes Abuse Entries:

Warnings Do Little To Prevent Bed Rail Entrapment

How To Measure Bed Rail Gaps: A Video

Nursing Homes Curtail Use Of Physical Restraints With Residents

The family of a man with a spina bifida has filed a lawsuit against Tower Hill Healthcare Center, alleging the facilities neglect resulted in the man's physical injury and deterioration since he was admitted to the facility.  

According to the lawsuit, the man was admitted to Sherman Hospital on July 5, 2008 for an elevated body temperature.  However, when staff at the hospital examined the man they noticed other problems such as: poor oral hygiene, bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) covered with feces and an exploded colostomy bag. 

Consequently, the hospital staff reported the suspected mistreatment to the Illinois Department of Health to investigate further.

The man died on July 31, 2008 due to a staph infection and pneumonia.  This nursing home negligence lawsuit is pending in Kane County, Illinois.  Read more about this lawsuit against Tower Hill Healthcare Center here.

About Tower Hill Healthcare Center

Tower Hill Heathcare Center is located at 759 Kane Street in South Elgin, Illinois.  Despite the facilities relatively impressive 4-star (out of 5 stars) rating, the facility has been cited numerous times for safety violations related to patient injury.  The majority owner is of Tower Hill is Jack Rajchenbach.  Mr. Rajchenbach knows his was around Illinois nursing homes, having ownership interest in the following facilities:

• BRIDGEVIEW HEALTH CARE CENTER 
• THE CARLTON AT THE LAKE
• CLARK MANOR CNV CENTER
• SPRINGFIELD TERRACE 
• TOWER HILL HEALTHCARE CENTER 
• GLENVIEW TERRACE NURSING CENTER
• THE IMPERIAL GROVE PAVILION
• THE ARC OF JACKSONVILLE, LTD.
• GROVE LINCOLN PARK LVG & REHAB
• PETERSON PARK HEALTH CARE CTR
• EMBASSY HEALTH CARE CENTER
• GROVE NORTH LIVING & REHAB CTR
• WHITEHALL NORTH
• HARMONY NURSING & REHAB CENTER

Related:

Why is a colostomy needed for patients with severe bed sores?

What are the signs of infection for people who have bed sores?

Is sepsis related to bed sores?

What are nursing homes required to do to prevent bed sores?

Why are physically disabled patients at risk for developing bed sores?

Bed Sore Resources

Bed Sore Treatment Specialists

In the ever mounting pile of problems facing nursing home patients, we can now add another-- nursing home patients are more likely to die following gastrointestinal (GI) operations than their peers living independently.  A study compared the mortality rates for nursing home patients who underwent six types of GI operations including: bleeding GDU's, benign colon disease, colon cancer, cholecystitis and appendicitis.

After evaluating data from 30,721 nursing home patients and 1.18 million Medicare beneficiaries, the studies authors determined that nursing home patients are more than three times more likely to die following the surgical procedures than those living in the community.

The dramatic differences in the surgical outcomes are believed to be the result of a variety of factors that the study was unable to assess including poor conditioning and malnourishment.  

Despite the obviously disappointing data, surgeons are still convinced that GI surgery is necessary for some nursing home patients as that many of these conditions have almost certain mortality when left untreated. 

Now that the medical community knows that this problem exists, they must work to develop a plan to minimize some of these health known problems.  "If we can tease these things out, that's when we can try to design interventions that would optimize outcomes in terms of preparing these patients for surgery and developing pathways and interventions postoperatively," said senior author Emily Finlayson, MD, MS, an assistant professor of surgery at the University of California, San Francisco.

Though I would never hold myself out as an expert post-surgical care, my experience has been that orthopedic injuries such as hip fractures and limb fractures that require surgery are particularly devastating for nursing home patients.  Sadly, I see many of these people deteriorate physically and emotionally after this trauma.  Perhaps this research would be useful for orthopedic patients as well?

Resource:

Nursing Home Patients Suffer Higher Post-op Mortality Rates, General Surgery News, March, 2010

Following a medication-error related death and other medication-related problems that resulted in patient injuries, Minnesota Department of Heath investigators concluded that Fair Oaks Lodge in Wadena, MN was guilty of neglect and other federally mandated nursing home standards.

The 'major medication errors' occurred within 16 days of one another.  According to the State's investigative report:

• A medication aide mistakenly gave an Alzheimer's patient drugs for her central nervous system, the heart and anti-psychotic medication all of which resulted in an immediate drop of her blood pressure.  Despite being rushed to the emergency room, the elderly woman died three days later.
• A patient was hospitalized after receiving two does of Tylenol within two hours and an improper medication related to hypertension
• A third nursing home patient was hospitalized after a nurse administered medications a medication aide had intended for another patient.

Despite the serious medication-related problems at Fair Oaks, state investigators still found a medication error rate of 18% 2 1/2 months later.  Read more about these medication errors in a nursing home here.

Medication Errors

In the nursing home setting, some of the more common medication errors include:

Administering The Incorrect Prescription

Medication errors can result when there is a mis-communication or misunderstanding of drug orders. These errors may be due to: poor handwriting, confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations. Doctors must take reasonable care in correctly and accurately writing prescriptions and staff must similarly confirm medication types and dosages when in doubt.

Medication errors can also occur when doctors take an incomplete medical history from a patient. For example, the doctor might not know about the patient’s allergies, any other medications the patient is taking, previous diagnoses, and lab results. Nursing homes should help treating physicians by ensuring that they provide the physician with accurate medical charts.

Failure to Consider Adverse Side Effects of Drugs

Many prescription (and over-the-counter) medications have serious side effects that should be considered before taking them. Some serious and common side effects include: allergic reactions, heart problems, liver and kidney failure, weight gain/loss, and psychological effects. The doctor prescribing your medication should consider the pros and cons of prescribing the medication as opposed to leaving the condition untreated or prescribing a different medication. Similarly, the staff in a nursing home, should monitor patients to help detect adverse reactions as quickly as feasible.

Incorrect Medication Dosage

Prescription medications have more serious dangers associated with them than over the counter (OTC) drugs. Therefore, it is important that nursing home staff issue the correct drug (the one the doctor prescribed) at the correct dose. At many nursing homes and medical facilities, medications are administered via a ‘medication cart’ where many similar-looking pills are stored. Consequently, staff in nursing homes must check and re-check before administering medication to assure the patient receives the proper dosage.

Medical complications may arise when patients are administered too much or too little of a drug. Many prescription medications require must be taken at a specific time, staff must be aware of these administration parameters and dispense the medication accordingly.

Adverse Drug Interactions

Many older adults, take multiple prescription medications, which are commonly prescribed my multiple doctors. However, problems can occur because the doctors prescribing these medications might not know about the other drugs you are taking. This can lead to serious complications stemming from drug interactions. Drug-drug interactions are not the only type of potentially dangerous drug interactions; there can also be drug interactions with foods, beverages, and dietary supplements.

There are three main types of drug interactions:

• Drugs with food and beverages
• Drugs with dietary supplements
• Drugs with other drugs

Drug interactions can reduce the effectiveness of drugs, cause unexpected side effects, or increase the action of a particular drug. Drug interactions with food and beverages might result in delayed, decreased, or enhanced absorption of a medication. Dietary supplements can also cause a variety of drug interactions, and with fifty percent of American adults using dietary supplements (vitamins, minerals, amino acids, herbs or botanicals) on a regular basis, the risk of negative drug interactions is high.

Nursing Home Liability for Medication Errors

Medication error cases can frequently be some of the more complex cases due to the fact that a variety of parties may be responsible for the error(s). In some cases, liability may be imposed on the physician, nursing home and pharmacy involved in the incident. Consequently, in order to fully investigate each parties culpability, it is important to speak with a lawyer experienced in handling cases involving medication errors as soon as feasible after the event.

Related Nursing Homes Abuse Blog Entries:

Medication Aides In Nursing Homes: A Push To Save Money Or Improve Patient Care?

Study Shows Errors In Timing Of Administration Of Medication In Assisted Living Facilities

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

Improper Drug Dosage, Wrong Medication, Interactions With Other Drugs.... May Be The Result Of Pharmaceutical Malpractice

Many families are forced to institutionalize their disabled children in nursing homes because of many states don’t have the resources to pay for in-home care. 

This puts parents in the difficult position of funding expensive home care on their own or having their child live in a nursing home, surrounded by elderly adults, and many families simply cannot afford the cost of in-home care workers and nurses. 

The Centers for Medicare and Medicaid Services estimates that about 4,000 children live in nursing homes in the U.S. and that number is steadily growing as health care resources are increasingly spread thin.

Thousands of children with disabilities end up living in nursing homes because of insufficient coverage for in-home care by state governments and a shortage of skilled home care workers. In 2000, the Centers for Medicaid and Medicare Services estimated that 4,886 children lived in nursing homes; of these children, 1,222 suffered from mental retardation or a developmental disability. 

Medicaid guarantees long-term care for all people with disabilities, including children. However, many disabled children, who would be adequately served by proper in-home care, end up in nursing homes despite higher costs for nursing home care than in-home care. 

The University of Minnesota Research and Training Center on Community Living reported that home and community care cost about $26,000 per year while the state of Georgia spends about $81,000 per year on each patient in nursing homes. Although some federal and some state funding has been increased to help remove disabled children from facilities with four or more disabled persons (congregate settings), the number of institutionalized children has remained largely unchanged. 

Many disabled children end up in nursing homes because of insufficient state resources. About 93,000 special needs people are on waiting lists for home and community based services. However, there are not enough skilled nurses, therapists, and home health care workers to support the people who most need their help. In many cases, the family’s private insurance won’t cover the cost of medical equipment, and in-home nursing and therapy. This leaves many families with only one choice, nursing home care. 

Most nursing home care is focused on older adults because elderly residents constitute the majority of the resident population. As expected, treatment and health concerns differ for older adults and children. Also, children often spend more years living in nursing homes than the elderly adults they are surrounded by because of the age difference. This means more years spent living in a nursing home, away from their family, usually costing Medicare more money than if the child were able to live at home receiving in-home support services. 

However, until states step up funding to improve in-home care resources, these children will remain stuck in nursing homes, hardly a suitable environment for most children, especially when their families would prefer them to be living at home. 

Nursing Homes, Group Homes & Day Care Facilities Responsibility To Care For Children

The foreign environment of a nursing-home-world created for adults, leaves many children at risk for abuse and mistreatment at the hands of caregivers and other patients.  I have successfully prosecuted cases on behalf of many of these children and young-adults in the following types of cases:

• Sexual Abuse
• Physical Abuse
• Neglect
• Molestation
• Food Poisoning
• Medication Errors

Working side-by-side with some of the most respected authorities on the long-term effects of abuse on young people, we have successfully secured money to provide for the future.  Many of the sexual abuse and molestation cases we work on can be resolved prior to the filing of a lawsuit, in a confidential manner-- with minimal impact on the individual. 

If you believe a young person suffered from an injury, abuse or neglect in a nursing home, foster home, day care, group home or any other structured setting, we would honor the opportunity to speak with you.  As always our services are free if we do not recover on your behalf. (888) 424-5757

Resources:

Medical News Today: Wall Street Journal Examines Nursing Home Care for Children with Disabilities

VirginiaSpecialNeeds.com: Thousands of Children with Special Needs Are Living in Nursing Homes 

Research and Training Center on Community Living: Number of Children in Nursing Homes 2002

Wall Street Journal: Babes Among Elders, Nursing-Home Kids

Related Nursing Homes Abuse Blog Entries:

Alden Village North Charged With Neglect After Child Dies Due To Inadequate Nursing Care

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

Child Injury Laws: Nursing Home Abuse: The Deaths Of 13 Children Linked To Poor Care At Chicago Nursing Home

“When planning for a year, plant corn. When planning for a decade, plant trees. When planning for life, train and educate people.” - Chinese Proverb

At employee at St. Anthony Health Care Center in St. Paul, MN failed to follow these words of wisdom when she failed to follow the fall precautions set for in a patients care plan.  An investigation into the matter, revealed that the nursing home employee's errors contributed to the patient's death. 

A Department of Health investigation into the matter cited the employee for neglect when she made the following errors:

• Failing to activate a fall alarm
• Failing to lower the patient's bed to a lower height
• Failing to put a mat beside the patient's bed to provide padding in cases of falls

The patient fell out of her bed and hit her forehead and sustained a subdural hematoma.  The patient died four days after the incident.

When questioned by Department of Health investigators, the CNA 'admitted she used poor judgment'. Incidentally, the investigation revealed the facility itself was not at fault.

I certainly appreciate this CNA's honesty when it comes to the careless errors she made.  However, I am always frustrated when Heath Department investigators fail to impute responsibility on the part of the facility itself.  I find it hard to believe no other employees witnessed this situation.  Further, it only would have taken another co-worker a few seconds to implement some of the fall precautions had they chosen to check on this patient.

Read more about this case involving neglect in a Minnesota Nursing Home here.

Related Entries:

Falls In Nursing Homes Are A Serious Threat To The Safety Of Many Patients

New Technology Promises To Reduce Falls In The Elderly Population

Poor Training & Under-Staffing Blamed For The Death Of A Nursing Home Patient Who Died From Injuries Sustained After She Was Dropped By A CNA In A Minnesota Facility

Even Common Falls Put Elderly At Risk For Developing Subdural Hematomas

Shelbyville Rehab & Health Care Center has 80 certified beds and a one-star (much below average) Medicare rating.  The facility is located in Shelbyville, IL.  Although the facility only had five health deficiencies between 9/1/08 and 11/30/09, a significant abuse incident (see below) occurred in 2009, which led to the facility’s poor rating. 

During an August 26, 2009 annual licensure and certification survey and complaint investigation, it was determined that the facility failed to identify one resident’s willful act of assault of another resident as an act of abuse which resulted in an Immediate Jeopardy situation.  According to the Centers for Medicare/Medicaid Services (CMS), Immediate Jeopardy (Level of Harm – Level 4) is defined as a situation in which immediate corrective action is necessary because the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident receiving care in the nursing home. 

On August 7, 2009, one male resident assaulted another male resident.  The perpetrator (the resident who attacked the other resident) approached the other resident who was sitting in his wheelchair and placed him in a choke hold and began punching him in the head and yelling at him.  The resident who was attacked was immediately removed from the area and examined.  Thankfully, the resident did not suffer any injuries from the attack. 

This incident was witnessed by a Registered Nurse (RN), who reported the incident to the Administrator.  The perpetrator told the nurse that he attacked the other resident because he made him mad.  The perpetrator received counseling and was removed from the area and was supposed to be placed on 15 minute behavior checks.  Despite orders for increased supervision of the resident perpetrator following the attack, the 15 minute behavior checks never started and the Director of Nursing could not find any documentation of the order, nor could the Director of Nursing explain why the checks were never started.  In the days following the attack, the resident was allowed to move about the facility in his wheelchair without any restrictions or staff observation in order to ensure that he did not have another violent outburst. 

During interviews on August 18th, the resident perpetrator stated that he had been told that the other resident was occupying his dining table spot.  He stated that the other resident refused to move and used a curse word and threatened to “blow [his] head off with a gun.”  The perpetrator said that the grabbed the other resident to see if he had a gun or other weapon before being pulled away by facility staff.  The perpetrator denied hitting the other resident and stated that the other resident had threatened him on previous occasion.  During the incident, both the Registered Nurse (RN) and Licensed Practical Nurse (LPN) witnessed the resident perpetrator hit the other resident in the back and side of the head with a closed fist. 

The facility experienced an Immediate Jeopardy situation, beginning on August 7, following the assault.  The facility failed to identify this assault as abuse and provide necessary resident protections for all residents.  The facility did not identify an Immediate Jeopardy situation until August 18, over a week after the assault.  The facility then took steps to remove the Immediate Jeopardy by placing the resident on visual checks, providing him with a private room, and educating staff about the facility’s abuse prevention policy.  The Immediate Jeopardy was removed on August 20, 2009; however, the facility remained out of compliance because of ongoing intensive monitoring of the resident perpetrator and ongoing re-education of staff. 

The resident who was attacked actually died on August 12, just days following the attack.  However, the resident’s attending physician reported that his death was attributed to a chronic medical condition and could not correlate the death to the recent incident. 

It is alarming that multiple nursing home staff members witnessed one resident attack another resident and no measure were taken to ensure the safety of the rest of the resident population.  The resident who was attacked had the right to be free of abuse and being attacked by another resident with no following investigation or efforts to ensure his safety constitutes abuse.  This abuse investigation also revealed that the facility failed to investigate two of three abuse allegations, and also failed to properly and thoroughly screen two CNAs for criminal backgrounds and eligibility. 

Although Shelbyville Rehab & Health Care Center has a relatively low number of health deficiencies (5), the deficiencies that did occur endangered the entire resident population.  This complaint investigation survey regarding an incident of abuse reveals how even one health deficiency can have dangerous and far-reaching consequences.

Shelbyville is owned and operated by Peterson Health Care.  Peterson Health Care owns and operates Nursing Facilities, Assisted Living Facilities, Independent Living Centers, Supportive Living Facilities and Developmentally Disabled Homes.

Special thanks to Heather Kiel, J.D. for her assistance with this Nursing Homes Abuse Blog entry.

 Resources:

IDPH: Shelbyville Rehab & Healthcare Center

Medicare: Shelbyville Rehab & Healthcare Center

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