Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Seems obvious.  But perhaps the best person to ask about the state of nursing homes is someone living in one.  Kathleen Mears is a resident at an Ohio Nursing Home.  Kathleen is a fellow blogger at Long Term Living.  Check out her latest entries here.

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

I have been a nursing home resident for 14 years. I came here when I was 47 years old and I am 61 now. I am a writer and have been writing a column in Long Term Living Magazine since September of 2009.

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

That is a difficult question for me to answer. The only positive trend that I can see is ' person centered care'. Our last administrator believed in that philosophy and it seemed like we had a better relationship with her.

I do think they are trying to change the design of the newer nursing homes. But since I do not live in that type of facility, I do not know how it would impact me as a resident.

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

I think that would be the building ideas that come about. I personally do not like the Main Street idea. It just seems like window dressing to me. What really needs to be changed as a way that care is delivered.

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

I think that most nursing home owners realize that nursing homes must get ready for the baby boomers who will be arriving in a few years. Nursing homes will no longer have the patient population born between 1900 and 1930 that will wait for their care. I know that care in nursing homes is definitely changing where I live. Maybe it is only one person at a time but it is changing.

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

Many nursing homes today are physically virtually unchanged from the way they were in 1990. Many of them are still styled in the way that they were built in the 70s. The biggest changes would be in the newer nursing homes featuring the Main Street design. They would definitely be prettier to the potential residents eyes.

Residents are treated with more respect today. The whole nursing home industry knows that they are being watched by visitors and others who enter their facility.

What suggestions do you have for families when selecting a nursing home for their loved ones?

I would suggest that family members to their own research into the facility's background. They should make visits unannounced. They should not take the PR given out by the marketing person at the facility as gospel. They should ask hard, tough questions. They should visit the units to see how they look, how they sound, and how they smell. They should taste the food to find out what it is like. If possible, they should read a few books about nursing home life and check out the New York Times Blog " The New Old Age".

Three words to describe nursing homes:

Custodial Care Homes

Sadly, the most recent episode of the sexual assault of nursing home patient at the hands of convicted felon-- who happens to be a fellow patient--- occurred last week in a Florida Nursing Home.  57-year-old Larry Donneal Evans, admitted to the sexual assault of a disabled female patient at the nursing home. 

The nursing home staff caught Mr. Evans in the act of assaulting the disabled woman and immediately reported the incident to police authorities. In addition to admitting to his inappropriate behavior, Mr. Evans stated that he did not stop his groping because the woman never said 'stop'. 

Prior to his admission to the nursing home, Mr. Evans served four years in jail for violently resisting an officer and possession of cocaine. 

To the left, is a photo of Mr. Evans that was taken by the Pinellas County Sheriff Department.  Read more about the sexual abuse of a nursing home patient here.

I'm getting sick of hearing about these type of sexual assault cases involving nursing home patients.  Facilities need to implement more protective measures to assure patients remain safe from the predatory acts of their fellow patients.  If facilities can not assure the safety of all patients, people with criminal backgrounds should never step foot in these facilities.

Related Nursing Homes Abuse Blog Entries:

Atleast 50 Convicted Sex-Offenders Living Freely In Illinois Nursing Homes

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

Sexual Assaults In Nursing Homes, Not Exactly A Pleasant Topic-- But Is An Issue That Needs Attention

Most people never associate dental care with with nursing homes.  To be honest, I never really did either until I was contacted by a family regarding a nursing home patient who developed a horrible infection in their mouth that went untreated for months.  By the time the infection was diagnosed, it had progressed to the point that the man's jaws had become infected.  Within weeks of the diagnosis, the man died from the infection.

While the above situation is certainly a case of extreme neglect, dental care of nursing home patients is an issue that deserves more attention than it currently receives.

Poor oral health and untreated dental conditions are a serious problem for nursing homes, especially because older Americans are more prone to tooth decay. Roughly 23% of adults between the ages of 65 and 74 have severe periodontal disease. Despite the high percentage of dental problems, adults aged 75 or older represent the adult age group with the lowest percentage visiting a dentist within the past year (U.S. Department of Health and Human Services – Oral Health Report 2002, Table 7.1.1). 

Figure 7.1.1. Percentage of the U.S. population that visited a dentist within the past year by age group

 

While bad teeth might seem like a relatively minor problem when compared to the many medical issues affecting nursing home residents (including disease, illness, neglect, mental illness, and isolation), untreated dental conditions can cause residents severe pain, malnutrition, social isolation, and severe dental disease. 

Furthermore, poor oral health can actually affect overall health (recent studies show a correlation between gum disease and heart disease, and periodontitis shares risk factors with several chronic degenerative diseases such as ulcerative colitis and lupus).  And, some diseases have oral symptoms, so proper monitoring of oral health can provide indicators for serious diseases and conditions (while examining patients’ teeth, gums, and tongues, dentists have found evidence of heart or liver disease, eating disorders, diet deficiencies, diabetes, arthritis, osteoporosis, and some autoimmune diseases).

Oftentimes, dental disease is caused by bacteria and fungus.  Nursing home staff members need to ensure that residents properly clean their teeth in order to decrease the number of bacteria and fungus.  This can be accomplished by having residents brush their own teeth, using fluoride (fluorinated water, fluoride in toothpaste, or fluoride lozenges), and having residents chew gum after meals.  However, chewing gum should be used with caution because many residents have difficulty swallowing and gum can create a choking hazard. 

Many residents require assistance with dental care and oral hygiene because they are unable to brush their own teeth because of weakness, arthritis, limited range of motion, illness, dementia, or diminished mental capacity.  Therefore, staff members must ensure that residents are able to properly and thoroughly clean their own teeth or provide the assistance necessary to achieve and maintain good oral hygiene.  Nursing home staff members should assist with brushing, flossing, and checking for canker sores and abscesses. 

Dry mouth is one of the most common dental problems for older people because it is a common side effect of many medications.  Dry mouth, besides just causing discomfort and irritation, can also increase gum recession, which can lead to root area cavities.  Dry mouth can be treated with increased liquid intake, rising the mouth out with water, using a commercially available saliva substitute, avoiding dry and salty foods, and sucking on sugarless hard candies. 

Illinois (through the Illinois Department of Public Health (IDPH) Steering Committee on Illinois Oral Health in response to the 2002 U.S. Oral Health Report) has recognized that efforts need to be made to improve statewide oral health education and awareness programs for at-risk populations (including the elderly).  Also, training programs for medical professionals who work with these at-risk populations need to be trained to recognize oral health disease.  The resources, nursing home dental health programs, and the staff members or professionals who provide dental services must improve before any widespread improvements will be seen in dental health in nursing homes. 

Many nursing homes focus on medical care to the detriment of their residents’ oral health.  It is important to achieve and maintain good oral health for nursing home residents because it can improve overall health and reduce health complications.  If you notice that a family member has decaying teeth, is not eating as much food, or having trouble chewing, they might be suffering from severe dental problems.  It is important to ask the nursing home about what dental services are being provided in order to ensure that your family members stay healthy and receive proper care.  

Thank you to Heather Keil, J.D. for her assistance with this entry.

Resources:

Dentistry.com: Oral Care in Nursing homes

A Place for Mom: Healthy Mouth, Healthy Body: Senior Dental Problems

Family Gentle Dental Care: Nursing Home Oral Health Care

Medical News Today: Case finds oral health of residents in nursing homes needs more attention, USA

TheFreeLibrary.com: Nursing-Home Patients Need Better Dental Hygiene

Academy of General Dentistry: Nursing Home Oral Health Care

Department of Health and Human Services: Oral Health U.S. Report, 2002

Today's question and answer session regarding nursing home care is from Kimberly Grandel, the director of Re-Creative Resources.  Thanks Kim!

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

My name is Kimberly Grandal. I am the Executive Director of Re-Creative Resources Inc., a LTC Therapeutic Recreation and Activity Consultant/Educator

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

Increased person-centered approaches to care

Increased interdisciplinary approaches to quality of life

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

I see more and more facilities adopting the culture change movement, which in theory is a wonderful approach to care. With this trend however, I also hear more and more stories that certified and qualified Activity Professionals and Recreational Therapists are being replaced by the "universal worker". Often times you'll see more domestic type activities in these culture change homes, which is fine for some residents, but not for all-I fear that we will abolish the field of therapeutic activities and recreation in LTC based on the assumption that uncertified, unqualified individuals can facilitate meaningful activities.

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

I see that nursing homes are much cleaner, more homelike, have higher quality food, more interdisciplinary approaches to meet the needs of the residents, more resident choices for food, activities, preferences and such, better staffing in terms of qualifications and numbers, and a much more pleasant atmosphere than many years ago.

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

I always tell families to interview the residents of the facility they are considering. I also inform them to tour on weekends and evenings as well. Of course staffing, food, activities, laundry, doctor services, therapy, should be considered as well.

Three words to describe nursing homes: ____, _____, _____

Care, life, corporation

A hot cup of soup, a radiator, an uncalibrated water thermostat or a fire can all pose serious burn risks for nursing home patients. Your skin is necessary for your body’s regulation of fluid and temperature; it also acts as a barrier against bacteria and viruses. When you burn your skin, you put yourself at risk for infection, tetanus, scarring, permanent injury, and even death depending on the severity of the burn. 

Stages of Burns

Burns are categorized as first degree, second degree, or third degree based upon the depth of the burn and the percentage of total body area affected. 

 

First-Degree Burn

A first-degree burn is the least serious type of burn where only the outer layer of skin (dermis) is burned. Symptoms include: redness, mild swelling, and skin that is tender to the touch.  

 

Second-Degree Burn

A second-degree burn occurs when the first and second layer of the skin is burned. Symptoms include: blisters, reddened and splotchy skin, swelling, and pain.  

 

Third-Degree Burn

A third-degree burn is the most serious type of burn and occurs when all layers of the skin are burned. This causes permanent tissue damage and may affect fat, muscle, and even bone. Third-degree burns damage the nerves and blood vessels, which can lead to a white and leathery appearance of the skin. Symptoms include: severe pain, areas of charred black skin, or skin may appear white or dry.  

 

 

If you suffer a burn (second or third-degree) that covers more than 15-20% of your body, you are at risk for significant fluid loss, which could lead to shock if fluids are not replaced intravenously. If you suffer a burn affecting over 50% of your body, then you have a significant mortality risk, especially if compounded by underlying medical conditions and advanced age. 

Burn Treatment

In order to properly treat a burn, it is important to first determine the extent of tissue damage. Minor first-degree burns and second-degree burns that are no larger than 3 inches in diameter require different treatment than third-degree burns. It is important that burns are properly and thoroughly cleaned in order to prevent infection because your body’s barrier against germs. 

For minor burns, you should:

• Cool the burn (hold burn under cool running water or immerse in cool water for 10-15 minutes)
• Cover the burn with a sterile gauze bandage (wrap gauze loosely)
• Take an over-the-counter pain reliever (aspirin, ibuprofen, naproxen, or acetaminophen)

It is important that you do not use ice directly on the burn (which could cause further damage to the wound), do not apply ointments to the burn (which could cause infection), and do not break blisters (which makes them more vulnerable to infection). As the burn heals, watch for signs of infection, symptoms include: increased pain, fever, redness, swelling, or oozing. 

For major burns, which are third-degree burns or large second-degree burns, you should contact emergency medical help and follow the following steps:

• Do not remove burned clothing
• Do not immerse burns in cold water (which could cause hypothermia and shock)
• Check for signs of circulation (breathing, coughing, or movement)
• Elevate the burned body part or parts
• Cover the area of the burn

Also, for severe burns, it is important to get a tetanus shot or make sure you have had one in the last ten years because burns are susceptible to tetanus. 

For major burns, doctors can use skin grafts to improve the function and appearance for large burn areas. A skin graft is a surgical procedure where a piece of skin from the donor area of the patient’s body (usually the buttocks or upper thighs) is transplanted to the damaged area of the patient’s body. The graft can help reduce fluid loss, protect the burn from infection, reduce pain, allow tissues underneath to heal, and improve the appearance of burned skin. In order to prepare the burned area for the skin graft, doctors remove (excise or debride) the burned skin. There are also skin banks, which store donor skin from organ donors, which provide donor skin that can be used for temporary skin grafts. 

Preventing Burns in Nursing Homes

Older adults (≥ 60 years) are at increased risk for burn accidents, second only to young children. The National Fire Prevention Agency reported that adults age 75 and older are the age group most likely to die in house fires. Older adults also suffer larger size burns on average than any other age group. The most common type of burn injury for older adults is usually a scald (a type of burn injury caused by hot liquids or steam). Also, elderly burn victims have a higher mortality rate than younger burn victims. 

As you age, so does your skin, and the skin of older adults is dry, wrinkled, loose, and less elastic because the dermis layer of the skin becomes thinner over time. This makes the skin more susceptible to the absorption of heat, which means that even moderate heat sources (warm water, electric blankets, radiators) can cause serious physical damage. Also, older adults are more susceptible to fluid loss and shock after suffering from a burn, which requires proper fluid replenishment. 

Elderly nursing home residents are more susceptible to dangerous burns because of their advanced age, prevalence of mental illness, reduced mobility, and underlying medical conditions. Many elderly nursing home residents are weak and vulnerable because of disease and illness, which makes any additional illness or injury all the more dangerous. 

Therefore, it is important that nursing home staff members take steps to reduce burn risks. This includes monitoring the temperature of the water in resident bathrooms to prevent scalding, monitor the temperature of food served to residents, not allowing candles or other open flames, covering radiators, and complying with proper fire prevention and safety standards. 

If you or a loved one suffer a serious burn while living in a nursing home, you may be entitled to collect damages. Nursing homes must provide safe environments for their residents and monitor residents to ensure that there are not any burn risks and that all injuries are properly treated.   When nursing homes fail to meet this duty, they can be liable for negligence. 

Thank you to Heather Keil, J.D. for her assistance with this important topic.

Resources:

Burn Survivor Resource Center: Medical Care Guide
The Mediterranean Council for Burns and Fire Disasters: Annals of Burns and Fire Disasters: Considerations on Intensive Care in Elderly Burn Patients
Burn Recovery: Skin Grafts for Burn Treatment

Related Nursing Homes Abuse Blog Entries:

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

Unsupervised Nursing Home Resident Dies From Burns

Even The Most Mundane Parts Of A Nursing Home Can Turn Deadly Without Proper Staff Supervision

Cigarette Lighter Mishap Results In Severe Burns To Nursing Home Patient

Faced a situation where a nursing home was providing inadequate or dangerous care to its patients, officials at the Department of Public Health-- the regulatory agency for Illinois Nursing Homes-- had relatively little in their arsenal when it comes to prodding along facilities.  That is, until now. 

Recently, the Illinois Appellate Court tossed out a Sangamon County judge's ruling that capped fines imposed by the Illinois Department of Public Health at $10,000.  In the case involving Peoria's Rosewood Care Center and The Illinois Department of Health, Judge Leo Zappa ruled in favor of Rosewood in a matter involving a $20,000 fine imposed against the facility for the death of a patient.  Zappa determined that the fine was improper due to the fact that it was illegally inflated and conflicted with state law.

Despite the Appellate Court decision, Illinois officials will continue to use their approach of imposing multiple fines against poorly performing facilities in lieu of more substantial single fines. 

"A fine is one of the few things we can do to make sure a nursing home is compliant with the law," says Illinois Department of Health spokesperson Melanie Arnold.

I agree.  However, until the significance of the fines reaches the point where they pose an actual threat to the livelihood of the nursing home owners and operators, they will not have their intended impact when it comes to motivating facilities to provide quality medical care to patients in need.

Thankfully, our legal system allows nursing home patients who receive poor or negligent care to pursue a claim for damages against the facility under the Nursing Home Care Act.  When pursuing a claim under the act, a patient has no financial limit on the damages they may recover from the facility. 

We have successfully prosecuted nursing home negligence claims in a wide variety of matters including: wrongful death, falls, burns, medication errors, sexual abuse and bed sores.

Read more about this Appellate Court decision involving Illinois Nursing Homes here.

Related Nursing Homes Abuse Blog Entries:

Illinois Nursing Home Task Force Holds Public Meeting Today

31 Allegations Of Abuse At Chicagoland Nursing Home

More Staffing & Stiffer Fines. Welcome To The New Way Of Doing Business For Illinois Nursing Homes?

42 Illinois Nursing Homes Cited In 4th Quarter of 2009 For Violations Related To Patient Care

I feel strongly about publicizing information related to poorly performing facilities.  In Illinois, we are fortunate to have a department of health that does a great job documenting nursing home violations and publishing them on a quarterly basis.  My hope is that families can use this information when making decisions relating to the placement of a loved in a nursing home.

Below are the actual facilities cited by the IDPH this quarter-- I do think the individual violators are important-- but I think the better understanding of the real state of nursing homes in Illinois can be visualized by looking at the violators in their entirety.

Nonetheless, if you have a loved one at one of these facilities, you should at least be aware of the facilities prior violations.  Further, looking at prior quarterly violations can help in making a determination if the facility merely had an isolated problem or truly has ongoing patient safety problems.

Summation of Illinois Nursing Home Violators: 4th Quarter 2009

• Total Number of Nursing Home Violations: 42
• Nursing homes cited more than once: 1 (South Shore Nursing & Rehab Center)
• Number of nursing home fined: 19
  • Lowest Fine - $5,000 (Rainbow Beach Care Center)
  • Highest Fine - $50,000 (Golden Moments Senior Care Center)
• Total fines implemented against Illinois Nursing Homes in the 4th quarter - $417,000

Illinois Nursing Homes Receiving Fines In 4th Quarter 2009:

Avenue Care Center
4505 South Drexel Avenue
Chicago, IL 60653

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Brother James Court
2500 St. James Road
Chicago, IL 62707

On November 14, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $10,000. A hearing has been requested.

Cambridge Nursing & Rehab Center
9615 North Knox Avenue
Skokie, IL 60076

On November 25, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $25,000. A hearing has been requested.

Capitol Care Center
555 West Carpenter
Springfield, IL 62702

On November 14, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $20,000. A hearing has been requested.

Cardinal Hill Healthcare
400 East Hillview Avenue
Greenville, IL 62246

By Final Order, Violation Amended, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Chestnut Manor
1404 South 14th Street
Herrin, IL 62948

On November 14, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $10,000. A hearing has been requested.

Covenant Health Care Center-Northbrook
2155 Pfingsten Road
Northbrook, IL 60062

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Danville Care Center
1701 North Bowman
Danville, IL 61832

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Division Street Home
317 West Division Street
Amboy, IL 61310

On November 25, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $10,000. A hearing has been requested

East Bank Center, LLC
6131 Park Ridge Road
Loves Park, IL 61111

On October 17, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $50,000.

Friendship Manor
1209 21st Avenue
Rock Island, IL 61201

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Gilman Healthcare Center
1390 South Crescent Street
Gilman, IL 60938

On October 29, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $15,000. A hearing has been requested.

Helia Healthcare of Energy
210 East College
Energy, IL 62933

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Heritage Fifty-Three
4601 53rd Street
Moline, IL 61265

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Jackson Square Nursing Home & Rehab Center
5130 West Jackson Boulevard
Chicago, IL 60644

By Final Order, Violation Reduced, Fine Assessment and Notice of Conditional License Withdrawn

Knox County Nursing Home
800 North Market Street
Knoxville, IL 61448

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Lexington of Streamwood
815 East Irving Park Road
Streamwood, IL 60107

By Final Order, Violation Reduced, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Manorcare of Rolling Meadows
4225 Kirchoff Road
Rolling Meadows, IL 60008

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Maplewood Care
50 North Jane
Elgin, IL 60123

On November 14, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $5,000. A hearing has been requested.

Meadowbrook Manor
431 West Remington Boulevard
Bolingbrook, IL 60440

By Final Order, Violation Amended, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Mount St. Joseph
24955 North Highway 12
Lake Zurich, IL 60047

On November 14, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $10,000. A hearing has been requested

Pleasant Meadows Christian Village
400 West Washington
PO Box 375
Chrisman, IL 61924

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Polo Rehabilitation & Health Care Center
703 East Buffalo
Polo, IL 61064

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Richland Care & Rehab
410 East Mack
Olney, IL 62450

By Final Order, Violation Amended, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Sacred Heart Home
1550 South Albany
Chicago, IL 60623

On December 9, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $20,000. A hearing has been requested

Timber Point Healthcare Center
205 East Spring Street
Camp Point, IL 62320

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

Transitions Nursing and Rehabilitation Center
1000 Dixon Avenue
Rock Falls, IL 61071

On October 3, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $10,000. A hearing has been requested

Turner Manor
PO Box 303
901 Oglesby Road
Harrisburg, IL 62946

On October 17, 2008, sent Notice of Type “A” Violation relating to the area of nursing and Notice of Fine Assessment of $25,000. A hearing has been requested

Washington Heights Nursing Home
1010 West 95th Street
Chicago, IL 60643

By Final Order, Violation Affirmed, Fine Assessment Reduced and Notice of Conditional License Withdrawn

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The other day, we discussed the popularity of physical therapy amongst nursing home patients.  The increasing use of physical therapy amongst the elderly-- and particularly nursing home patients-- has resulted in increases in the number of incidences of patient injury or death.

Obviously, the intent of physical therapy is to help improve a nursing home resident’s physical well-being. In skilled nursing facilities injuries may occur during physical therapy session that for a variety of reasons including the physical therapists unfamiliarity with the patients, inadequate supervision or broken equipment.

When an injury of a nursing home patients does occur during a physical therapy session, a cause of action for medical malpractice or negligence may be brought for the resulting injury or death.In a negligence case, you can sue your physical therapist for negligence regarding the care you received or failed to receive. 

A physical therapist (PT) owes each patient the duty to fully evaluate their signs and symptoms in order to diagnose and treat the patient so they benefit from physical therapy. A court of law can hold a physical therapist responsible/liable for an error, omission, or negligent act that results in harm. 

A successful negligence case against a physical therapist requires you to prove the following elements:

1. You were owed a duty from the physical therapist
2. The physical therapist breached the standard of care
3. This breach caused harm to you, and
4. There was actual harm or “damages” to you

Many states, such as Illinois, regulate physical therapists.  The Illinois Physical Therapy Act requires that physical therapists have licenses to practice. The Department of Financial and Professional Regulation, Division of Professional Regulation is responsible for licensing physical therapists. Physical Therapists can also pay to participate in malpractice insurance or Professional Liability Insurance (PLI) to shield their personal assets and ensure that there are adequate funds to make amends for wrong-doing. A PLI policy covers errors, omissions, or negligent acts. 

A study on PT malpractice revealed that treatment-related events and events related to improper technique were the most common reasons for a malpractice report. Civil litigation and professional discipline are two tools that can help reduce medical error by holding professionals responsible for their actions. 

If you or a family member is a nursing home resident receiving physical therapy, it is important to understand the medical necessity of physical therapy and its associated risks. Also, be aware that your physical therapist must be licensed by the state to ensure that the person is qualified to perform physical therapy. Injuries can easily occur when your physical therapist is negligent. 

For elderly nursing home residents, these injuries can be even more dangerous because of their weak bones and underlying medical conditions. If you or a family member suffered an injury at the hands of a physical therapist, you could be entitled to compensation for your injuries.

Common examples of physical therapist malpractice include:

• Dropping patients
• Leaving patients unattended on equipment
• Failure to supervise
• Using broken equipment
• Sexual assault
• Over-extending joints
• Failing to inform patients of risks

If you suffered an injury during a physical therapy session, you may have legal rights.  We would honor the opportunity to discuss your situation.  As always, you can speak to a lawyer for no initial charge to you.  (888) 424-5757

Related:

Advance for Occupational Therapy Practitioners: IL Court Overturns Malpractice Statute

Physical Therapy For The Elderly: A Necessity Or Just A Waste Of Time?

Physical Therapy For Nursing Home Patients

When a family member is hurt, injured, or sick, you want to know that their hospital has a good reputation with few serious medical errors. 

You expect doctors and nurses to treat your loved ones with the respect, care, and caution that is owed to them to ensure that they get better, not worse.  

The frequency and prevalence of medical malpractice and medical errors, especially those medical errors leading to serious injury or even death, are significant factors when choosing a hospital. Illinois has made it easier for patients to know how frequently medical errors occur at hospitals with the Illinois Hospital Report Card and Consumer Guide to Health Care.  

In 2009, Illinois launched the Illinois Hospital Report Card and Consumer Guide to Health Care website in an effort to increase transparency about the quality of health care provided in Illinois hospitals. This website, driven by the Hospital Report Card Act (Public Act 93-0563), which was passed in 2004, gives consumers the information necessary to make more informed healthcare choices. The website provides the following information:

• Volume and cost of services in hospitals and ambulatory surgery treatment centers
• Quality and safety data
• Nurse staffing data
• Patient satisfaction surveys
• Summaries and links to Illinois laws that ensure consumer protection

Information Contained on Report Card

The Hospital Report Card Act requires that all Illinois hospitals compile, maintain, and report the following information to the Illinois Department of Public Health (IDPH):

• Nurse staffing
• Infection prevention measures
• Hospital acquired infections
• A typical Hospital Report Card includes the following information:

Overview

• Name
• License Number
• Address
• Phone Number
• State Designations

Process of Care and Inpatient Quality

• Process of Care (indicators are used to measure how often hospitals use recommended treatments known to get the best results for certain conditions)
  • Overall Heart Attack Care
  • Overall Heart Failure Care
  • Overall Pneumonia Care
  • Inpatient Mortality
    • Mortality Rate: Congestive heart failure
    • Mortality Rate: Stroke
    • Mortality Rate: Hip Fracture
    • Mortality Rate: Pneumonia
    • Mortality Rate: Inpatient Heart Attack Deaths
    • Mortality Rate: Hip Replacement
  • Inpatient Utilization (examines procedures whose use varies significantly across hospitals and for which questions have been raised about overuse, underuse, or misuse)
    • Incidental Appendectomy in the Elderly
    • Bi-Lateral Cardiac Catheterization
    • Cesarean Section Delivery
    • Laparoscopic Cholecystectomy (minimally invasive gallbladder removal)

Safety Measures

• Surgical Care Improvement
• Pre-Surgical Antibiotic Given at the Right Time – Overall Rate
• Surgical Patients Given the Right Kind of Antibiotic – Overall Rate
• Preventative Antibiotics Stopped at Right Time – Overall Rate
• Pre-Surgical Antibiotic Given at the Right Time – Knee Arthroplasty
• Surgical Patients Given the Right Kind of Antibiotic – Knee Arthroplasty
• Preventative Antibiotics Stopped at Right Time – Other Cardiac Surgery
• Health Care-Associated Infections
  • Central Line Associated Bloodstream Infections in Medical/Surgical ICU
  • Central Line Associated Blood Stream Infection Rate in the Surgical ICU
  • Central Line Associated Bloodstream Infections in Medical ICU
  • Central Line Associated Blood Stream (CLABSI) Infection Rates – Detailed Report
  • Patient Safety
  • Unexpected Deaths
  • Accidental Puncture and Laceration
    • Latrogenic Pneumothorax (health care-associated collapsed lung)
    • Foreign Body Left During Procedure
    • Postoperative Hip Fracture

Satisfaction Survey Responses

• Percent of Patients Highly Satisfied
• Doctors Always Communicated Well
• Nurses Always Communicated Well
• Patient Always Received Help As Soon As They Wanted
• Staff Always Explained About Medicine
• Pain Was Always Well Controlled
• Patient’s Room Always Kept Quiet At Night
• Patient’s Room and Bathroom Always Kept Clean
• Patients Given Information About Recovery At Home
• Patients Would Definitely Recommend This Hospital to Friends and Family

Services

• Patients, Median Length of Stay, and Median Change
  • Appendectomy
  • Asthma
  • C-section
  • Chest Pain
  • Chronic Obstructive Pulmonary Disease
  • Diabetes
  • Gallbladder Removal
  • Heart Failure
  • Normal Newborn
  • Pneumonia
  • Vaginal Delivery

Beds – Nursing Staffing

• Nurse Staffing
  • Hospital-Employed Nurses
  • Contract Staff Nurses
  • Percent RN Nursing Staff Hours
  • Percent LPN Nursing Staff Hours
  • Percent Nursing Assistant Staff Hours

• Authorized Beds
  • Bed Type
    • Medical-Surgical Beds
    • Intensive Care Beds
    • Pediatric Beds
    • OB/Gynecology Beds
    • Long-Term Care Beds
    • Neonatal ICU Beds
    • Acute mental Illness Beds
    • Long-Term Care Acute Care Beds
    • Total Beds

The Consumer Guide to Health Care uses discharge data from hospitals and ambulatory surgical treatment centers to report “the conditions and procedures demonstrating the widest variation in changes and quality of care.” The website will also include “inpatient and outpatient data with current comparison information related to volume of cases, average charges, mortality rates, complications and hospital associated infections.”

The methodology used by IDPH to produce the Hospital Report Cards includes using the following data sources to create composite measures and rates to assess the main information set, including: quality, surgical care improvement, infection rates, patient safety, satisfaction, services, and staffing. The data sources for the Hospital Report Card are as follows:

Quality-Recommended Care (how well a hospital cares for patients with specific conditions) – data comes from the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services

Surgical Care Improvement Project – data comes from data submitted by Illinois hospitals to the Illinois Department of Public Health

Patient Satisfaction – data comes from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys

Administrative Data (information on hospital stays) – data comes from the Illinois Department of Public Health’s Discharge Data Set

Volume (number of times a procedure was performed) – data comes from the Department of Public Health Hospital Discharge Data Set

Infection Data – data comes from the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN)

Facility Information – data comes from the Annual Hospital Profile and the Annual Ambulatory Surgical Treatment Center Profile

Nurse Staffing Data – data comes from hospital reports submitted to the Office of Policy, pursuant to the Illinois hospital Report Act

Revenue – data comes from the Illinois Department of Public Health

Methicillin-Resistant Staphylococcus aureaus (MRSA) Data – data comes from data submitted by hospitals to the Illinois Department of Health

Clostridium Difficile Data - data comes from data submitted by hospitals to the Illinois Department of Health

What does this mean for consumers?

The hope is that with better transparency into medical errors, hospitals will improve care, and these unfortunate situations where patients are actually injured by medical error can be avoided. The Hospital Report Cards provide one tool to ensure that you or your family member receives quality care in hospitals. 

However, be aware that medical errors can still occur even at hospitals with good report cards. Also, the Illinois Department of Health (IDPH) posts a disclaimer noting that while IDPH attempts to make efforts to ensure that the website provides accurate and reliable information, it does not guarantee that the information on the site is complete, accurate, or up-to-date. Therefore, it is still important that you question the doctors and nurses who are treating your family member to ensure that they receive quality care. So, remember, the Hospital Report Cards are just one tool you can use to guarantee that hospitals are safe and effective. 

I applaud this push towards transparency in the field of medicine.  For too long consumers have steering blindly when attempting to locate a hospital.  Hopefully, this tool will prove valuable not just in the selection process, but also in encouraging poorly performing facilities to improve care.

Thanks to Heather Keil, J.D. for her assistance with this Nursing Homes Abuse Blog Entry

Resources:

Illinois Department of Public Health: State Public Health Director Announces Launch of Hospital Report Card and Consumer Guide to Health Care Web Site

IDPH: Division of Patient Safety and Quality

ILGA: Hospital Report Card Act

Illinois Hospital Report Card

Illinois Hospital Report Card: Data Sources

Illinois Hospital Report Card: Disclaimer

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My guess is that you'd be hard pressed to find any person-- out of all the people admitted to hospitals this very day-- who is aware of the fact that they are at an increased risk for developing  pressure sores based on the very fact that they are in the hospital.

Pressure sores acquired during a hospitalization are one of the most devastating problems facing patients in all demographics and with various types of conditions. The fact remains that thousands of hospital patients will develop a pressure sore during their hospitalization this year.  

This is not a new trend.   Rather hospital acquired pressure sores have long been a problem facing the young and old during the time they spend in hospitals.  However, unlike other medical complications that have been addressed over the past decade, pressure sores related to a hospitalization remain an untamed dragon. 

The most recent study on medical errors related to hospitalizations, the seventh annual HealthGrades Patient Study in American Hospitals should convince any skeptics out there that pressure sores (also referred to as: bed sores, pressure sores or pressure ulcers) acquired during a hospitalization are a real-- and growing problem.

In making this determination, the study evaluated medical records from 39.5 million hospitalizations at 5,000 hospitals across the country based on standards set forth by the Agency for Healthcare Research and Quality.  The studies findings indicate:

• Pressure sores are the second most common patient safety incident with a development rate of 36.05 incidents out of every 1,000 hospitalizations
• Medical treatment related to treatment of hospital-acquired pressure sores results in $2.64 billion in costs

So what does this study really tell us?

Pressure sores are not just a problem facing nursing home patients.  Hospitals must acknowledge the fact that pressure sores are a real threat to patient well-being and train staff regarding early identification and treatment.  

My hope is that by by focusing more attention on pressure sore prevention, future hospital patients can avoid the pain, embarrassment and risk associated with this ailment.

Pressure Sores Are Preventable

When high-risk patients are properly identified and preventative measure such as: regular turning, personal care, nutrition and pressure relieving mattresses are provided, the incidence of pressure sores acquired during a hospitalization can be minimized.  

It's not just me claiming this!  Medicare has placed hospital-based pressure sores on its 'never list' -- its list of medical errors that are so easily preventable that they should never happen.  No longer can hospitals seek reimbursement from Medicare for pressure sore related medical treatment if the wound developed during an admission to their facility.

Related Nursing Homes Abuse Blog Entries:

Pressure Sores In Hospitals On The Rise

Over 500,000 Adults Suffer From Bed Sores In Hospitals

Reducing Decubitus Ulcers In Hospitals. How One Facility Managed To Reduce Hospital-Acquired Wounds By 63%

Bed Sore FAQ:

How many hospital patients suffer from bed sores?

What can hospitals do to reduce the rate of bed sores in their facilities?

Are hospital patients prone to develop bed sores?

Bed Sore Resources

The United States’ population of older adults is increasing rapidly. With this growth, the number of older adults requiring physical therapy is also increasing. There are different concerns when performing physical therapy with older adults as opposed to younger patients. 

Older adults have weaker bones and are more vulnerable to injury, including dangerous falls. Therefore, it is important that there are enough physical therapists who specialize in or are educated in geriatric therapy in order to reduce the risk of injury. 

Many physical therapist (PT) and physical therapist assistant (PTA) programs have made efforts to incorporate geriatrics into existing curricula. However, barriers to the expansion of geriatric clinical internships exist because of lack of funding, lack of qualified faculty, and lack of student interest. It seems obvious that schools need to make additional efforts to improve their geriatric programs because of the growing demand. 

All Medicare-certified nursing home facilities are required to assess each resident’s status and needs, including the medical necessity for physical and occupational therapy. In order to qualify for Medicare coverage, the therapy must be: reasonable, necessary, specific, and effective treatment for the resident’s condition. The Department of Health and Human Services, Office of Inspector General released a report in 1999 on the Cost of Improper Billings to Medicare. 

This report revealed that Medicare reimbursed skilled nursing facilities for almost $1 billion of improperly billed physical and occupational therapy in 1998. The primary reason was because the therapy was not medically necessary or was performed by staff that did not have the appropriate skill for the resident’s medical condition. Medicare also reimbursed skilled nursing facilities almost $331 million for undocumented physical and occupational therapy in 1998. 

These discrepancies in Medicare covered physical therapy are alarming because residents might not be receiving physical therapy that was ordered by their physicians. Some residents’ medical records did not match the time billed to Medicare for therapy. So, either they did not receive the prescribed amount of therapy or their charts had errors, either of which is worrisome.

When a physician prescribes physical therapy for a nursing home resident, that resident should receive the therapy from a staff member with the appropriate skill level; otherwise, who is to say that the resident is receiving the full benefit of the therapy or that the therapy will be safely performed. 

It is important that nursing home staff members ensure that each and every resident’s medical records match physician’s orders and Medicare bills so that residents receive proper treatment and that treatment is recorded. Without such precautions, vulnerable nursing home residents can suffer serious injuries. 

A news report revealed that some nursing home facilities are competing with hospitals and rehabilitation facilities for short-term patients who require postoperative rehabilitation. These nursing homes often offer treatment at lower costs, allowing people to save money. This is because Medicare estimates that a nursing home can rehabilitate a knee or hip replacement patient for far less than a hospital (from 33-50% less cost than a hospital, see chart on right). This is because nursing homes have a lower overhead than hospitals. 

However, some people criticize nursing homes’ lack of expertise when compared to hospitals. Some data shows a decline in the quality of their rehabilitative care (In March 2007, the Medicare Payment Advisory Commission cited data that it said showed a falling quality of rehab care at nursing homes). Some nursing home rehab facilities don’t have the same access to therapy equipment or doctors as hospital rehab facilities. This calls into question how well nursing homes can offer rehabilitative services to these people, many of whom are younger than the typical nursing home resident. As the number of residents requiring rehabilitative services grows, you have to ask whether the quality of care offered by nursing homes can keep up or will your health suffer?

Sources:

American Physical Therapy Association: Liability Awareness
Illinois Physical Therapy Association: Professional Liability/Malpractice Insurance

FindArticles.com: Malpractice by Physical Therapists, Descriptive Analysis of Reports in the National Practitioner Data Bank Public Use Data File, 1991-2004

Department of Health and Human Services: Office of Inspector General: Physical and Occupational Therapy in Nursing Homes Cost of Improper Billings to Medicare

Related Nursing Homes Abuse Blog Entries:

Physical Therapy For Nursing Home Patients

McKnight's had a recent story about how more than 4,500 mentally ill nursing home patients living in Illinois facilities will soon have the option of moving to smaller, less nursing intensive facilities under the terms of a settlement with the American Civil Liberties Union.  The settlement applies to patients living in nursing homes categorized as Institutions for Mental Diseases or IMD's, of which there are approximately 25 within the state.

The move comes after the well publicized problems regarding younger, mentally-ill patients living amongst a predominately elderly nursing home community.

A time-line for providing the new housing options has not been released.

My take:

Nursing homes are medical facilities for people who require skilled nursing, not for the mentally ill.  In this sense, I do feel as though moving younger, mentally ill patients out of nursing homes is a good step towards improving the safety of the fragile nursing home population.

However, my reservation regarding this development is the current lack of facilities on hand to accommodate these mentally ill people.  I hope that every facility, be it new or old, receive a complete review of credentialing to assure that the mentally-ill are appropriately cared for in their new living arrangements.  

As I have seen firsthand, quasi-nursing facilities such as group homes, day facilities and other alternative living arrangements can be dangerous for the patients' physical and psychological well-being when staff at the facilities fail to monitor patients and take necessary protective actions.

Related Nursing Homes Abuse Blog Entries:

Illinois Attorney General 'Cracks The Whip' At Violent Criminals Living Amongst Nursing Home Patients

Feds Yank Funding From Another Chicago Nursing Home With A Troubled Past

Family Claims Assisted Living Facilities Neglect Resulted In Death Of Mentally Disabled Woman

Are Group Homes A Viable Alternative To Nursing Homes?

Today's glimpse into the world of nursing homes comes from Anthony Cirillo, FACHE, ABC, a leader in healthcare marketing and patient management.  Learn more about Anthony and his important work at his website and blog, Who Moved My Dentures? Thanks for these great responses.

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

I am a strategic healthcare marketing and patient/resident experience
management professional who fell into a mission for seniors when I went to
sing in a nursing home. My mission is to bring respect and dignity to
seniors while educating everyone about aging issues before they become a
crisis.

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

The introduction of F tags around dignity has at least made organizations
start to pay more attention to resident experience. The Green House and
Eden approaches are commendable but really out of reach of most.

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

Most are only giving lip service to experience management. The industry
does little to call attention to the positive it work it does or reach out
to the community as a vital partner. That adds to the already bad
perception they have. Reimbursement is declining. And worse, most of the
aging industry seems to want to will nursing homes out of existence. When
you see that we are 37th in the World Health Organization and plagued with
chronic conditions, it is quite clear we will need nursing homes.

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

I am not sure I can make that correlation unless perhaps you can list 2-3
trends and I can respond. CMS calls the shots here so much is driven by
F-tags. I do not see any consistency nationwide for how nursing homes are
surveyed. Five Star Ratings, while controversial, will be here to stay and
nursing homes need to be able to tell their story around them because the
public will be paying attention to them. Transparency will be key because
consumers have more and more information at their fingertips to research
organizations.

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

Honest to goodness, they have not improved much. There is still rampant
fraud and abuse. Activities have progressed slightly. Many residents are
lonely and depressed and have no visitors. The biggest change has been a
focus on rehabilitation work, which contributes to the bottom line but also
contributes to organizations paying less attention to the full time
residents who are living the final chapters of their lives inside these
homes.

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

I have an entire resource section in my book, Who Moved My Denture,
regarding this. Would be happy to share.

Three words to describe nursing homes:

sterile, lonely, depressed

Three words to describe what nursing homes should be:

home, compassion, healing places