Nursing Homes Abuse Blog - By Jonathan Rosenfeld

In a previous post, I talked about Reglan (Metoclopramide), a drug commonly used to relieve heartburn in patients with GERD (gastroesophageal reflux disease) or to relieve symptoms of slow stomach emptying for people with diabetes. Well, it turns out that this drug can also cause tardive dyskinesia (TD). Tardive dyskinesia is abnormal muscle movements, mostly in the face muscles, that you have no control over. TD has no treatment, and the symptoms might not go away even you stop taking raglan. 

Clearly, TD is not a minor side effect. The FDA took action requiring manufacturers of the drug to add a “black box” warning about the drug’s risks. The U.S. National Library of Medicine – National Institute of Health Website now includes an IMPORTANT WARNING in its information for metoclopramide (better known as Reglan) –

“Taking metoclopramide may cause you to develop a muscle problem called tardive dyskinesia. If you develop tardive dyskinesia, you will move your muscles, especially the muscles in your face in unusual ways. You will not be able to control or stop these movements. Tardive dyskinesia may not go away even after you stop taking metoclopramide. The longer you take metoclopramide, the greater the risk that you will develop tardive dyskinesia. Therefore, your doctor will probably tell you not to take metoclopramide for longer than 12 weeks. The risk that you will develop tardive dyskinesia is also greater if you are taking medications for mental illness, if you have diabetes, or if you are elderly, especially if you are a woman. Call your doctor immediately if you develop any uncontrollable body movements, especially lip smacking, mouth puckering, chewing, frowning, scowling, sticking out your tongue, blinking, eye movements, or shaking arms or legs.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with metoclopramide and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website(http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide. Talk to your doctor about the risks of taking metoclopramide.”

The FDA’s medication guide also includes warnings about how Reglan can cause tardive dyskinesia. TD (as a result of Reglan) is most common in the elderly, especially elderly women.  

Reglan Drug Timeline

• June 1985 – FDA approved metoclopramide – FDA approved metoclopramide for short-term use (less than 12 weeks). 
• February 26, 2009 – FDA Press Release – “FDA Requires Boxed Warning and Risk Mitigation Strategy for Metoclopramide-Containing Drugs – Agency warns against chronic use of these products to treat gastrointestinal disorders”
• March 2009 – FDA’s MedWatch Safety Alerts, March 2009 – FDA alert discussing boxed warning. Also, manufacturers must ensure that patients receive a medication guide with the drug risks each time they receive the medication from a pharmacy.

Prescribing Reglan

At the time of the FDA’s decision to require a black box warning, more than 2 million Americans were taking metoclopramide drugs. Reglan was commonly prescribed for patients suffering from acid reflux, GERD (gastroesophageal disorders), and nausea. According to the FDA, metoclopramide is only recommended for short-term treatment (≤ 3 months) of gastrointestinal disorders. 

However, many patients have taken Reglan for longer periods of time, increasing their risk of TD. In many cases, Reglan was a treatment option that offered positive results in treating gastroesophageal problems, but it came with a serious risk. Reglan now carries a warning against frequent and long-term use, but this warning came too late for many people who now suffer from lasting side effects such as tardive dyskinesia. Older people, especially older women, and people who have been taking Reglan for a long time are most at risk for tardive dyskinesia. 

Metoclopramide was even prescribed to women suffering from morning sickness. In a June 2009 article, MSNBC reported about a study in the New England Journal of Medicine that showed that metoclopramide could be prescribed to pregnant women suffering from morning sickness in the first trimester without causing harm to their babies. The drug was prescribed to pregnant women for short-term use and most women in the study only took the drug for 7 days. 

Morning sickness is most common in the first trimester, but it can last throughout pregnancy for some women. Because morning sickness can last longer than the 12-week maximum that the FDA recommends in order to reduce the risk of TD, it seems misleading and inappropriate that the reports would not at least mention the FDA black box warning. The risks associated with long-term use of a drug should be discussed, or at least mentioned, when discussing a new use of a drug, especially to inform potential users of all possible risks. 

Status of Reglan Litigation

Reglan has been prescribed to numerous patients since it was approved in 1985. And, according to the FDA, over 2 million Americans use metoclopramide. According to the drug makers, there have been over 20 years of Reglan litigation. 

On June 3, 2009, the U.S. Judicial Panel on Multidistrict Litigation denied the plaintiffs request to consolidate the Reglan litigation during pretrial proceedings in a Multidistrict Litigation (MDL). This motion was filed by plaintiffs in 15 different Reglan lawsuits in 11 different district courts. The drug makers opposed the consolidation, citing that since the first Reglan case was filed in 1988, there have been more than 20 years of Reglan litigation, and 80% of those cases were resolved. 

The Panel determined that there was no single common defendant and most questions that remained were too complex or numerous to support consolidation, despite the cases involving the common factual issue about whether Reglan causes tardive dyskinesia. 

In one of the Reglan cases, a woman from Arkansas alleges that she developed TD after taking Reglan for over a year. Her case alleges that she did not have access to the FDA’s warnings. The lawsuit states that almost one-third of all patients taking Reglan took the drug for at least a year, increasing their risk for TD. These patients trusted their doctors to make informed and safe decisions about their medical treatment, and they also trusted the drug companies to test the drugs and provide information to patients so they could make informed decisions. Some of the lawsuits claim that the drug makers knew about the risk of tardive dyskinesia for decades. Unfortunately in the case of Reglan, the system seems to have let people down. 

If you believe that you or a loved one suffered an injury after taking Reglan, we would honor the opportunity to speak with you.  In certain situations, a lawsuit may be pursued against the drug manufacturer and the physician who was prescribing it at the time.  As will all of our cases, we prosecute drug-related claims on a contingency basis-- clients never pay any expenses out of their pocket.  (888) 424-5757.

Thank you to Heather Keil, J.D. for her assistance with this Nursing Homes Abuse Blog entry.

Sources:

Nursing Homes Abuse Blog: Use of Reglan Has Been Linked to Development of Tardive Dyskinesia or Abnormal Muscle Spasms

Medicine Net: Metoclopramide

FDA’s MedWatch Safety Alerts, March 2009: Reglan and Nervous System Disorder

About Lawsuits: Reglan Litigation Will Not Be Consolidated in MDL

eMedicine: Tardive Dyskinesia

National Institute of Neurological Disorders and Stroke: NINDS Tardive Dyskinesia Information Page

The Public Record: More Warnings Needed on Reglan Side Effects

Recognition of Movement Disorders: Extrapyramidal Side Effects and Tardive Dyskinesia

The New England Journal of Medicine: The Safety of Metoclopramide Use in the First Trimester of Pregnancy

The New York Times: Drug Appears Safe for Morning Sickness

Too little, too late-- best summarizes Pilgrim Haven Health Facility of Los Angeles, reaction to fall-prevention measures suggested by a patient's physician and the facility itself.  The omissions appear to be responsible for the fall-related death of an 85-year-old man and have initiated a substantial fine by the California Department of Health.

In the course of investigating the death of the elderly patient, authorities determined that Pilgrim Health made numerous errors with respect to its medical treatment of a patient with a history of falling. 

After an initial fall in October, 2009, fall precautions were order by the man's physician and by Pilgrim Health itself.  The physician instructed the nursing home to use an electronic fall monitor on the patient and the facility noted that the man should have his walker within reach at all times and should further be supervised while walking.

Just two months later, the man was involved in a second fall at the facility without the knowledge of the facility staff--- and away from his walker.  The facilities initial examination of the man appeared to show little with respect to visible injuries.  However, in the evening following the fall, the man's injuries quickly became apparent. 

During the evening following the fall, the man's condition began to deteriorate becoming pale, motionless and began vomiting.  Even after staff at Pilgrim Haven noted the change in the man's condition, they failed to immediately conduct a full neurological assessment or notify the man's doctor as to his change in condition.

Hours after the extent of the man's injuries began to be apparent, he was transported to a hospital where he died shortly after his arrival.  A CT scan determined that the man's death was due to bleeding in his brain that investigators attribute to his previous fall.

As a result of the fall, Pilgrim Haven was fined $100,000 -- the maximum fine allowable under California law.  Pilgrim Have is part of the American Baptist Homes of the West. Read more about this nursing home fall as reported by the L.A. Times here.

Head Injuries From Falls

As we age, our bodies lose some of the protective fluids that cushion our joints and even our brains putting us at risk for more serious type of injures that are usually not associated with younger people.  For this reason, older people are at a heightened risk for sustaining head injuries in fall.

Even a minor head trauma can put excessive force on the brain that may result in inter-cranial bleed (commonly referred to as a subdural hematoma).  Subdural hematomas occur when blood vessels burst in the space between the brain and the outermost membrane that covers the brain (dura mater). The collection of blood forms a hematoma, which puts pressure on the brain tissue.  When the pressure builds and goes unrelieved, people can suffer serious injury or even death.

Nursing homes must be tuned in to patients who sustain even minor head-related trauma and be mindful of the symptoms of a subdural hematoma.  When identified early, patients who sustain a head injury are more likely to have better outcome and survival rate.

Related Nursing Homes Abuse Blog Entries:

Even Common Falls Put Elderly At Risk For Developing Subdural Hematomas

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

How Many Falls Is Enough To Impose Responsibility On Nursing Home?

'Poor Judgment' To Blame For CNA's Failure To Implement Fall Precautions In Minnesota Nursing Home Death

Allowing a nursing home patient to sit comfortably in their wheelchair in a hall or perhaps in an outdoor area of the facility seems like a pretty innocent act-- right?  I mean aren't patients in wheelchairs entitled to a little fresh air or just hang out in an common area with other patients?

Despite the seemingly harmless act of sitting in a wheelchair, nursing home employees need to take steps to ensure the safety of these handicapped residents-- even if they appear to be sitting idly.  Too often nursing home employees take for granted that wheelchair patients' limited mobility puts them at increased risk for falls and collisions with their surroundings at the facility.

A recent situation involving a disabled nursing home patient made the news, after the woman sustained serious injuries in a fall from her wheelchair.  The woman's injuries include: fracturing her collarbone, sustaining a closed head injury and suffering multiple bruises and abrasions.  The incident occurred at the Jewish Home of Eastern Pennsylvania. 

The incident gave rise to a lawsuit against the facility that alleges aides left the patients wheelchair unattended on a sidewalk that had a decline which caused the wheelchair to roll and crash into a nearby street.  Read more about this nursing home lawsuit involving an injury to a wheelchair-bound patient here.

The need to supervise patients in wheelchairs

Putting a patient in a wheelchair does not relieve nursing home staff of their duty to provide ongoing supervision.  Depending on the patients physical and mental capacities, they should provide a level of supervision appropriate to the individual.  In most cases, providing a safe environment for wheelchair patients includes:

• Making sure locks on the wheels are engaged when the patient is sitting in one area or is incapable of appreciating harm
• Parking wheelchairs in areas where the ground is level
• Keeping patients in wheelchair away from congested areas when they could be pushed or bumped
• Properly utilizing leg braces to make sure they do not have the patients legs in a manner where they could catch on things
• Keeping patients away from fall hazards and unguarded stairways

Certainly, wheelchair-bound patients are entitled to freedoms, yet it remains the responsibility of nursing home staff to supervise them and assure that the wheelchair use does not put them at a heightened risk of harm to themselves or others.

Related Nursing Homes Abuse Blog Entries:

2 Residents Fall From Wheelchairs With 2 Days At Nursing Home

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

Nursing Home Worker Charged With Raping A Wheelchair-Bound Patient At Rhode Island Facility

Can a nursing home tie my dad to a wheelchair if he has had episodes of wandering around the facility?

According to a January, 2010 report from the Illinois Department of Health, Colliinsville Rehabilitation & Health Care Center made several errors with respect to handling incidents in which a patient was sexually assaulted by another patient.

The nursing home survey revealed that in November, 2009 a convicted felon as admitted to the facility as he was accompanied by his parole officer.  Management at Colliinsville was also aware of the man's criminal background and existing diagnoses of:

• Alcohol abuse
• Cocaine dependency
• Hepatitis C
• Antisocial personalty disorder- a perverse pattern of disregard for and violation of, the rights of others that begins in early adolescence and continues into adulthood

Even with the man's questionable background, officials allowed the man to enter the Collinsville Rehabilitation & Health Care Center as a patient.  However, within just a few weeks of his admission to the Collinsville, the man was involved in numerous incidents which call into question the facilities judgment in admitting him.

There were multiple reports where the new patient entered the room of a female patient, closed the door and began to grope the patient.  Despite the fact that the female patient voiced her concerns about her safety due to the acts of co-resident, the facility failed to take any interventional acts.  Moreover, despite the patients complaints of threats to her safety to staff on the floor, the staff never communicated the safety concerns to the director of nursing or other management at Collinsville.

In response to the multiple errors made at Collinsville Rehabilitation & Health Care Center, the Illinois Department of Health cited the facility for violations related to the Nursing Home Care Act.  The agency also issued at Type A Violation and fined the facility $20,000.

Related Nursing Homes Abuse Blog Entries:

Another Sexual Assault Of A Nursing Home Patient At The Hands Of A Convicted Felon

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

First Quarter 2010 Illinois Nursing Home Violations Released

Overcrowding is a common problem and complaint at many nursing home facilities. These facilities house large numbers of elderly residents, often in close proximity to each other, creating the ideal environment for dangerous outbreaks of communicable diseases. Communicable diseases are diseases that spread from person to person (contagious, infectious). These diseases are caused by germs (fungi, viruses, bacteria, and parasites). 

Disease Prevention

Communicable diseases are spread by organisms that live in the soil, water, and air. They can be spread by:

• Touching
• Breathing
• Eating
• Drinking
• Kissing
• Sexual contact
• Insect bites
• Animals

Our bodies have numerous microorganisms that live both in and on our bodies without causing problems. However, for people with compromised or weakened immune systems, opportunistic diseases and infections can occur. The elderly are particularly vulnerable to these diseases. The most effective tool in combating communicable diseases is prevention. Many elderly nursing home residents are already weak or ill, and their systems cannot fight any new diseases or infections as well as when they were well. 

Nursing homes must take precautions to prevent dangerous communicable diseases and protect their residents. Unfortunately, nursing homes are the ideal environment for these infections. This is because residents live in close proximity to each other with limited common areas, shared meal areas, and shared sources of food, water, and air. Furthermore, there is a constant stream of new residents, staff, and visitors entering and leaving the facility, transporting pathogens as they move. 

Steps To Prevent Disease In Nursing Homes

In order to prevent communicable diseases, nursing homes should:

• Keep residents and staff up to date on vaccinations
• Ensure that the facility is regularly cleaned and surfaces sterilized
• Require nurses and other staff members to change gloves for each new task, especially after touching a resident
• Frequent hand washing
• Wear protective clothing and masks when dealing with contagious situation
• If a resident is sick, limit their exposure to other residents and common areas
• If necessary, isolate the sick resident or even quarantine residents who have been exposed 

Bacterial infections can be treated with antibiotics. Viral infections, on the other hand, cannot be treated with antibiotics, but there are some antiviral treatments available. And, anti-fungals can be used to treat fungal infections. 

Some states, such as Illinois require nursing homes to report disease outbreaks.  The Illinois Department of Public Health (IDPH) requires that some communicable diseases be reported to a local health department or IDPH (Reportable Communicable Disease Cases, 2000-2008). This is so the state can help prevent dangerous outbreaks, put people on notice, and provide proper treatment. 

Proper hand washing techniques

Proper hand washing technique is one easy and effective tool to help prevent the spread of germs, disease, and contamination. Hand washing procedures:

• Use a paper towel to turn on the water (avoid touching any surfaces that might be contaminated)
• Wet your hands and forearms
• Apply soap to your hands and lather
• Rub hands together and over forearms for at least fifteen seconds (make sure to wash around nails)
• Rinse hands under stream of water with hands pointing down so they don’t drip toward elbows
• Using a clean paper towel, dry hands
• Use paper towel to turn faucet off
•  If no hand washing facilities are available, use antiseptic gel or towelettes

Types of Communicable Disease

Communicable diseases can be caused by bacterial, viral, or fungal organisms, or even parasites.

Common bacterial diseases:

• The common cold
• MRSA (Methicillin-Resistant Staphylococcus Aureus)
• Botulism (foodborne)
• Clostridium difficile (C. difficile / c. diff)

The common cold is spread by direct contact or breathing in droplets of nose/throat secretions. When a nursing home resident has a cold, it is important to monitor the resident to ensure that they cover their nose and mouth when sneezing or coughing. In addition, staff members should ensure that tissues or other soiled materials are properly disposed of, and that any surfaces that the resident touches are properly sterilized. 

MRSA is a bacterial infection that is often resistant to multiple antibiotics. This infection is most common in hospital settings, but is also a significant problem in nursing home facilities. This infection is spread through direct contact, often by the hands of a health care worker who touched an infected patient. Therefore, proper hand washing is especially important in preventing MRSA. (See “MRSA In Nursing Homes On The Rise Amongst Residents and Staff”)

C. difficile is another infection that is common in hospitals and long-term care facilities. Older adults are more at risk for this infection, especially after undergoing antibiotic therapy. (See “Left Untreated, Stomach Aches Can Be Deadly For Elderly Nursing Home Patients”)

Common viral diseases:

• Influenza
• Hepatitis A, B, C
• Infectious mononucleosis
• Shingles

Influenza or the flu is a common illness, but for the elderly, it can prove fatal. Adults over 50 years old are at most risk for influenza-related complications. Older adults can develop ear infections, acute sinusitis, bronchitis, pneumonia, and encephalitis. Pneumococcal pneumonia can be deadly for elderly nursing home residents. Health care workers and people with certain chronic diseases should be vaccinated each year. Unfortunately, flu shots are less effective in older adults, but the vaccine is still recommended for people over 50. 

Hepatitis A is spread by fecal-oral contamination or by a contaminated food handler. If a nursing home staff member contracts Hepatitis A, it is important to ensure that they do not return to the facility for one week after onset of symptoms; if they handle food, they should not return to work for two weeks. 

Common fungal infections:

• Ringworm (reddish ringlike rash caused by direct or indirect contact with items contaminated with fungus from skin, hair, or scalp)

Common parasites:

• Head lice

Head lice are parasitic insects that feed off human blood and lay eggs in the scalp. Lice is extremely contagious. Therefore, if one resident has head lice, all residents should be examined. Nursing home staff must ensure that grooming tools, hats, scarves, etc are not shared and are stored separately. 

Nursing homes must take precautions to prevent communicable diseases because elderly nursing home residents are vulnerable to dangerous complications. Many residents already suffer from various diseases, infections, and conditions, and their bodies are weakened. Older adults are already at higher risk for certain infections, such as the flu. And, they are more at risk for dangerous complications, such as pneumonia. 

Proper hygiene and cleanliness can go a long way to prevent these communicable diseases. If you or a loved one suffered injury from a communicable disease at a nursing home because of unsafe practices or inadequate precautions, you may be entitled to compensation from the facility where the illness originated.

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

Sources:

Health Blurbs: Types of Infectious Disease, Communicable Contagious, Emerging, Childhood Infectious Diseases

New York State: Department of Health – Communicable Disease Reporting

New York City Department of Health and Mental Hygiene: Bureau of Communicable Disease

Pub Med: Infectious disease outbreaks in nursing homes: an unappreciated hazard for frail elderly persons

New York State: Department of Health – Methicillin-Resistant Staphylococcus Aureus (MRSA)

The New York Times: MRSA Infection

Stanford: Use Proper Handwashing Techniques – Protect Your Health

Nursing Homes Abuse Blog: MRSA In Nursing Homes On The Rise Amongst Residents and Staff

Nursing Homes Abuse Blog: Left Untreated, Stomach Aches Can Be Deadly For Elderly Nursing Home Patients

The failure of California Gardens to properly implement a facility-wide smoking policy resulted in a recent fine of $5,000 and a Type A violation issued by the Illinois Department Of Health.  According to a November, 2009 survey report, state officials focused on a 68-year-old patient at the facility who had and extensive history or physical and psychiatric ailments.  

State officials noticed that the man had multiple burns on his chest that were indicative of him smoking in bed--- a clear violation of the facilities smoking policy.  A review of the man's nursing home chart confirmed that he had a history of smoking violations-- including smoking in his bed.

Interviews with nursing home staff at California Gardens paints a picture of a facility with a poorly implemented smoking policy.  On more than ten occasions staff at California Gardens suspected the man of smoking in his room-- yet they failed to take effective action to correct the pattern of dangerous behavior.  

The fact that staff allowed this patient to smoke in his bed obviously poses a threat to the safety of himself and other patients and staff at the nursing home.  According to California Gardens smoking policy:

• No smoking is permitted in any patient bedroom or bathroom
• All residents are expected to abide by the facilities smoking policy
• Cigarettes are to be distributed by the facilities activity department
• Smoking privileges will be withdrawn if they are not properly followed

Certainly, given the obvious safety risks associated with careless smoking facilities need to create and effectively implement a smoking policy for the safety of everyone at the facility.  I have worked on a number of matters where patients have sustained serious burns due to the facilities failure to look after patients who smoke.  Hopefully, this citation will be a wake up call for California Gardens Nursing & Rehab Center to improve their smoking safeguards before a patient is seriously harmed or killed in a smoking-related event.

If you have a family member at California Gardens and are concerned about the care they receive, I would be happy to discuss your legal options with you.  As always, there is no charge to speak to a lawyer and all consultations are confidential.

Related Nursing Homes Abuse Blog Entries:

First Quarter 2010 Illinois Nursing Home Violations Released

Unsupervised Nursing Home Resident Dies From Burns

Nursing Home Patient Sustains Serious Burns After Smoking In His Bed

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

I spend a lot of time talking with families regarding the selection of an initial nursing home for a family member or perhaps transferring the person from one nursing home to another.  Soon into our discussion, I see mild mannered people become downright angry when discussing the problems they encounter when selecting a facility.

Most of the time, the selection of a skilled nursing facility is done during a stressful period such as the onset of a sudden illness or when change in medical condition necessitates such a move. Frustration levels seem to get compounded when families visit facilities only to have all the facilities they visit appear universally average. 

Sure there are things to look for when selecting a nursing home: location, amenities and the facilities themselves; but families need to focus on one factor in particular when choosing a nursing home staffing -- staffing should remain the primary focus throughout the selection process.  Without a properly trained and devoted team, the other aspects of nursing homes are insignificant.

I was again reminded of the importance of staffing--- and how important it is for families to acknowledge its significance in a recent New York Times article appearing in the New Old Age blog. The article entitled One Way To Judge a Nursing Home written by Dale Russakoff has some really excellent points regarding the importance of a steady and enduring staff.  However, all points aside, I think perhaps the most insightful part of the article relates to Russakoff's suggestion for families to speak to the nurses aides during the initial nursing home selection process.

Though hardly a radical concept, speaking to the people who are on the front lines of providing patient care --- really is a great idea.  Asking CNA's about their position, how long they've worked at the facility and their job satisfaction is really a brilliant way of gaining valuable insight on the facility in an accurate way.

As Russakoff points out, facilities where staff aren't happy tend to have high staff turnover rates.  High turnover rates of staff is continually related to higher rates in the development of bed sores (decubitus ulcers, pressure ulcers, pressure sores), use of catheters, increased use of feeding tubes and other troublesome medical problems.

Even if you only spend a handful of minutes speaking to the CNA's, I firmly believe Russakoff is on target.  Credentialing and tenuring aside, are the people pleasant?  Do they smile?  Do they seem satisfied with their job?

Unfortunately, when staff are unhappy they tend to seek work at other facilities or leave the field all together.  Next time you go to a nursing home, listen to all the scripted information the marketing director, but take the next step and meander to the nursing desk to talk with the people who will be really caring for your loved one.

Related Nursing Homes Abuse Blog Entries:

Study Reinforces The Need To Seek Out 'Non-Profit' Facilities When Selecting A Nursing Home For A Loved One

Attorney General Lays Out Guidelines For Selection Of Nursing Homes & Assisted Living Facilities

Take Your Loved One With You

Less Patients, Happier Staff, Healthier Patients. Research Shows Less May Actually Be More When It Comes To Patient Loads For Nurses

Why Would Anyone Want To Work In A Nursing Home?

I've seen a significant number of cases where an Alzheimer's patient gets admitted to a nursing home or assisted living facility only to have their health rapidly decline within a brief period.  In several cases, I've seen patients deteriorate so significantly that within a few weeks of their admission they needed to be rushed to a hospital due to rapid weight-loss and dehydration.  

The event likely leads to a hospitals request that a feeding tube be surgically implanted in patient to provide life sustaining nutrients.  Unfortunately, further complications typically arise with the use of the feeding tube adding further problems to a typically messy situation.

A recent New York Times article, "Feeding Dementia Patients With Dignity" reinforced the obvious, feeding patients with dementia and Alzheimer's is difficult and time consuming. Moreover, the alternative in installing a feeding tube can lead to anger in the patient and negatively impacts the patients quality of life.

I highly recommend that all family and caregivers of Alzheimer's patients check out this article authored by Roni Caryn Rabin that chronicles some of the problems encountered by the more than 5 million people suffering from Alzheimer's disease and specifically-- feeding. 

If there's one message I was left with after reading the article, it is that Alzheimer's patients require a great deal of patience during mealtimes in order for them to really flourish.  Ms. Rabin's article describes how a husband spends more than 45 minutes feeding his wife at every meal in order for her to to physically get enough food without physically or emotionally stressing her.

Certainly, nursing homes and assisted living facilities need to be mindful of the patients nutritional needs and provide the staffing levels for all patients to live with the highest feasible quality of life. 

Related:

Nursing Home Staff Must Pay Special Attention To Avoid Complications When Caring For Patients Dependent On Feeding Tubes

Feeding Tubes May Be Over-Used In Dementia Patients

Feeding Tube Mishap Results In Patient Death & Large Nursing Home Fine

By some accounts, more than 66% of nursing home patients are currently being treated for a complete or partial loss of bladder control.  Unknown to many, patients with a loss of bladder control suffer serious physical and psychological consequences.  Emotionally, patients may withdraw due to embarrassment of having an accident in public. 

Physically, nursing home patients suffering form incontinence tend to suffer higher rates of medical complications than their peers due to the fact that they may suffer from more rapid de-conditioning, dehydration (because they are scared to increase their fluid intake), higher rates of falls (rushing to get to the toilet) and perhaps most problematic-- an increase in the rate in development of bed sores.

Bed sores, also referred to as: pressure sores, pressure ulcers or decubitus ulcers, are wounds that develop when a nursing home or hospital patient remains in one position for an extended period of time.  Patients suffering from bowel or bladder incontinence are at a heightened risk for developing bed sores due to the caustic nature of feces and urine.  When the urine and feces remains in contact with the skin, the skin breaks-down faster than under 'normal' conditions.

I was happy to read about a new approach to treat urinary incontinence currently being implemented at Golden Living at Phoenixvile, a Pennsylvania nursing home.  The nursing facility utilizes a team-approach to analyze and implement an treatment plan for each patient according to their physical and cognitive abilities.

Typical urinary incontinence treatment plans include:

• Strengthening exercises for the pelvic region, hips and abdomen
• Behavior modification programs to help patients relax
• Modifying medication dosages and types
• Simple, practical methods such as: scheduling bathroom trips, modifying clothing to make removal easier and changes in eating routines

The urinary incontinence program appears to be working. "Loss of bladder control is not just a condition of the aging process," according to Roxanne Higgins, Rehabilitation Coordinator at Golden Living at Phoenixville.  "Our UI programs can help successfully treat many patients and help them enjoy more active lives."

Related:

Are incontinent patients at an increased risk for developing bed sores?

In order to prevent pressure sores, it is important to analyze the factors that make a person susceptible to developing them.

6 Most Common Causes Of Bed Sores & How Caregivers Can Help

Lack Of Cleanliness & Incontinence Contributes To Development Of Bed Sores In Nursing Home Patients

Incontinence Amongst The Nursing Home Population

A recently filed wrongful death lawsuit claims that clostridium difficile, or commonly known as C. Diff, is to blame for the death of a patient in an Illinois Nursing Home. 

The lawsuit alleges two short-term stays at Helia Healthcare facilities (Helia Healthcare of Energy and Helia Healthcare of Benton) are to responsible for the man's C. Diff infection and development of decubitus ulcers.  It is further alleged that these medical complications contributed to the man's death.

Despite the fact that the man had a prior episode of C. Diff, and was at an increased risk for return of the infection, the nursing homes failed to recognize tell-tale signs of the infection including:

• Poor appetite
• Poor fluid intake
• Diarrhea

It wasn't until the man had long been struggling with signs of the infection did the facility send him to the hospital for treatment. Read more about this wrongful death lawsuit here.

C. Diff and Nursing Homes

C. Diff s a bacterial infection that can cause diarrhea and serious intestinal conditions (such as colitis - inflammation of the colon) and even death.  Though contracting C. Diff may be a relatively common occurrence (there are an estimated 3 million cases reported annually), C. Diff involving nursing home patients is especially problematic due to the fact that many elderly patients have compromised immune systems and are already in a weakened state.

C. Diff bacteria are are contagious and can be passed through the feces of an infected person and can spread to food, surfaces, and objects when infected patients and other nursing home staff do not wash their hands thoroughly.  Proper sanitation techniques such as thorough cleaning and hand washing is crucial in order to prevent the bacteria from getting spread to other patients.  Spores of C. Diff can survive for months unless facilities to a proper job sanitizing patient rooms and common areas such as bathrooms and cafeterias.

Related Nursing Homes Abuse Blog Entries:

Left Untreated, Stomach Aches Can Be Deadly For Elderly Nursing Home Patients

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

What is a surviving spouse entitled to in a wrongful death lawsuit against a nursing home?

Spotlight On: Helia Healthcare of Urbana

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