Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Everyday I am reminded never to take the health of myself and my family forgranted.  If there's one thing that I continued to be impressed with is the fact that no one ever expects to be injured due to the negligence or poor decisions of another person. 

Particularly with doctors and medical professionals, we expect that their knowledge will help guide us through an illness or injury.  Unfortunately, there are never any guarantees that the person or medical facility we entrust to make correct decisions for us will actually do so.

With the uncertainly in life, go out and live every day as full as you possibly can, and never take forgranted the health of yourself or those around you.  

The Nursing Homes Abuse Blog wishes everyone a happy, healthy and prosperous 2011. Thank you for taking the time to read our blog and make this one of the most popular medical-legal websites on the web!

With more than 300 blog posts in 2010, its easy for entries to get buried, here are the 10 most popular Nursing Homes Abuse Blog entries for your review.

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

News & Observer, had an article about the difficulty proving physical abuse in disabled nursing home residents who are unable to communicate any information about the act. The article focuses on an 88-year-old disabled woman who sustained bruises to her face(consistent with abuse) while a resident at Sunnybrook Healthcare and Rehabilitation in Raleigh, N.C. The woman suffered from advanced dementia and was unable to walk or roll over-- therefore bruising due to a fall could immediately be ruled out. Continued....

2) Bed Sores: Not Just A Pain In The Butt-- More Like An Uncontrollable Killer

Pressure sores (also referred to as bed sores, pressure ulcers, or decubitus ulcers) are an all too common and painful problem for nursing home residents.

Most pressure sores are preventable and are caused by faulty care where the nursing home or hospital does provide adequate care to prevent and treat bed sores. Patients vulnerable to developing pressure sores are the elderly, people who are bedridden, and people with diabetes. Continued....

3) Nurse Faces Murder Charges After Patient Dies From Morphine Overdose At A Britthaven Facility

Perhaps someone should have advised Angela Almore, a nurse at Britthaven in Chapel Hill, NC, that physicians are the only ones capable of prescribing prescription medications for patients.

Seemingly taking the practice of medicine into her own hands when she administered Morphine to patients who should not be taking it; Ms. Almore now faces one count of second-degree murder and six counts of felony-patient-abuse after the death of one patient and the hospitalization of six others she was responsible for caring for in the Alzheimer's unit at the facility. Continued....

4) Children In Nursing Homes: Truly The Most Vulnerable

Many families are forced to institutionalize their disabled children in nursing homes because of many states don’t have the resources to pay for in-home care. This puts parents in the difficult position of funding expensive home care on their own or having their child live in a nursing home, surrounded by elderly adults, and many families simply cannot afford the cost of in-home care workers and nurses.

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

5) Admissions Suspended At An Emeritus Assisted Living Facility Following The Discovery Of: Medication Errors, Bed Sores & Falsified Medical Records

After discovering multiple health and safety problems, Florida officials have suspended the admission of new residents to Emeritus at Crossing Pointe-- a Florida Assisted Living Facility.

A September inspection of Emeritus revealed:

• An 82-year-old patient who died after staff failed to provide her heart medication for four days
• Inaccurate resident counts by facility managers
• Residents with infected bed sores (also called decubitus ulcers, pressure ulcers or pressure sores)
• Neglected patients- some Alzheimer's patients had toe nails so long that they curved around their toes
• Falsified medical records
• Staff administering the wrong medications to patients that resulted in injury

Continued....

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

Given the frequency (approximately 80+% of all nursing nursing home patients will experience a fall this coming year) with which nursing home falls occur, facilities must be on the lookout when it comes to implementing fall prevention techniques in order to improve patient safety. Too often, the prevention comes too late-- if at all.  Continued....

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

An improperly inserted nasal feeding tube was the cause of an 84-year-old's death in a California Nursing Home according to an investigation completed by the California Department of Health.

Investigators from the department determined that the nursing home patient died from aspiration pneumonia after insertion of a feeding tube because the nasal feeding tube was incorrectly inserting into his lungs rather than his stomach. Continued....

8) Brookdale Assisted Living Facility Fails To Learn From Mistakes: Dementia Patient Dies After Ingesting Detergent

In 2008 authorities from Florida regulatory agencies warned Homewood Residence, a Brookdale Senior Living facility, to secure areas of its kitchen and other areas of the facility that were accessible to residents with dementia.

The warning came after dangerous products such as: coffee pots, curling irons and chemical products were found unsecured at the facility. Continued....

9) Special Focus Facilities: The Worst Nursing Homes Of All

I get a large number of questions from nursing home patients and families regarding focused on finding the 'best' facilities available. For some reason, I get an even larger number of people who ask me who the 'worst' facilities are. Maybe there's some sport associated with identifying these facilities? But for to today, let's feed the need to identify the poor performing nursing homes-- the Special Focus Facilities.

If you are a nursing home operator or employee the Special Focus Facility (SFF) is definitely a club you want no part of. Rather, the SFF was created by The Centers for Medicare & Medicaid (CMS) as an assemblage of facilities that deserve special recognition for the inadequate care they typically provide to their patients. Continued....

10) Sheesshh!! Move Along, Nursing Homes Trying To Cover Up Incidents Involving Sexual Abuse

In a world full of crazy people, some have managed to infiltrate the world of nursing homes. While occurrences involving the sexual abuse of nursing home patients are certainly not a common place occurrence, the incidents do occur--- yet too often they are brushed aside by nursing home staff whom may attempt to hide the incident out of embarrassment or perhaps at the request of nursing home management. Continued....

Caring for a loved one can be difficult.  The added dynamic of caring for a loved one who requires the services of a nursing home can be even more so.  Too often families find themselves grasping for information at a time when tensions run high.  Here are some great sites I've accumulated. 

Of course, there are tons more sites out there.  Have some suggestions?  Don't hoard them.  Pass them along to me so others can learn from them.

PATIENT ADVOCATE SITES

1) American Association for Homecare http://blog.aahomecare.org/

This blog focuses on accessing care for people and advocating for people in their homes. They provide information about compliance, trends, education, and training and information for the patients and their families.

2) Pathway Medical Staffing http://pathway-medical.com/blog

Pathway Medical Staffing recruits and employs nurse case managers and non clinical nursing professionals for nursing home environments.

3) Jacqueline’s Patient Advocacy Blog http://jacquelinespatientadvocacy.wordpress.com/

This blog allows and informs patients to navigate and learn the healthcare system.

4) Suzanne Gordon http://www.suzannegordon.com/

Suzanne is a writer, speaker and advocate for patients. Suzanne’s blog tackles important issues such as nurse communication and patient care.

5) RN Patient Advocates, PLLC http://patientadvocates.com/

A group of RNs who teach people about their health care through advocacy, education, and guidance. The blog dives into issues that RN’s help patents work through.

6) Healthcare Whisperer http://healthcarewhisperer.com/Blog/

Hari Khalsa writes the Healthcare Whisperer. Hari is a RN who concentrates in natural medicine and healing and provides insights to families trying to navigate the healthcare system.

7) Nursezone.com http://www.nursezone.com/Nursing-News-Events/message-boards-and-blogs.aspx

Nursezone.com provides nurses with communication that helps with professional development and personal feedback. There is constant communication on the site/blog to help nurses at all levels.

8) North Carolina Estate Planning Blog http://www.ncestateplanningblog.com/articles/nursing-homes/

Gregory Herman-Giddens assists in helping those in nursing homes do their estate planning.

9) California Health Advocates http://www.cahealthadvocates.org/pro.html

Based in California, they specialize in Medicare advocacy and education.

10) My Elder Advocate http://myelderadvocate.typepad.com/blog/

Jack Halpern, author of my elder advocate, brings people together discussing a huge realm of elder care concerns.

Sure, I like to make light of some of the amazingly horrific news that comes out of nursing homes.  Sometimes, its just important to laugh at some of the stupidity that surrounds these facilities because if you don't, you'll walk around consistently saddened by the abuse and neglect-filled conditions at many of these facilities.

Today's version of such a shocking event-- that it makes you question the reality comes out of New York.  According to a report in LoHud.com, a CNA at Putnam Ridge Nursing Home has been charged with larceny after she apparently stole jewelry directly from a patient at the facility.

The CNA will be in court for a January 6th hearing.  No word as if she continues to work at the nursing home.

My take:

This is another stunning example of the caliber of person we continually see working in nursing homes.  When nursing home continually pay their staff extremely low wages and heap endless tasks upon them, the quality of the staff inevitably deteriorates.

Even a slight bump in the wages paid to nursing home workers will go a long way towards improving the quality of the job applicant pool and will likely improve patient care.

Want to connect with like-minded advocates?  Perhaps you just want to vent on a situation impacting your family?  Whatever your reason, I encourage all Nursing Homes Abuse Blog readers to check out re-disgned Facebook page.

Become a fan today, and show your support-- but also become eligible for prizes and drawings in 2011!

American Senior Communities has agreed to pay $376,432 under the terms of a settlement reached with Indiana Attorney General Greg Zoeller after it was discovered the company was engaging in Medicaid fraud. 

The alleged fraud involved American Senior Communities submitting claims to Medicaid (a state program) on behalf of seven employees who were ineligible to participate in the Medicaid program due to their criminal histories.  Federal law prohibits any health care providers from participating in the Medicaid or Medicare programs.

In addition to the significant fine, the company has also agreed to implement procedures to prevent these errors from occurring in the future.

Healthcare Fraud

By some accounts, fraud in the Medicare and Medicaid programs costs tax-payers a whopping $6 Billion every year!  Obviously, the significant significant impact of healthcare fraud on our society can not be minimized.  Fortunately, the government has created provisions of the False Claims Act (31 U.S.C. Section 3729) which provide a financial incentive for healthcare workers to report corporate healthcare fraud.

The False Claims Act empowers health care workers in nursing home or hospital settings to report fraudulent billing practices perpetrated by their corporate employers. In pursuing a claim under the False Claims Act, an employee who witness unlawful acts to bring a lawsuit against the perpetrating company on behalf of the government. The lawsuit is referred to as a Qui Tam action.

As an incentive to pursuing a Qui Tam lawsuit (whistle blower), a healthcare worker may be entitled to a substantial portion of the recovery related to the fraud.  Similar to a plaintiff in a personal injury case, a nursing home worker may be entitled to 20-30% of the proceeds.

Unfortunately, as corporations continue to put their bottom lines ahead of ethical practices, healthcare fraud continues to be a part of some companies customary business practices. 

Common examples of healthcare fraud include that may give rise to a cause of action under the false claims act include:

• Pharmacy Fraud

• Billing for services that were never provided

• Charging for services with a patient who was deceased or no longer a patient in the facility

• Inflating time sheets that do not accurately reflect the time spent with patients

• Using inferior medicine or medical equipment, yet billing the government for the premium services

Related:

If I Work In A Nursing Home Where I Suspect Fraud, Can I File A Qui Tam or Whistleblower Lawsuit?

When The Going Gets Tough, Some Nursing Homes Turn To Medicare & Medicaid Fraud

Nursing Home Bookkeeper Admits To Stealing Money From Facility

State Reaches Settlement With Nursing Home Operator Inside Indiana Business, December 6, 2010

When a person’s kidneys no longer work properly, dialysis can filter waste products from their blood.  Your kidneys keep your blood clean and balanced.  They filter 200 quarts of blood every day, filtering out waste and excess water, which becomes urine. 

Diabetes and high blood pressure are the two most common causes of kidney disease.  As your kidney health declines, your renal function worsens. 

If your kidneys have less than 25% of their kidney function, serious health problems can occur.  And, if your kidneys have less than 15% of their kidney function, dialysis or kidney transplant is required. 

About 11.5% of adults (ages 20+) in the United States show evidence of chronic kidney disease (CKD).  Signs of chronic kidney disease include:

• Increase or decrease in frequency of urination
• Fatigue
• Loss of appetite
• Swollen hands or feet
• Itchiness or numbness
• Drowsiness
• Trouble concentrating
• Muscle cramps
• Darkened skin

When the kidneys have failed or are close to failing (End-stage Renal Disease – ESRD), the body fills with waste and excess water (uremia).  If left untreated, this can lead to seizures, coma, and even death.  Treatment options are dialysis or kidney transplant.  In 2007, in the United States, mortality rates for ESRD were 157.3 deaths for every 1,000 patient years. 

There are two types of dialysis: hemodialysis and peritoneal dialysis.  Hemodialysis involves a dialyzer filter that connected to a hemodialysis machine.  Your blood flows out one set of tubes to the dialyzer that filters the blood, then the clean blood flows back into your body through a second set of tubes.  The treatment takes about 3-4 hours and must be performed 3 times/week.  Peritoneal dialysis involves a dialysis fluid that is inserted into the abdomen that collects waste products then is drained with a catheter. 

Risk of dialysis-related injuries

One complication of peritoneal dialysis is infection because a tube goes from the peritoneal cavity to the outside of the body where bacteria could enter.  Therefore, the patient must take cleanliness seriously. 

Dialysis patients also have an increased risk of falls because of hemodynamic changes which can cause low blood pressure and dizziness.  Also, many dialysis patients are older adults who suffer from bone or muscle weakness and have limited mobility. 

The average age of dialysis patients is 65 years old.  Risk factors for dangerous falls include: low systolic blood pressure before dialysis, history of falls, low vitamin D levels, comorbidities, and old age.  Therefore, dialysis centers must take extra precautions to reduce the risk of falls including performing a fall assessment, use exercises to improve strength, and avoid low blood pressure.

Human error is another common complication of dialysis.  Dialysis treatment involves multiple medications, dialysis access, and dialysis equipment several times a week.  This poses a dangerous set of circumstances, where errors can have deadly results.  Possible problems include:

• Medication errors
• Dialysis solution (dialysate) could be contaminated
• The wrong dialysate could be used
• The dialyzer could leak
• There could be problems with the patient’s access
• Improper blood draws from area close to patient's access site

One major problem in the 80's was incorrect sterilization of dialyzer membranes, which allowed a patient to be exposed to another patient’s blood and all their associated diseases including Hepatitis and HIV.  To reduce such errors, the Association for the Advancement of Medical Instrumentation (AMMI) set dialyzer reuse standards.  Many patients refused to participate in the reuse programs, and providers favored single-use membranes. 

Dialysis is an important and lifesaving tool for patients with renal failure.  However, dialysis can also pose serious dangers.  Therefore, it is important that dialysis centers take precautions to reduce errors and promote patient health and safety.

Resources:

MedicineNet; Dialysis

Agency for Healthcare Research and Quality: Dangerous Dialysis

Heartland Kidney Network Quality Improvement Department: Fact Sheet – Patient Safety in the Dialysis Facility

Clinical Journal of the American Society of Nephrology: Falls and Fall-Related Injuries in Older Dialysis Patients

International Urology and Nephrology: Prevalence of Falls Among Seniors Maintained on Hemodialysis

National Kidney and Urologic Diseases Information Clearinghouse: Kidneys

“Don’t go to the hospital if you don’t want to get sick” is frequently said in jest by many of my colleagues who represent people who have been harmed by mistakes made in hospitals. 

Now, a new study published in the New England Journal of Medicine regarding errors made at North Carolina hospitals reinforces this saying. 

The study evaluated hospital data from 2002 to 2007 and looked at patient charts that contained codes for medical conditions that where generally associated with errors made by hospital staff.

Amongst the common errors made by hospitals include:

• Severe bleeding during an operation
• Breathing troubles caused by an incorrectly performed procedure
• Falls
• Vaginal cuts that resulted during delivery

The overall rate of hospital errors was a shockingly high 25.1%!   However, a closer analysis revealed that most of the errors resulted in temporary illness or injury and were treatable. 

A closer evaluation of the studies data still revealed an alarming rate of serious hospital errors resulting in serious patient injury with 2.4 % of the errors causing or contributing to patient death.  Another 2.9% of cases involving hospital errors resulted in a permanent injury to the patient.

What makes the rate of hospital errors in this study even more alarming (as if there wasn’t enough to be concerned about) is the fact that many North Carolina hospitals are actively involved in programs to reduce errors at their facilities.

Dr. Mark Chassin, president of the Joint Commission, an organization that accredits hospitals responded to the studies findings saying, “preventable complications are way to frequent in American health care” and “it’s not a problem we’re going to get rid of in six months or a year.”

While the results of this study certainly are alarming, the fact that most hospital patients are completely unaware of the potential threats to their health is even more so.  Hopefully, public outcry will drive hospitals to disclose their error rate and put a premium on patient safety.

Related:

Study Finds No Progress in Safety at Hospitals by Denise Grady The New York Times November 24, 2010

Medical Facilities Can Reduce The Incidence Of Infection By Taking Some Basic Precautionary Steps

Hospital Acquired Pressure Sores Are Devastating Source Of Patient Injury & Death

Now that we score nursing homes, is it time to do the same with hospitals?

The California Department of Health has rendered its most severe citation (AA) and a $80,000 fine following an investigation into the death of an 86-year-old woman at Walnut Whitney Care Center (California).  An investigation determined that the woman was admitted to the facility in March, 2008 for medical care related to injuries she sustained in a fall.

Just five weeks after her initial admission, the woman was transferred to a hospital emergency room where she diagnosed as having septic shock.  Less than 24-hours after her hospital admission she died from resulting complications.

Specifically, the investigation determined that the nursing home failed to:

• Monitor the woman for developing a urinary tract infection
• Monitor the patient for dehydration
• Provide necessary fluids

Walnut Whitney is owned by Horizon West Healthcare.  Earlier this year, a jury awarded the family of a deceased nursing home patient $29.1 million in lawsuit premised upon elder abuse.

Related:

State levies fine $80,000 fine in Carmichael nursing home death The Modesto Bee November 20, 2010

Nursing Home Injury Laws: California

Nursing Home Abuse: Workers' Prank In Applying Grease To Dementia Patients In California Results In Criminal Charges

Failure To Follow Supervisory Guidelines Results In Substantial Fine For California Facility

Untreated Urinary Tract Infections In Nursing Home Patients May Result In Urosepsis

Joseph Clint Offutt lived an admirable life.  Like many of his generation, Mr. Offutt served in World War II, working on the farm and was a dedicated husband for 58 years.  Yet despite all of his accomplishments in life, age began to creep up on Mr. Offutt. 

After suffering a stroke in 2007, Mr. Offutt's family realized that they were no longer able to care for him at home so they looked for a skilled nursing facility. 

On March 25, 2008 Mr. Offutt was admitted to Harborside of Madisonville (currently known as Hillside Villa Care and Rehabilitation Center).  Just nine days later, Mr. Offutt was transferred to a nearby hospital for multiple complications he developed during his brief stay inlcuding:

• Severe dehydration
• Malnutrition
• Bed sores
• Infections

On April 3, 2008, at the age of 92, Mr. Offutt passed from the complications that developed during his brief stay at Harborside (Kentucky).

As a result of the poor care, Mr. Offutt's family initiated a wrongful death lawsuit against Harborside and the parent company Sunbridge Healthcare Corporation.

After three weeks of hearing evidence in the case, a jury awarded Mr. Offutt's family $42.75 million comprised of $1 million pain and suffering, $1.75 million for his wife's loss and $40 million for punitive damages.

Short Stays, Rapid Declines

While the juries award in this matter is certainly not typical for most nursing home negligence matters, the fact patter unfortunately is.  Many of the nursing home negligence cases my office is currently prosecuting involve the development of a medical complication after a brief admission to the facility.

In some cases the rapid spiral of poor care stems from the fact that the patient is new and staff may be infamiliar with their medical needs.  In a substantial number of cases, I tend to see facilitieis over-promise and under-deliver when it comes to being capable of providing care that the patient requires and that the familiy was assured of.

Either case is unacceptable and merits furhter evaluation by an attorney who prosecutes nursing home cases to determine if the correlation between admission and death is a coincidence or due to the negligence of the facility.

Related:

Jury awards $42.75M in nursing home death Lexington Herald-Leader

Hours After Admission To Illinois Nursing Home For 'Respite Care', Resident Fractures Hip

Respite Care: A Welcome Break For Caregivers Or Exposing A Loved One To Unnecessary Harm?

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

Here is great piece that has been circuluating around the web for some time.  I don't know who wrote it, but I figured its worth posting as I saw it most recently in Jonathan Chevreau's column in the Finacial Post. 

Let’s put the seniors in jail, and the criminals in a nursing home. This way the seniors would have access to showers, hobbies, and walks, they’d receive unlimited free prescriptions, dental and medical treatment, wheel chairs etc. and they’d receive money instead of paying it out.

They would have constant video monitoring, so they could be helped instantly, if they fell, or needed assistance. Bedding would be washed twice a week, and all clothing would be ironed and returned to them.

A guard would check on them every 20 minutes, and bring their meals and snacks to their cell. They would have family visits in a suite built for that purpose.

They would have access to a library, weight room, spiritual counseling, pool and education.

Simple clothing, shoes, slippers, P.J.’s and legal aid would be free on request.

Private, secure rooms for all, with an exercise outdoor yard, with gardens.

Each senior could have a P.C. a T.V. radio, and daily phone calls.

There would be a board of directors to hear complaints, and the guards would have a code of conduct, that would be strictly adhered to.

The “criminals” living in the nursing home would get lousy food, be left all alone, and unsupervised, lights off at 8pm, and showers once a week, live in a tiny room, pay $3,000 per month and have no hope of ever getting out. Justice for all.

Though far less eloquent, here is an old article, What Can Nursing Homes Learn From Jails?, I wrote regarding a similar analogy particularly with nursing homes failing to supervise wandering patients.  Maybe I was onto something?