Jonathan Rosenfeld's Nursing Homes Abuse Blog : Jonathan Rosenfeld's Nursing Homes Abuse Blog | Lawyer & Attorney : Strellis & Field Law Firm | Bed Sores, Senior Neglect, Elder Abuse, Sexual Abuse: Chicago, Illinois

Talk about worthless news stories, here's a news-clip about a Brown University professor who will be releasing a new book devoted to.... a cat.  Not just any alley cat, 'Oscar' allegedly has the ability to predict the impending death of nursing home patients.  Oscar has apparently successfully predicted the impending death of more than 50 patients in a Rhode Island nursing home.  Apparently, when Oscar cuddles up with you, your day may be numbered.

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Diabetes is a serious illness affecting many nursing home residents.  Diabetics face an increased risk for a variety of health problems and complications, including ketoacidosis.  Diabetic ketoacidosis is a dangerous complication of diabetes that occurs when you don’t have enough insulin in your body.  This serious complication is more common in people who have type 1 diabetes, rather than type 2 diabetes. 

Diabetic ketoacidosis develops when you have too little insulin in your body, raising your blood sugar level.  This causes your body to break down fat for energy, creating toxic acids known as ketones.  If left untreated, this can cause you to lose consciousness and even result in death.  Symptoms develop quickly and include:

• Excessive thirst
• Frequent urination
• Nausea and vomiting
• Abdominal pain
• Loss of appetite
• Weakness or fatigue
• Shortness of breath
• Fruity-scented breath
• Confusion. 

Doctors can test for high blood sugar level and high ketone level in your urine in order to confirm ketoacidosis. 

Ketoacidosis is commonly triggered by an illness or a problem with insulin therapy.  Elderly diabetic nursing home residents are more susceptible to infection and other illnesses, which in turn puts them at greater risk for developing ketoacidosis.  However, the risk of ketoacidosis is highest if you are age 19 or younger and suffering from type 1 diabetes.  Other possible triggers include: stress, physical or emotional trauma, high fever, surgery, heart attack, stroke, and alcohol or drug abuse. 

Treatment of ketoacidosis is done with fluid replacement, electrolyte replacement, and insulin therapy.  These very treatments that are used to correct ketoacidosis are also the source of most ketoacidosis complications.  These complications include: low blood sugar (hypoglycemia), low potassium (hypokalemia), and swelling of the brain (cerebral edema). 

The best way to prevent ketoacidosis is to properly manage your diabetes with healthy eating and physical activity as well as monitoring your blood sugar level to ensure that it remains within your target range. 

Many nursing home residents rely on nursing home staff to properly monitor their blood sugar level and adjust insulin dosage as needed as well as provide healthy and well-balanced meals.  Therefore, it is important that nursing homes develop care plans to provide adequate care and services to manage diabetic residents.  Most diabetic complications develop faster in elderly diabetics with poor glycemic control.

Diabetes in the Elderly

Diabetes is a serious disease that can cause many complications for elderly diabetics.  Ketoacidosis and other diabetic complications require that nursing home staff take special precautions to properly monitor diabetic residents and ensure that they receive necessary care and services to attain and maintain the highest quality of life possible. 

If you worry that a nursing home facility is not providing adequate care to manage your diabetes, it is important that you take immediate action to get your diabetes under control and prevent medical problems and complications. 

Resources:

Medicine Net: Ketoacidosis

Diabetes Disease: Ketoacidosis

Journal of Geriatric and Gerontology: Diabetes in the Elderly

Resident Grand Rounds: Diagnosis and Management of Diabetic Ketoacidosis in Adults

Nursing Homes Abuse Blog:

Nursing Homes Must Be Prepared To Handle Diabetic Patients

Never Event #3: Poorly Controlled Blood Sugar, Hyperglycemia & Hypoglycemia

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A new study published in Health Affairs concluded Hispanics are more likely to live in bad nursing homes than other demographics.  After analyzing data from predominately Hispanic vs. non-Hispanic nursing homes, the studies leader Mary Fennell, a professor of sociology and community health at Brown University, believes the data conclusively demonstrates that Hispanics live in inferior nursing homes.

Amongst the studies findings:

• 4.5 million elderly Hispanics require nursing home care in 2010
• From 2000 - 2005, the percentage of Hispanic nursing home patients increased from 5% to 6.4% of the total nursing home population
• Most of the Hispanic patients in nursing homes had already endured prior hospitalizations and require high-level care

One of the reasons the study suggests for the increase in Hispanic nursing home patients is that many of the predominately female care-givers now work outside of the home.  

Whatever the underlying reason for the increase in Hispanic nursing home patients, I strongly believe that all nursing home patients are entitled to the best care that is feasible.  

As a personal injury lawyer in Chicago, I unfortunately see many minorities flocking to inferior nursing homes because they are conveniently located within the confines of their neighborhood. Consequently, I always suggest that families should select a facility based on the quality of the services they provide over the convenience of its location.

Read more about this study of Hispanic nursing home patients here.

Related:

Nursing Homes With Higher Percentage Of Hispanic Residents Have Higher Rate Of Bed Sores

Blacks Receive Inferior Care At Most Nursing Homes

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

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As the number of older adults increases, families are faced with the question of where their parents and grandparents will receive the best care. 

The answer for many families is to keep their family members at home. Many older adults who live at home require home health services, home nursing services, and in-home support services in order to maintain a high quality of life. 

Although home care nursing affords seniors more flexibility, the lack of a structured setting makes them particularly susceptible to elder abuse, neglect, and financial exploitation-- especially at the hands of unqualified or dangerous in-home caregivers. 

About 7.5 million individuals receive long-term care at home because of an acute illness, long-term health condition, permanent disability, or terminal illness according to the American Association for Long-Term Care Insurance. This is significantly more than the 1.5 million individuals in nursing homes and 1.1 million individuals in assisted living facilities who receive similar care for the same types of conditions. 

In order to protect individuals who receive health services at home, some states such Illinois, have passed laws to protect seniors who receive care in their homes.  Illinois' Home Health, Home Services, and Home Nursing Agency Licensing Act (210 ILCS 55) ensures that people who receive home health services, home nursing services and in-home support services at their residence are granted consumer protection and quality care. The Act establishes and enforces standards for services and care. 

In addition, all home nursing agencies must be licensed by the Illinois Department of Public Health as one or more of the following entities: home health, home nursing, and home services agencies. One requirement for licensure is compliance with the requirements of the Health Care Worker Background Check Act (225 ILCS 46), which helps protect frail and disabled citizens through a criminal background check of health care workers. A licensee of an agency that violates of the Home Health Licensing Act may be subject to penalties or fines of $100 per day starting on the date of the violation and ending on the date the violation is corrected. 

No doubt about it, legislation applicable to home nursing certainly provides a foundation for patient safety.  Nonetheless, as the demand for home nursing continues to grow, many companies that provide home nursing care will cut corners with respect to screening and training their workers in order to satisfy the demand.

If your loved one has suffered an injury or abuse at the hands of a home care worker, you should immediately report the situation to law enforcement.  Many of these tragic situations give rise to civil lawsuits against these home care agencies.  As always, you can talk candidly with our lawyers about your legal options for free.  Only if we are successful recovering money on your behalf, will we accept a fee. (888) 424-5757

Sources:

Illinois General Assembly: 210 ILCS 55 Home Health, Home Services, and Home Nursing Agency Licensing Act

Illinois General Assembly: Administrative Code, Part 245 Home Health, Home Services and Home Nursing Agency Code

Illinois General Assembly: 210 ILCS 46 Health Care Worker Background Check Act

Medical News Today: New Study Reports Three Times More People Receiving Health Care Support at Home Rather Than in Nursing Homes or Assisted-Living Facilities

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For families and individuals who provide care for older adults, adult day care centers or adult day services can be an important tool in providing adequate care. Providing round-the-clock care for an elderly loved one can be a huge, but worthwhile time commitment.

Adult day care centers can provide a much needed break for caregivers, while offering elderly adults therapeutic services.

Adult day service is the direct care and supervision of adults 60 years of age and over in a community-based setting for the purpose of providing personal attention and promoting social, physical, and emotional well-being in a structured setting.

Adult day care can serve an alternative to nursing homes depending on the focus of the facility (social or health services). These facilities provide services to adults with physical or mental impairments for the purpose of restoring or maintaining their ability to care for themselves. They can serve as an alternative to nursing home care when 24-hour nursing care is not medically necessary or when nursing homes are against the wishes of the individual or the family.

The State of Illinois does not require licensing or certification for adult day care providers. The Department on Aging Community Care Program (CCP) does not include provision for adult day care other than those stated in the Administrative Code (building, fire, health, and safety codes and standards, environmental barrier codes, and food service sanitation and vehicle codes).

In addition, the Illinois Department of Public Health has the authority to conduct performance reviews of adult day care centers in Illinois. The Provider Performance Review includes reviewing a sample of client and employee files to evaluate compliance with administrative rules and ensure that the center adheres to policies and procedures set by the Department.

The following are services that the Department requires adult day care centers to provide:

• Activities of daily living (ADL) assistance
• Health education and counseling
• Health monitoring / health-related services
• Medication administration (administered by an appropriately licensed professional)
• Nursing services
• Social services
• Transportation

Optional services include:

• Physical therapy
• Occupational therapy
• Speech therapy
• Skilled nursing services

Illinois, like most states, does not stipulate a specific staffing requirements for adult day care; only require only that each adult day service provider have adequate personnel in number (at least two people) and skill to provide for program and financial administration, nursing and personnel care services, nutritional services, planned therapeutic/recreational activities, and transportation to and from the service site. There are suggested staffing ratios: two staff for every 1-12 clients, three staff for 13-20 clients, four staff for 21-28 clients, and one additional staff person for each 7 additional clients.

As the population of older adults increases, the use of adult day care services can help provide necessary services to improve their the lives of older adults without having to institutionalize them in nursing home facilities.

For more than 30 years we have championed the rights of the elderly in all settings: hospital, nursing home, assisted living and day care.  If you or a loved one was injured or abused in an adult day care setting, you may have legal rights that include a claim for monetary damages.  Let us put our experience to work for you. 

Free consultation.  A track record of results for people like you. (888) 424-5757

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

Resources:

U.S. Department of Health and Human Services – Regulatory Review of Adult Services
U.S. Department of Health and Human Services – Regulatory Review of Adult Services: Illinois
National Respite Network & Resource Center: Adult Day Care 

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Thanks to Sarah Cole at the ADR Blog for addressing the Ohio Supreme Court's decision in Hayes v. Oakridge Home, (slip opinion No. 2009-Ohio-2054).  I believe this decision represents a major setback for the rights of nursing home residents who sustained injuries due to the negligence of the facility. 

In Hayes, a 95-year-old woman signed an arbitration agreement at the the time she was admitted to Oakridge Home, a Cleveland nursing home.  The arbitration agreement stated that disputes (injuries) between the parties were to be resolved via binding arbitration as opposed to jury trail.  Further, the arbitration clause stated that Hayes could not claim punitive damages or attorneys fees.

Shortly after her admission, the Hayes suffered serious injuries due to a fall from a wheelchair due to the alleged negligence of the facility. Subsequently, the woman died and the executor of her estate filed a nursing home negligence lawsuit against the nursing home in state court. 

The facility claimed that the the lawsuit was inappropriate and the exclusive means of resolving the negligence claim was via arbitration as stated by the admission document.  Although the lower courts ruled the arbitration agreement to be unconscionable due to Hayes' age and the unequal bargaining power of the nursing home vs. elderly, the Ohio Supreme Court ruled the agreement to be enforceable.

As Cole succinctly points out, the primary issues presented before the court were Hayes' age and the 'procedural and substantive unconscionably' of the arbitration clause. In my practice, I see firsthand how skilled nursing facilities take advantage of elderly nursing home patients and their families by burying arbitration agreements in stack of other types of admission paperwork. 

Unfortunately, this decision stresses the need for families to become aware of the legal pitfalls that accompany nursing home life.  Therefore, I suggest, striking any arbitration agreements on all admission paperwork to protect the rights of your loved one.

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Most of the time a family contacts my office, it is due to an incident involving abuse or ongoing neglect. Although perhaps less obvious, after we investigate many of the cases, the underlying problem may be a complex medical condition that may ultimately prove important in successfully prosecuting the matter.

Here are some of the medical conditions we have discussed over the past year:

Clostridium Difficile / C. Diff

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

Stevens Johnson Syndrome

Stevens-Johnson Syndrome (“SJS”) is a systemic disorder that affects the skin and mucous membranes, usually caused by a severe drug reaction. SJS often begins with flu-like symptoms (fever, sore throat, cough, burning eyes), then progresses to red or purple rashes and blisters (photos), especially around the mouth, nose, eyes. These symptoms eventually lead to skin sloughing (the shedding of the top layer of skin) because of cell death. Some patients with extreme cases of SJS appear as though they were severely burned due to the extensive skin loss.

Legionnaires Disease

Legionnaires disease is an infectious disease caused by the Legionella bacteria. There are two types of Legionnaires disease: Legion fever (where people generally develop pneumonia) and Pontiac Fever (symptoms similar to the flu).

Legionnaires disease got its name when a group from the American Legion conference all developed pneumonia. When scientists analyzed the group, they noticed that they all had the same bacterium called Legionella.

Subdural Hematoma

A subdural hematoma is a type of intracranial bleeding (hemorrhage), caused by head injury. 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.

There are three types of subdural hematomas: acute, sub-acute, and chronic. Acute subdural hematomas are the most dangerous and are usually caused by a severe head injury. With sub-acute hematomas, the signs and symptoms take longer to appear (days or weeks). Chronic hematomas can be caused by less severe head injuries, and symptoms can take weeks to appear because of slower bleeding.

Hypotension

Hypotension (low blood pressure) is a problem for many nursing home residents, causing dizziness and fainting. Blood pressure readings measure the pressure in arteries - systolic pressure (the top number in a reading) measures the pressure the heart generates when pumping blood out to the rest of the body and diastolic pressure (the bottom number in a reading) measures the amount of pressure between heartbeats. A systolic blood pressure of 90 millimeters of mercury or less or a diastolic blood pressure of 60 millimeters of mercury or less is considered low.

Sepsis

'Sepsis' is a bacterial infection in the bloodstream or body tissues, frequently found in patients with severe bed sores. In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below below 4000 cells/mm.

Frequently, people use the term sepsis to describe 'severe sepsis' and 'septic shock.' Severe sepsis is used to describe people who have organ dysfunction following a diagnosis of sepsis. People diagnosed with septic shock have sepsis with hypo-tension (abnormally low blood pressure).

Amyloidosis

Elderly nursing home residents, especially those suffering from other diseases such as bed sores, have a higher risk of developing amyloidosis, a disease which can damage various tissues and organs. This can cause dangerous complications in residents who are already weak from advanced age or underlying disease.

Amyloidosis is a group of diseases caused by abnormal deposits of amyloid protein (usually produced by cells in bone marrow) in the body’s tissues and organs. The disease frequently affects the heart, kidneys, liver, spleen, nervous system, and gastrointestinal tract. The amyloid protein can deposit in a localized area (localized amyloidosis) or affect tissues throughout the body (systemic amyloidosis). Amyloidosis is diagnosed for testing for the amyloid protein in a biopsy of involved tissue.

Impacted Bowel

An impacted bowel is the condition where feces are trapped in the lower part of the large intestine, causing a waste obstruction. The stool collects in the bowel and becomes hardened. This hard stool can irritate the rectum, resulting in the production of mucus and fluid which can leak, causing fecal incontinence.

One of the most common symptoms is lack of appetite, caused by pressure on the abdomen. Hemorrhoids (a mass of dilated veins in swollen tissue around the anus) are a common sign of impacted bowels because it is more difficult to rid your body of fecal matter. Other symptoms include: a constant feeling of fullness; diarrhea; hardened feces; cramping and pain; vomiting; constipation; bad breathe; and bloating. If left untreated, the waste obstruction can cause a rectal infection that can lead to sepsis or death.

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In a January 2009 speech, President Obama supported creating electronic health records for all Americans within five years, lowering the cost of health care, making the system more efficient, preventing medical errors, and saving money and jobs. 

The term “electronic health records” does not refer to any specific system and could refer to sophisticated system that allows doctors to order tests, send prescriptions, and track medical history or a much less sophisticated system. Therefore, one of the first requirements would be establishing standards for what constitutes an electronic health records system. 

Only 17% of the nation’s 800,000 doctors and 8% of the nation’s 5,000 hospitals currently use electronic medical records (“EMR”). This low percentage could be attributed to cost. Electronic systems could cost tens of thousands of dollars to implement and also require annual maintenance fees. 

These electronic systems also require skilled personnel to build and implement the technology. Studies indicate that the plan could cost at least $75-100 billion over the ten years that hospitals would probably need to implement the program, with the biggest costs probably going towards paying and training the labor force needed to create the network. 

Electronic health records also raises questions about information privacy and security. HIPPA (Health Insurance Portability and Accountability Act) does not currently include any regulations of Web data handling and patient privacy. Already, lawmakers are pushing for safeguards to protect consumers. 

Despite concerns over cost and privacy, electronic health records could help improve the quality of health care. Supporters assert that it could help eliminate redundant tests, better prepare doctors for their patients, prevent medication errors, reduce malpractice lawsuits and help patients be better-informed. 

Additionally, supporters claim that a fully computerized health record system could save the heath care industry $200-300 billion a year. This could eventually slow the rise of health care premiums, which would save Americans money. However, some people do not think that a national electronic health record system will save the nation as much as President Obama asserted ($80 billion a year). 

Nursing home facilities and residents might also benefit from electronic records. This is because records can be shared among health care providers. Many times, nursing home residents require hospitalization for injuries, illness, and disease. 

Electronic medical records could better allow doctors and nursing home staff to share information concerning changes in physical and mental health. This could help provide more updated and personalized care of residents through electronic records of any changes in condition. 

However, nursing home facilities have different information needs than hospitals. Nursing home facilities need larger records with more extensive patient histories and descriptive information focused on the long-term treatment of residents instead of acute hospital-oriented systems. 

A study by the American Association of Homes and Services for the Aging (AAHSA), suggests that 43% of U.S. nursing homes maintained electronic health records, with 48% using computerized physician orders, 51% using electronic medication orders, and 41% using electronic systems to manage laboratory information. 

The study also revealed that larger facilities and those that were part of a chain were more likely to use electronic systems than smaller, stand-along facilities. The greater percentages of nursing homes using electronic records suggests that implementing electronic health records in nursing homes might be an easier transition than in other health care facilities. In addition, electronic systems that allow staff to document care at the point of service delivery could improve the quality and accuracy of medical-record documentation and improve quality of care. 

Resources:

New York Times: Privacy Issue Complicates Push to Link Medical Data 

B-net: Electronic records in long-term care

AAHSA: Research Shows Nursing Homes Lead the Way in Electronic Health Record Use

The Gerontologist: Improving the Quality of Nursing Home Care and Medical-Record Accuracy with Direct Observational Technologies

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Not all nursing home patients are elderly!  A blog-reader sent me this inspirational video of Kenny, a 34-year-old man who now lives relatively independently after spending 17 years in a nursing home. Kenny suffered a cerebral hemorrhage as a child that left him confined to a wheelchair, but has not stopped him from enjoying life.  Kenny has created a website The Traveling Wheelchair that shows his accomplishments.  Go Kenny Go!

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Happy 2010!  Best wishes for a happy, healthy and prosperous New Year to all of our readers.  

Thank you for making 2009 a busy and exciting year for me.  Through this blog, I was fortunate to meet many of you in person or via email.  Although most families and caregivers contact me after a distressing incident, I continue to get calls and emails from many people with nursing home questions or concerns.  Either way, I am always grateful for the opportunity to assist or at least exchange ideas.  I look forward to building on many of these relationships over the coming years. 

Jonathan

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Nursing home facilities often house young and middle-aged residents suffering from mental illness (including schizophrenia, depression, and bipolar disorder) with older nursing home residents.  In some cases, this has led to violence against already frail elderly residents. 

Younger mentally ill people now make up more than 9% of the nation’s almost 1.4 million nursing home residents.  Last year, there were almost 125,000 young and middle-aged adults with serious mental illnesses living in nursing homes in the United States.  This was a 41% increase from 2002, when only 89,000 mentally ill people ages 22 to 64 lived in nursing homes.  The federal government helps pay for nursing home residents’ care under Medicaid so long as the facility’s mentally ill population stays under 50%.  If the population of mentally ill residents is above 50%, the facility is classified as a mental institution and is no longer eligible to receive funds under Medicaid.   

Illinois has the highest number of mentally ill adults under age 65 living in nursing homes.  This is in part because Illinois only has 1,480 public hospital beds for mentally ill patients since the state shut down seven state-run mental hospitals since 1980.  Under federal law, nursing homes may only admit mentally ill patients if the state has determined that the person needs the high level of care the nursing home can provide. 

Mentally ill nursing home residents are often younger and stronger than the elderly nursing home population.  This leaves elderly residents less able to protect themselves when younger mentally ill residents suffering from behavioral problems and become aggressive and violent.  There are also correlations between nursing home residents suffering from dementia and increased aggression despite antipsychotic drugs. 

Elderly nursing home residents are already at greater risk of injury because of frail or weak bones, underlying disease, and weakness.  In addition, many nursing home residents are bed-bound, restricted in movement, or in wheelchairs, also making it more difficult for them to remove themselves from potentially dangerous situations involving mentally ill residents.   

In May 2008, a Chicago nursing home resident (Ivory Jackson – age 77, suffering from Alzheimer’s) at All Faith Pavilion was beaten with a clock radio by his roommate who was almost thirty years younger.  Mr. Jackson later died from his injuries.  The attacker, who had a history of aggression and “altered mental status,” was ruled unfit to stand trial and now resides in an Illinois state mental hospital.  All Faith Pavilion was fined $32,500 for failing to prevent the deadly assault. 

In January 2009, a 21-year-old mentally ill nursing home resident suffering from bipolar disorder with aggression was charged with raping a 69-year-old fellow nursing home resident at a facility in Elgin.  The mentally ill resident was admitted to the nursing home facility despite a history of violence and was left unsupervised even after telling staff that he was feeling sexually frustrated. 

In light of recent violent episodes (assaults, rapes, and murders) occurring in nursing homes, Illinois lawmakers have organized a Nursing Home Safety Task Force to improve Illinois’ nursing home system and ensure the safety of residents.  The Task Force hopes to deliver recommendations for improving the state nursing home system to Governor Quinn by January. 

What can you do?

If you are concerned about the living conditions of a loved one, here are some simple suggestions:

• Ask the facility about their policy with respect to accepting patients with criminal backgrounds and/or mental illness.
• Look at your state's sex offender registry, many states offer the opportunity to input a specific address-- such as a nursing home-- to see if any convicted offender live there
• Visit a facility multiple times before placing a loved one there.  Does it seem safe?  
• Check with your local police and see if any reports of violence have been reported at the facility.
• Report all violence to the police immediately

Sources:

Medical News Today: Patient Groups Tackle Stigma Attached to Bipolar Disorder and Other Mental Illnesses With New Tools

The Gerontologist: Mental Health Correlates of Aggression in Nursing Home Residents With Dementia

MSNBC: Mentally Ill Endanger Nursing Home Patients

US News: Health Buzz: Mentally Ill in Nursing Homes

Illinois Nursing Home Safety Task Force

Associated Press: Task Force Targets Violence in Illinois Nursing Homes

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Have you ever tried to read a nursing home patient's chart?  Were you able to read everything?  If so, please shoot me an email, because I surely have a difficult time sorting through many entries in charts.

A new collaboration between Golden Living and Microsoft may help to improve not just the legibility of medical records, but also aid in transmission of individuals medical records from one provider to another.  The system known as Microsoft Amalga Unified Intelligence System (UIS) stores each patients medical records on-line to allow ease of access by both the patient and subsequent health providers.

"The use of Microsoft Amalga allows the bridge of information between the various care settings and build a robust view of the patient across the enterprise no matter where they've been," said Brad Savage, a senior vice president and chief information officer for Golden Living.

Given the complexity of many nursing home patients' medical records, I'm all for any tool to help assist medical professionals with their treatment.  Especially, in situations involving critical care, where a patient may be unconscious or uncommunicative, this new technology may prove to be a literal life safer.

Read more about this new technology here.

About Golden Living:

Golden Living is a national company that provides medical care in a variety of settings.  In particular, Golden Living strives to serve people:

• Recovering from Joint Replacement Surgery
• Recovering from a Stroke
• Progressive Dementia or Alzheimer's Disease
• Assistance with Activities of Daily Living
• Managing a Chronic Disease
• Declining Health that Requires Long-Term Care
• Managing a Terminal Illness

There are more than 300 Golden Living nursing homes and assisted living centers located in more than 20 states. 

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Information compiled by the Illinois Nursing Home Task Force revealed that out of 407 complaints directed to administrators from 2005 through 2009, only three of the complaints resulted in discliplinary action.  Obviously, the overwhelming majority of complaints directed towards nursing home adminsitrators-- the effective heads of the operation--- went without any action.

In Illinois and other states, nursing home administrators may be disciplined by state and federal authorities for a variety of legal infractions such as professional incompetence and violating Illinois' Nursing Home Care Act, which protect patients from emotional and physical harm.

According to Toby Edelman, an attorney with the Center for Medicare Advocacy, "[l]ess than one percent is ridiculous.  There should be more accountability on the part of the administrators."

We will soon learn how serious state officials are with respect to holding administrators responsible for incidents involving safety violations at their facilities, when state officials decide the fate of Jamie L. Loyd.  During Loyd's tenure at Maplewood Care in Elgin, a young resident (with a criminal background) sexually abused an elderly patient.  Officials cliam Loyd was careless when she failed to adequeately screen the young man prior to his admission to the facility.

While supporters of the nursing home lobby will argue that nursing home administrators should not be held accountable for the unforseeable acts committed by residents against other residents-- which I strongly agree with.  

The fact remains, that many situations involving abuse or injury stem from the fact that the administrators failed to supervise or intervene.  Hopefully, we will see the numbers of administrators who are disciplined begin to rise and patient care will improve as well.

Resources:

Few nursing home admins disciplined, Carla Johnson, The Associated Press

53 Illinois Nursing Homes Cited In 2009- 2nd Quarter Violations

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

Illinois 4th Quarter Nursing Home Violators Score Just 1.72 Out Of 5 Stars

Man Charged With The Rape Of Fellow Resident In Illinois Nursing Home

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Lots of chatter on Twitter over the weekend about Thai Hodges, a disabled woman who was taken to a homeless shelter by the good folks at ManorCare after her funds had apparently dried up. Hodges was admitted to ManorCare for rehabilitation and skilled nursing care after she suffered a stroke and became paralyzed.

The good news about the story (if there really is any) is that Sylvia Negley, the shelter coordinator realized that Hodges was clearly in need of medical care and refused to take her in and sent her back to the nursing home for additional care.

Negley says the transfer of patients from hospital and nursing homes is on the rise.  "'Hospital dumps' is what we call them,"Negley said.  "I've seen people wheeled in here in a wheelchair, placed on a chair and then they take the wheelchair away."

Can nursing homes do this?

If a nursing home accepts Medicare funding (the overwhelming majority of facilities do), then they are obligated to comply with its rules. 

Section 483.12(a)(2) Transfer and Discharge Requirements:

The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless:

(i) The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;

(ii) The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility;

(iii) The safety of individuals in the facility is endangered;

(iv)The health of individuals in the facility would otherwise be endangered;

(v) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. For a resident who becomes eligible for Medicaid after admission to a nursing facility, the nursing facility may charge a resident only allowable charges under Medicaid; or

(vi) The facility ceases to operate.

In this case, it sounds as though ManorCare acted recklessly in discharging a disabled patient who obviously needed skilled nursing care.  However, in cases where a medical condition is less acute, it may be within the facilities rights.  As we see the nursing home population grow and additional economic pressure put on these facilities, I'll bet we see more situations such as this in the future.

Read more about the dumping of a Florida nursing home patient here.

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The joy that accompanies the holidays is frequently absent from the halls of nursing homes.  The celebrations and meals that make the holidays a joyous time of year for many of us may be impossible for people who may be immobile or ill.

Regardless on how long its been from your last visit, a brief visit with a friend or family member in nursing home can lift spirits especially during this time of year.  Leave whatever guilt you may hold regarding the infrequency of visits or prior relationship problems look to the present.

I found some excellent suggestions for a positive nursing home visit at this website Agedcarer.com.  

If a family member is immobile or unable to communicate simply holding their hand, stroking their forehead and talking quietly lets them know you care.

Talk about recent outings, bus trips or events at the nursing home.

Bring photos or a family movie of recent special events. Watch a DVD together and bring some snacks.

Share a meal with your family member in the dining room or order take away food. Call the nursing home ahead of time to organise a table.

Bring grandchildren to visit. Ask a grandchild to read from a favourite book or to brighten a room with current art projects.

Help a family member write a letter to a friend. Receiving a letter or card in return will lift their spirits.

Give your mum a manicure or hand massage.

Bring the family pet to visit, go for a walk in the garden or show off the pet to other residents.

If you play an instrument put on a concert for all the residents.

Take a family member out for the day. A simple car trip to the beach can be invigorating.

If you live far away organise a weekly phone call with staff at a certain time of day. 5 minutes on the phone can brighten your loved one's day.

Receiving cards, letters and photos from family can be a conversation starter for weeks between residents and staff. Bring some large print books, magazines and cross-word puzzles.

Residents needs to know they are still an important part of the family. Give your family member lots of affection, support and reassurance. Discuss family matters and try to involve them in decision making.

At some point take time out to listen to any complaints. Allow your loved one to vent any frustrations and arrange a time to talk to staff about any concerns. Remember to let your loved one know of the outcome.

If you can try not to focus too much on current health problems. Keep in mind that your loved one may also get embarrassed by any offensive smells or distracting noises in the aged care home so try to ignore them where you can.

A short visit can break up the routine of the day for a family member in an aged care home and for many residents it is the highlight of their week.

However, arranging the time can be difficult for some carers and many people find visiting an aged care home too confronting. If this is the case simply sending a message over the phone or sending a card will let someone know you care.

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Like many families, Kenneth Gall sought a sense of closure with respect the circumstances surrounding his mother's death after she sustained an injury during her admission to Presbyterian Homes of Arden Hills.  Unfortunately, more than a year after his mother's death, questions still remain as to the facilities role in the matter-- and how a disabled, primarily bed-bound-woman managed to fracture her neck while admitted to a nursing home.

Was it due to a fall?  Was the fracture related to violence?  Did Mrs. Gall get entangled in a bed rail?

What is known is that 91-year-old Gladys Gall died about two weeks following an incident in which she sustained a unusual type of fracture in her neck called a hangman's fracture and died from complications shortly thereafter.  

The circumstances surrounding Mrs. Gall's death were investigated by the Minnesota Office of Health Facility Complaints (OHFC) and a determination was made by the agency that the incident was due to mistreatment.  The state even consulted with a neurosurgeon who opined that the nature of Mrs. Gall's injury could only be caused from severe trauma.

Now however, after the nursing home appealed the states findings and presented evidence from their own investigation, the state has changed its findings relating to improper care from 'substantiated' to 'inconclusive'.

The role of state investigations into injury or death in a nursing home

Most states have agencies (usually associated with their health department) to investigate suspected mistreatment of patients in a nursing home.  Investigators can quickly access the patient's chart and interview employees and other patients who may have knowledge of the incident.  While certainly not always perfect, the investigations typically provide much sought after information to families asking 'how' and 'why' an incident occurred.

In most jurisdictions, the state investigative findings and the reports generated are not admissible in court proceedings related to a nursing home negligence lawsuit.  Nonetheless, the information contained within the investigative report can be invaluable in the course of litigation.

In the case of Mrs. Galls death, I humbly suggest to her family to seek out an experienced lawyer to prosecute this matter and give them more information relating to the circumstances of their loved ones death.

Read more about this suspicious death in a Minnesota nursing home here.

Related:

Nursing Home Cited For Mistreatment Of Resident Following Investigation Of Resident's Fractured Neck

Falls Amongst The Elderly Can't Be Ignored

Nursing Home Watchdogs: Ombudsmen

Nursing Home Inspectors Miss Major Problems

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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

The documented findings above, come on the heels of a suspected Norovirus outbreak in August at the facility.  The outbreak originated in the facilities cafeteria and sickened 19 residents and two staff members.

In response to the recent findings, management of Emeritus at Crossing Pointe recently held a meeting for residents and their families.  According to acting executive director, Pam Campbell, the identified conditions by inspectors are "not what Emeritus stands for" and calls findings "very sad for us."

Rest assured, once the state lifts the suspension on new admissions, Ms. Campbell says her facility is prepared.  "We're ready for them any day."  

Great.  

I find it difficult to believe the Ms. Campbell-- or any manager in her position-- is capable of turning around such a troubled facility so quickly.  The reason the state's inspection report listed such extensive violations is because Emeritus allowed a culture of poor patient care to exist.  My guess is that until management decides to delve deeply into these problems and evaluate each employees role in this neglect, it is only a matter of time before more problems surface.

Emeritus Corporation

Emeritus Senior Living is part of the Emeritus Corporations, a publicly traded company based in Seattle.  Emeritus Senior Living operates more than 300 assisted living, Alzheimer's care, and retirement communities across the country.

Resources:

Report: Patient at South Orange County assisted-living facility died after she wasn't given her medicine, Orlando Sentinel, November 15, 2009

We're fixing problems, assisted-living manager tells residents, Orlando Sentinel, November 17, 2009

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Seven cases of Legionnaires' Disease have been reported at an assisted living facility in Waverly, Maryland.  According to the Baltimore City Health Department, all the people were living at Stadium Place Apartments before they were diagnosed with the disease.  So far, the disease has claimed the life of one of the residents.

What is Legionnaires Disease?

Legionnaires disease is an infectious disease caused by the Legionella bacteria.  There are two types of Legionnaires disease: Legion fever (where people generally develop pneumonia) and Pontiac Fever (symptoms similar to the flu).

Legionnaires disease got its name when a group from the American Legion conference all developed pneumonia.  When scientists analyzed the group, they noticed that they all had the same bacterium called Legionella.

Although Legionnaires' disease not contagious, outbreaks may occur in long-term care facilities due to contaminated water or heating equipment.  Most authorities believe Legionnaires is contracted by inhaling airborne water droplets containing legionellae. Some authorities also believe that Legionnaires may be acquired by drinking contaminated water or using contaminated water to clean wounds.

Legionnaires disease is particularly dangerous for the elderly because they are significantly more susceptible to complications from pneumonia and fever compared to the general population. Fatality rates attributed to legionnaires are believed to be between 5 and 50%.

Resource:

Legionnaires' Disease in Long-Term Care Facilities: Overview and Proposed Solutions, Meena H. Seenivasan, Victor L. Yu, Robert R. Muder (Journal of American Geriatrics Society, 53:875-880, 2005.

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

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

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

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

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

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

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

Finding A Good Nursing Home In Your Area

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

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

Related:

High Staff Turnover Rates Plague Most Nursing Homes

Eden Or A Warehouse? You Choose.

Nurses Admit To Problems At Nursing Homes

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

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

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

Expand the federal program monitoring nursing homes. 

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

Use a national comparison for nursing homes. 

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

My take

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

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

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

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

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

Resources:

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

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

Related Nursing Homes Abuse Blog Entries:

The Worst Nursing Homes In America

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

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

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

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

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

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

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

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

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

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

Sources:

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

MayoClinic: Type 2 Diabetes

CDC: National Nursing Home Survey (NNHS)

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

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

Diabetes Care: Diabetes in Nursing Homes: United States 2004

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

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The results from a five-year study addressing the ability of care-givers and family to perceive pain in nursing home patients has revealed both parties fail to accurately assess chronic pain levels. In reaching this conclusion, researchers in the Netherlands studied 174 nursing home patients with and without cognitive impairments.  The study also concluded that family members were better at accurately assessing pain levels in their loved ones compared with nursing home staff.

Perhaps most disturbing, the study concluded most nursing home patients suffer from pain-- even while resting.  When researchers questioned resting patients, most scored their pain as four out of 10, compared with a median pain assessment of zero by family and caregivers.

Study author, Dr. Rhodee van Herk summarizes the findings well,

"Our study shows that nurses and relative find it hard to accurately assess pain in nursing home residents, especially if the resident has a cognitive impairment, such as dementia or is unable to speak. Pain seemed to differ, not only on an individual basis but also in different daily situations.  It is clear that pain at rest is a particular issue that needs addressing as residents rated this much higher than caregivers and relatives.  Using a simple pain intensity scale, like the zero to ten scale employed in our study, is clearly not enough.  We would like to see nurses use a combination of the existing pain scale, together with multidimensional pain observational scales to judge how much discomfort a patient is experiencing."

Nursing Homes Duty To Provide Pain Relief

Nursing homes have an obligation to provide pain relieving measures to their patients. While certain medical conditions such as bed sores (decubitus ulcers, pressure ulcers or pressure sores) may cause staff to implement pain relieving measures, staff must be diligent to look for signs of distress in patients with less visible condition that require pain relief.  

In particular with disabled nursing homes patients, staff should take note of patients facial expressions, involuntary motor actions, moans and changes in behavior as potential indicators that the patient may indeed be suffering and contact a staff physician.

Pain relief is required pursuant to federal regulation of nursing homes.  F-Tag 309 (Quality of Care) requires nursing homes to provide 'necessary care and services to attain or maintain the highest practical physical, mental and psychological well being, in accordance with the comprehensive assessment and plan of care.'

Although the term 'highest level of practicable care' is fairly vague, proposed interpretive guidelines to F-Tag 309 provide more specific guidance for providing pain relief.

Recognition and Management of Pain

In order to help a resident attain or maintain his or her highest practicable level of well-being and to prevent or manage pain, to the extent possible, the facility:

• Recognizes when the resident is experiencing pain and identifies circumstances when pain can be anticipated;
• Evaluates the existing pain the cause(s), to the extent possible; and 
• Manages or prevents pain to the extent possible, consistent with with the resident's goals, the comprehensive assessment and plan of care, and current clinical standards of practice.

As a nursing home attorney, I consistently see facilities that fail to provide compassionate pain relief. Many times I will see a written description of an obviously painful medical condition, yet the Medication Administration Record indicates the staff failed to notify the attending physician and no pain relief was provided. 

Source:

van Herk et al, Assessment of pain: can caregivers or relatives rates pain in nursing home residents? Journal of Clinical Nursing, 2009; 18 (17): 2478 DOI:

Related Posts:

Nursing Home Patient With Broken Hip Sits In Pain. Why Federal Law Requires Staff To Administer Pain Medication

Fentanyl Overdose Leads To 1.6M Nursing Home Settlement

Woman Poses As Nurse To Steal Medication From Nursing Home Residents 

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I was pleasantly surprised to see a follow-up article in the Philadelphia Inquirer regarding the Philadelphia Veterans Nursing Home and how it managed to make tremendous improvements with respect to patient care and safety. As we recently discussed, this VA facility miserably failed to provide adequate care for its patients. Less than one year after reports documenting; bed sores, filthy living conditions and general patient neglect was made public, the facility has implemented changes that dramatically improve patient care.

Seven months after the embarrassing report was made to VA officials, an unannounced inspection revealed 'dramatic improvements'.  After an in depth inspection including: meeting with every resident, talking with many resident's families, physically examining patients and reviewing medical charts, inspectors learned that in every instance, the facility properly cared for each patient.

When addressing bed sores alone, inspectors could not find any patients who developed bed sores (also referred to as: decubitus ulcers, pressure ulcers or pressure sores) at the facility within the last five months due to improper care.  This improvement in terms of pressure sure management is particularly impressive given the earlier report of the facility failing to intervene after noticing gangrene and maggots on a patients foot.

So how did the VA manage to turn around a troubled facility?

1) Make providing quality patient care a priority.

2) Learn where problems existed and investigate the full extent of the problems.

3) Reduce the number of patients.

4) Replace top-level managers who allowed poor conditions to exist during their tenure.

5) Hire more staff and specialists.

6) Ask an 'outside' organization to do an independent assessment.

Too often we (myself included) are too quick to write an under-performing facility off as just a 'bad' facility.  The remarkable turnaround implemented at this VA Nursing Home demonstrates that change can come about.

Not surprisingly, as this situation reinforces, change must come from the top.  In the case of private-sector nursing homes, parent companies, administrators and managers must take the initial steps towards improving patient care.

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If our government can't provide a proper environment for members of our armed forces to receive skilled nursing care-- changes must be made...immediately.  Today, many veterans who bravely fought in battles to defend our country are reliant on the Veterans Administration for care necessitated by injury, disability and old age. Unfortunately, abuse and neglect still occurs in these VA operated facilities-- just as is does in privately controlled counterparts.

I was disturbed to read a recent article describing the horrific living conditions of vets living in a Veterans Affairs Nursing Home in Philadelphia.  The pattern of poor care was so prominent, a private company, the Long Term Care Institute, was hired to investigate the living conditions and medical treatment rendered at the facility. 

Although the facility only cared for 120 Veterans-- half of its rated capacity of 240, the Long Term Care Institute concluded the facility, "failed to provide sanitary and safe environment for their residents." The report went on to say that, "[t]here was a significant failure to protect their residents' rights to autonomy and to be treated with respect and dignity."

If the conditions described in the report are accurate, I think we all should be ashamed of ourselves for allowing our most courageous citizens to live in such conditions.  Among the disgusting conditions documented by investigators include:

• A Veteran's foot had become so infected with maggots, it required amputation
• Veteran who suffered from extreme weight loss for no reason
• Unsanitary conditions- dried blood on feeding tuns that were left on the floor

Three months before this external investigation was initiated, the Veterans Affair Nursing Home set upon its own internal investigation after a mute and disabled Vietnam Veteran choked to death on solid food-- despite the fact that he was on a 'soft food' diet.  Consequently, two agency nurses were terminated and other staff members were given additional training on patients with swallowing difficulties.

As a nursing home lawyer who has seen some of the worst of the worst, I believe the more attention these dangerous facilities receive-- the faster change will come about.  I will be contacting my legislators to make them aware of problems in VA facilities.  Don't our Veterans deserve better?

Related Nursing Homes Abuse Blog Entries

Feds Investigate VA Nursing Home For Dangerous Care

Nursing Home For Veterans To Shut Down

Feds Allege Veterans Nursing Home Provides Inadequate Medical & Nursing Services

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

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Some politicians have thrown 'tort reform' into the mix of President Obama's new health care plan under the guise of saving money.  Several states already have full-fledged tort reform measures in place where the state legislature has set caps on the amount of money an injured person can recover.  Years after many of these damage caps have been put into place, neither physician malpractice premiums nor individual health insurance rates have declined.

Nonetheless, rather than debate the philosophical aspects of imposing limits on recovery, here are some facts regarding tort reform:

• Medical malpractice has no place in the healthcare debate. Healthcare reform is about making sure that every American has access to quality, low-cost healthcare, not about limiting the legal rights of innocent patients harmed by medical negligence.
      
• Tort reform does not improve the quality of our healthcare system or produce cost savings. Forty-eight states have already enacted at least one medical malpractice tort reform measure. Yet, these legal restrictions have done nothing to improve our health care system—forty seven million Americans still have no health care, costs are still escalating and 98,000 Americans still die each year from preventable medical errors. Limiting the legal rights of injured patients will do nothing to fix these problems.
   
• Medical malpractice is about real people, with real injuries. The Institute of Medicine estimates that 98,000 people die each year in the US from preventable medical errors.  And, this number does not even include the countless other people who are injured by medical errors. Rather than reforming the legal system that provides protections to these injured patients, we must focus on reforming the medical system in this country to prevent these errors from ever happening in the first place.
   
• There is no medical malpractice crisis. In 2008, medical malpractice payments accounted to 0.2 percent of all health costs – the lowest level on record. Furthermore, researchers at the Harvard University School of Public Health have found that nearly all medical negligence claims are meritorious, with 97 percent of claims involving medical injury and 80 percent involving physical injuries resulting in major disability or death.
   
• Americans should not have to give up rights, in order to gain the right to healthcare. President Obama has repeatedly stated that in America, healthcare is a right.  Likewise, Americans should not have to relinquish their constitutionally protected 7th Amendment rights in order to gain access to quality healthcare.  
   
• Lawmakers should focus on the key issues. Achieving consensus on the health reform is an extremely delicate balance. Lawmakers must not unnecessarily insert extraneous, controversial issues such as tort reform into an already complicated issue. 
     
• Health courts would be an expensive, bureaucratic nightmare. They would exchange a patient’s constitutional right to a jury trial for a schedule of pre-determined outcomes that would be handed out by judges more interested in appeasing special interests than rendering justice to the injured patients standing before them. And health courts would not protect patients from wrongdoers, but instead, would shield doctors and hospitals from accountability for their careless, harmful acts. Health courts truly are an unfair proposition for patients.  

For more information, go to www.peopleoverprofits.org

Related Nursing Homes Abuse Blog Entry

Who Benefits From Damage Caps In Nursing Home Lawsuits?

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Glendale Uptown Home is a large 240 bed nursing home facility located in Philadelphia, Pennsylvania.  On June 30, 2009 there was a small fire that occurred across the hall from the room of Selma Kirk, an 82 year-old resident.  The fire resulted in some damage to the room, but no charring, and all the residents in the wing who had been evacuated were returned to their rooms. 

Ms. Kirk’s daughter, Susan Margoles, went to the facility after the fire to check on her mother and take photographs of the fire damage.  Ms. Margoles reported that the administrators got upset and banned her from her mother’s room for taking these photographs.  A Philadelphia Daily News Columnist, Ronnie Polaneczky, was able to get into Ms. Kirk’s room on three separate occasions just by signing in at the front desk.  The facility’s executive director would not comment about the situation, citing patient-privacy laws. 

Ms. Margoles told the reporter that there was caution tape over the doorway to the wing where the fire occurred.  On this visit, she used her camera to take pictures of the damaged room.  A facility administrator witnessed Ms. Margoles taking the photographs and accused her of trespassing, telling her that she had to delete the photos or she would be arrested.  Ms. Margoles said that she finally just gave her camera to an administrator who deleted the photos.  Then, when she came back to visit her elderly mother to deliver clean clothes, the administration told her that she would be arrested if she went past the lobby and was indefinitely banned from her mother’s room. 

Ms. Margoles filed an emergency petition in Common Pleas Court for court-ordered access to her mother’s room.  Then, on July 9, 2009, the Pennsylvania Department of Health visited Glendale Uptown to investigate Ms. Margoles’ complaints.  Investigators did not find any nursing home deficiencies and described Ms. Margoles’ mother (Ms. Kirk) as congenial.  However, later that day, the nursing home called to say that Ms. Kirk had suffered a change in mental status and was being admitted to the hospital.  The day after Ms. Kirk’s hospitalization, Glendale’s executive director wrote to Ms. Margoles, stating that her mother was not welcome back.  Ms. Margoles found a new nursing home for her mother at Manor Care Huntington Valley.

According to the Medicare website, the Glendale Uptown Home received one out of five stars, which is a much below average rating.  The facility received only two out of five starts for health inspections, which is a below average rating.  In the past year, the nursing home had six health deficiencies, which is equal to the average number of health deficiencies in Pennsylvania, and two less than the average number of health deficiencies in the United States. 

Resources:

She took pix, nursing home booted her mom, Philadelphia Daily News, August 4, 2009

Just Do It. Photograph Everything, Nursing Homes Abuse Blog, June 13, 2008

Videotape Confirms Resident Murdered By Peer At North Carolina Facility, Nursing Homes Abuse Blog, June 7, 2009

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NHC Healthcare is a, 120 bed nursing home located in Bristol, Virginia.  According to the government’s Medicare website, the facility received only one out of five stars, which is a much below average rating.  In the past year, the nursing home had sixteen health deficiencies, which is eight more than the average number of health deficiencies in Virginia and eight more than in the United States.  The number of health deficiencies has increased steadily over the past two years, especially in the area of qualify care. 

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Heartland of Springfield Nursing Home is a large 126 bed nursing home located in Springfield, Ohio.  According to the government’s Medicare website, the facility received only one out of five stars, which is a much below average rating.  In the past year, the nursing home had eighteen health deficiencies, which is eleven more than the average number of health deficiencies in Ohio and ten more than in the United States.  The number of health deficiencies has increased in the past year, especially in the area of quality care.  

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One of the things I do each morning is to look through my google reader account to see the new updates regarding nursing home news and information.  Today, I glanced through the news stories to find another unfortunate report regarding the alleged abuse of a patient at an Ohio nursing home.  You can read about this report of nursing abuse here. 

As I read the article, where abuse was alleged to have occurred at Heartland Lansing Nursing Home, I realized how deceptive the names of nursing homes can be to the general public.  In the case of Heartland, it is part of the nursing home behemoth, HCR Manor Care. 

Yet by looking at the name alone most people, including most of the residents at the facility, likely have no idea that Heartland Lansing Nursing Home is actually owned by ManorCare.  Further confusing the matter is that ManorCare operates nursing homes around the country under the Heartland, ManorCare and Alden Courts surnames.

Why don't large nursing home chains want to lend the parent companies name to individual facilities? 

I am open to ideas, but I firmly believe large nursing home operators carefully name (and re-name) facilities with the intent of shielding the parent company from possible liability in the case of an injury or death.  Additionally, these knock-off names are also used to give an appearance that many of the facilities are small mom-and-pop operations as opposed to being operated by a health care conglomerate controlled with decision makers thousands of miles away.

The name-game gets much more complicated when it comes to other national nursing home chains.  For example, Kindred operates 14 nursing homes in Ohio all with different names and all without any signal to the pubic that Kindred owns and operates these facilities.  

While I may be making a big deal about the names of nursing homes, the fact is that the names are crucial when it comes to naming responsible entities in a legal proceeding.  In this respect, there can be little doubt that a number of lawsuits get dismissed or a parent company evades responsibility because the name of the facility where the alleged negligence occurred throws off the injured party.

The corporate ownership behind the names can be even more complex and confusing.  Many corporate owners have split up all aspects of the daily operation of nursing homes into different entities and --- you guessed it--- all with different names.  In some cases of corporately owned nursing homes, parent companies have successfully evaded responsibility for the actions of their employees by hiding under these shell companies.

All this is to say, is that many nursing home operators have become extremely sophisticated when it comes to using 'legal loopholes' to avoid responsibility for specific acts.  Consequently, a thorough examination of each nursing home's corporate structure must be analyzed prior to initiating any legal proceeding.

Related Nursing Homes Abuse Blog Entries:

Golden Living Sells All Its Arkansas Nursing Homes

Investors To Gain From Increase In Elderly Population

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A recent study sponsored by the National Institute on Aging (NIA) and produced by the U.S. Census Bureau, “An Aging World: 2008”, predicts that by 2040, the 65-plus population worldwide will more than double, from about 506 million to 1.3 billion. 

In the course of thirty years, the percentage of older people in the world will double from seven to fourteen percent of the entire world population.  There is also an expected rise in the number of people 100 years or older (centenarians).  The global aging trend is caused by a pattern that is seen across the globe; the world population has been growing, coupled with a rising life expectancy in most areas.  This leads to increasingly large elderly population worldwide. 

 A growing elderly population means that the health care system needs to adapt to changing and increasing health care needs.  In addition, more people are not having children (childlessness could soon reach 20% in the United States).  This leaves more elderly people who don’t have families to help take care of them, leaving assisted nursing home facilities to provide additional services.  In the next ten years, the number of people older than 65 might be more than the number of children under five for the first time ever.

The global aging trend presents both social and economic challenges for most areas of the world.  The fastest growth of the older population is occurring in developing countries, where it has more than doubled the growth rate of the older population in developed countries.  The older elderly (aged 80 and older) are the fastest growing portion of the total population in many countries. 

The United States’ system of nursing home facilities is already strained.  Many facilities provide inadequate or improper care to their residents.  With increased nursing home populations, these problems and shortcomings might become worse as facilities struggle to provide basic care to all residents. 

Resources:

Naples News - Study: Older Population Expected to Double as Life Expectancy Increases

NIH News - Unprecedented Global Aging Examined in New Census Bureau Report Commissioned by the National Institute on Aging 

U.S. Census - An Aging World: 2008

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Firefighters, teachers and doctors are all important to the functioning of our society.  Without the services they provide, people would suffer in many respects.  But when it comes to jobs that are pivotal to the immediate safety, health and overall welfare of people-- especially the elderly, I nominate state and local nursing home inspectors as the most important job in America.

Go ahead email me about how 'wrong' I am.  There can be no doubt that without this group of civil servants an untold number of our elderly would suffer serious injury or die needlessly. 

Nursing home inspectors are on the front-lines of patient safety-- assuring all applicable laws our complied with.  In the case of a patient injury, inspectors are there again to determine how the incident occurred and how similar incidents could be prevented in the future.  Similarly, when a facility says it will take corrective action, nursing home inspectors are there to assure the plan is complied with.

Today's example of the vital role nursing home inspectors play in our society comes from Tennessee.  After fielding complaints relating to poor patient care and conducting an annual survey, inspectors found multiple conditions at the Life Care Center of Chattanooga that posed a risk to patient safety.  During the June / July inspections, inspectors (also referred to as surveyors) discovered safety violations in the following areas:

• Administration
• Performance Improvement
• Physician Services
• Nursing Services
• Medical Records
• Pharmaceutical Services

The conditions discovered by inspectors resulted in daily penalties, appointment of a special monitor at the facility, and suspension of new patients.  Additionally, a copy of the order from the Tennessee Commissioner of Health that articulated the dangerous conditions and the resulting state and federal actions was posted on the entrance to the facility.

Nursing homes are heavily regulated by federal and state standards, not to make life more complicated for nursing staff, but because the regulations are crucial to provide quality patient care.  If we did not have nursing home inspectors out and about in these nursing homes, who would ensure that the regulations are complied with and everything is done to protect our vulnerable seniors?

Read more about the suspension of new patient admissions at Life Care Center of Chattanooga here.

Related Nursing Homes Abuse Blog Entries

"Life Care Center" Permitted To Accept New Patients After State Finds Poor Living Conditions

State Inspectors Find Safety Violations In Indiana Nursing Home

Who Regulates Nursing Homes?

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A grand jury indicted, Douglas Harris, following allegations relating to the financial exploitation of a mentally disabled resident at the nursing home where he was a social worker.  According to the Tennessee Bureau of Investigation (TBI), Harris was director of social work at Brookhaven Manor.  During a period between November, 2007 and March, 2008 Harris unlawfully persuaded the resident to give him: a $20,000 check, cash, and a luxury van.

A statement from a TBI spokesman reads, "Harris was employed as the director of social work at Brookhaven nursing home located in Kingsport Tennessee when he obtained property and cash from a resident of the facility who was incapable of making financial decisions."

The grand jury indicted Harris on the criminal charges related to his financial exploitation of July 14th and he was arrested shortly thereafter by authorities.  Currently, Harris is free on bond and has an arraignment set for September 11th in Sullivan County Criminal Court.

Read more about this financial exploitation at a Tennessee nursing home here.

Financial Abuse In Nursing Homes

Financial abuse is the most common type of abuse in the elderly population.  Financial abuse is generally considered to be the theft or conversion of money or other property by caregivers, relatives, or other people the elderly person trusts. Many cases of financial abuse remain undocumented because those initiating the fraud have become sophisticated in evading authorities. 

For example, parties involved in financial abuse may sign over the title to the older person's home or other assets to the abuser and then sold. Other examples of financial abuse include unauthorized removal of funds from: checking, savings, and investment accounts. Another major area of financial abuse amongst the elderly is the alteration of wills.

If you suspect financial abuse, notify authorities immediately before the property or funds are forever lost.

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As injury lawyers in Chicago, we are honored to have represented many families in times of need. For many of our clients, a proper burial represented closure to a tragic chapter in their families history.  Now we have learned that a Chicago-land cemetery that many of our clients entrusted with their loved ones has destroyed this bond.

The crimes committed at Burr Oak Cemetery, are a shameful example of complete disrespect to these families.  State and federal authorities have determined Burr Oak Cemetery employees dug up at least 200 to 300 bodies and dumped the remains in order to resell the plots.  So far, four cemetery workers have been charged with felony-related charges of dismembering a human body. If convicted, the employees face a possible 30 year prison term. 
 
State Representative Bobby Rush, who represents the district where Burr Oak is located, is pushing for new federal legislation to oversee cemeteries in Illinois to prevent future cemetery crime.  However, the federal government has yet to take action to provide more oversight to prevent cemetery abuse even after several high profile cases in other states in 2002.
 
Cases involving cemetery misconduct can occur where: the body is buried in the wrong location; the body is placed in the wrong casket; head stones are discarded or even in situations similar to the atrocities that occurred at Burr Oak.  When a loved one dies, the family puts their trust in a cemetery to lay their family member to rest.  However, this trust is not always respected, as was the case at Burr Oak Cemetery.  In these situations, the cemetery and its workers can be held liable for their participation in the mishandling of the burial of your loved one. 
 
Family members have several options in order to find justice in situations involving mishandling of remains including the following lawsuits: dismembering a human body, negligent cemetery operations, intentional infliction of emotional distress / negligent infliction of emotional distress arising from negligent mishandling of a corpse, interference with the right of the next of kin to possess and preserve the body of the deceased, and desecration. 
 
Mishandling of a corpse involves situations where a person intentionally, recklessly, or negligently removes, withholds, mutilates, or operates upon the body of a dead person or prevents its proper interment or cremation.  In these situations, the family member, who has the right to control the body, may bring an action against the wrongdoer pursuant to the Cemetery Protection Act (765 ILCS 835). 

The recent events at Burr Oak Cemetery make obvious the need for more regulatory oversight of cemeteries in Illinois.  This is essential to protecting the sanctity of the final resting place of your loved one.  If your family has been affected by cemetery wrongdoing at Burr Oak, there are options available to hold wrongdoers responsible. We remain available for a case consultations regarding this disturbing event.  

Whether you live in Chicago-land or across the country, we are available to discuss your concerns regarding this tragedy.  (888) 424-5757 
 
Sources:
Chicago Breaking News Center: Burr Oak Cemetery Nightmare
Chicago Tribune – Burr Oak: Calls for cemetery reforms are a familiar refrain
Courtney v. St. Joseph Hospital (149 Ill. App. 3d 397 (Ill. App. Ct. 1st Dist. 1986)

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Dubuque Retirement Community was the largest assisted living center in Iowa.  It was run by Assisted Living Concepts, a Wisconsin for-profit-corporation that operates 216 care facilities in twenty states.  Now, Assisted Living Concepts has given up its assisted-living license on the troubled 116-resident facility. 

In its short two-year history as an assisted living center, Dubuque Retirement Community amassed several fines for failure to meet minimum government standards with respect to providing adequate resident care.  For example:

• A $500 fine for having no hot water for three days in February 2008;
• A $2,000 fine in October 2008 for problems including staffing, food, and medication;
• A $4,000 fine in February 2009 for continued problems with medication and staffing, including a fifteen-hour delay in finding a resident who had fallen and broken a hip;
• Another $10,000 fine for medication errors and failure to employ trained staff.  

In April of this year, government inspectors placed the Dubuque Retirement Community’s license on conditional status.  Less than two months later, the facility announced its decision to abandon its license.

But that is not the end of the story.  Assisted Living Concepts intends to continue to provide housing for seniors at the same facility as an independent living facility, acting as a “landlord” to the seniors.  It will allow the former residents to enter into new contracts to pay separately for round-the-clock healthcare. The company that will provide medical care for residents is also a wholly-owned subsidiary of Assisted Living Concepts.  

Assisted Living Concepts has severed the link of housing and medical care that triggers licensing and government oversight.  It appears, therefore, to have found a loophole that allows it to avoid the rules and regulations that it was having trouble following, rules that are designed protect vulnerable residents of assisted living facilities. 

Not surprisingly, an Iowa state representative has asked the state to monitor the facility and report back as to whether legislative action is needed.  I can think of no reason why legislators should allow a loophole that allows facilities, particularly those that have been repeatedly cited and fined for sub-standard operations while licensed, to operate provide essentially the same services without the careful oversight of the government.

Source: Clark Kauffman, Assisted Living Center Changing Its Status to Avoid Licensing Rules, Des Moines Register (July 13, 2009).

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For the more than a year, residents at Charlotte Harbor Healthcare in Port Charlotte, FL were intentionally monitored by hidden cameras camouflaged beneath ceiling tiles.  The cameras were discovered when investigators from the Florida Agency for Health Care Administration (AHCA) were inspecting the facility for mold earlier this year.  The feeds from the cameras were routed to the administrator, Thomas Bell's office.

Bell told AHCA representative that the cameras were there 'to prevent theft'.  Despite Bell's assertion, no theft-related incidents had been reported at Charlotte Harbor.  Residents were never informed on the cameras presence.  AHCA is evaluating the circumstances and may impose a fine for this cleat violation of privacy.

Is it realistic to expect privacy in a nursing home setting?  Too often were forget that nursing homes are 'home' for more than one million people in the United States.  True, most of the people are elderly and many of them face serious medical conditions-- but every effort should be made to promote as home-a-like setting as possible. 

Read more about this situation involving a violation of privacy in a Florida nursing home here.

Related Nursing Homes Abuse Blog Posts:

Invasion Of Privacy; Two Kentucky Nursing Homes Cited After Employees Use Cellular Phones To Take Photos Of Residents

New Law May Improve Privacy In Nursing Homes 

'Dignity Training' Ordered For Staff In New York Nursing Home After They Humiliate Residents Who Need Assistance With Toileting

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After a week where the facility was banned from accepting new residents, Life Care Center of Red Bank is now permitted to accept new patient admissions.  One June 17th, the Tennessee Department of Heath Commissioner suspended new patient admissions to this Tennessee nursing home because of conditions encountered during a survey (inspection).  During the survey inspectors found heath and safety violations concerning:

• Nursing home administration
• Performance improvement
• Physician services
• Nursing services
• Medical records
• Pharmaceutical services

In addition to suspending admission of new patients, Life Care was issued a one-time civil penalty by the state and $6,150 per day until the conditions were corrected by federal authorities.

Kudos, to nursing home inspectors for getting this facilities attention the only way possible--- by hitting them in the pocket book. Due to the inherent nature of the business, most nursing homes rely on a steady stream of new patients to keep their facilities full and profitable.  A drop in the number of residents cuts into the facilities profits.

Life Care Centers

Life Care Centers operates more than 200 skilled nursing homes, assisted living facilities, retirement living communities, home care services, and Alzheimer's centers across the country. In Tennessee alone, Life Care operates 27 nursing homes and assisted living centers.

Source:

Admissions To Life Care Center Of Red Bank Nursing Home Suspended TN.gov

Life Care Center Of Red Bank Nursing Home Admissions Suspension Lifted TN.gov

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A very informative, and frankly disheartening, investigative article on race in Chicago Nursing Homes was recently published in The Chicago Reporter.  The article's author, Jeff Kelly Lowenstein, concluded that black nursing home residents received inferior care compared to their counterparts in predominately white facilities-- even when the facilities were owned by the same person.

Lowenstein analyzed the care rendered to residents at Alden Nursing Home, a well known chain of Chicago facilities owned by Floyd Schlossberg.  Lowenstein obviously did his homework, he analyzed data from: the Illinois Department of Public Health's website, staffing levels on the Centers for Medicare and Medicaid Services (Nursing Home Compare) and racial composition data from the Department of Community Health at Brown University.

The research conducted by Lowenstein, reveals the following disparities between predominately black v. predominately white nursing homes:

• Each of the three predominantly black facilities received the lowest possible rating in 2009 from Nursing Home Compare, a federal database to evaluate nursing homes that are Medicare- and Medicaid-certified. Less than half of Schlossberg’s 16 predominantly white facilities received that same rating.
• Two facilities received the highest ratings. At both facilities, located in Evanston and Skokie, at least 84 percent of the residents were white.
• Residents at Schlossberg’s predominantly black homes received much less staff time than residents of his predominantly white facilities. For example, residents at Alden Estates of Evanston received an average of 5.53 hours of care per day, compared with 2.04 hours at the Greater Grand Crossing facility and 1.73 hours at the Heather Health Care Center in Harvey, which are both predominantly black. The combined total of daily care given at the three, predominantly-black homes was just 19 minutes more each day than the time at the predominantly-white facility in Evanston.
• Sclossberg's predominately black facilities has three times as many lawsuits filed against them as half of other Chicago nursing homes.

I hope the public will put pressure on Schlossberg to raise standards in all of his facilities.  Why should the quality of care be based on race?

Resources:

Disparate Nursing Home Care, by Jeff Kelly Lowenstein

Map Of Alden Nursing Homes and racial composition, from The Chicago Reporter

Related Nursing Homes Abuse Blog Articles

Nursing Homes With Higher Percentage Of Hispanic Residents Have Higher Rate Of Bed Sores

Chicago Nursing Homes Not Making The Grade

Man Falls From Fourth Floor Window To His Death At Alden Nursing Home

See the Alden facilities below:

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Tennessee Department of Heath officials have suspended new  resident admissions at the Pigeon Forge Care and Rehabilitation Center.  The suspension of new admissions follows the identification of problems related to the facilities administration, performance and resident rights observed during an inspection of the nursing home between April 20 and May 11. 

In addition to the suspension on new admissions, Tennessee officials imposed a $3,000 fine and recommended a daily fine of $4,550 until the conditions are corrected.  A monitor has been assigned to the facility to keep track of the nursing home's progress.  In addition, a copy of the order prohibiting new admissions has been posted on the door to the facility.  Read more about this Tennessee nursing home here.

Pigeon Forge Nursing Home is a 120-bed facility and has been licensed since 1992.  According to Center for Medicare and Medicaid Services, the facility rates two stars out of five in terms of overall quality.  In 2008 nursing home inspectors found violations in reporting changes in residents' physical or mental health to family members and doctors; helping residents with eating, drinking, grooming and hygiene when necessary; staffing; and making sure that the nursing home area is free of potential accident-causing dangers, among other citations.

Violations were cited in February 2008 and corrected in March, and cited again in October and corrected in November. The most recent survey was done in March of this year.

Nursing Homes Abuse Blog Related Posts

Improper Record Keeping Leads To Suspension Of New Admissions In Nursing Home

When It Comes To Governmental Oversight, Assisted Living Residents Are On Their Own

Medicare Pulls Funding From Troubled Nursing Home Due To Concerns Over Resident Safety

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End of life decisions are an obvious personal decision.  Whatever the individuals decision to use or withhold lifesaving measures, the individuals decision should be respected and followed by the facility.  In medical emergencies where time is of the essence, it may not be practical for nursing home or hospital staff to carefully review the contents of the residents chart to make the determination in providing these life-extending treatments.

Following a series of cases where life-saving procedure were carried out against resident wishes and in other situations where life saving measures were withheld from residents who wished to resuscitated, Kentucky officials are considering a new law to help ensure the residents wishes were followed.  A purple wristband worn by residents would alert staff that the resident executed a 'do-not-resuscitate' or 'DNR' order. 

Kentucky, like many states, has no formal regulation regarding how to inform staff or DNR orders in nursing homes or hospitals.  This new proposal follows the publicized confusion related to residents' end of life decisions.

As reported in the Lexington Herald-Leader, the the confusion has resulted in fines against facilities for their errors:

• Kenton Healthcare in Lexington was cited in September 2007 after the staff allegedly did not initiate lifesaving measures on a resident despite a doctor's orders that everything possible be done to save the patient.
• Hillcrest Health Care Center in Owensboro was cited in December 2008 after cardiovascular pulmonary resuscitation was not performed on a resident who wanted to be resuscitated.
• In April 2007, staff members at Christian Health Center in Bowling Green did not immediately resuscitate a resident, despite a doctor's orders that lifesaving measures should be used.
  Staff members told state investigators that the facility did not have a system that allowed immediate access to the code status of a resident.
• Woodland Oaks Nursing Home in Ashland is appealing a citation it received in January. Officials there deny failing to perform CPR on a dying patient who had requested lifesaving measures.
• Green Meadows Health Care in Mount Washington received a citation in March 2008 for trying to revive a resident who had signed a DNR order.
• In March, Jefferson Manor in Louisville was cited after 95-year-old Eva Karem was resuscitated in February 2008 despite a DNR order. (It received a citation that was not as serious as a Type A.)

Nursing home and hospital officials will meet in the next few weeks to determine if the 'purple bracelet' program is feasible.  Although the program would not likely apply to hospitals, the Kentucky Hospital Association is considering a similar color-coded wristband system to help alert staff to residents' with allergies or who may be at high risk for falls.

I'm all for such a safeguard system with respect to DNR orders, allergies and falls.  We live in an era where many facilities are chronically short-staffed and high staff turn-over is the norm, anything that can both improve patient care and reduce the work-load of staff should certainly be given top consideration.

DNR Orders

A 'Do-Not-Resuscitate Order'  (most commonly referred to as a 'DNR' order) is a medical treatment order stating that cardiopulmonary resuscitation (CPR) will not be attempted if your heart and/or breathing stops.

In addition to properly executing the legal document, it is also important to inform your family, physicians, and your attorney of your decision to make one or more advance directives or a DNR order. If your family is aware of your advance directives / DNR orders, it will be easier for them to follow your wishes at a time when you may be unable to communicate them. If you cancel or change an advance directive or a DNR order in the future, remember to tell these same people about the change or cancellation.

All hospitals, long-term care facilities and nursing homes must follow your advance directive decisions.  It is entirely your decision. If a health-care facility, health-care professional or insurer objects to following your advance directive or DNR order then they must tell you or the individual responsible for making your health-care decisions. They must continue to provide care until you or your decision maker can transfer you to another health-care provider who will follow your advance directive or DNR order.

Here is an example of a DNR order.

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The Richmond Health and Rehabilitation Complex, otherwise known as 'Madison Manor' has been added to the Special Focus Facility List following the disclosure of a videotape nursing assistants at the facility physically abusing, failing to provide food and failing to clean an 84-year-old resident at the facility in August.  The family of the woman placed a hidden camera in the woman's room after they discovered more than 30 unexplained bruises on her body during a visit. 

The Kentucky Attorney General filed criminal charges against three of the CNA's involved in incident and one has already pleaded guilty. Madison Manor dismissed all three employees following the filing of criminal charges.

This incident is not the sole reason for Madison Manor's placement on  the government's watchdog list.  According to Beth Fisher, spokeswoman for the Cabinet of Health and Family Services, Madison Manor's "history of non-compliance over the past three years" was the primary reason the facility was added to the Special Focus Facility List.

In 2008, Madison Manor received 25 citations related to resident care compared with the Kentucky average of 7 deficiencies per facility.  In addition to Madison Manor, there are two other Kentucky nursing homes on the watch list: Cambridge Place in Lexington, and Britthaven of Somerset.

A list of Special Focus Facilities can be found here.  Facilities on the list are inspected twice as frequently as other nursing homes.  If the facilities consistently fail to improve their facilities they risk losing government funding-- essentially forcing most facilties out of business.

Read more about this troubled Kentucky nursing home as reported by the Lexington Herald-Leader here.

About Extendicare

Extendicare Homes Inc. is national owner and operator of nursing homes based in Milwaukee, WI.  Extendicare runs 268 facilities across the country that provide services for more than 30,000 residents.  Nearly all of Extendicare's nursing facilities have higher-than-average scores for health deficiencies and safety violations.

Related Nursing Homes Abuse Blog Posts

Videotape Reveals Abuse In Kentucky Nursing Home

Nursing Home Negligence Lawsuit Filed Against Extendicare

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The American Health Care Association’s (AHCA) theme for the 2009 National Nursing Home Week observance is “Nurturing a Love that Lasts.” National Nursing Home Week will occur nationwide beginning Mother’s Day, May 10, and continuing through May 16, 2009.

The theme highlights how a supportive and caring environment, such as a nursing home, nurtures and enables residents and families to continue the human interactive process of “growth,” “learning” and “teaching.” Life and its “connections” continue in a nursing home where its staff contributes by sustaining an environment that recognizes and values its residents’ innate desire for connectedness with families, especially grand children.  -

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A friend tried to lure me into a trip to Vegas by emailing me a link to a live video camera mounted poolside at a swank hotel.  Did it work?  No, my wife is still not so understanding when it comes to guys weekends in 'sin city'.  Nonetheless, the video camera did give me a glimpse of the glamorous life to be had thousands of miles away---in a place I may not see for a long time.

Use of video cameras has come a long way since the days when they were used exclusively capture a baby's first steps or for submission on America's Funniest Home Videos.  Today, video cameras and internet-based streaming videos can help relieve some of the inherent stress created by the physical distance between loved ones.  That is, unless the loved one lives in one of the thousands of nursing homes still failing to accept new technology and a new expectation of openness.

What is the hesitancy of nursing homes to embrace not just video technology, but also a spirit of openness?  Is it fear that the public may condemn these facilities once they become aware that they may be providing inferior care or allowing a culture of abuse and neglect to persist?  

Add another proponent of video surveillance to the mix.  Oklahoma District Attorney, David Prater, publicly said in a recent hearing that he supports the use of video cameras not just in the public areas of nursing homes, but also in individual patient rooms.  "If they're above-board and fully staff and take care of the residents, what to they have to hide?" Prater asked during a hearing on nursing home care.  "I would think they would offer that option to the residents," he added.

Not surprisingly, the executive direct of the Oklahoma Association of Health Care Providers, Becky Moore, felt that placing cameras within each residents room was unnecessary and created a privacy violation.  "Most of our personal care is at bedside, and residents don't want people taking pictures of their personal care," Moore added.

Has Moore ever considered that many nursing home residents are disabled and rarely leave the confines of their bed?  What about the fact that many of the friends and family who may be watching the video probably provided care for this individual?

No longer, can nursing homes argue that the technology is insufficient to provide video surveillance in the nursing home setting.  I assume that until nursing home administrators learn to embrace a culture of openness at their facilities we will not see the use of video cameras on a widespread basis. 

Demand the use of video cameras in nursing homes.  If I can use video technology to 'check-in' on the scantily clad young ladies sitting poolside, why in the world should a family member be told that they can't view their loved one as they sleep, eat, or receive 'personal care'? There's just no reason not to.

Read more about the debate over use of video cameras in Oklahoma nursing homes here.

Related Nursing Homes Abuse Blog Entries:

Hidden Camera Reveals Caretaker Abuse By Nursing Home Worker

Videotape Reveals Abuse In Kentucky Nursing Home

Video: New York Nursing Home Worker Caught On Tape

Why Didn't I Think Of This?

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The report of a Virginia nursing home worked allegedly stealing the identities of nine residents at two facilities to fraudulently obtain credit cards and merchandise raises the issue of how well nursing homes safeguard personal information.  In this particular case, Karen Priscilla Jones was indicted by a federal grand jury on 32 counts-- including 18 counts of aggravated identity theft.  The alleged crimes took place while Jones worked at The Oaks Assisted Living and Avante Assisted Living Facility.

If convicted, Jones faces up to 386 years in prison and $8.5 million in fines.

The following are some great suggestions for reducing incidence of identity theft--old or young-- compiled by the Legal Counsel For The Elderly.

• Do not give out identifying numbers or financial information on the phone unless you initiate the call and know the person or organization being called. Never underestimate the persuasive skills of these crooks; they can fool the smartest of consumers.
• Shred or tear into small pieces all mail solicitations, bank records or any other discarded documents that may provide information that can be used to identify you.
• Know the due dates for your bills and statements. If a regular bill or statement fails to reach you within a week of the usual time, contact the company to find out why. Thieves often divert mail to themselves to avoid alerting victims.
• Opt out of receiving pre-screened credit card offers. The three major credit bureaus use the same number: 1-888-OPTOUT (1-888-567-8688). (Experian is the only major credit bureau that goes a step further and offers removal from other lists - those used for marketing and promotional purposes.)
• Opt out of MDV lists. Notify the Alabama Department of Motor Vehicles that you do not want information about you provided to marketing and promotional groups. The Alabama law has many loopholes but this may help.
• Register on the Do-Not-Registry by calling 1-888-382-1222, from the number you wish to register; or register online at www.donotcall.gov. Registration is good for five years.
• Opt out of direct mail solicitations and e-mail lists.
  To cut down on unwanted mail, write:
  Direct Marketing Association, Mail Preference Service
  P.O. Box 643
  Carmel, NY 10512
• Give your name (all names you are known by), addresses, previous addresses if you have been there less than five years, and state that you do not wish to receive mail solicitations.
• To remove your name from e-mail lists visit http://www.dmaconsumers.org/offmailinglist.html.
• Do not put your Social Security Number on your driver license and do not carry your SS card in your wallet. Unfortunately, this will provide only limited benefit, since Medicare and other health insurers use the SSN as an identifier. This problem has been called to the attention of the SS Administration and others, but it seems that little is being done to address it.
• Store new and cancelled checks in a safe place, report lost/stolen checks to your bank immediately, and carefully review every statement.
• Periodically request a copy of your credit record. The report will let you know who has asked for information about you recently, which can give an early warning of trouble. To request a copy of your credit report for a very small charge (no charge if you have recently been denied credit), call:

Equifax @ 1-800-685-1111;
Trans-Union @ 1-800-916-8800 or
Experian @ 1-888-EXPERIAN (888-397-3742)

Nursing Homes Responsibility In Identity Theft Cases

If you have become the victim of identity theft in a nursing home setting, the first thing that should be done is to contact the local police.  A police investigation will help determine what information was taken and by who.  If the nursing home failed to safeguard personal information or became aware information was missing- yet failed to act, the facility may be responsible for all damages resulting from identity theft losses.

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In a brazen display of greed, a nurse's aid entered the room of a disabled New York nursing home resident and removed her engagement ring directly from her hand.  Local police say Chad Smith, a nurses aide at Eastern Star Nursing Home will be charged with third-degree grand larceny.

After Smith removed the engagement ring from the resident's hand, he used a nail clipper to pry the diamond from the setting.  Smith took the loose diamond to a local pawn shop where he apparently received $300 for the stone.  The stone's actual value was estimated to be more than $4,000.

Police say the diamond has not been recovered.  No word if authorities at this nursing home are keeping this thief on the payroll. Read more about this nursing home theft here.

Theft In Nursing Homes

Nursing home theft is the most common type of crime in nursing homes.   Most nursing home residents never expect themselves to be victimized by criminals in a setting they consider to be safe. In order to minimize theft, the following precautions should be in place:

• Lock boxes should be available and used
• Criminal background checks should be conducted on all nursing home employees, visitors and volunteers.
• Family members should do an inventory of items when their loved one enters the facility and periodically during visits
• Keep valuables and cash with loved ones if possible
• Report any missing items to staff immediately
• Consider securing televisions, stereos and computers to a fixed object such as a deck
• Take photos of all valuables
• Consider taking out an insurance policy to insure all personal items

Nursing home residents are entitled to use their personal items.  If you believe some personal items were taken, it is best to report the incident to local police immediately so they may conduct a timely investigation.

Web Resources Regarding Theft In Nursing Homes

Report Examines Heartbreak Of Theft In Nursing Homes, by Diana Harris and Michael Benson

Reducing nursing home theft: tips from a consultant, by Patrick Donaldson

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Acting on an anonymous tip alleging improper care, investigators from the Indiana Department of Public Health conducted an inspection of the Royal Oaks Health Care and Rehabilitation Center.  The inspection revealed 13 violations of federal nursing home laws.

Although the person initiating the investigation had a relative who developed advanced bedsores (also called decubitus ulcers, pressure sores or pressure ulcers) and sepsis during their stay at Royal Oak, the investigation concluded that no residents were harmed by the violations.  "There were deficient practices and violations of federal regulations, but no one was actually harmed," said Ellen Greig, a spokeswoman with the Centers for Medicare / Medicaid Services Chicago Regional Office.

Among the findings documented in a 90-page nursing home inspection survey include:

• Nurses failing to follow proper sanitation guidelines
• Staff failing to follow bedsore treatment and prevention guidelines
• Failure to properly use mechanical lifts
• Having enough nurses to care for every resident in a way that maximizes the resident’s well-being.
• Making sure that each resident who enters the nursing home without a catheter is not given a catheter unless it is necessary.
• Making sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.
• Making sure the doctors visit residents regularly, as required.
• Having drugs and other similar products available, which are needed every day and in emergencies, and give them out properly.

In response to the findings, Royal Oaks administrator Brenda Hatfield issued a statement.  "[T]his is normal survey activity and we embrace the opportunity to work with the state to examine and enhance our care delivery system through education and training of staff.  We have submitted a plan of correction for the issues the state identified and are confident the state will find us to be in substantial compliance upon their revisit."

Was the inspection worthwhile?

Federal and state regulation of nursing homes provides essential guidelines for the safety and well-being of nursing home residents.  In most cases, nursing home inspectors are the exclusive means to establish if the facility was able to provide adequate care to residents.  Even if inspectors failed to establish that residents sustained injuries due to the facilities safety violations, the report will become part of the facilities file.

Nursing home inspections also ensure safety violations get corrected to protect not just the current residents of the facility, but the safety of future resident's as well.  Most states allow residents and families of residents to make anonymous reports of safety violations to authorities.  If you suspect improper care or safety violations, here is a useful resource to find the regional agency to report  the issues to.

Royal Oaks is part of Kindred Healthcare, a national hospital and long-term care conglomerate.  Strellis & Field has successfully represented individuals and families in matters against Kindred.  We invite you to speak with our team of nursing home attorneys for a complimentary consultation.  Please fill out this form and and we will promptly contact you to discuss your matter.

Web Articles Regarding Royal Oaks

State inspection finds problems at Royal Oaks, Tribstar.com, April 3, 2009

Related Nursing Homes Abuse Blog Articles

What Are Signs Of Nursing Home Abuse?

Nursing Home Rating System Reveals Inferior Care Provided At For-Profit Facilities

Minimum Nurse Staffing Ratios

Where Will Nursing Home Residents Go When Medicare Closes Dangerous Facilities?

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Dennis Long's relatives confirmed that he was indeed the man who drove his car through the front entrance of St. Sophia Health and Rehabilitation Center in St. Louis, MO last Friday.  Apparently Long drove his car into the facility out of anger.  He was banned from visiting his mother who was an Alzheimer's patient at the facility due to his 'bizarre behavior' weeks earlier.

St. Louis Circuit Court records reveal Long had a troubled past.  In 2007, Long was similarly barred from visiting his mother while she was a resident at Barnes-Jewish Hospital.  In the same year, court records also confirm Long had threatened to kill his three sisters and a niece.

Long's sister, Terry Hall, said Long had been so verbally and physically abusive to their mother that other nursing home residents were scared for their safety.  According to Hall, there were nursing homes that refused to take her mother because of her brother's behavior.  "My mom was moved from different nursing homes because of him.  We have gotten restraining orders on him but nothing happened," she added.

Long was the only person seriously injured in the incident having received extensive burns.  A resident at St. Sophia was treated for minor injuries at a local hospital.

Nursing Home Safety

Obviously, nursing homes are intended to provide medical care to residents, however they are also responsible for ensuring resident safety.  In many situations, the staff at a facility must act as the eyes and ears of vulnerable residents to ensure their well being.  If a facility becomes aware of threats against particular residents they should report the situation to law enforcement immediately.

Web Resources:

Car crashes into Florissant nursing home, Stltoday.com

Man who crashed car into nursing home had history of threats Stltoday.com

Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers United States Department of Labor

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Tennessee officials have suspended new the admission of new residents at the Quality Care Health Center in Lebanon, TN.  The suspension comes after state and federal investigators found multiple safety violations during an investigation related to a complaint filed against the nursing home.  Investigators from the Federal Center for Medicare-Medicaid Services found violations in physician services, nursing services and with medical records.

Investigators discovered residents at the Tennessee nursing home were put in 'immediate jeopardy' because nurses did not keep proper charts.  Additionally, nursing home inspectors also documented instances of dramatic weight loss among residents.

Quality Care Health Center was opened in 1978 and has a 290 bed capacity.  The facility has until April 3rd to correct all deficiencies or it will lose federal funding.  Read more about this troubled Tennessee nursing home here.

Watch the video clip regarding Quality Care Health Center from NewsChannel5.com here.

Department of Heath & Human Services Report

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The Daily Herald, recently had an article on growing part of the nursing home population-- young nursing home residents.  Most of the younger people in nursing homes are admitted to the facilities, not for nursing care, but because there are few alternatives for people with mental illness.  The number of younger nursing home residents with mental illness has increased 41% in the past six years.  Currently, young residents (ages 22 to 64) make up more than 9% of the nations nursing home residents.

Many of these younger residents suffer from conditions such as: schizophrenia, depression or bipolar disorder which can make them difficult to control.  States are responsible for assessing each young nursing home resident in making the determination if they require the high level of care that nursing homes provide.  This determination is essential, because federal law bars the mentally ill from entering the facilities unless the individual has been determined to require the level of care provided in a nursing home setting.

"Sadly we're seeing the tragic results of federal and state governments to provide appropriate treatment and housing for those with mental illness and to provide a safe environment for the frail elderly," says Janel Well, director of public policy for the National Citizens' Coalition for Nursing Home Reform.

Many nursing home workers accustomed to caring for more 'typical' residents are not prepared to care for the younger residents who are more likely to behave aggressively.  Killings and mental assaults committed by the mentally ill against the elderly in nursing homes have become more prominent as the younger portion of the nursing home residents continue to expand.  Among the crimes cited by the Daily Herald:

• In 2003, a 23-year-old woman in Connecticut was charged with starting a fire that killed 16 fellow patients at her Hartford nursing home. A court guardian said Leslie Andino suffered from multiple sclerosis, dementia and depression. She was found incompetent to stand trial and committed to a mental institution.
• In 2006, 77-year-old Norbert Konwin died at a South Toledo, Ohio, nursing home 10 days after authorities said his 62-year-old roommate beat him with a bathroom towel bar. Sharon John Hawkins was found incompetent to stand trial.
• In January, a 21-year-old man diagnosed with bipolar disorder with aggression was charged with raping a 69-year-old fellow patient at their nursing home in Elgin, near Chicago. A state review found that Christopher Shelton was admitted to the nursing home despite a history of violence and was left unsupervised even after he told staff he was sexually frustrated.
• On May 30, 2008 Ivory Jackson was beaten to death with a clock radio by his roommate, Solomon Owasanoye-- a man with history of violent behavior and more than 20 years Jackson's junior.  Owasanoye pleaded not guilty to first-degree murder, and after a psychiatric review was ruled unfit to stand trial. He now lives in a state mental hospital.

Pat Willis of the Center for Prevention of Abuse says that younger, aggressive residents are terrifying elderly residents.  "The senior residents are afraid," Willis said.  "They would prefer to sit in their rooms and keep their doors shut."

Given the lack of alternative care for younger people with mental illness, the reality is that it is unlikely that younger residents will be leaving nursing homes across the country anytime soon.  Nonetheless, federal law guarantees nursing home residents can have a safe environment.  In order to promote safety, residents and their families should keep in mind the following:

• Does you nursing home accept younger nursing home residents with mental illness?
• What is the facilities policy with respect to housing these individuals?
• Are younger residents allowing to live amongst older nursing home residents?
• Does the facility train its staff to handle individuals with mental illness?
• Does the facility have a psychiatrist or other mental health professionals on staff?

Related News Article:

Illinois nursing homes tops in younger mentally ill, Daily Herald, 3/19/09

Related Nursing Homes Abuse Blog Posts:

Update: Lawsuit Filed Against All Faith Pavilion

Man Charged With The Rape Of Fellow Resident In Illinois Nursing Home

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Three Brooklyn nursing homes have received fines by federal and state official totaling almost $18,000 for failing to provide safe living conditions to their residents.  The New York nursing homes that received fines include:

Wartburg Nursing Home: The East New York facility was ordered to pay $10,400 due to the fact that Wartburg was not "administered in a way that leads to the highest possible level of well-being for each resident." Residents felt that the facility has failed to provide an adequate level of care due to under-staffing. 

Wartburg resident Darrell Carolina, claims he lost close to 20 pounds in recent months because of unsavory food.  Another resident claims she could tell the facility was understaffed by the fact that she was left stranded in a bathroom for 45 minutes and that she was given the wrong medication three times by the staff.

Norwegian Christian Home & Health Canter: The Dyker Heights nursing home was fined $3,575 for failing to keep the facility free from dangers and to ensure a high quality of life for residents.

Schulman and Schachne Institute for Nursing and Rehabiliation: The Brownsville, NY nursing home was fined $4,000 for an smoking incident when a resident ignited their clothes on fire.

The fines do little to force the nursing homes to improve care, according to Richard mallow of the Long Term Care Community Coalition.  "Too often because the fines tend to be small, its a slap on the wrist.  "A facility won't make any long-term changes to improve the quality of care because its just part of doing business."

Read more about the fines related to these New York nursing homes here.

Nursing Homes Abuse Blog Articles On Staffing:

Nursing Home Cuts Jobs Of 14 Nurses

High Staff Turnover Rates Plague Most Nursing Homes

Nursing Shortage Is A Crisis

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I was honored to be asked to start writing periodic blog posts for Long Term Living Magazine (LTLM).  LTLM is read by many professionals in the nursing home and long-term living industry.  I hope my blog posts provide a unique perspective to the issues repeatedly encountered by the hardworking men and women who are entrusted with caring for our elders.  Feel free to contact me if you have an idea for a post.

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The Iowa Department of Inspections and Appeals has imposed $3,500 in fines against Country View Nursing Home.  The fines follow a December visit to the facility where investigators determined the facility failed to provide proper care to residents with pressure sores and errors with administration of medication.

A follow-up inspection revealed the initial findings had been substantially corrected, but revealed new problems such as problems with housekeeping, disrepair of wheelchairs, failure of staff to protocol related to the cleaning and feeding of residents, and failure to provide sufficient care to incontinent residents.  As a result of the findings cited in the second inspection, Country View faces a $200 daily fine and denial of payments from Medicare and Medicaid for new admissions.

"We take this very seriously, and we've been working to correct and deficiencies that are in the facility," said Frank Magsmen, a supervisor for the nursing home.  "We believe strongly that it is a quality facility, and we have ongoing consulting coming in to address the issues and work with staff so we can provide the best possible service to the residents of County View."

Country View's Administrator, Jack Musker, acknowledges that a lack of staff training is a big part of the recent problems encountered by the facility.  The facility has been without a staff trainer for nearly a year and relies on temporary employees to fill many positions. "We're sorting out our agency people that we have," Musker said.  "If they can't perform well, we'll ask them not to come back."

Country View is a county-run nursing home in Iowa.  In addition to providing long-term care, the facility also has an intermediate care facility for mentally retarded residents. Read more about this Iowa nursing home here.

Staffing In Nursing Homes

Perhaps the most important predictor of patient care is the nursing home staff.  The staff are responsible for assessing residents and implementing their care.  As nursing home lawyers who prosecute cases on behalf of those injured or killed while a resident in nursing homes.  Most cases come down to the quality and quantity of staffing.  Medicare has put an emphasis on nursing home staffing levels and rates each nursing home in this area.

Nursing Homes Abuse Blog Entries On Staffing

Minimum Nursing Staffing Ratios

The Correlation Between Staff Satisfaction And Patient Care

Nursing Shortage Is A Crisis

High Staff Turnover Rates Plague Most Nursing Homes

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Residents in assisted living facilities are very much on their own with respect to receiving help from CMS as to the quality of their facility.  As we've discussed, nursing homes are subjected to a centralized rating system that provides consumers with information on both an overall rating of the facility as well as ratings in critical areas such as: staffing levels, inspection ratings and quality measures (such as the incidence of pressure sores amongst residents, amongst other factors) on a five star rating scale.

As the Charleston Post and Courrier reports, no federal rating system exists for assisted living facilities, home to many elderly people.  Some states have instituted their own rating systems for the facilities, but in most areas of the country people are on their own to do their own evaluation of the facility.

What is an assisted living facility?  Assisted living facilities, licensed as community residential care facilities, are different from nursing homes. Assisted living residents need help with a few activities, such as taking their medicine, dressing or cleaning, but do not require the higher level of medical care nursing homes offer.

Despite the differences between assisted living facilities and nursing homes, many of the problems remain the same.  Problems facing assisted living residents can range from serious allegations of abuse and neglect  to dinner being served late. 

The Post Courrier article chronicles the issues faced by Sandra Belaja, a resident of Palmetto Residential Care Facility-- a South Carolina assisted living facility.  Belaja entered Palmetto for assistance with her daily living needs as well as for help with administration of medication after a hospitalization.  

According to Belaja, the care she received at Palmetto was so poor that she was forced to move out of the assisted living facility and into a nearby hotel where hospice workers monitored her well being.  Belaja says she moved into the hotel because residents at Palmetto often went without toilet paper and soap in the common bathroom, which had two toilets for 12 people, she said. And she said that when the heating broke, the oven was used to keep residents warm

The poor living conditions were verified by the South Carolina Department of Health and Environmental Control (DHEC) during an inspection of the facility.  In October 2006, the authority issued a letter to suspend Palmetto's license. In July 2007, however, DHEC lifted the suspension because the facility complied with standards.

Jerry Paul, former DHEC director of regulations, said closure of assisted living facilities is hard. "With the administrative law system, you're looking at long periods of time with a facility out of compliance that can operate. You really have to have horrendous goings on at a facility before you can close one down," he said.

In most states the only way to access information on assisted living facilities is to file a Freedom of Information Act request with state health officials.  Obviously, for a family faced with the stress of placing loved one in a care facility due to immediate care needs this is not practical.  Although a wealth of information may be obtained on nursing homes via the internet, no centralized database exists to access valuable information on assisted living facilities.

Why is this acceptable?  Why does our society treat millions of assisted living residents like second hand citizens?

Related Nursing Home Abuse Blog Entries:

Assisted Living Facility Lets Resident Walk Out Door and Into Semi

How Much Freedom Should An Assisted Living Facility Give the Mentally Disabled?

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

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The Enquirer-Herald had a really interesting article regarding younger people in nursing homes.  Increasingly, nursing home are becoming a place for people of all ages.  Over the past 20 years, the number of residents at nursing homes has surged.  Today, people under 65 comprise almost 10% of the nursing home population. 

At Orchards Rehabilitation and Care Canter, an Idaho nursing home, four out of five people are under 55.  According to administrator Mindy Shepard, a lack of alternatives is the real reason for younger people are entering facilities once deemed only for the aged.  "It's not that uncommon because we have a gap in the health care system between the hospital and the nursing home," says Sheppard.

One of the reasons for the increase in younger residents is the increase in poorly controlled chronic disease.  Manny younger nursing home residents suffer from:

• Obesity
• Diabetes
• Multiple Sclerosis
• Side effects of stroke
• Side effects of heart attack
• Chronic asthma
• Pulmonary disease

Another reason for the increase in younger nursing home residents is likely due to the progress made in medical care over the past 20 years.  Younger people may be surviving chronic conditions as well as traumatic injury such as automobile accidents due to medical treatment previously unavailable.

Medical needs aside, younger people frequently have difficulty adjusting to a nursing home setting due to generational differences.  "They don't want Lawrence Welk," says Judy Wood, the activity director at Orchards Rehabilitation for more than 20 years. "The younger residents have different interests in music, technology .  It's challenging.  I try to gear activities to their interests and give them group opportunities to express their feelings about being in a long-term care facility."

Nursing home staff must not assume younger residents are automatically better able to care for themselves. Younger nursing home residents frequently require the same assistance with daily living tasks as older nursing home residents.  Staff should follow the the specific procedures set forth in younger residents 'care plans' to avoid confusion and injury causing situations such as falls, pressure sores or medication errors.

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The C.M. Tucker, Jr. Nursing Care Center has agreed to settle allegations of poor care levied on it by the Justice Department following an eight month investigation into the state-run facility.  The South Carolina facility houses 360 resident including 70 veterans and residents with long-term psychiatric illnesses. 

The Justice Department conducted the report conducted the unannounced investigation under the powers granted it under the Civil Rights of Institutionalized Persons Act.  In May, the investigative report was released to the public.  Among the conditions cited to in the 36- page report include:

• Staff failing to identify residents with swallowing problems
• Failure to identify infection
• Swallowing problems
• Malnutrition
• Failing to regularly turn residents at high risk for developing pressure ulcers
• Not providing adequate pain medication
• Not doing enough to prevent falls that cause injury
• Inadequately investigating accusations of abuse
• Unsanitary conditions

According to Grace Chung Becker, acting attorney general for the Civil Rights Division of the U.S. Justice Department, "[t]his agreement establishes systems to ensure that nursing home residents receive adequate services to meet their needs."  Additionally under the terms set forth between the government and the state; the facility must keep the government informed as to staff training, reporting and evaluation.  The settlement further requires staff to pay special attention to residents weight, food intake, pressure sores, pain management and report all deaths at the facility to the federal agency.

Read more about this settlement of nursing home investigation here.

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Authorities are looking for Jacqueline Anne Lumpkin, a certified nursing assistant at an Alabama Nursing Home, who is accused of stealing an elderly resident's identity to fraudulently buy goods and services valued at more than $5,000.  Warrants for Lumpkin's arrest were issued on December 4, 2008 and she is being charged with: elder abuse / neglect, financial exploitation, identity theft and fraudulent use of a credit card.  Each count caries a $15,000 bond.  Authorities are still attempting to learn if there are more residents that Ms. Lumpkin has taken advantage of.  Read more about this case of financial exploitation of the elderly here.

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On December 18th, the Justice Department's Civil Rights Division, released a 45-page report relating to numerous conditions and practices that violate the 'constitutional and federal statutory rights'  of the residents at the William F. Green Veterans Home.  The report follows an inspection, interviews and document review by officials of the Alabama Veterans Home.  The  federal report, authored by acting Assistant Attorney General Grace Chung Becker, concludes residents at the facility 'suffer significant harm and risk of harm from the facility's inadequate medical and nursing services.'

In particular, the report identifies the following problems relating to improper patient care:

• Inadequate nutrition and hydration
• Improper use of psychotropic medication
• Inadequate pressure sore treatment
• Inadequate restorative care and specialized rehabilitation services
• Failure to protect residents from harm due to falls
• Failure to investigate allegations of resident abuse
• Inappropriate use of restraints

Human Management Resources has had the contract to staff Alabama's three veteran's home since 2004. In 2007, an Alabama Department of Public Health inspection revealed staffing violations and the company was downgraded to probationary status.

Despite the reports of serious safety violations, no immediate penalties have been implemented.  'Scot Montrey, a spokesman for the Justice Department's Civil Rights Division says, "It is quite possible that some remedies will already be under way.  "Our next step ... depends on the level of cooperation we receive, but typically we reach some kind of settlement rather than having to file a lawsuit."

Read more about these allegation of improper nursing care here.

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The Washington Post had an article on the growing diabetic population in nursing homes.  Despite the fact that up to 25% of nursing home residents have diabetes, a study published in Diabetes Care determined many diabetic nursing home residents are not getting appropriate care according to the standards proposed by the American Diabetic Association.  The study revealed while 98% of diabetic nursing home residents had their blood glucose monitored, only 38% met their short-term glucose goals.  

One of the problems facing nursing home residents with diabetes is the lack of specific guidelines set forth to care for elderly people with diabetes.  According to Helaine Resnick, director of research at the Institute for the Future of Aging Services for the American Association of Homes and Services for the Aging, most of the glucose control standards are intended for younger people and the needs of an elderly nursing home resident with a cognitive impairment may be substantially different.

"Diabetes medications are designed to lower glucose levels, which can prevent complications from developing in diabetic people,  But, when you take medicines to lower blood glucose, it can go too low, which can be extremely dangerous, especially for older adults,"  Resnick said.  It's difficult to find "the appropriate balance between keeping sugars low with the risk of keeping it too low," she added.

Both Resnick and Paul Strumph, M.D., Chief Medical Officer of the Juvenile Diabetes Research Foundation, recommend active family involvement  when developing an individualized care plan for diabetic seniors. "Families have to be very involved, and the communication needs to be ongoing because people's values can change," added Resnick.

Related Posts From The Nursing Homes Abuse Blog:

Poorly controlled blood sugar in nursing homes.

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The Brownsville Herald had an article on nursing homes inability to care an increasingly large portion of the nursing home population-- the morbidly obese.  Under-staffing is particularly problematic for large nursing home residents.  Obese nursing home residents require special equipment and additional staffing in order for their needs to be met.  Read more about the special needs of obese nursing home residents here.

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Rarely do nursing homes have isolated problems.  Rather, problems with patient care usually stem from a culture of poor staff training and under-staffing.  Case in point-- The Summerville at Potomac nursing facility in Maryland.  Following a routine inspection, state and county nursing home surveyors discovered numerous violations governing patient care in nursing homes.  Among the violations, the surveyors discovered: improperly care for pressure ulcers, mismanaged patients' medication, lack of fall precautions for patients prone to falling and patients with excessive weight gain and loss.  

According to Wendy Kronmiller, director of the Maryland Department of Health and Mental Hygiene's Office of Health Care Quality, many of the reported problems can be attributed to a lack of coordination of care.  The survey found that Summerville lacked a delegating nurse to monitor care of each resident. Despite state laws that require a delegating nurse to visit the facility every 45 days, no delegating nurse had visited the facility for months.

In addition to receiving a $10,000 fine and a ban on admission of new patients, the facility was ordered to complete a six-point 'directed plan of correction'.  The plan includes the following mandates:

• Appointment of a full-time registered nurse
• Conduct an examination of each patients skin
• Hire a wound care specialist to address pressure ulcers
• Hire a monitor to report conditions to officials
• Notify residents families about the conditions found in the survey

Obviously the nursing home's decision to provide a 'bare bones' staffing of the facility had a drastically negative impact on patient care.  Nonetheless, a $10,000 fine still seems like little more than a slap on the wrist to a publicly traded corporation that owns the facility. The Summerville at Potomac is owned by Emeritus Corporation.  Emeritus owns and operates 289 nursing homes in 37 states.  Read more about this Maryland Nursing Home here.

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David Cohen at the Nursing Home Lawyer Blog recently wrote how sloppy medical records have a disastrous impact on patient care--- I couldn't agree more.  In nursing home litigation, records play a crucial role in determining who did what, when.  As lawyers we must work backward to determine why happened to our clients. Perhaps a better characterization would be that we try to determine what may have happened to our clients.  If medical charts are littered with vague notation, absent notation, or perhaps most common--sloppy penmanship--our jobs become difficult.  At some points we must fill in the blanks.

In many nursing home litigation cases, we will order medical charts several times--not because we are tree killers--but to assure clients that we are working with a complete set of records.  Invariably, each set of records is different.  Pages or even complete sections may be included in one set only be missing from another.  

Unlike most areas of the law, reviewing sloppy medical charts does not get any easier with practice.  Too often I receive stacks of medical records from a nursing home or hospital, and desperately try to decipher the cryptic penmanship of an attending nurse or physician. The reality likely is, that although I may get frustrated when I can't read the scribbled notes on page after page of medical records, a nurse or other nursing home employee probably also tried to decipher the abstract code with the same lack of success that I did. 

Nurses and physicians will attest to the importance of keeping detailed and accurate medical charts is essential in providing quality care.  What happens when a nursing home employee is presented with a medical chart containing gaps, scribbles and missing pages when making a medical decision?  If a nurse can't read an order, how can the order be implemented?

No doubt about it, frequent errors are made, not necessarily due to a lapse in medical judgment or mistake when performing a complex task--but because of poor recordation and chart-keeping. As David points out, until nursing homes and hospitals make patient documentation a priority, there will be countless situations where sloppy record keeping will force nursing home workers to literally play a guessing game with respect to providing quality patient care.

Read more about the Nursing Homes Abuse Blog's entry on the use of barcodes to prevent prescription errors here.

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With two seemingly preventable patient deaths in recent weeks, officials have ordered Willow Crest Manor to be immediately shut down.  An investigation of the deaths revealed multiple safety violations at the facility.  "The department has determined that the conditions and the care provided here constitute an immediate danger to the residents," said Matt Jones of the Pennsylvania Department of Public Welfare.

The recent deaths include: a 49-year-old resident who died from complications related to pressure sores on her legs and the unexplainable death of a 24-year old man with cerebral palsy patient who was found dead in his room by a roommate.  Pennsylvania officials doing a preliminary investigation of the matters determined that the facility had multiple violations relating to patient care in each incident.

These suspicious deaths come after the owner of Willow Crest Manor, David Mittal, has been in the headlines for allegedly choking a resident with Parkinson's for 'banging on the door'.  While Mr. Mittal awaits trial for criminal charges related to his 'choking incident', a judge banned him from Willow Crest Manor and the other assisted living facilities he owns.

Why are people like put in positions where they are caring for handicapped and elderly?

Read more about the two recent deaths at Willow Crest Manor here.

Read more about the alleged choking of a Parkinson's patient here.

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The report of staff at the Edgewood Vista Assisted Living Facility, incorrectly telling the family of a resident she was dead gave me chills.  For six hours the family mourned the loss of their loved one--no reason to second guess the grim message.  An afternoon-shift nurse at the facility caught the mistake while making medication rounds and realized the facility had mistakenly switched the roommates identities-- and realized the 'deceased' resident was very much alive.  Officials at the assisted living facility, acknowledge the mistake happened because the roommates charts were 'mixed up' and because the death occurred early in the morning when 'employees working that shift weren't familiar with the two roommates.'

The 'mix-up' in identity also resulted the assisted living facility to failing to see a DNR order in the deceased's chart.  Consequently, the facility attempted to resuscitate the woman and ignored her wishes to go to a specific funeral home.

How long had this 'mix up'  been in place?  I imagine there are countless 'mix ups' with roommates taking place everyday throughout nursing homes, assisted living facilities and hospitals. Nonetheless, mistakes impacting to patient care are inexcusable.  Facilities need to take all necessary steps to assure residents and their families that they are actually providing the specified care to the person it is prescribed for.

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I just got an email from Wes Bledsoe, founder of A Perfect Cause, regarding the Minnesota State's Attorney's indecisiveness in bringing felony charges against the young women who allegedly abused Alzheimer's patients at the Good Samaritan Society - Albert Lea Nursing Home.

Here is a copy of the email.  I encourage everyone to forward this email, as this really is an issue that deserves to be in the headlines.

Here’s your call to action!

Please call Craig Nelson… the Freeborn County Attorney in Albert Lea, MN… as soon as possible today. Please send this appeal to ALL on your email lists… plus ask family, friends, associates, and co-workers to call.

Nelson’s office number is 507.377.5192.

You can even fax him at 507.377.5196. I do not have his email address but anyone who does have it, please send it to me and I will circulate that too.

We invited Nelson to attend the town hall meeting last night. He declined, saying he’d “wait to see what happened in the media and hear from the court of public opinion.”

So… here’s your chance to be the “court of public opinion.”

What do we want?

1.       Felony Charges filed against the alleged assailants

2.       If convicted, the assailants should be required to register as sex offenders

3.       If he chooses not to file felony charges, he should immediately recuse himself and turn the case over to the MN Attorney General’s Office due to a conflict of interest

Why?

 1.       The families of the Good Samaritan Society – Albert Lea (nursing home) victims and many citizens of Albert Lea have asked us for our help.

2.       Nelson has

a.       Charged the alleged assailants of these victims with only class five misdemeanors

b.      Stated the assailants will "most likely will face suspended jail sentences and probation, so they'd have the threat of jail hanging over them if they get in more trouble”

c.       A conflict of interest due to a reported relationship with at least one of the alleged assailant’s families (he therefore should recuse himself and his office from the case)

3.       The alleged assailants are smarter than the County Attorney, as reported the alleged         assailants targeted victims who could not tell on them and if they did, that no one would       believe them

a.       Nelson’s office states the victims are not reliable witnesses

4.       Failure to prosecute physical and sexual battery committed against vulnerable adults by caregivers sends a loud and clear message that it is open season on any long-term care             residents in the future

5.       The alleged criminal acts committed against these elderly and vulnerable adults should be considered as “Hate Crimes”

Background on the case

Larson – Complaint - http://stmedia.startribune.com/documents/2albertlea.pdf?elr=KArks:DCiUHc3E7_V_nDaycUiacyKUU

Broitzman – Complaint - http://stmedia.startribune.com/documents/1albertlea.pdf?elr=KArks:DCiUHc3E7_V_nDaycUiacyKUU

Minnesota Department of Health – Investigative Report - http://www.health.state.mn.us/divs/fpc/directory/surveyapp/ohfcfindings/h5441019.pdf

More to Come

Yes, I am upset about the State of Minnesota and CMS’ policy to cite ZERO deficiencies if facilities “self-report” and “offer an acceptable plan of correction.” These agencies will be our next target, but I want to give them an opportunity to talk and modify this policy before we move on them.

Yesterday was an incredible experience. We met with two families… had seven television interviews throughout the day… two print media interviews… met with an ally who is funneling information to us… plus the town hall meeting.

Here’s what the media had to say about…

Last Night’s TOWN HALL MEETING

Star Tribune

Families sound off on abuse at Albert Lea nursing home

http://www.startribune.com/local/36022444.html?elr=KArksUUUU

Albert Lea Tribune

http://www.albertleatribune.com/news/2008/dec/12/residents-respond-alleged-abuse-case/

Advocate stirs debate on elder case

KIMT

Good Samaritan Abuse Charges Get National Attention

http://www.kimt.com/news/local/36024879.html

FOX 9

Town Hall Meeting Addresses Albert Lea Nursing Home Abuse

http://www.myfoxtwincities.com/myfox/pages/News/Detail?contentId=8054920&version=4&locale=EN-US&layoutCode=TSTY&pageId=3.2.1

KXMC

Minn. nursing home hit hard by abuse allegations

http://www.kxmc.com/News/308028.asp

WCCO

Nursing Home Hit Hard By Abuse Allegations

http://wcco.com/health/nursing.home.abuse.2.885548.html

KSTP

Minn. nursing home hit hard by abuse allegations

http://kstp.com/article/stories/S702828.shtml?cat=1

KAAL

Family Members Speak Out on Nursing Home Abuse

http://kaaltv.com/article/stories/S702744.shtml?cat=10151

KTTC

Family member appalled over nursing home charges

http://www.kttc.com/global/story.asp?s=9508954

KARE 11

Albert Lea community speaks out about nursing home allegations

http://www.kare11.com/news/news_article.aspx?storyid=531759&catid=14

Yes… we can… and together… we are… making a difference!

Many thanks for all!

Wes

Wes Bledsoe

Citizens’ Advocate & Founder

A Perfect Cause

1501 N. Broadway Blvd., Bldg B

Oklahoma City, OK 73103

C – 405.308.3858

C – 405.802.2903

Wes@APerfectCause.org

www.APerfectCause.org

Our Mission - To End Needless Suffering & Preventable Deaths

 "A Perfect Cause must produce a perfect effect."

Science of Mind, Dr. Ernest Holmes

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Eleven people exposed to tuberculosis at Pinecrest Hospital, a West Virginia nursing home, have settled their lawsuits brought against the facility.  The lawsuit was brought on behalf of nursing home patients, employees and visitors claims the nursing home was negligent in failing to keep air contaminated with TB out of the general areas of the facility.

Tuberculosis is bacterial infection commonly found in the lungs.  Pulmonary TB is contagious and may be easily spread through the air.  Symptoms include: heavy cough with sputum, tiredness, weight loss, fever increased pulse and swelling of the lymph nodes.  TB is treatable, but requires extensive medications and the symptoms may linger for six months or more.  TB can be fatal among nursing home residents as many already have weakened immune systems.

Nursing homes should take precautions to assure their residents remain free from TB.  In addition to screening new residents, nursing homes should make sure TB patients are segregated from the general population.  Obviously, if the nursing home chooses to provide medical treat met to a person with TB, they also need to have separate air circulation systems in place to assure the safety of their residents.

Read more about the settlement of this nursing home lawsuit here.

Information on Tuberculosis from Web MD can be found here.

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The azstar.net reported that the Santa Rosa Care Center has been ordered to pay $17,500 in fines for more than two dozen violations that relate to patient safety.  An April inspection by Arizona nursing home inspectors revealed the following problems:

• The facility waited 10 days to tell a resident's medical provider that the resident had suffered a seizure, fallen to the floor and was unconscious for about 10 minutes. The resident's condition deteriorated after the seizure, state records show. He became increasingly confused and needed assistance to walk and eat. Doctors later determined he had intracranial bleeding from the fall.
• A resident's "do not resuscitate" directive was not correctly documented by staff.
• One woman fell in the bathroom and was given Tylenol for ankle pain. It wasn't until almost a full week later that the care center determined she had fractured her ankle, even though the woman said she told staffers that her pain was at least an 8 on a 10-point scale even with the Tylenol.
• A nursing note indicated a man was discovered giving oral sex to a resident with a documented history of dementia on March 16. There was no notation that the second resident's physician or family member was notified. The perpetrating resident had a history of "sexually inappropriate behaviors," state records say.
• One staff member said that if residents' don't object or resist, staffers consider sexual activity between two residents to be consensual. When asked if the resident's ability to consent was assessed, the staff member said no.
• Multiple, alert residents from four or five sections of the facility complained of urine odors at all times of the day; visitors to the facility also complained about an odor.
• A staff member who was helping to put a resident into a wheelchair made an unkind remark about the resident's leg being heavy. State rules say residents in licensed facilities "have the right to be treated with respect and dignity."
• Earlier this year, the Centers for Medicare and Medicaid agreed with state health inspectors that a "substandard quality of care" was being provided at Santa Rosa and suspended Medicare payments until Santa Rosa made the corrections. The federal government also required the care center to pay fines of $7,000.

According to state records, the 144-bed nursing homes has taken corrective steps and improved staff training.  Realistically, if the same employees and same administrator are still in place, how much change can really take place in six months?  For the sake of the residents, I certainly hope the facility has turned the corner with respect to patient care.  The Nursing Homes Abuse Blog will continue give readers updates on the Santa Rosa Care Center. 

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Toledo's Liberty Nursing Center has the dubious honor of being cited for situations posing 'immediate jeopardy' to its residents.  The 'immediate jeopardy' violations are were cited in a state report to pose an immediate harm to residents safety.  The report contains various situations involving nursing home abuse including: staff stealing medicine, unlicensed nurses, physical abuse among residents and failing to report injuries occurring at the facility to state authorities.

Read more about this dangerous Ohio nursing home here.

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Ever think where many of the violent criminals crowding our jail system will go when they are done serving their sentence? Unfortunately, many convicted felons will spend their senior years in a nursing home intermixed with the general population.  For many convicts, their mingling with other senior in a non-restrictive environment is their first exposure to freedom.  

Age has not softened the criminal propensities of many criminals.  According to Wes Bledsoe, founder of A Perfect Cause, estimates that convicted felons living in nursing homes account for more than 60, murders, rapes and assaults to other nursing home residents living among them each year.

Currently, there is little regulation at a state or federal level to keep tabs on aging criminals.  Many of the elderly criminals have been released into the general population before the development of sex offender data bases or other tracking methods were developed.

Oklahoma nursing home residents are one step closer to living in safety as state officials move closer forward in the construction of a nursing home dedicated to the housing of convicted sex offenders. The nursing home for 'elderly felons' would have special provisions such as 24-hour security to protect the residents as well as the general public.

This is a welcome concept whose time has come.  Nursing home residents deserve to live in safety and free from violence.  Unfortunately, this concept of segregated nursing homes for violent offenders is still years away from national availability.  In the meantime, nursing home should conduct background checks and surveys to help in identifying potentially violent residents. Further, nursing home staff should always be on the look out for any violent or aggressive behavior in their facilities.

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It makes sense.  Specialization is increasingly becoming common among doctors, lawyers and now nursing homes.   A skilled-nursing facility is taking a new approach to treating diabetes. The Hurlbut, a new york nursing home has partnered with the Joslin Diabetes Center out of Boston. Affiliated with Harvard Medical School, Joslin concentrates in diabetes treatment and research. The Hurlbut is one of two nursing homes in the country to adopt a Joslin diabetes program.

Diabetes is a common medical condition.  By some estimates, more than 25% of nursing home patients have diabetes yet most facilities don't offer specialty care.  While the treatment may be adequate, most nursing home are designed to treat a wide variety of medical conditions. Specialization allow nursing homes to concentrate on doing one thing and doing it well.

"What we've done here is educate everyone in the facility from the front desk person, to the person in the kitchen to the aides. Almost anyone who will listen," said Suzanne Meyer of the Joslin Diabetes Center.

With a team approach, blood sugar levels are monitored, meals are planned, and medications adjusted."Until we look at diabetes management, until we improve those blood sugars I don't think that the quality of life will be great. And I think most people will want to look at this model," Meyer said.

There will likely be more specialized nursing home in the future.  Grouping people according to their medical condition allows the staff to focus on one ailment as opposed to treating a variety of physical and psychological conditions.  Read more about this progressive approach to diabetes care here.

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A faulty handicapped lift is being blamed for the death of a Canadian nursing home resident.  According to the coroner, the LIKO 102EE mechanical lifting device malfunctioned during operation at the Leisureworld Caregiving Center (O'Conner Gate) in Toronto.

This particular lift is widely used in Canada and throughout the United States.  There are 12 reports of LIKO lifts malfunctioning since 2005 in the United States.  This lifting device is used to transfer people with limited mobility from bed into their wheelchairs.

Coroner Jim Edwards recommends the lifts be removed from nursing homes until the manufacturer can correct the problem.  The Swedish manufacturer has agreed to replace specific model lift.  Injuries occurring during the transfer of patients are some of the most frequently encountered amongst both nursing home residents and staff.  Nursing home should make sure their staff are properly trained in the use of all lifting devices and manual lifting techniques to assure resident safety.
 

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Talking Heads split up in 1991, but leader David Byrne continues to create.  Byrne is greyer than he was 20 years ago, but has cranked out some of his best material with the help of Brian Eno in his new album Everything That Happens Will Happen Today.  Below is a clip of one of Byrne's new songs done with the heap of Young @ Heart Chorus.  Young @ Heart Chorus is a touring group of elderly singers in age from 72 to 88.  The group was formed in 1982 and covers everything from classics to hip hop....and of course, David Byrne.  Get this album.

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Does the government turn a blind eye to the large elderly and disabled population living in nursing homes?  Why does the Centers for Medicare and Medicaid Services (CMS) specifically not reimburse hospitals for 10 'reasonably preventable' conditions related to improper care when nursing homes continue to provide the same inadequate care without reprocussion?

Steve Gold, at the JF Activist blog raises these issues in his recent post, 'Stop Paying Nursing Homes That Injure Elderly and Disabled People.'  Steve points out that as (CMS) has begun the crackdown on hospital safety, nursing homes continue to receive poor marks in national surveys.  In 1998, 81% of nursing homes were cited for at least one deficiency during CMS inspections.  By 2001, the number of nursing homes cited for deficiencies had risen to 89%.  In the most recent CMS survey, in 2007, the percentage of nursing homes receiving violations has increased to 91%.

Even more outrageous is the increase in 'immediate jeopardy' and 'actual harm' violations--the most serious-- handed to nursing homes by CMS.  The percentages of 'immediate jeopardy' violations has risen from 1.4% in 1998, 2.3% in 2001, to 17% in 2007.  To give people an idea of what these safety violations entail, Gold cites 2007 CMS OSCAR data:

• 19.1% of nursing facilities had residents with avoidable pressure sores, and the nursing facilities received deficiencies for failing to meet the federal standard.  Up from 17.2% in 2001.
• 11.8% of nursing facilities imposed physical restraints on residents for purposes of discipline or convenience and not required by the residents' medical symptoms, and they received deficiencies for this category.  Up from 11.0% in 2001.
• 19.2% of nursing facilities had failed to prevent incontinence in residents and to restore bladder functioning as much as possible to residents, and the nursing facilities received deficiencies. Up from 12.0% in 2001.
• 7.0% of nursing facilities failed to provide residents with acceptable nutrition to maintain their body weight, and the nursing facilities received deficiencies.  Down from 8.4% in 2001.
• 37.9% of nursing facilities failed to ensure residents with environments "free of accident hazards" to "prevent unexpected and unintended injury," and the facilities received deficiency citations.  Up from 22.1% in 2001.
• 6.6% of nursing facilities failed to provide residents with appropriate range of motion services to those people who required such services, and the nursing facilities received deficiencies.  Down from 8.1% in 2001.
• 16.6% of nursing facilities failed to promote residents' care in a manner and in an environment that maintains or enhances the residents' dignity and respect for the individual resident, and the nursing facilities received deficiencies for violating the federal standard.  Down from 17.3% in 2001.

Gold rightly feels that there is a double standard being applied to elderly and disabled nursing home residents.  Most of the safety problems would never be tolerated in a hospital setting, yet we continue to allow them to occur nursing homes.  Until our society puts a premium on helping the elderly, nursing home residents will not get the rights and safety they deserve.  It is unfortunate that our culture turns their head from the elderly and their living conditions.  If any of the above safety problems occurred in a nursery school people would be out in the streets in rage.  Until then, let watch the annual safety violations escalate. 

The JF Activist blog is published by The American Association of People with Disabilities (AAPD).  AAPD is the largest national nonprofit cross-disability member organization in the United States, dedicated to ensuring economic self-sufficiency and political empowerment for the more than 50 million Americans with disabilities. AAPD works in coalition with other disability organizations for the full implementation and enforcement of disability nondiscrimination laws, particularly the Americans with Disabilities Act (ADA) of 1990 and the Rehabilitation Act of 1973.

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California Governor, Arnold Schwarzenegger recently signed a state budget for California that cuts funding for local ombudsman programs.  Ombudsman programs investigate complaints of nursing home abuse and nursing home neglect and provide training for nursing home staff on how to prevent abuse.

The budget cuts will make it harder to respond to nursing home complaints and protect the rights of residents in long-term care facilities, according to Kathleen Johnson of Advocacy Inc.  Advocacy Inc. operates an ombudsman program in two counties in California and oversees approximately 2,500 nursing home residents in 44 facilities.  All of the facilities in the two counties have been cited for deficiencies during inspections.  Johnson goes on to say,

"The governor makes it clear that the most vulnerable and least visible population in our state does not merit protection, advocacy respect or a voice."

As the credit crisis on Wall Street spreads to Main Street, look for similar nursing home-related budget cuts in your state.  As Ms. Johnson points out, many nursing home related budget cuts are first in line because residents are tucked away out of the publics' view.  Read more about this potential problem for California nursing home residents here.

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Following on the well publicized nursing home violations at the Westside Health Care Center and The Terrace at Westside, the Cincinnati Health Department has been stripped of its ability to license and inspect nursing homes.

Cincinnati City Council members determined that that city health inspectors failed to protect some of the community's most frail residents. The city health department's oversight duties will be turned over to the state authorities.

In March, a surprise inspection found dangerous conditions in the nursing home including: 

Nursing Home Facility Problems

• Fire doors tied shut
• Mold on walls
• Cigarette butts in walkways
• Soiled mattresses
• Roach infestation
• Uncleaned vomit

 Nursing Home Staff Violations

• Allowing residents to smoke near oxygen tanks
• Storing medication improperly
• No psychological training for staff caring for residents with psychological problems
• No first aid training
• No fire drill training
• 20% medication error rate

The city counsel should be applauded for putting the important responsibility of nursing home inspections in the hands of more capable people.  Obviously, with the violations described above, many serious violations slipped through the cracks.  More information about this nursing home inspection can be found here.

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Bloomberg reported that more than 90 percent of U.S. nursing homes in each of the past three years were cited for violating federal standards, according to a government report.  The article substantiates that many nursing homes are simply not doing an adequate job caring for our nations elderly population.  According to the inspector general's report for the Department of Health and Human Services:

• For-profit facilities had a higher percentage of violations than other nursing homes-94% of for-profit nursing homes surveyed were cited for deficiencies, compared to 88% of not-for- profit and 91% of government nursing homes
• The most common violations related to improper storage and distribution of food, accident hazards and lack of services necessary for residents' mental and physical well-being

• The rate of violations differed by state, with every nursing facility surveyed in Alaska, the District of Columbia, Wyoming and Idaho reporting citations compared with a low of 76% in Rhode Island.

There are 1.5 million people living in 16,000 nursing homes in the United States.  The facilities are reliant on government payments for the vast majority of their operating budget.  In order for the facilities to be reimbursed by Medicare and Medicaid, the nursing homes must be certified as meeting certain federal standards.

According to Susan Feeney, a spokeswoman for the American Health Care Association, a Washington advocacy group for 9,000 nursing homes, nursing home inspections are too subjective.  ``We're looking to work with Congress and the administration to implement a process that's less subjective and has incentives for quality improvement,'' Feeney said.

Federal and state regulation of nursing homes provides essential guidelines for the safety and well-being of nursing home residents.  In order to provide the safest environment for nursing home residents, all aspects of the facilities need to be properly monitored.  Any efforts on the part of the nursing home industry to relax or eliminate the standards should be considered self-serving.

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We recently discussed how the Metron Nursing Home in Allegan was losing its Medicare and Medicaid funding due to multiple violations in patient care.  Now, more information has come to light about the the Michigan Attorney General's investigation and the forced sale of the facility.  Two nursing home residents at Metron of Allegan died after nursing home workers failed to administer oxygen. 

The incidents follow a similar 2005 incident when, Sarah Comer died at the Metron of Big Rapids. The death of Comer lead to a lawsuit against the nursing home.  In the course of litigation, allegations of nursing home workers covering up Ms. Comer's death began to surface.  The workers were alleged to have conceived of a story to suggest that Ms. Comer died from caused unrelated to the negligent administration of oxygen.

The facility was recently found to be in violation of 11 safety violations partially consisting of:

• Failure to provide oxygen, resulting in two deaths.
• Failing to prevent resident-on-resident physical and sexual abuse.
• Failing to investigate a resident who eloped from the facility.
• Failing to provide pain medications prescribed by doctors.

Prior to losing its Medicare and Medicaid funding, Metron has has ample warning to correct the consistently poor care served to its residents: Metron has been under state oversight for two years, fined over $300,000.00 for heathcare citations and had its facility in Kalamazoo closed when inspectors found serious violations relating to patient care.  It seems that for the good of all residents at Metron facilities, they should be shut-down for good.

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The Justice Department is investigating the quality of care at the Minneapolis Veterans Home in Minnesota.  "Essentially they want to know if the civil rights of residents mights have been violated by not getting the care they should have," said Gil Acevedo, deputy commissioner of the Minnesota Department of Veterans affairs, that operates the facility.

What started this investigation is unknown.  However, this veterans nursing home has had many problems in the past.  Since 2005, the facility has 66 state rule violations, $42,300 in fines and was required to hire a consultant and monitor to look over it.  Of the many state rule violations, medical errors at the facility have been associated with the deaths of three residents.

The Justice Department has been investigating the VA nursing home for several months.  As a preliminary step in the investigation, the Justice Department has asked the facility to hand over two years of medical records from veterans and their spouses.  The state has refused to comply with the request stating violations of state and federal privacy laws (HIPPA).  However, the state has disclosed information regarding the number of falls, injuries and deaths at the facility since 2006.

The Special Investigations Section of the Justice Department is conducting this investigation under the Civil Rights of Institutionalized Persons Act.  The Act was intended to protect people in prisons and other institutions, but has recently been used by the Justice Department to investigate suspect VA nursing homes.  The Justice Department cited the State of Tennessee earlier this year for improper care at two veterans homes.  Read more about this investigation here.

Getting the Justice Department involved in nursing home quality is a good thing.  VA nursing home are subject to the same rules and regulations as privately operated facilities.  If the Justice Departments involvement helps raise the level of patient care even everyone involved, including state officials, should be happy.  Obviously, with the number of violations and injuries at this veterans nursing home, people are not doing their job and patient safety is not getting the attention it deserves.

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Residents at Michigan's Metron Nursing Home in Allegan will soon be looking for new places to live following the facilities violations of  federal nursing home regulations.  Metron has received 11 federal violations, including a violation concerning immediate jeopardy to a patients health.  It is unfortunate that resident's must be displaced and care routines will be interrupted, but there is a reason that federal nursing home regulations are in place--to provide quality care for nursing home residents.  What residents and visitors may not see, may lead to serious lapses in the quality of patient care in the future.  Metron operates seven nurisng homes in Michigan.  Read more about the revocation of Medicare and Medicaid funding here.

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The above description is of a person in Clinton, Iowa police are searching for.  The woman called the Alverno Health Care Facility and tricked an employee of the facility into giving her the names of several nursing home patients with Fentanyl patches.  The woman then went into the facility to visit the patients whose names she was given.  The woman tore the Fentanyl patches off the patients bodies and fled the facility.  Read more about this incident involving stolen medication here.

Obviously, this facility is responsible for this incident.  How and why they would release the names of residents is not only a safety concern but also violate all concepts of privacy.  Then the facility physically let this woman into the facility to see these residents whom she had no relationship with is also disturbing and a nursing home safety violation.

Fentanyl is an extremely strong pain reliever that is absorbed through the skin. Fentanyl acts upon specific receptors in your brain and spinal cord to decrease the feeling of pain and to reduce your emotional response to pain. Fentanyl is used to manage moderate to severe pain, usually in people who have chronic pain. Fentanyl is often used when your other pain medicines no longer work.

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I came across this news video about a New Mexico nursing home that took it upon itself to improve patient care.  After losing Medicare and Medicaid funding, this facility has received a clean bill of health and is now providing quality care to New Mexico's elderly.



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Physical therapists (PTs) work with people who have limitations, impairments, disabilities or those who may have suffered an injury.  Before the actual work begins, physical therapists must conduct an examination and evaluation of the patient and generate a program to help each patient achieve his or her highest level of functional outcome.

Treatment often includes a comprehensive program that includes: flexibility, strength training and aerobic endurance work.  If a person suffers from a disability, the physical therapist should also help each resident learn how to use adaptive devices such as wheelchairs, crutches or prostheses.  The ultimate goal of physical therapy should be to improve each person's quality of life.

Injuries occurring during physical therapy sessions in nursing homes are on the rise.  Part of the reason that physical therapy injuries have increased recently stems from the fact that some nursing home are trying to increase their bottom line.  According to reports on MSNBC, nursing homes have added physical therapy into the regimen of both short-term and long-term residents as physical therapy generates a much higher Medicare reimbursement rate for the nursing homes.

An increased focus on physical therapy in nursing home settings has lead to a dangerous combination of unskilled physical therapists and residents who may not physically be ready for the physical rigors.  Common injuries occurring during physical therapy include:

• Falls
• Fractures
• Torn ligaments
• Traumatic brain injury
• Burns

Frequently, physical therapists in nursing homes are independent contractors or may work for an outside agency and not directly employed by the nursing home.  Therefore, if you have been injured during a physical therapy session it is important to contact a lawyer soon after the incident to learn the full extent of your rights.

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You never know who may turn up at your local nursing home...unfortunately.  68-year old, David 'Daddy Dave' Green was recently discovered as a resident at Florida nursing home. Mr. Green had been on the run for 8years following his escape from an Ohio jail.  Mr. Green is not your ordinary nursing home resident, as he is currently listed as one of America's top 15 most wanted fugtives. Read more about this nototius nursing home resident here.

Nursing home residents have a right to a safe and violence free environment.  If a facility knew or should have known of a residents violent tendancies and they commit a violent act against other residents, the nursing home should be held accountable.

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Unknown to many, some nursing homes and long-term care facilities have buses, vans, and cars to transport nursing home residents to appointments outside of the facilities.  When nursing home take on this responsibility, they must take necessary steps to provide safe transportation. For many nursing home residents, this mean securing wheelchairs, providing an adequate supply of medication and staff sufficient personnel to assure safety. 

This recently filed lawsuit, involving the wrongful death of a wheelchair-bound nursing home resident is a reminder that nursing home staff must take extra precaution when transporting nursing home residents.  The lawsuit against Fort Armstrong Assisted Living Center, claims the nursing home negligently restrained a resident during transport in a nursing home van.  The driver of the van drove erratically causing the resident to fall out of her wheelchair and become injured.

Nursing homes who are involved in the transportation of elderly are responsible for any injury occurring to the resident  during vehicle transportation, including:

• Dropping the resident
• Failing to secure residents
• Negligent driving
• Failing to monitor their medical condition
• Inproper operation / defective wheelchair lift

If you were injured in a nursing home vehicle contact my office to learn your rights.  If you are involved in a automobile accident while in a nursing home vehicle you may also be entitled to recovery for your injuries through their uninsured motorist coverage--even if the nursing home's driver was not responsible for the accident.  Call us today.

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The case of a nurse intentionally giving a lethal doses of morphine to a resident at a Chicago- area nursing home raises many concerns surrounding patient care, but one that jumps out at me is: who is looking after the medication stash in nursing homes?  Are most facilities so short staffed that no person is assigned to monitor the quantity of medications distributed?  Are potentially lethal medications treated with no more controls than a glass of water?

I recently came across this article regarding drug abuse amongst medical professionals in South Carolina and it seems as though many nursing home run a self-serve medication administration plan for their employees.  How widespread is prescription drug abuse (this includes stealing medication):

• More than 1 our of 100 nurses has been disciplined for a drug-related offense- most involve stealing medications
• 1.3% of licensed practical nursed (LPN) has faced discipline for: stealing drugs, forging prescriptions, failing drug screens and showing up to work impaired
• The percentage of medical professionals addicted to drugs is higher than the general population
• According to the DEA, 7 million American abuse prescription drugs
• the most commonly abused drugs amongst the nurses involved in disciplinary cases are: morphine, Demerol and hydrocodone
• nurses also tended to abuse pain killers such as: Dillaudid, Stadol, OxyContin, phenobarital and Duragesic patches

Obviously, an impaired nurse puts patient care in jeopardy because the nurse may not be able to tend to the patient's needs.  Also, an impaired nurse may be so desperate for his or her fix that they withhold necessary medication from the patient and use it for themselves.  There are reported instances where nurses have: removed Duragesic patches for nursing home residents, replace Oxycontin with similarly colored pills and replaced liquid medications with water.

While I sympathize with the nurses who may have addition problems, the real victims here are the nursing home residents who have medication withheld or improperly administered.  Nursing home owners must take responsibility for controlling access to highly addictive medications and implement programs to assure residents are receiving not only the proper dosages of medications, but also that there is real medication administered in the first place. 

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Cincinnati City Council members are requesting that the city get out of the nursing home inspection business following the discovery of 'crack house' conditions at Westside Health Center and Terrace Assisted Living Facility.  The council members suggest the investigatory responsibilities be turned over to the Ohio Department of Public Health to improve the quality of resident care at the facilities.  Safety concerns were discovered at the facilities during a police raid on March 13th.

About time!! Nursing home inspectors have an important job to protect the safety and welfare of the facilities residents.  If the the inspectors fail to discover safety violations at these facilities, then who will?  Passing the torch on safety inspections to a state group of inspectors is similar to the inspection system used in Illinois Nursing Homes.  Read more about the proposal to remove Cincinnati Nursing Home Inspectors here.

For more information on the 'crack house' conditions found at Westside Health Center and Terrace Assisted Living Facility look here and here.

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 In anticipation of the arrival of Hurricane Gustav, nursing homes throughout Louisiana are evacuating.  All nursing homes must have evacuation plans on file and conduct rehearsals for situations like this.  Best wishes to all in Gustav's path.

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Despite conditions that would make most fraternity houses seem like the Ritz, Westside Health Care Center and The Terrace at Westside in Ohio continues to receive government payment for providing substandard services in a physically dangerous setting. 

Authorities have long been aware of problems at Westside, yet the facility continues to operate with government funds.  Ohio health inspectors have more than 200 pages of violations at the facilities from 2003 through 2008 and extensive monetary fines slapped on the owners, yet the dangerous conditions  remain. 

A police raid on the facility on March 13th revealed conditions that made the City Council take notice and suggest residents find new places to live.  The police raid found the following physical problems  with the facility and nursing home staff:

Facility Problems

• Fire doors tied shut
• Mold on walls
• Cigarette butts in walkways
• Soiled mattresses
• Roach infestation
• Uncleaned vomit

Staff Violations

• Allowing residents to smoke near oxygen tanks
• Storing medication improperly
• No psychological training for staff caring for residents with psychological problems
• No first aid training
• No fire drill training
• 20% medication error rate

Nursing homes and long-term care facilities that receive Medicare and Medicaid funding must be in compliance with federal regulations.  I guess the government is giving Westside a freebie?  Read more about the nursing home violations at Westside here.

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An article published in the Journal of American Geriatric Society says that although seniors may inceasing in size, they continue to have increasing longevity.  After analyzing data from 4,000 senior citizens in England, the analysis determines that amongst the elderly there is not a corelation between obestiy and mortality rates.  The mortality rates increase only amongst the most severely obese.

The news is not all good for over-weight elders.  According to the article, over-weight senior suffer from decresed mobility and difficulty performing daily living activities.  The extra pounds have a dramatic impact on seniors in nursing homes and long-term care facilities.  Over-weight nursing home residents are at increased risk for development of pressure sores, diabetes and other medical complications.

Read more about the study on overweight elders here.

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Criminal charges were dismissed against three employees at Cherrywood Nursing and Living Center in Sterling, Michigan.  The Michigan Court of Appeals dismissed the misdemeanor patient abuse charges that the employees were originally charged with.  The court reasoned that the deceased nursing home resident could not be categorized as a patient because she was dead. 

In 2004, the nursing home employees were ordered to get the body of a deceased nursing home resident ready for transport to a funeral home.  The threesome told the corpse to 'wake up' and took photographs of each other with the corpse. Read more about this incident of corpse abuse here.

The women were fired for their behavior, but alarmingly, the Macomb County Department of Community Health did not revoke their licenses, even though the facility was cited for violation of patient dignity. 

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AAHSA (American Associate of Homes and Services for the Aging) has released a new report titled: 'Broken and Beyond Repair: Recommendations to Reform the Survey and Certification System.'  The  report documents the problems with the inspection system for nursing homes.  The report calls for an independent panel to come up with standardized criteria for both the inspection of nursing homes and for the inspectors themselves.  As a temporary fix, the report makes 31 recommendations to improve nursing home care until an independent panel can be established.

"We have to break the cycle of fear that paralyzed us all: consumers fear nursing homes, nursing homes fear the state, states fear the federal government, the federal government fears Congress and Congress fears voters," says Larry Minnix, AAHSA president.

The real problem with the system is its enormity of regulations placed on all parties involved in the nursing home industry.   Like our tax system, regulators tend to pile additional rules and regulations on an already overwhelmed system.  No nursing home worker could possibly digest all applicable regulations and still do their job.  While rules and regulations are certainly essential to provide quality care for the elderly, before placing additional regulations on a system it is better to take a step back and look at how to cure the current problems. 

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7-foot-7, Sandy Allen, the world tallest woman died yesterday in an Indiana nursing home.  Sandy Allen was 53-years old.  Ms. Allen received care at Shelbyville Nursing Home for medical conditions related to her extreme height.  Poor circulation in her legs caused Ms. Allen to rely on a wheelchair for getting about.  Although Sandy Allen weighed just 6.5 pounds at birth, she developed quickly.  By the age of 10, she was 6 feet 3 inches.  By the time Ms. Allen was 16, she was 7 feet 1 inch.  Read more about the world's tallest woman here.

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1. If the resident is well enough to go home.
2. Discharge the resident for care only available elsewhere.
3. Danger to the safety of other residents.
4. Danger to the health of other residents.
5. Failing to pay bills.
6. If the facility shuts down.

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We've heard how home based nursing home care may be a great alternative to nursing homes. How realistic is it for the disabled and elderly to rely on home-based nursing care in their own homes? Can we really afford to provide an in-home-nurse for each person who requests one?

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The Milwaukee Journal Sentinel, is running a series of articles documenting some of the problems with nursing homes and other long-term care facilities in Wisconsin.  After reading the articles, it is apparent that the quality of care nursing home residents receive is deteriorating.  The need for additional regulation of the nursing home industry is apparent.  The 20 year old laws (1987 OBRA) regulating the industry are not producing the results for which they were intended.

Some of the more striking statistics identified in the articles, include:

• Most nursing home staff positions have high turnover-- some nursing positions have more more than 200% annual turnover
• Bad care in corporation owned nursing homes is more widespread than ever:
  • 401 Number of nursing homes in Wisconsin
  • 56 Number of residents who died in cases in which a nursing home was cited since 2005
  • 359 Number of residents injured in homes from 2005 to 2007
  • 262 Number of homes cited for serious violations in 2005-'07*
  • 109 Number of nursing homes owned by out-of-state companies
  •  $8.7 million Fines issued by state regulators since 2005
  • $3 million Amount of those fines yet to be collected
• Current training requirements for nurse aids is a joke.  Barbers and beauticians need more training than nursing assistants, state records show.
  • Nursing assistants must get 75 hours of classroom and practical instruction to be state certified. People who style hair for a living need 648 hours of theory and 1,152 hours of practical instruction. The training requirements for certified nursing assistants have not changed since 1987, authorities said.

The authors identified the five most common types of serious safety violations in nursing homes from From 2005-’07:

    1. Failure to provide quality care (mostly nursing care and pain management)
    2. Failure to prevent or treat pressure ulcers
    3. Failure to prevent accidents or provide a safe environment
    4. Failure to notify a physician after significant change in a resident's condition
    5. Failure to promptly report alleged abuse or neglect

Ultimately, all safety issues in nursing home are the result of inadequate care and under-staffing.  Most nursing homes are designed to provide 24 hour care to their residents.  Facilities that have higher ratios of nurses to patients tend to provide superior care to their residents.  If there is one criteria to check when evaluating multiple nursing homes facilities, it is to look into the number of nurses on staff and the ratio of nurses to patients.

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More than 30 veterans will be forced to relocate from a Washington VA after an outside review raised concerns about the quality of care and an internal audit validated those concerns.  The Long Term Care Institute was contracted by the VA nationally to review nursing homes around the country.  A surprise inspection at the Jonathan M. Wainwright Memorial Veterans Affairs Medical Center on raised immediate concerns about the physical infrastructure of the nursing building. Concerns included sloping floors and patients' access to doors and stairwells.  The review was also critical of control of medication and the competence of nursing staff inserting intravenous catheter lines.

"We had to do the right thing for patients, and if we can't provide care that is equal to or better than the private sector, we shouldn't be doing it. So we had to shut it down," medical director DeAnn Dietrich said.

Established in 1858 on an 84-acre campus at Fort Walla Walla, the Jonathan M. Wainwright Memorial VA Medical Center serves an estimated 69,000 veterans in southeastern Washington, northeastern Oregon and northern Idaho. The center has 66 beds for acute care, nursing, psychiatric and substance abuse treatment. Thirty beds are devoted to nursing.  Inspectors raised concerns about patients' access to doors and stairwells at the end of long, blind corridors, as well as the aging building's sloping floors and narrow doors and hallways.

"While the building is seismically up to code, it's not adequate and it doesn't meet anyone's idea of what a long-term care facility should look like," Dietrich said. "We also realized the clinical competency issues weren't isolated. We did have staff doing some good work, but we didn't have a good system for ongoing training, documentation."

The medical center has a plan in place to address the immediate concerns and is conducting a feasibility study to determine if it should be reopened, according to Dietrich.  It is unfortunate that the facility is forcing residents to relocate, but the facility must be applauded for hiring an outside company to conduct a report and for acting on the reports findings.  If this facility were to remain open, there is little doubt the safety of the nursing home residents would be compromised.

Read more about VA nursing homes here.

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The elderly are particularly susceptible to flu symptoms.  The elderly population who live in nursing homes is also particularly susceptible to contracting the virus.  Unfortunately, the 2.5 million people living in 18,000 nursing homes, there is no vaccine or other medicine proven to prevent the flu.  Moreover, the addition of new medication or vaccine can be harmful to an already weakened population.

Researchers at Arizona State University have determined the best way to prevent the flu is to prevent the introduction of the flu virus into the nursing home or long-term care facility. Non-pharmaceutical interventions (NPI) are what the study suggests as the best preventative  tools.  In order to maximize the effectiveness of the NPI's, the nursing home must have a prevention program in place before any resident contracts the flu.

The study suggests the following NPI's are useful in flu prevention:

• Screening visitors and staff who leave and return to the facility.  Did they come into contact with any sick people?
• Restricting visitors.  If a visitor has come in contact with a sick person, they may be asked to make a telephone call or communicate through email
• Modified work schedules for employee.  Studies have found that employees who spend time away from the facility may have less likelihood transferring disease
• Washing hands and using protective masks.

Lead study author, Miriam Nuno, states:

Facilities must eliminate disincentives.  For example, employees sick themselves with flu or forced to care for afflicted family members must be paid for time away.  A single act of non-cooperation can bring down and entire facility.  In return, those employees who recover become immune, become fully available for further service and no longer represent a threat for introducing the virus.

As with all treatment provided in nursing homes, it is up to the nursing home owners and administrators to create guidelines for the benefit of the residents.  It is ultimately the responsibility of each nursing home employee to implement the guidelines.  If either the administrators or employees do not follow the guidelines, the nursing home residents will be adversely affected.  Read more about the study here.

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Seniors in Connecticut will soon have an easier time obtaining State-run services.  Under the new plan, Connecticut will have a centralized cabinet-level office on aging created by the Governor.  The new agency makes it easier for seniors to get information on long-term care and assisted living care. 

Services will range from help with basic daily chores to around the clock medical care.  The new program will provide alternatives for seniors who may have ordinarily gone to a nursing home.  68% of  Connecticut's Medicaid spending goes to institutionalized nursing home care. 

Studies have shown well over 90% of seniors do not wish to be in a nursing home.  Studies have also shown that providing community based elder care is cost effective as it is less expensive than nursing home care.  Read more about Connecticut's efforts to change long-term care for the elderly here.

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The face of the typical nursing home resident is changing --- and becoming less wrinkled.  Today, more young people are entering nursing homes and long-term care facilities in their 30's and 40's.  More than 15% of nursing home residents nationwide are under 65 compared with 12.3% under 65 in 2003.  The number of younger nursing home residents is expected to grow as our society continues to have inadequate facilities to care for younger people who require extensive care and rehabilitation.  Young people with traumatic brain injuries, extensive orthopedic injuries and chronic disease have few alternatives to traditional nursing home care.

For more information regarding the changing demographics at nursing homes, look at this New Jersey newspaper article.

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