Suspect A Problem Nurse? Learn More About The Nurses History Here?

I received a lot of emails from families who were concerned about the safety of their loved ones following our recent Nursing Homes Abuse Blog entry regarding the lack of national regulation of nurses.  Our blog entry was based on an in depth report regarding nursing regulation that appeared in a ProPublica series on poor care provided by nurses with a blemished record of providing quality patient care. 

The articles highlight the problems associated without a centralized database regarding nurses backgrounds and whether they have been disciplined in one state-- only to legally find work in another.

Thankfully, ProPublica reporters Charles Ornstein and Tracy Weber did a great service compiling information on nurse regulation on a national level.  The duo's compilation contains links to the following information:

  • License look-up page
  • Whether the states has a free on-line license look-up
  • Free disciplinary documents on-line
  • Contact information regarding obtaining medical records
  • Lists of disciplines nurses by state

While the information contained in this link can not eradicate poor nursing care, providing transparency on nurses background may help prevent additional situations involving abuse or neglect.  

Nonetheless, should you have further concerns regarding the staff at a nursing home or hospital, don't be shy about reporting the individual to the head of the facility or to law enforcement officials.  Thankfully, most staffing issues can be resolved in this matter-- before further intervention is necessary.

Below is a map that appeared in the ProPublica series.  The purple states allow free retrieval of license look-up on line.

 

Wait A While & Bad Nurses May Just Migrate To Your State To Care For Your Loved One

Loopholes in a reciprocity program amongst 24 states that allows nurses from one state to transfer to another may be putting a tremendous number of nursing home and hospital patients at risk for receiving poor care-- or perhaps more accurately downright dangerous care.

A recent USA Today article "Bad nurses able to keep working in other states" highlights the problems associated with the lack of a national database to keep track of nurses with blemishes on their records.  The article chronicles how some nurses legally obtain work in one state when they may have been disciplined for poor care in another.

The 24-state pact was originally intended help under-utilized areas of the county get the nurses when they need them--- without the nurses having to obtain licensing from the state board.  However, it seems like the dangers associated with states almost blindly allowing nurses to transfer into their state are alarming. 

In particular, there are multiple episodes where nurses have admitted and/or been disciplined in the following circumstances:

  • Stealing patients medicine
  • Medication errors
  • Providing negligent medical care
  • Neglected patient needs
  • Physically abusing patients
  • Failing to register as a convicted sex offender

Certainly, after reading this article, you will likely be left with a similar impression to myself that there needs to be a national tracking system for nurses and all health professionals who may have reciprocity rights that allow them to transfer from one state to another. 

However, until such a system is put into place, I firmly believe it is the responsibility of individual facilities (and staffing agencies) to provide qualified staff at their facilities to assure proper care and patient safety.  In my opinion, these responsibilities are non-delegable and when a facility fails to uphold their end of the bargain and a patient suffers harm they certainly expose themselves to civil responsibility.

Related Nursing Homes Abuse Blog Entries:

Temp Workers Becoming An Increasing Threat To Nursing Home Patients' Safety

Failure To Conduct Adequate Pre-Employment Criminal Background Search Costs Assisted Living Facility $750,000

'Significant Medication Errors' Discovered In Nursing Home Following Investigation Related To Patient Injury & Death

Why Would Anyone Want To Work In A Nursing Home?

Nursing Home Chain Hit With Landmark Verdict In Under-Staffing Class Action Lawsuit

I guess there's probably a lot a screaming and yelling going on at the Skilled Healthcare Group (SKH) headquarters in California.  Perhaps the anger derives from the miserable looking financial chart for the company showing a whopping 75% decline in price per share in one day!

Another portion of the companies anger is probably being misdirected at the lawyers who defended the company in a class action lawsuit brought against Skilled Healthcare based on systematic under-staffing at 22 nursing homes owned by the corporate giant.  Really, the only people to blame are the managers in the company who intentionally chose to limit that staffing at their facilities.

After hearing months of evidence regarding staffing levels at the nursing homes operated by Skilled Healthcare, the jury awarded the maximum amount permissible under the California Health and Safety Code--- a whopping $671 million to the members of the class. 

The massive jury award is hardly an arbitrary number.  Rather, the compensatory damages were awarded based on a statutory violation of $500 per-patient per-day at the 22 subject facilities for not providing that state minimum staffing of 3.2 hours for each patient living at the nursing homes on a daily basis.

In addition to the compensatory damages, the lawsuit also seeks punitive damages against Skilled Healthcare.  Unlike compensatory damages, punitive damages are intended to punish the wrongdoer for their acts.  The punitive aspect of the lawsuit will move forward in the coming weeks.

I'm sure that it will take some time before any of the plaintiffs involved in this case receive any portion of the recovery, this verdict will likely force nursing home operators to re-evaluate the way they operate and the decisions they make with respect to staffing levels at their facilities. 

Sadly, when facilities are short staffed, nursing home patients suffer.  Under-staffing in nursing homes continually contributes to incidents of nursing home abuse and neglect. 

Dare I say that this verdict may improve the quality of life-- not just for patients at Skilled Healthcare facilities-- but countless other who suffer from systematic under-staffing at other facilities across the country?

Related:

Class Action Lawsuit Against Skilled Healthcare Seeks Damages For Chronic Under-staffing Of Nursing Homes

Under-staffing At Nursing Home Blamed For Pressure Ulcer, Infection & Subsequent Death

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

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

Minimum Nurse Staffing Ratios

Nursing Home Bookkeeper Admits To Stealing Money From Facility

Sadly, at a time when many are feeling severe financial strain, some nursing home operators and employees are turning to another source of potential income-- stealing state and federal funds intended for nursing home patients.

The most recent case of stealing or Medicare fraud-- which is essentially what most of these cases come down to because that is where most funds derive-- comes from Missouri.  Connie Jean Beckerman, the former bookkeeper at Perryville Nursing and Rehabilitation Center, pleaded guilty to: forgery, stealing by deceit, and abuse of a person receiving health care-- all felonies.

The criminal acts were perpetuated between September 2007 and October, 2007 put more than $14,500 in Ms. Beckerman's pocket.

While Ms. Beckerman's profit may seem like small potatoes, these criminal acts must be fully prosecuted to the fullest extent possible in order to deter other acts from occurring at the facility and others.

Read more about this case of financial fraud in a nursing home here.

Related Nursing Homes Abuse Blog Entries:

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

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

 

Class Action Lawsuit Against Skilled Healthcare Seeks Damages For Chronic Understaffing Of Nursing Homes

If you were to look at just one criteria for selecting a nursing home, I'd tell you to look at the facilities staffing levels.  Sure, its nice to have a sparkly new facility and perhaps a gourmet chef, but when it comes down to patient care nothing can take the place of a sufficiently staffed facility with properly trained men and women.

In order to assure that nursing home patients are adequately cared for, some states such as California have legislated minimum hours of care provided to patients on a daily basis.  While the number is of course somewhat arbitrary and varies substantially from patient to patient, the patient care requirements do provide somewhat of a floor with respect to minimum staffing requirements for nursing homes.  

In other words, the minimum daily time requirements really translate to the number of staff nursing home owners must hire to legally operate their facilities.

A class action lawsuit filed in California against Skilled Healthcare Group, Inc., alleges that corporation failed to provide patients at their facilities with the minimum staffing levels set forth in California law.

According to Michael Thamer, a lawyer representing the nursing home patients in this case, "The message from he top is simple: state beneath the budget."  Thamer goes on to say, "This corporate greed is what has kept the defendant from adequately staffing their facilities."

A jury will soon make a determination as to the sufficiency of the allegations made by the nursing home patients and the damages they are entitled to.  In addition to compensatory damages related to Skilled Healthcare's under-staffing at their facilities, the lawyers for the nursing home patients also seek statutory damages based on the residents age and the amount of money they pay the facilities every month.

Despite the fact that Skilled Healthcare filed for bankruptcy protection in 2001, the company appears to be thriving. In the past five years, the company has acquired nursing homes in Texas, Illinois, New Mexico, Kansas, Nevada and California.

Read more about this nursing home lawsuit here.

Related Nursing Homes Abuse Blog Entries:

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

Long-Term Care Hospitals: More Profit, Less Staff

Poor Nursing Home Care Subject Of Class Action Lawsuit Against National Nursing Home Chain, Extendicare

Minimum Nurse Staffing Ratios

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

Without proper staffing, even the most modern nursing homes are nothing more than buildings with beds.  Knowledgeable and plentiful staff has always appeared to improve patient morale, but a new study determines that added staff may actually save lives.

The Journal of Health Services Research compared the outcomes from 1.1 million people who had general surgical procedures performed at more than 800 hospitals in California, New Jersey and Pennsylvania.  Of the three states, patients in California fared the best.

It's not just the warm weather in California that improved the heath of surgical patients.  Turns out, the patients in California tended to receive more attention from nurses than the patients in other states. Nurses in California medical-surgical units are limited to caring for 5 patients at a time compared with similar facilities in New Jersey and Pennsylvania where nursing loads tended to be more than 6 patients.

When analyzing death rates of surgical patients, researchers concluded that the California regulations would have improved the survival rates of patients.

According to Linda H. Aiken, professor of nursing and director of the Center for Health Outcomes and Policy Research and University of Pennsylvania, "Nurses are the surveillance system right at the bedside; they are the first to see something and mobilize a rescue."

In addition to the improved patient survival rates associated with the limited number of patients, the study also reported that California nurses had higher rates of jobs satisfaction and were more likely to remain in the profession.

Staffing & Nursing Home Care

In an age whee we see nurses caring for upwards of 20 patients during a shift.  Yes, more than 20! I doubt we're going to see nursing home chains rushing to implement 5:1 patient staffing ratios anytime soon.  However, this study is important for that fact that once again we see that staffing levels are extremely important to patient safety and well being. 

Related Nursing Homes Abuse Blog Entries

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

Long-Term Care Hospitals: More Profit, Less Staff

Under-staffing At Nursing Home Blamed For Pressure Ulcer, Infection & Subsequent Death

Are Nursing Homes Required To Have Certain Numbers Of Staff?

Temp Workers Becoming An Increasing Threat To Nursing Home Patients' Safety

As if we need another reason to be concerned over nursing home patient safety, an article in the L.A. Times on temporary nurses in hospitals and nursing homes will surely make you cringe.  A desire to run a streamlined operation and the inherent uncertainly of required staffing levels has resulted in a booming temporary staffing industry-- in particular with nurses.

Unregulated and widely unknown, there are an estimated 3,000 to 6,000 temp. agencies in what is believed to be an industry that takes in more than $4 billion per year--- and growing.  

Though there are certainly many highly qualified and responsible nurses who eagerly accept jobs via temp agencies due to the flexibility and generous pay and benefits, there is a noticeable group of nurses working at temp companies that pose an immediate threat to patients.

An investigation by the non-profit group ProPublica and the Los Angels Times, found many nurses were hired without any background or license checks.  In particular, the investigation revealed nurses who had many problems with prior jobs, caring for the sick and elderly.  

  • Temp firms hired nurses with criminal backgrounds including: prostitution, stealing drugs and possession of cocaine
  • Nurses who had their licenses suspended or restricted in other states were hired by temp firms
  • Even after medical facilities continually complained about a nurses performance (nurses who made errors and fell asleep on the job), the nurse was placed at another facility
  • Nurses who were terminated at one agency were quickly hired by another one without any questioning as to why they left the first agency

No surprise, but it always comes down to money

The lack of industry regulation, a national nursing shortage and easy profits (most temp agencies get paid a substantial percentage of the workers salary) does nothing to discourage people with no nursing or health care knowledge to the field.

Our sick and elderly deserve better.  Patients can and should expect that the person who is caring for them is more than a warm body.  Facilities must begin to demand that the full background checks be conducted on the fresh faces working in their facilities.  On a regional and national level, elected officials must propose legislation to regulate this growing industry.  Unfortunately, until these changes are made, we will continue to see preventable errors contribute to injury and death of patients. 

Resources:

Temp firms a magnet for unfit nurses, With scant regulation and some agencies' poor screening, workers can hopscotch from job to job. L.A. Times, December 6, 2009

Health Care Worker Registry, Nursing Homes Abuse Blog, June 27, 2008

Bye Bye Criminals, Nursing Homes Abuse Blog, June 1, 2008

Failure To Conduct Adequate Pre-Employment Criminal Background Search Costs Assisted Living Facility $750,000, Nursing Homes Abuse Blog, June 5, 2009

Would you want this man to care for your granny at the nursing home?

 

Sure looks can be deceiving, but this guy sure looks creepy to me!

The guy pictured above is Franklin D. Hughes, a former CNA at Bartlesville Care Center.  If his creepy looks weren't enough, Mr. Hughes stands accused of sexually assaulting two dementia patients he was responsible for caring for at Bartlesville.

Making situation even more tragic is that Mr. Hughes was was accused of committing similar sexual acts with dementia patients at his prior job at the Nowata Nursing Center.  

According to a court affidavit, the patients at Nowata filed complaints with the Oklahoma State Department of health in 2003 and 2007.  Probably due to the patients dementia, the cases were closed because the patients could not provide details of the sexual abuse.

Admittedly, I am unfamiliar with the reporting professional reporting policies in Oklahoma, but if Bartlesville Care Center officials had access to the state's investigative file relating to Mr. Hughes prior conduct and either failed to make an inquiry or turned a blind eye, they certainly may open themselves to civil liability with respect to these most recent incidents.

Read more about this abusive CNA in an Oklahoma nursing home here.

Related Nursing Homes Abuse Blog:

Ohio Nurse Sentenced To 12 and 1/2 Years For Sexually Abusing 100 Nursing Home Residents

'Senior Sitter' Charged With Sexual Assault Of Nursing Home Residents

Nurses Admit To Problems At Nursing Homes

A Rosewood Care Center Loses Almost Half Its Staff After Probe Reveals Many Employees Working Illegally

A probe by the U.S. Immigration and Customs Enforcement of the staff at Rosewood Care Center in Northbrook, IL revealed many employees at the Chicagoland nursing home were working at the facility illegally--- without proper paperwork the government requires for aliens to legally work.

Over the course of a three month inspection of worker documents, Customs officials determined that many of the work-documents were missing or expired. 

Not surprisingly, Mike Brady, president of Bravo Care of Northbrook, the management company for Rosewood, says the nursing home not at fault for hiring the workers.  Rather, Brady claims the nursing home was duped by workers who faked or forged documents to get jobs.

After news of the illegal employment was formally disclosed, 51 of the 130 nursing home workers abandoned their positions at the facility.  Consequently, many essential positions at the nursing home were left vacant.

Mr. Brady said not to worry.  "I would say our care being provided in excellent.  We're still operating," he added.

Who can blame these workers? 

Particularly in difficult economic times, I'm sure these people were eager to snatch up these jobs. From the patients perspective, I'm sure that many of them were glad to have these foreign employees caring for them in many unglamorous-- yet extremely necessary positions. 

Given the substantial number of illegal aliens working at this facility, I simply find it hard to believe that the nursing home owners and management are completely innocent in their role in this situation. 

Whoever is responsible for this staffing problem, I certainly hope that the nursing home patients at Rosewood Care Center of Northbrook, do not suffer any adverse effects with the huge turnover of staff. Read more about the staffing problems at this Illinois nursing home here.

Presently, there are 14 Rosewood Care Centers, all located in Illinois and Missouri. Below you will find the locations.

Related:

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

Judge Limits Fines For Poor Nursing Home Care

Why Would Anyone Want To Work In A Nursing Home?

High Staff Turnover Rates Plague Most Nursing Homes

Continue Reading...

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

A report issued by the Minnesota Department of Heath has cited White Community Hospital and Nursing Home for errors made by a nursing assistant during the transfer of a patient.  The incident occurred when the CNA attempted to transfer a disabled patient from their bed to a wheelchair using a sling. During the transfer, the patient was dropped.  The patient suffered a broken arm and leg which contributed to their death two days later.

Specifically, the department of health report and the facilities own investigators determined that the CNA's errors caused the patient's injuries and subsequent death.  In particular, the CNA  and nursing home failed to:

  • Use two-person lifting technique
  • Properly train staff
  • Develop and follow a comprehensive 'care plan' for the patient

Laura Ackman, the nursing home's CEO called the patient's death, "an unfortunate accident, and we regret it very much."  According to Ackman, the facility took immediate corrective action, including staff training and the purchase of new equipment.

Certainly, from the information we know about this incident, it appears that the family of this nursing home patient would have a strong case against the nursing home should they wish to pursue a wrongful death case against them.  

I applaud the facility for taking corrective measures following this incident. Nonetheless, it sounds as though the root of the problem is related to under-staffing.  

Despite federal regulations that require nursing homes to have certain 'minimum staffing levels', many facilities simply do not have adequate numbers of staff to provide quality care for their patients.  In the situation discussed above, I am certain that a closer examination of the situation would reveal that there simply was inadequate staff around to assist him or her with lifting the patient.

At a minimum, federal law requires nursing homes to have: at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day.

Resource:

N. Minn. nursing home contributed to death of resident, report says, Statrtribune.com, October 9, 2009

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

Nurses Admit To Problems At Nursing Homes

Minimum Nurse Staffing Ratios

Authorites Suspend Admission Of New Patients At Life Care Nursing Home After Authorities Discover Conditions That Threaten Patient Safety


On July 31, 2009, the Tennessee Department of Health suspended any new resident admissions to Life Care Center of Athens nursing home due to violations.  Life Care Center of Athens is a large 128 bed nursing home facility located in Athens, TN.  The Department Commissioner can suspend admissions to a nursing home if conditions are or are likely to be detrimental to the health, safety, or welfare of the resident.   

The Tennessee Department of Health’s decision was based on conditions that investigators discovered during a complaint investigation conducted and annual survey conducted from June 14 to July 21.  The facility faces a one-time state civil monetary penalty of $1500 and a federal civil penalty of $4,150 per day until the violations are corrected. 

The facility deficiencies included violations of the following standards:

  • performance improvement
  • nursing services

On August 10, 2009, the Tennessee Department of Health announced that it was lifting the facility’s suspension of admissions.  This occurred only after the Department confirmed that the nursing home facility was in substantial compliance for state licensing purposes. 

According to the government’s Medicare website, Life Care Center of Athens received two out of five stars, which is a below average rating. The facility also received two stars for health inspections, having received eight health deficiencies in the past year.  This is two more health deficiencies than the average number in Tennessee and equal to the average number in the United States. 

The low rating included a level of harm rating of 3, which indicates actual harm, for failing to give residents proper treatment to prevent new pressure sores or heal existing pressure sores.  The facility also received a level of harm rating of 3 for failing to ensure that the nursing home area is free of dangers that cause accidents. 

Resources:

Knox News – Admissions to Athens Nursing Home Suspended

Life Care Centers of America – Life Care Center of Athens

Clarksville Online – Tennessee Department of Health Lifts Suspension for Life Care Center of Athens

Medicare – Life Care Center of Athens

Nursing Homes Abuse Blog - "Life Care Center" Permitted To Accept New Patients After State Finds Poor Living Conditions

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

Perhaps one of the most de-humanizing aspects of nursing home life is the reliance on others for toileting needs. Especially in the case of bed-bound residents, notifying a staff member every-time one needs to use the toilet, means being reliant on others for basic bodily functions.

When the staff fails to timely assist with toileting needs, the results can be not only embarrassing but downright dangerous.  If left in their own waste, residents are at an increased risk of pressure ulcers (also referred to as bed sores, decubitus ulcers or pressure sores) and infection.

This failure to timely tend to the toileting needs of residents resulted in Glendale Home's $20,800 federal fine and their staff's mandatory enrollment in 'dignity training'.  The sanctions come after six residents complained to New York Department of Health officials that the staff at the facility humiliated them when they failed to answer their calls for assistance in using the toilet.

In the case of an obese nursing home resident, who required two-person assistance and a mechanical lift for transfers with transfers out of bed, a nursing home inspector noted:

"She state that sometimes staff would become angry with her for calling out when they were so bust and tell her she would have to wait.  She also stated that when she was waiting for help she would be in pain from the urgency of needing to void.  The resident said that on several occasions she had wet herself while waiting for the staff and that she was mortified and embarrassed when she wet her bed."

In another case, nursing home inspectors observed a man sitting naked on a bed pan who was yelling for staff to close the door as attempted to gain some privacy.

When officials questioned the nursing home staff about the delay in bringing residents to the toilet and obvious disrespect of privacy, many said the some days the facility seemed short staffed in order to cope with the needs of the residents. In addition to delays in toileting, the under-staffing was also manifested by the fact that some residents were not turned in their beds or bathed regularly.

Despite the staff's own contention that the facility was under-staffed, the facility administrator chose to 'redeploy' the current staff to cope with spikes in call-bell use as opposed to hiring more staff.

Read more about the disrespect of nursing home residents in New York here.

Related Nursing Homes Abuse Blog Entries

Nursing Home Owner Leave Resident On Bedpan for 24-Hours, Now Faces Jail Time

Call Lights. How Should Staff Respond?

Incontinence Amongst The Nursing Home Population

Home Care Nurse Gets Probation For Ignoring Bedsores On Child

Cook County Judge James Linn sentenced Morris Lee Brinkley, a home-care nurse, to two years probation and 60 days of community service following her role in the death of a Chicago boy who she responsible for caring for.   Earlier, Brinkley pleaded guilty to criminal neglect of a disabled person.

Brinkley provided home-care nursing to the 13-year-old boy with cerebral palsy.  Despite the fact that she only saw the boy on weekends, she admitted that she was aware that the boy was mistreated by his mother-- yet she failed to alert authorities.

When questioned, Brinkley knew the boy's mother:

  • Left the boy alone for extended periods
  • Allowed the boy to sit in his own excrement
  • Become malnourished
  • Develop serious bedsores
  • Canceled regularly scheduled doctors appointments

In March, 2008 the boy was taken to La Rabida Children's Hospital because he was having trouble breathing.  Unfortunately, by the time the boy was taken to the hospital, there was little medical officials could do.  On March 15th the boy died from infection known as sepsis that originated in the advanced bed sores.

"These are acts of omission rather than commission," according to Judge Linn. "Something got out of control here," he added.

The boy's mother and another home-care nurse were also charged criminally for their role in the boys death.  Their cases are pending.

Thank goodness this judge decided to punish (albeit seemingly lightly) a health care professional who violated her duty to protect a disabled person she was responsible for caring for.  Hopefully this will 'encourage' other nurses to do their job and report abuse and neglect when they witness it.

Read more about this Chicago home-care nurse here.

Related Nursing Homes Abuse Blog Posts

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

Cook County Nursing Home Pleads Guilty To Gross Neglect Charges

Government Report Confirms Pressure Ulcers Harm All Nursing Home Residents; Regardless Of Race, Sex or Age

Criminal Charges Filed Against Assisted Living Employee In Relation To Resident Suffering Burns While Eating

As an injury lawyer who frequently handles nursing home negligence matters, I find myself regularly thinking 'what happened to plain old common sense'?  I mean, you can train the nurses, physicians, maintenance workers and administrators til' you're blue in the face-- yet most of the commonly encountered nursing home problems could easily be avoided with plain old common sense.  

Want an example?  How does checking on the temperature of food before feeding a disabled person? Is that too much to ask? 

Along those lines, homicide charges were filed against Alador Thompson, an employee of Cambridge-Brightfield Assisted Living Facility in Hatfield, PA.  The charges are related to an October 8th incident in which Thompson poured scalding oatmeal into the mouth of an Alzheimer's patient she was responsible for feeding.  The oatmeal caused the resident to suffer burns to his lips, tongue, and the inside of his mouth.

The resident was taken to a local hospital for burn treatment.  After three days of hospitalization, the resident was returned to Cambridge where he apparently stopped eating and died.

On August 5th Thompson will be arraigned on charges related to involuntary manslaughter and neglect of a care dependent person. 

Hey district attorney, can I make a suggestion?  How about filing similar charges against the administrator of the facility for accepting this poor man back at the facility and allowing him to starve to death following the obviously severe burns he suffered on hands of your employee? 

Read more about this case of severe neglect at a Pennsylvania assisted living facility here.

Related Nursing Homes Abuse Blog Posts

Ohio Nurse Sentenced To 12 and 1/2 Years For Sexually Abusing 100 Nursing Home Residents

Guilty Plea From Nurse Accused Of Abusing Tennessee Nursing Home Resident

Nursing Home Resident Chokes To Death On Dinner

Why Would Anyone Want To Work In A Nursing Home?

There is a general assumption that the more you work you put into your career, the more opportunities you will have for advancement.  That is, unless you are certified nursing assistant (CNA) at a nursing home.  A new study published in The Gerontologist paints a relatively bleak work future for CNA's working in nursing homes today.

The National Nursing Assistant Survey sampled 3,017 CNA's working in nursing homes.  CNA's were surveyed in: recruitment, education, training and licensure, job history, family life, management and supervision, client relations, organizational commitment, job satisfaction, workplace environment and work related injuries.  

The survey outcomes leave me wondering-- 'why would anyone want to be a CNA in a nursing home?' Among the survey results:

  • One in three CNA's receives some form of public assistance
  • Over 50% of the CNA's suffered at least one work-place injury over the course of the last year
  • Work-related injuries required 25% of the nursing to take time off from work
  • 42% of the CNA's not participating in their employers sponsored insurance plan due to the fact they could not afford to participate
  • Experience means nothing--- well almost-- in terms of pay, CNA's with 10 year or more job experience earn just $2.00 more per hour than their counterparts with just began working in the industry

My guess is that the inherent 'problems' with the job force urgently needed CNA's into more lucrative areas.  More experienced CNA's will undoubtedly leave their current positions until the industry chooses to put a premium on improving working conditions for this under-paid, and injury-prone group. Consequently, too few highly-skilled CNA's will remain to care for the growing nursing home population.

At the end of the day, who can blame them?

Nursing Homes Abuse Blog Entries On Staffing

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

High Staff Turnover Rates Plague Most Nursing Homes

Nursing Shortage Is A Crisis

Resource

The National Nursing Assistant Survey: Improving the Evidence Bast for Policy Initiatives to Strengthen The Certified Nursing Assistant Workforce, The Gerontologist, Vol. 49 No. 2, 185-197

Nursing Home Staff: Does Your Facility Love You? If So, They Would Properly Insure You.

Long before summer parties have begun, some nursing home owners are getting into a limbo contest of their own-- how low can they go with respect to the liability insurance they carry for their facility.  In terms of liability insurance coverage, many facilities are electing to completely forgo such insurance or obtain such negligible coverage that provides mostly for the 'cost of defense' -- to pay lawyers to defend them.  

These are termed 'eroding' or 'wasting' where the cost of defense is deducted from the policy limits. Hence, if a facility had a $500,000 eroding policy and there were $400,000 in defense counsel fees (this is not necessarily an extravagant cost of defense), the most an injured party could recover under the policy would be $100,000.  In situations involving a severe injury, such an amount would cover little more than a fraction of an injured parties medical expenses.

True, most states allow an injured party to recover money for damages directly from a nursing home owner if a judgment exceeds the limits of the policy.  In reality recovery of personal assets from a nursing home owner rarely occurs.  Most nursing home owners create limited liability companies, many times based outside of the United States, that insulate their personal assets from any judgments.

Is this legal?  You bet.  As a plaintiffs' lawyer I feel very strongly that the real losers in this game of 'insurance roulette' are those that are severely injured or maimed due to the negligent acts of the nursing home. 

Personal Liability Of Nursing Home Employees

While we can debate, the 'fairness' of the lack of mandatory liability insurance for nursing homes when it comes to residents, I want to focus on a second-- and usually forgotten group-- nursing home employees. 

As agents of a nursing home or hospital, nurses, CNA's, administrators and physicians have generally been able to sleep well at night they even if they were accused of negligence and a lawsuit was brought against them. Their employer almost universally defend the lawsuit and if needed pay a settlement or judgment.  

Today, this situation is less common. Increasingly, nursing home employees are being named personally in nursing home lawsuits--especially in situations where a facility has no coverage or is likely uninsured.  This means that nursing home workers are becoming personally exposed with respect to being named as a defendant in a lawsuit.  That's right, you--the nursing home worker-- could be responsible for paying for a legal defense and for paying any judgment or settlement.

This new era litigation should not be passed off a new guerrilla tactic employed by plaintiff's lawyers. To the contrary, most plaintiffs' lawyers would much rather pursue a cause of action against a large company as opposed to an individual-- jurors are more likely to hand down larger verdicts if they know a corporate entity is paying for it.  In most cases this is due to a complete lack of other options for an injured party to recover.

The real blame for this situation falls squarely on the shoulders of the individuals and corporations who own these nursing homes.  For the most part, this group has made a conscious decision to forgo or minimally insure their facilities without little regard to personally exposing their employees.

Time For Employees To Become Familiar With Insurance Coverage

If you work in a nursing home or long-term care facility, it's time for you to get acquainted with the insurance procedures at your facility.  Without sounding overly alarming (and I know I already have), your failure to learn some of the insurance lingo could jeopardize both your professional career and personal finances.

I now believe all nursing home employees should secure professional liability insurance for themselves.  The cost of this coverage is less than you would think and becoming necessary in situations where injured parties are increasingly looking to individuals to be held responsible for their damages.

Before purchasing an individual policy, keep in mind the following:

  • Does the policy pay for both costs of legal defense and a settlement or judgment?
  • Would the policy pay for claims made against you by your employer-- if they were to sue you for a contribution claim?
  • Does the policy cover you if you change jobs?
  • Will the policy reimburse you for time spent at a trial or deposition?

Related Nursing Homes Abuse Blog Posts

Who Benefits From Damage Caps In Nursing Home Lawsuits?

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

An aging nursing population, the growing need for nursing services and an insufficient number of facilities to train new nurses are coming together to create a 'nursing crisis', according to a recent article in The Iowa Independent.  The congruence of factors will lead to dramatic shortages of nurses both in Iowa and on a national basis.  

The American Health Care Association estimates the the nursing shortage will explode in coming years.  Among the nursing shortage numbers predicted by the AHCA include:

  • July, 2009: 116,000 vacant nursing positions in hospitals and 19,000 vacant nursing positions in long-term care facilities.
  • 2010: 275,000 vacant nursing positions
  • 2020: an anticipated shortage of more than 1 million nurses in hospitals and long-term care settings

The shortage of qualified nursing educators is the crux of the issue according to Dr. Rita A. Frantz, of the University of Iowa College of Nursing.  "We have a national shortage of nurse faculty as well as a shortage of practicing nurses.  The two are intricately intertwined.  That is, without the appropriate number of nurse faculty, we can't admit all the qualified applicants to our nursing programs."

Unfortunately, the number of nurses in teaching positions is also expected to decline at a time when they are needed the most.  At the University of Iowa, the average age of the nursing faculty is 56 years-old, and the average age of professors at the school is 59.  "We're going to have large numbers of them leaving the academic environment to retire in a fairly short period of time," according to Frantz.

The final factor coming into play is the aging population and the inherent nursing demands placed upon it.  Along with the increase in aging population comes a larger proportion of the population turning to public health coverage to pay for their care.  In the case of Medicare or Medicaid, the reimbursement rates offered for many services do not cover the facilities expenses. How do facilities cope?  The only way they can, by keeping nursing staff to a bare minimum.

The article does not specifically address the nursing shortage in nursing homes or other long-term settings--in these situations the nursing shortage is likely even more dire as many nursing facilities pay substantially less and demand longer hours than hospital based nursing.  Read more about the looming 'nursing crisis' here.

Under-Staffing In Nursing Homes

Nurse shortages in nursing homes are believed to be a primary factor related to poor patient care. Although, federal regulations stipulate to minimum staffing levels, many of these requirements are insufficient for residents who may require substantial help for daily living needs.  Under-staffing in nursing homes is routinely blamed for: falls, medication errors, bed sores, elopement and general neglect.

Many nursing home experts believe the the number one predictor of patient care is the number of hours spent by staff tending to residents needs per day.  A great resource to find this information is the Medicare compare website where you can see how facilities rate in this area. 

There is no current federal standard for the ideal nursing home staffing levels in all facilities. Nonetheless, federal laws do require nursing home must have at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day. Individual states may have additional staffing requirements.

Resources

U.S. healthcare system pinched by nursing shortage, Reuters.com, March 8, 2009

Nursing home 'understaffed' death results: damages awarded.(Nursing Law Case of the Month), Encyclopedia.com, June 1, 2005

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

Yes. Under the Federal Civil False Claims Act (31 U.S.C., Section 3729), private citizens act on behalf of the Federal or State Government to bring an action against government contractors or any company who acts fraudulently with government funds. Under the False Claims Act, a qui tam lawsuit entitles individuals employed by the entity guilty of fraud to bring a lawsuit for fraud-related damages against the offending company. 

Fraud Is Rampant In The Nursing Home Industry

Many nursing homes and medical service providers have turned to illegal practices to boost their bottom line.  By some accounts, up to 10% of Medicare charges have some some type of fraud. Examples of fraud-related qui tam cases in the nursing home setting include:

  • Ghost billing- billing for patients that do not exist
  • Using inferior medicine or medical equipment, yet billing the government for the premium services
  • Billing more than once for the same service
  • Billing for services not performed
  • Offering free items or services in exchange for a Medicare or Medicaid number
  • Waiving co-payments routinely
  • Someone other than the physician completing the Certificate of Medical Necessity

Qui Tam Lawsuits Can Be Lucrative To Those Who Report Fraud

The government recognizes that fraud in the medical field leads increased costs and inefficiency.  Further, the government realizes that they have the best chance of discovering medical fraud by providing a financial incentive to those who witness illegal acts.

If you uncover a situation where you believe the government is being defrauded, qui tam whistleblowers have the right to recover between 15 and 30 percent of the total amount recovered from the fraud lawsuit.   The damages related to qui tam lawsuit can be substantial as the party initiating the lawsuit can sue for triple the amount of actual fraud damages plus civil penalties ranging between $5,500 to $11,000 per claim. 

For example, if a nursing home charged Medicare $50 per physical therapy sessions for 1,000 sessions, it never provided to residents, the potential damages under a qui tam theory could be $11,150,000 ($50 x 1,000 = $50,000 x 3 = $150,000 + 1,000 x $11,000).  In this case, the whistleblowing employee could be entitled to $3,345,000.

In the year 2003 alone the amount of U.S. recoveries in qui tam cases totaled 7.8 billion, with whistleblowers recovering a total of 1.3 billion.  If you suspect any person, company or entity involved in defrauding the government, you should contact an experienced qui tam lawyer

At Strellis & Field, not only do we have experience handling qui tam matters, but we have the unique advantage of understanding the inner workings of nursing homes and other medical facilities having litigated many cases against these entities.  We put this experience to work for you.

Lastly, qui tam cases require you to act quickly. In many situations only the first individual to file a claim will have a right to compensation.

Examples Of Qui Tam Related Recoveries:

  • $355,000,000 AstraZeneca
  • $334,000,000 Amerigroup
  • $325,000,000 HealthSouth
  • $257,000,000 Bayer
  • $155,000,000 Medco Health
  • $49,000,000 Pfizer
  • $26,000,000 Key West Pharmacy

Qui Tam Web Resources:

FALSE CLAIMS ACT CASES: GOVERNMENT INTERVENTION IN QUI TAM (WHISTLEBLOWER) SUITS

Medicare Fraud

HHS Takes Further Steps to Protect Medicare From Fraudulent Durable Medical Equipment Suppliers

Caregiver Fired For Reporting Abuse In Nursing Home

After witnessing a co-worker verbally abuse of a handicapped resident at Montrose Health Care Center in Montrose, IA, Lora Washburn, did the correct thing and reported the incident to the facility's administrator.  Or did she?  Not satisfied with the nursing home administrator's failure to respond to the situation, Washburn filed a complaint with the state documenting the abuse. Days after the complaint was made to state authorities, Washburn was accused of trying to intimidate co-workers and was fired from her position.

In another incident involving an Iowa nursing home employee, Janice Rardin, the Director of Nursing at the Evangelical Free Church Home, was terminated from her job after filing two complaints of suspected abuse with state authorities.  The alleged abuser was the facilities administrator.  Rardin allegedly overhead the administrator telling an attorney for the facility that he intended on firing her for making the report.  The attorney alleged told the administrator to hold off on Rardin's termination dispel any talk of retaliation.

Iowa, like 44 other states, requires nursing home employees to report suspected abuse of residents to authorities.  If nursing home employees fail to report the abuse they face potential licensing sanctions and fines.  Despite documented cases of known abuse by nursing home workers, no nursing home employees in Iowa have been prosecuted for failing to report abusive situations in the past ten years.

In addition to losing their livelihood, terminated whistlerblowers also face the reality that nursing homes rarely are prosecuted for terminating a mandatory reporter.  If a facility is prosecuted, the facility will likely only be prosecuted for a simple misdemeanor. 

John Judisch, a former Polk County prosecutor who now works for the state inspections department, said he does not recall ever getting complaints from whistle-blowing caregivers who were fired. "I'm not naive enough to think that sort of thing has never happened," he said. "But if they don't come forward, we're not going to hear about it."

Clearly, until stronger laws are on the books to protect nursing home employees who report instances of physical and psychological abuse, few employees can afford to risk the potential fallout from retaliation from administrators.  In reality the biggest losers in this situation are the residents of nursing homes and assisted living facilities around the country who are at risk for being trapped in abusive situations with little chance of assistance.

Read more about this incident involving whistle-blowing in a nursing home setting here.

Broken Door Alarm Cited In Investigation Of Nursing Home Residents Death

On February 2nd, Carrie 'Christine' Evans wandered from Primrose Villa Nursing Home just a few hundred yards to her death.  Officials from the North Carolina Medical Examiner's office concluded that Ms. Evans' death was due to a closed head injury after a fall.  The incident occurred less than 1/5 of a mile from the North Carolina nursing home.  There were similar episodes where Ms. Evans' wandered from the facility prior to this incident.

The investigation into Evans' death also confirmed the following:

  • Primrose Villa had been visited by state inspectors 28 times in the past two years despite the fact that state law only requires quarterly inspections
  • The facility failed to assume referral and follow-up to meet the health care needs of residents
  • On the day of Evans' wandering from the facility, the door alarm was disengaged because a supervisor was not trained on how to operate it
  • The staff failed to document falls and other injuries despite the fact that residents received medical treatment for the injuries

As a result of the Ms. Evans' death and the subsequent investigation, Primrose Villa faces two Type A penalties and potentially two Type B penalties.  A Type A violation is when a nursing home resident suffers serious physical harm and carries a potential fine of $20,000 per violation.  A Type B violation is given for an incident that impacts the residents quality of care but has not been corrected despite request from the state to do so.  Read more about this case of the death a North Carolina nursing home resident here.

Nursing home fines aside, I imagine a wrongful death lawsuit is in this nursing home's future.  If proven accurate, the fact that this facility was aware of Ms. Evans' propensity to wander from the facility yet failed to implement preventive measures is appalling.  This type of hap-hazard care needs to be prosecuted by public officials and private attorneys.

Nursing Homes Abuse Blog Entries On Wandering Nursing Home Residents

Nursing Home Negligence Lawsuit Filed After Man Wandered From West Virginia Facility

Man Wanders 20 Ft. From Chicago Nursing Home To His Death

How Much Freedom Should Assisted Living Facilities Give The Mentally Disabled?

Judge Tosses Manslaughter Charges Against Nursing Home Employees In Case Involving Death Of Disabled Resident

Judge Susan Grant dismissed the manslaughter charges against three nursing home employees in a case involving the death of a disabled resident at a Michigan Nursing Home.  The charges were filed in 2006 following the death of Sarah Comer at Metron Nursing Home.  

The case received national attention when it was revealed that Comer was transferred to Metron from a hospital in critical medical condition on a weekend when the facility was under-staffed. Shortly after her arrival at Metron Nursing Home; Comer died.  It was alleged that Comer died because the staff allowed her oxygen supply to run out.

In dismissing the manslaughter charges, Judge Grant concluded the evidence against the employees was inadequate to substantiate the charges.  Prosecutors have been unable to "show with competent and credible probable cause evidence that the lack of oxygen is what caused Comer's death," according to Grant.  "In fact, even though the oxygen tank was empty when Comer's lifeless body was discovered, none of the witnesses could establish whether Comer died before or after the tank ran out," the Judge added.

Despite the dismissal of serious criminal charges, an investigation into the incident revealed multiple procedural errors on the part of Metron's staff.  In May 2006, Metron Integrated Health Systems, based in Grand Rapids, MI settled a claim brought by state officials for failing to properly monitor certain operations (oxygen supplies) in its nine Western Michigan nursing homes.  Metron paid a $78,015 fine to the state.

Even Judge Grant saw problems with the way Metron and the hospital handled Comer's care.  In her rulings the Judge said there was, "plenty of blame to go around" in Comer's death.  The Judge also questioned the hospitals decision to discharge Comer to a nursing home in her condition.  "What was the hurry to release her?" the Judge asked.  Read more about the dismissal of criminal charges against nursing home employees here.

Nursing Homes Abuse Blog Posts Related To Metron Nursing Home

Medicare & Medicaid Funding Pulled From Nursing Home With Violations

More Information About Patient Care In Metron Nurisng Home

Caretaker Admits To Stealing From Residents In Georgia Nursing Home

Yvonne Winslow, a Georgia nursing home worker, has been charged with six felony counts including abuse of the elderly after admitting to authorities she stole an elderly couples debit care and used it at several stores in the Savannah, GA area.  The financial abuse of elderly took place at the Savannah Specialty Care Center where Winslow was working as a caretaker.  Winslow has been terminated from the facility and is in jail as she awaits trial.  Read more about this case of financial exploitation of the elderly here.

Nursing Home Cuts Jobs Of 14 Nurses

The Laurel Crest Rehabilitation & Special Care Center in Pennsylvania has recently cut the jobs of 14 nurses on its staff.  These staff reductions, follow the recent dismissal of 39 other workers at this county-run nursing home. 

Cambria County officials say the home has enough staff to meet the state standards. The home's annual budget is based on an expected census of 274 patients. The home has 264 patients and its previous staffing level was enough for 350 patients.

The home has been cited for various deficiencies in recent years, including a $27,560 fine when a virus similar to the type that hits cruise ships was detected late last year.

This is a disturbing trend in many cash-strapped nursing homes.  The number one indicator of nursing home care is the level of staffing at these facilities.  As nursing homes cut staff, residents will likely feel negative effects in staffing reductions.  Let's see how many fines related to patient care Laurel Crest receives over the next year.

Read more about this Pennsylvania nursing home here.

Ohio Nurse Sentenced To 12 and 1/2 Years For Sexually Abusing 100 Nursing Home Residents

John Riems, a former night-shift nurse at various Ohio nursing homes has entered a guilty plea to multiple counts of sexual battery and sexual imposition.   Judge Tygh Tone handed down the sentence that was agreed to by both the prosecutor and the attorney for Riems.  In January, authorities obtained a videotaped confession of Riems where he admitted to sexually abusing about 100 residents at multiple nursing homes since the 1980's.  Most of Riem's victims suffered from dementia or Alzheimer's disease.  Joe Bilgen, whose father was a victim, said Riems' crimes were similar to child abuse because most of the patients had similar states of mind.

Read more about the sentencing of this Ohio nursing home worker here.

Read the Nursing Homes Abuse Blog's earlier entry on this nursing home abuse here.

The Keystone Of The Nursing Home: Nurses

Too often we report on the poor conduct of nursing home staff.  This video should be a reminder to the quality people working hard in nursing homes across the country to provide compassionate care to residents. Thank you.

 

Guilty Plea From Nurse Accused Of Abusing Tennessee Nursing Home Resident

Joyce Stanley plead guilty to assault of a blind resident at the Etowah Health Care Center. Ms. Stanley's McMinn County Court appearance follows an investigation by the Tennessee Department of Health regarding allegations of Stanley's alleged abuse of a blind resident.  "A resident was hit with a clipboard and incontinence pad and the information was reported to the senior person on duty where there was a delay in reporting the matter," said Andrea Turner of the Department of Health. Ms. Turner also notes the investigation revealed Stanley slapped and pulled the hair of the resident.

Following the investigation, Etowah was fined $1,500 by the Tennessee Department of Health and ordered to complete a plan of correction and stop admission of new residents.  "Based on the investigation and the report it has been determined that conditions at the facility either are, or likely to be detrimental to the health, safety and welfare of residents at the facility," Turner added.

Ms. Stanley's sentence for her abusive treatment is one year in jail.  However, according to a court clerk, Ms. Stanley will only serve 30 days and the remainder of her sentence will be probationary. Ms. Stanley was fired from her position at Etowah immediately after this incident was discovered.  As to the nursing home worker who 'delayed' reporting the abuse--- hopefully he or she has been removed from the facility before there is another 'delay' in reporting abusive treatment.

For the full story on this abusive nurse at this Tennessee Nursing Home please look here.

Tracheotomy Care: Suctioning

Staff in nursing homes need to monitor tracheotomy residents-every day, every shift.  Part of providing good tracheotomy care is literally listening to the patient's breathing.  If fluid collects in a tracheotomy patient's airway, it needs to be suctioned out.  Failure to suction tracheotomy patients can result in the patient asphyxiating. 

Nurses Fired For Distributing Patient Photos On Facebook

Three nurses at New Park House, an English Nursing Home, were fired following the posting of patient photos on their Facebook accounts.  The incident highlights the importance of patient privacy in a world where confidential patient information can be distributed with the click of a mouse.  

Nursing home residents have a right to privacy.  In the U.S. patient privacy is protect by the Health Portability and Accountability Act of 1996 (HIPPA- Federal Register, 164.508).  The Act specifies that patients' medical charts can only be distributed to authorized individuals with the written authority of the individual.  Further, the request can be withdrawn at any time.

Join the Nursing Homes Abuse Blog's group on Facebook for in depth discussion of issues relating to residents and their families. 

High Staff Turnover Rates Plague Most Nursing Homes

This article from Hutchinson News Online, details the high rate of nursing home staff turnover at most facilities.  Most nursing homes have annual staff turnover rates that exceed 100%.  The lack of continuity of care is problematic for both the nursing home and residents.  For the nursing home it means an exertion of time and money to train and attract new employees.  For nursing home residents,  high staff likely has a direct impact on the quality of their care.  According to a 2006 University of Kansas study on nursing homes, employee turnover is "the most important factor in predicting nursing home deficiency scores."

In our nursing home liability practice, it is common to see cases involving medication errors, dietary errors and general medical mistakes occurring at a disproportionate rate among new nursing home staff.  In a pending matter, a CNA at a Chicago Nursing Home mistakenly served a resident a steak dinner when the resident was on a strict 'soft foods' diet.  The resident chocked on the steak and suffered a brain injury from lack of oxygen.  Barely 24-hours on the job, the nurse was unaware of the resident's dietary restrictions. 

Hazing Type Abuse In Mississippi Nursing Home

Recent national headlines regarding abusive nursing home workers appear almost surreal.  Abusive people caring for the most vulnerable seems commonplace.  Nonetheless, I was particularly disturbed to hear the report of nursing home abuse involving nurses at a Mississippi Nursing Home.  Clarionledger.com reports, two employees of Graceland Care Center have been arrested for crimes involving abuse of vulnerable adults.  According to the Mississippi Attorney General, Jim Hood, the arrests of the nurses were made following indictments by a Mississippi grand jury.

Cynthia Hunt, a 46-year-old LPN was charged with two felony counts of abuse of a vulnerable adult for an alleged incident where she poured aftershave on the genitals of a nursing home patient and administering medication that caused pain.  If convicted, Ms. Hunt faces up to 40 years in jail and $20,000 in fines.  The other LPN, Kathy Brooks, is accused of stealing a nursing home patients' pain medication, hyrocodone.  If convicted Ms. Brooks, faces one to five years in jail.

How many other nursing home residents were victimized by these abusive nursing home employees before they were caught?

Nursing Home Abuse Charges Filed Against Teenage Workers

Criminal charges have been filed against six teenagers who worked at the Good Samaritan Nursing Home in Albert Lea, Minnesota.  As we discussed earlier in the Nursing Home Abuse Blog, the young women mistreated the Alzheimer's and dementia patients they were responsible for caring for.  Now the Minnesota Department of Public Health has released a report substantiating the criminal charges.  The report contains reports of physical, sexual and verbal abuse.

Amazingly, these young women were responsible for the care of nursing home residents requiring a substantial amount of medical care.  All six suspects were under 18 at the time of the alleged abuse.  As teenagers, how much resident training or experience could they have had?  Why was this nursing home giving such inexperienced workers access to medically dependent residents?

Read more about this case of nursing home abuse in Minnesota here.

Read the Minnesota Department of Public Health's Report related to their investigation at the Good Samaritan Nursing Home here. tinyurl.com/5ds5h3

 

'Senior Sitter' Charged With Sexual Assault Of Nursing Home Residents

In a new twist on the widely reported under-staffing in many nursing homes, some families of nursing home residents have chosen to provide supplemental care for their family members by hiring private sitters.  Similar to baby sitters, the senior sitters are intended to provide additional supervision and assistance for individual nursing home residents.  Because these senior sitters are not employees of the nursing homes, they are not regulated or subject to background checks.

The story of a senior sitter, who sexually assaulted several nursing home residents made headlines, recently.  The incident will hopefully increase public awareness about all visitors to nursing homes.  No matter how harmless or well intentioned a visitor may seem, nursing homes must take basic steps to safeguard the well being of their residents.  Nursing homes should not only keep an accurate record of visitors, but they should also keep track of the visitors whereabouts while they are in the facility.  Read more about this sad incident involving sexual assault in a nursing home here.

 

Nursing Shortage Is A Crisis

Another crisis is about to grip our country.  As we attempt to get a over our finances, a nursing shortage is beginning to effect patient care and seems to be a problem that will plague us for many years to come.  Nurse Tom reports that nursing shortages in hospitals and nursing homes are an ever increasing problem for patient safety.  The safety problems created by under-staffing have become an even bigger problem for hospitals has they can no longer receive Medicare and Medicaid reimbursement for event determined to be preventable or commonly referred to as 'never events.'

How extensive is the nursing shortage?

In 2007, a survey completed by the American Hospital Association found that hospitals require an additional 116,000 RN's to fill immediate vacancies. Statistics from Flotsam and Jetsam Blog report current nursing shortages at 14% of hospitals where there is a severe vacancy.  By 2025 the nursing shortage is expected to increase to 500,000 RN's- the most highly trained nurses.

Increased liability risk for hospitals and nursing homes

"As I see it, nursing is the most important area to focus on when it comes to preventing hospital mishaps," according to Tom Sharon, creator of the Legal Nurse Consultant website.  Hospital Corporation of America is currently facing a class-action lawsuit claiming the company engaged in systematic under-staffing of RN's throughout all of its hospitals.  The lawsuit claims that the 'systematic under-staffing' places patients at increased risk for complications such as infections, bedsores and death. 

Nurses are on the front lines of responding to patient needs.  If nurses are not there to attend to patients it is no secret that serious medical problems may go unattended.  A new wave of lawsuits is being filed against hospitals for under-staffing.  It is increasingly becoming not a question of what was done improperly, but a question as to what medical treatment was not provided.

A cure for the nursing shortage

There is no immediate cure for the nurse shortage problem.  The Registered Nurse Safe Staffing Act, recently introduced federal legislation, would ensure that each hospital generate a staffing system that ensures appropriate number of registered nurses on each shift and in each unit of the hospital.  

Other ideas include using volunteers to help with basic tasks such as monitoring patients in waiting areas and hospital rooms to make sure nothing happens while they are recovering form a procedure or waiting to see a doctor.  As nurse Tom says, 'There's no skill to that. Just sit there and watch to prevent falls."

The nursing shortage's impact on nursing home

Residents of nursing home will likely see a bigger impact that other medical care recipients.  Many skilled nurses who currently work in nursing home will be sucked out of those facilities and into higher paying nursing positions in hospitals.  A nurse in a hospital may earn several times what the pay rate for nurses is in a nursing home.  Unfortunately, until a priority is placed on providing quality nursing home care, there will likely be a continued correlation between inadequately staffed facilities in incidents involving nursing home injury and neglect.

Just Charge It. Nursing Home Employee Uses Company Credit Card For Personal Gain

A former employee at the Crown Healthcare Nursing Home in Mobile, Alabama recently plead guilty to first-degree theft.  The former nursing home worker used the nursing home's credit card to buy $14,373 in personal purchases from Sam's Wholesale Club.  From June, 2005 through May, 2007 the nursing home worker bought gas, tires, a washing machine and groceries for personal use as though the were purchased for the benefit of the nursing home. The employee was sentenced to two years, which was suspended, placed on probation for five years, ordered to pay full restitution and fined $500.  Learn more about the theft from an Alabama nursing home here.  I hope the residents of Crown Healthcare have double checked their bank accounts....

A First Hand Account Of Nursing Shortages

How real of a problem is under-staffing in nursing homes?  I came across this post from the Nursing Home Reality blog from a nurse who works at a 200 bed facility.

I am an RN in a nursing home licensed for just over 200 residents that offers skilled, intermediate and personal care. This facility has four nurses stations/units. I work on a unit with 38 residents. Many of these individuals have dementia.

My unit is allowed four nurses aides and an LPN on day shift, 3 nurses aides and an LPN on evenings, 1 - 2 aides and an LPN on nights.

While I try hard to understand the “budget” for staffing on my unit, my repeated requests for additional help has been ignored. In August I had eight (8) resident falls on my unit and they all happened on evening shift. My unit’s LPNs are frequently out of time compliance on distributing medications.

I would like to see mandatory staffing based not only on the number of residents, but also on their needs. This is especially important on a unit that has residents with many needs.

Nursing homes are required to have minimum staffing ratios that are controlled by Medicare.  However, when a facility has a combination of residents requiring 24-hour nursing, rehabilitation and personal care the lines of what is required get blurred.  As this nurse points out, some people simply require more care than others and general staffing guidelines will not always provide sufficient care.

If this nursing home fails to listen to its staff complaints of under-staffing, they should recognize the problems with patient safety.  If eight residents fell within one month, I bet at least several of of them sustained serious injuries requiring medical attention.  These are the type of inexcusable cases where the nursing home should be held fully accountable for their deliberate choice to cut corners on patient safety by under-staffing their nursing home.

Make Sure There Are Enough Nurses

The Legal Medicine Blog written the Dan Frith and Lauren Ellerman commented on a recent incident involving a Colorado nursing home's failure to provide assistance to a nursing home resident using the the bathroom.  Firth and Ellerman get at the meat of the issue with respect to many nursing home falls and scores of nursing home injuries--not enough nurses.

Sure shiny, pretty facilities are nice, but when evaluating facilities, the most important criteria in the selection of the facility is if the facility has enough staff.  Not just nurses, but also nurses aides, physical therapists, maintenance personnel and even cafeteria workers are all important to the providing quality patient care.  Adequate staffing provides ample manpower to properly look after nursing home residents. 

A nursing home staff member must provide assistance, not only in skilled nursing care, but also in looking after residents basic needs goes far in prevention of incidents which may harm residents and eventually cost the facility in litigation expenses.  As the Legal Medicine Blog points out you should ask to see staffing polices when selecting a nursing home and don't be shy about speaking to the residents about their experience.  If the facility will not let you speak to residents, thank them for their time and leave right away.

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Improper Transfer Leads To Broken Arm

 A lawsuit has been filed against the Edwardsville Nursing & Rehab Center in Illinois by the family of a nursing home resident who was dropped in the process of being transferred from her bed to a wheelchair.  The incident resulted in the fracture of the resident's arm.  

The lawsuit was filed in Madison County Circuit Court alleges the nursing home failed to:

  • Properly notify and consult with the resident's physician
  • Notify family of her fall
  • Hire sufficient staff to provide adequate care for the resident
  • Timely notify Illinois Department of Public Health of the injury

The real problem with this situation is the facilities failure to provide adequate staffing.  Despite nursing home's obligation to have minimum staffing ratios, many nursing home residents require additional care.  This incident, like many nursing home injuries, would likely have been prevented had the facility had another worker to help with the transfer.  

Read more about this incident involving inadequate nursing home staffing here.

Girls Gone Wild In Minnesota Nursing Home

I came across this article regarding the abuse of Alzheimer's patients at a Minnesota Nursing Home --the extent of mistreatment makes me sick.  According to a Minnesota Department of Public Health report, 15 residents of the Good Samaritan Society Nursing Home fell victim to ongoing physical and psychological abuse of 4 teenage nursing assistants.  Since the results of the investigation have been disclosed, the employees have been terminated.

The employees were terminated party due to cooperation of a 5th teenage girl implicated in the investigation.  According to the teenage girl, the foursome victimized residents suffer from dementia or related disorders such as Alzheimer’s disease. The report alleges the following incidents of physical abuse and neglect:

  • spitting in mouths
  • poking breasts and nipples
  • putting fingers in mouths
  • touching and tapping genitals
  • sticking rear ends in faces
  • rubbing buttocks
  • rubbing penises
  • touching perinea
  • anal insertion
  • holding residents down
  • teasing residents

This story is important because it demonstrates a culture of neglect that has developed in many nursing home.  The fact that multiple employees were involved in this incident makes me very skeptical that the nursing home administrator knew nothing if this criminal behavior.  Adding fuel to the fire, an employee told investigators that two of the girls had been “bragging about this for the past one to two months.”

There are 230 Good Samaritan Society locations nationwide, with several across Minnesota. Its full name is the Evangelical Lutheran Good Samaritan Society, but it is not part of the Evangelical Lutheran Church of America. The nonprofit company is based in Sioux Falls, S.D.

What Were These Nursing Homes Thinking?

There are many daily occurrences that occur in nursing homes that beg the question: what in the world were they thinking?  Everyday we hear about tragic incidents that are preventable not only with proper medical training, but plain old common sense. 

Some recent stories make me question the intelligence and sincerity of the people who work in nursing homes.  I mean everyone knows that: people need water, if you leave people laying in bed for days they will develop bedsores, sexual predators probably shouldn't be living amongst around the elderly, a bed-bound person will have a difficult time running out during a fire and nursing home residents require ongoing care.

Lara Pettiss Harrill of the South Carolina Nursing Home Blog, drives home nursing home residents' needs for basic care in her recent post on a Belleville, Illinois nursing home resident who filed a lawsuit after he contracted gangrene on his penis.  Ms. Harrill sums up the nursing home care issues faced by residents who suffer from nursing home neglect on a daily basis;

'Bottom line is, this gentleman was in a nursing facility, presumably because he needed nursing care - presumably because he needed assistance with activities of daily living, like bathing, dressing and using the bathroom.  What on earth were the employees doing (or not doing) that they could miss something like gangrene . . .'

The above situation further demonstrates a culture of neglect that has developed in many nursing homes where employees willingly ignore critical health problems and hope the worker on the next shift does the routine work they should have done.  Gangrene does not develop overnight.  Dare I say to the entire staff at the Calvin Johnson Care Center, 'what were you thinking?'

Murderer Assigned To Do Community Service In Nursing Home

Many states, such as Illinois, have passed laws to prevent convicted criminals from working in nursing homes.  Their violent backgrounds, put the most susceptible elderly at risk.  In a new twist, this news story uncovers the facts that a convicted murderer was assigned to work at a nursing home as part of her 'work release' program.  This story further demonstrates the importance of monitoring all people who enter nursing homes.  Protection of nursing home residents can only be assured when all people entering a facility are carefully monitored.   What is your facilities policy with respect to volunteers and visitors?

Woman Poses As Nurse To Steal Medication From Nursing Home Residents

A woman accused of sneaking into Beaverton's Maryville Nursing Home has been arrested.
Theresa Kim Smith is a certified nursing assistant in the Portland area and someone the police listed as “a person of interest” in a reported theft of Fentanyl pain patches.  The suspect woman posed as an employee at the Maryville Nursing Home on three separate occasions, but no motive was suspected at the time. Tips from the public led police to interview Smith, and the stealing Fentanyl patches from residents could be a possible motive.

Smith, who works at the Care Center East Nursing Home in Portland, is suspected of stealing the pain patches from multiple nursing home locations.  The Oregon State Board of Nursing has been conducting its own investigation into Smith’s reported Fentanyl thefts and has suspended her CNA certification.  Read more about the posing nurse here.

Is the staff turnover at nursing homes so great that the people who actually work at the facilities can not recognize a new face?  Perhaps equally frightening is how lazy these facilities are when it comes to securing such a dangerous drug like Fentanyl.  The authorities should investigate the self-serving Fentanyl incident.

Caught On Tape: 90-Year-Old Man Beaten By Home Nurse

Think the term 'nursing home abuse' is made up by lawyers?  Cameras don't lie...

 

The Correlation Between Staff Satisfaction And Resident Care

It makes sense.  If members of the nursing home staff are satisfied with their job, treated appropriately, receive good job benefits, they will be happier and their happiness will likely be translated to better patient care.  On the other hand, look closely into the eyes of any employee at struggling company-- you can sense their stress, their frustration and their anger.  In this sense nursing home patients and staff have interests that are very much aligned with each other. 

In nursing home owner's desire to squeeze every cent of profit out of their facility, nursing home staff and residents are the ones who are ultimately harmed.  In some respects many nursing home residents and the people who care for them on a daily basis are very much in the same boat.  Just as a nursing home resident may likely have few alternatives to living out the remainder in an undesirable facility; many people employed by the nursing home have few alternatives as well.  For many nursing home workers, they have little or no education, many are immigrants who possess few job skills. 

Many of the nursing homes that frequently have episodes of patient falls, pressure ulcers, medication errors and physical abuse of residents also happen to be the facilities that pay their employees the least.  Is this a coincidence?

Clearly, if there really is a desire on the part of nursing homes to improve patient care, they should first look improving morale of the nursing home staff.   Give the staff a $1.00 per hour raise, pay them overtime, give them some flexibility in their schedule, throw in a benefit or two-- before you know it overall patient care may begin to improve. 

For a more information on the correlation between employee satisfaction and patient care look here.

Nursing Home Workers Protest Over Safety Concerns

Nursing home workers at Windsor Healthcare nursing homes are holding a demonstration today to protest resident safety.  The nursing home employees hope current resident safety issues will be corrected.  Federal surveys document over 360 health and safety violations at the Windsor Healthcare nursing homes.  Many of the violations stem from high staff turn-over and poor employee training.

While the facilities were accumulating safety violations, the facility owners were collecting substantial profits.  In 2006, Windsor owners profited over $2 million from just two of the eight facilities they own.

Many nursing home employees are substantially under-paid.  Many fast-food workers earn more than the people responsible for the care of our elderly.  Perhaps if the owners of the nursing home passed a small percentage of their profits along to nursing home employee as raises and to employee training some of the safety violations could be averted?

Read more about the protesting nursing home employees here.

Nurse's Aide Sentenced to 3 1/2 Years In Prison

A nurse's aide responsible for the home care of a 61-year-old Bensenville woman, was sentenced to 3 1/2 years in prison for stealing.  The nurse's aide stole at least $7,000 from the Chicago-area woman who suffered from disability related to polio and was dependent on a respirator to breath.  According to the victim, her home care provider studied her sleep patterns and noise levels to steal from her when she was in a deep sleep.

Read more about this incident here.

Failure To Properly Screen CNA Could Cost Facility 3.5 Million

A lawsuit was recently filed on behalf of a mentally disabled man who police say was sexually assaulted by a CNA at an assisted-living facility.  The lawsuit alleges that the Cote De Neige Home for Adults and its owner, Rose Daniels Potter, failed in their duty to exercise "reasonable care" when they hired Junious Boyd Batten for a job as a certified nursing assistant in a facility with developmentally impaired residents.

The home "knew or should have known that (Batten) was unfit, unsuitable, untrustworthy and incompetent for the position ... and was likely to cause injury and harm to residents," the lawsuit contends, saying the home showed "reckless disregard" for the safety of its residents. The suit also says the company didn't adequately supervise Batten, instead making him an assistant administrator.

The civil lawsuit includes a list of 13 criminal offenses that Batten was charged with before, or during the time, he worked at Cote De Neige. The list includes several dismissed charges, as well as four that he was found guilty of: a public intoxication charge, two assault and battery charges, and a contempt of court charge.

The owner was aware of Mr. Batten's criminal past and still hired him to work with particularly susceptible people.  Despite the extensive history, the owner claims that she had no way of knowing from the background check that Batten could end up being accused of sexually assaulting the home  residents.

This situation is exactly why all nursing home and long-term care employees with criminal records should be banned from working with seniors and the developmentally challenged.  Read more about this case here.

 

Lets Award The Under-Acheiving

Three out of seven nursing home featured in the 2008 Iowa Governor's Quality Care In Heath Care Industry have numerous violations from federal and state authorities.  The three facilities have been cited for problems in meeting minimum health and safety requirements and have been cited by state inspectors for medication errors, failure to follow physicians' orders, unsanitary conditions, or failure to treat serious problems, such as broken bones.

Some of the 'award winning facilities' also had violations for failing to provide the prescribed amount of food to residents; unsanitary food service; failure to lock a medication cabinet in the unit for mentally impaired residents; failure to verify that two nurse aides had proper training; and six fire-safety violations.

The above safety violations are not minor nor do they require a savvy investigator to determine the nature of the violations.  Rather, these facilities demonstrate the need to do an on-site visit before placing any loved one in a nursing home.  Read more about the Iowa 'award winning'  facilities that  fail to  meet  basic safety standards here.

Elder Abuse By Home Aides On The Rise

Unlike nursing home employees, home aides remain a largely unregulated entity.  Many home aides are unlicensed and are not subject to the same criminal background checks as nursing home employees.  The number of home health care workers for the elderly is on the rise.  Currently, there are 1.6 million people employed in the home health care industry.

An incident involving an 85-year-old Priscilla Stovall, who was lethally drugged by her home care aid, draws attention to the need for extensive criminal background checks and ongoing monitoring of home aids who work with the elderly.  Although Ms. Stovall's aid was hired by an agency which specializes in providing home care workers for the elderly, the worker had an extensive criminal background.   The worker had a criminal background involving domestic assault, drug smuggling and had done time in prison.

Conducting criminal background checks for the health care workers can be difficult because there is no centralized database with employee information.  In a recent Michigan State University study sponsored by Centers for Medicare & Medicaid Services, researchers screened 214,167 people who held or sought jobs working with the elderly.  Of the sample group, 5,462 had criminal histories which should have excluded them from the position.  Read more about abuse among home care aids amongst the elderly in the Wall Street Journal here.

Before hiring a home care worker for an elderly person or yourself, keep the following in mind:

Nurses Admit To Problems At Nursing Homes

According to American Nurses Association, most of the 10,000 nurses participating in a recent poll believe the quality of nursing care has declined in the past year.  Other poll results are just as alarming.  A similar percentage (48.3%) of the nurses polled admit that they would not feel confident in having a person close to them receive care at the facility they work at.

The nurses recognize under-staffing as a major problem.  Almost three-quarters of the respondents believe there to be an insufficient number of nurses in their unit.  It appears the widespread under-staffing is forcing the nurses to look for work at better staffed facilities. 51.9% of the nurses are considering leaving their current positions due to inadequate staffing.

Under-staffing and high employee turnover at nursing homes leads to dangerous conditions for residents.  Most of the situations involving: pressure sores, malnutrition, dehydration, medication errors and inadequate supervision stem from an overall staffing problem.

The complete poll results are here.

Minimum Nurse Staffing Ratios

the quality of a nursing homes staff is one of the biggest predictors in quality of patient care.  An under-staffed nursing home puts patients at risk for developing conditions such as bedsores, improper medication or malnutrition.  An overworked staff may lead to patient neglect.

The Nursing Home Reform Act (NHRA) sets forth minimum staffing levels for registered nurses (RN), licensed practical nurses (LPN), and minimum educational training for nurse's aides (NA).  The requirements are:

  • A registered nurse must be the director of nursing
  • A registered nurse must be on duty at least 8 hours per day, 7 days per week
  • A licensed nurse must be on duty the rest of the time.
  • Nurse's aides must have at least 75 hours of training

States may legislate as to more intensive staffing requirements.  In addition to the above requirements the NHRA requires nursing homes "to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychological well-being to each resident."  Until the government legislates to provide specific nursing ratios, nursing home owners and administrators have little incentive to provide more than a bare bones staffing of their facilities.

Read the full article here.