When I read news clippings about a downstate nursing home patient who wandered from a facility into these cruel temperatures, I couldn't help but cringe as I knew more bad news would follow.

Sadly, I was correct. 

The body of the 75-year-old nursing home patient, identified as Aubrey Giles, was found in a creek located just a block away from Midwest Rehabilitation and Respiratory Care in Belleville, IL.  The elements were simply too much for that man to bear, and a medical examiner has ruled Mr. Giles died from exposure-related hypothermia.

In response to this unfortunate incident, officials from the Illinois Department of Heath have descended upon the Southern Illinois Nursing Home to begin an investigation into matter.  Much of the investigation will focus upon Mr. Giles' care plan created by the facility to best serve the his needs. 

Because many Alzheimer’s and dementia patients are considered to be elopement risks, I presume the state’s investigation will closely review what type of safeguards were ordered under the care plan for this patient vs. the safeguards (such as door alarms, wanderguards and gps tracking bracelets) that were actually in place at the time Mr. Giles wandered from the facility.  In  addition to safeguards, I would anticipate most of the staff on duty at the time of Mr. Giles incident would be questioned about their knowledge of his past behavior in addition to the circumstances of the day in question.

While wandering safeguards will indeed be reviewed, according to news reports surrounding this incident, the timeliness of the facilities notification of officials following the known departure of Mr. Giles’ departure from the facility appears to be within the boundries of the law.  Amazingly, while officials from Midwest Rehabilitation discovered Mr. Giles missing at three in the afternoon--- it was not until 7:30 that evening that the facility notified Department of Health officials.  Yet, this scheduling is completely legal.

Moreover, despite the fact that nursing home workers knew their patient with diminished capacities went into the frigid elements, no local police departments were contacted to help in the search for this missing patient-- again completely legal under the present laws.

Situations such as this shout the need for state lawmakers to begin to reevaluate the nursing home laws applicable to the tens of thousands vulnerable patients in Illinois whom are completely reliant on facilities for every part of their subsistence.  I find that fact that a nursing  home can use their own methods to locate a missing patient for 23-hours after they go missing downright shocking.  If a similar incident were to occur with a child leaving his home, I have little doubt the the public outcry over such an incident would be deafening. 

Related Nursing Homes Abuse Blog Entries:

Investigation Initiated After Suspicious Nursing Home Death, Involving Patient Wandering and Drowning

Too Little, Too Late. Nursing Home Submits Corrective Plan After Disabled Patient Wanders From Facility To His Death

State Fines Nursing Home Where Patients Drowns In Puddle In Front Of Facility

Lack Of Door Alarms Allows Assisted Living Patient To Wander To Her Death

Today, physciatric drugs-- and anti-psychotic drugs in particular-- are prescribed to an astounding 14% of all nursing home patients.  The bulk of the psychiatric drugs are administered to patients with dementia or Alzheimer's in order to calm their potentially aggressive behaviors.

Despite the prevalence of this practice, anti-psychotic drugs such as AstraZeneca's Seroquel and Eli Lilly's Zyprexa have been associated with an increased mortality rate in seniors.  Other documented side-effects include: elevated blood sugar levels, increased cholesterol and weight gain.

Even with their dangers, doctors can legally prescribe anti-psychotic medications for off label use.  What is not legal, however, is for drug companies to actively promote the off label uses of their drugs when they have not been cleared by the FDA.

This controversial--- but widespread issue-- took front and center when an inspector from the U.S. Department of Health and Human Services (HHS) told a Senate Committee on Aging about how widespread the practice of prescribing psychiatric drugs for off label use has become in the nursing home industry.

As a solution to this prevalent issues, HHS Inspector General Daniel Levinson suggested that Medicare should stop reimbursing nursing homes for expenses related to inappropriate off-drug use.  Further, if nursing homes continue the dangerous practice, Levinson suggested that the offending facilities get removed from the Medicare program altogether.

As a lawyer who has seen how these powerful psychiatric drugs can adversely impact nursing home patients, I urge lawmakers to consider Mr. Levinson's proposal.  In addition, I would hope that the FDA take the regulation of this class of drugs one step further and simply ban the practice of prescribing anti-psychotic medications for dementia patients.

Read more about this topic in the Washington Post article "Gov't inspector says penalties needed to curb use of psychiatric drugs in nursing homes" here.

Related Nursing Homes Abuse Blog Entries:

Government Continues To Pay For Nursing Home Patients To Receive Unnecessary Anti-psychotic Medications

Pile On The Medication

Nursing Home Employees Plead 'Not Guilty' To Charges Related To The Intentional Chemical-Sedation Of 22 Elderly Residents

Half Of Nursing Home Residents Wrongly Drugged

Ultimately, the woman sustained multiple injuries as a result of a fall she sustained in the restricted area including: broken facial bones, bleeding in her brain and multiple cuts on her face that required hospitalization.

Interestingly, the incident was investigated by a state adult-protection worker who determined that the woman's fall deserved to be evaluated for possible sanctions against the facility considering the severity of her injuries and the fact that she was a victim of caretaker neglect whom had been exposed to an extreme safety risk.  Yet, the Kentucky Attorney General declined to prosecute the matter as the injuries were deemed accidental.

Given the size of this verdict, I guess that the people sitting on this jury sided with the opinion from the adult protection worker?  

Post-incident investigations

The timeliness of an investigation by regulatory agencies can prove to be pivotal in determining both how an incident occurred and the role the facility may have played.  Unlike families or attorneys hired by families--- state regulatory workers--- and even law enforcement personnel have the ability to investigate the circumstances following the discovery of a concerning situation. The investigations can provide families with the answers they frequently seek concerning how and why an incident occurred.

Additionally, should the family choose to pursue the case civilly, the investigation can be extremely helpful in prosecuting the case because many of the details contained in the investigative report can be used to establish liability and damages.  As a nursing home lawyer, I always suggest that families contact the department of health within their state or similar regulatory agency as soon as feasible following an incident so a thorough investigation can be done while the event may be fresh in the minds of witnesses and staff.

Related Nursing Homes Abuse Blog Entries:

Alzheimer's Patient Fractures Her Neck As She Attempts To Crawl Out Of Window

Another Example Of Nursing Home Negligence: Disabled Patient Falls Down Unsecured Stairway

Rapid Decline For Elderly Nursing Home Patients Following Fall-Related Injuries

California Nursing Home's Failure To Provide Fall-Prevention Safeguards Results In A Substantial Fine

Patients with developmental disabilities and other conditions like Alzheimer's or dementia are most at risk for episodes of self-inflicted harm-- be it intentional or not. 

Consequently, facilities that care for these people must take additional precautions that go beyond merely keeping some of these materials out of sight.  Because many of these people remain vigorous and able-bodied, facilities should ensure that potential dangerous materials are kept in a sure area and train staff on this potential threat to resident safety.

Tragically, an episode involving a developmentally disabled man at a Washington Assisted Living Facilty made headlines when he died after drinking laundry detergent.  The Seattle Times reported that the 30-year-old man was transferred to a community living program months before the deadly incident where he was to be supervised by an organization that concentrates in caring for those with disabilities.  It was also reported that this man lived alone.

Presently officials with The Department of Socials Health Services and local police are investigating the circumstances surrounding this incident.

While we await the results from this investigation, I'm sure that authorities will focus both on this man's background with respect to any similar incidents in the past as well as why a potentially deadly poison was so accessible. Hopefully this agency will take a second look at the way it care for people with similar disabilities an implement much stronger safeguards to prevent similar incidents from occurring in the future.

Related:

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

Are Group Homes A Viable Alternative To Nursing Homes?

Dementia Patient Found In Freezer At Assisted Living Facility: An Isolated Event Or Real Cause For Concern?

Acute renal failure following detergent ingestion (pdf) Singapore Med J 2009; 50(7) : e256

All too often, nursing home residents with Alzheimer’s and dementia are overlooked and over-medicated. Perhaps this arises from serious miscommunications, or - more likely - a deep misunderstanding from staff.

“Antipsychotic Drug Use Among Elderly Nursing Home Residents in the U.S.”

Right?

Or, maybe not?

An Arizona nursing home geared towards caring for patients with Alzheimer's disease, the the focus of the facility is on allowing patients to do exactly what they wish.  Other than ensuring each patient is provided the care specified by their doctor, Beatitudes a facility in Phoenix, facility gives patients' complete flexibility over what and when they do to fill their days.

By giving patients more control over their lives at Beatitudes, the facility hopes to improve the patients' quality of life and generally make the facility a better place for both patients and staff.  The flexibility is also thought to reduce the stress put upon Alzheimer's patients who frequently have a difficult time when being 'redirected' --- or encouraged to change tasks based on the requests of staff.

I certainly find this simple-- but significant---  change in providing care to be very encouraging in the care of Alzheimer's patients. If successful, hopefully other facilities can implement parts of this program.

Caring for Alzheimer's patients

Indeed the needs of Alzheimer's patients may be quite unique from those of other patients at the nursing home.  In order to maximize the potential of each Alzheimer's patient some expert's suggest:

• Recognizing the progressive nature of the disease
• Incorporating as many of the person's life's passions into their routines
• Re-phrasing terms of minimize the stress put upon patients when talking

Related Nursing Homes Abuse Blog entries:

Lack Of Door Alarms Allows Assisted Living Patient To Wander To Her Death

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

Assisted Living Facilities Need To Re-Evaluate If They Are Capable Of Caring For Dementia Patients

Mentally Disabled Patients Are Easy Targets For Abuse In Institutional Settings

Allegations of nursing home neglect

Like many families coping with a family member's declining health, Tom Douglas knew it was time for his mother needed additional care that a skilled nursing facility could allegedly provide.  After recognizing that he was having difficulty caring for his mother at home, he sought out a facility that was uniquely equipped to care for her various ailments including: Alzheimer's, Parkinson's and dementia,

While he waiting for space to open at an Alzheimer's facility, he temporarily placed his mother at a facility for which he intended to be a short term stay.  In September, 2009 Tom placed his 87-year-old mother, Dorothy Douglas, into Heartland of Charleston for a short-term admission.

Within three weeks, Ms. Douglas' physical and emotional condition rapidly declined.  During her stay she was transformed from a woman who was capable of walking, talking and generally recognizing her family to a shadow of herself. 

By the time space had become available at the facility Ms. Douglas' family had selected for her care, she had lost 15 pounds and was on the brink of death.  In fact, a day after her transfer Ms. Douglas was taken to a nearby hospital where she died.

Damages intended to punish the facility

Like some states, West Virginia allows families to recover both compensatory damages and punitive damages against nursing homes and other medical facilities responsible for the injury or death of a family member.  In this case, lawyers for the family argued that Manor Care's under-staffing and high staff turnover were the underlying reasons for Ms. Douglas' rapid decline and eventual death.

According to news reports of the trial, former Heartland workers testified that it was physically impossible for them to care for their patients due to their extraordinary workloads.  Similarly, documents produced by Heartland demonstrated that staff turnover was 112% during the year Ms. Douglas was at the facility.

My take

At some point, even the largest corporations need to take notice of the fallout from their actions.  As the largest (and likely most profitable) nursing home operator, Manor Care needs to acknowledge that there are consequences for their actions. 

Even as the the giant of the nursing home industry, ($4 billion in annual revenue and more than $8 billion in assets), when verdicts this size come down, the company surely must taken notice.  Surely, verdicts such as this send a message to the decision makers that inadequate care is simply not acceptable.  Even when the human impact of their poor care is removed from the equation, poor care is simply bad business.

Related:

Care home's neglect was fatal, lawyers argue Charleston Gazette, by Zac Taylor, July 26, 2011

Heartland must pay $91.5M in fatal neglect case Charleston Gazette, by Zac Taylor, August 5, 2011

What's In A Name? Are Large Nursing Home Chains Intentionally Attempting To Deceive The Public When It Comes To Corporate Ownership?

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

Criminal charges have been brought against three nursing home workers on duty the night an Alzheimer's patient wandered from Texas nursing home to his death.  The three were employed in various capacities at a facility known as Tumbleweed Nursing Home on the evening of February 3rd of this year.

Surveillance video from the nursing home demonstrated that an Alzheimer's patient that the staff was responsible for supervising wandered without any intervention from the safety of the nursing home into the frigid outside temperatures.  Hours after the patient left the nursing home, he was found dead outside.  An autopsy revealed that the man's death was related to hypothermia.

After evaluating the evidence related to this nursing home death, a Grand Jury determined that there was sufficient evidence for to prosecute the workers on charges related to injury to the elderly, a third-degree felony.

Like other situations involving injuries to a nursing home resident, the family of this deceased nursing home patients may also elect to pursue a civil lawsuit against this facility based upon the negligence in supervising their loved one.  Unlike a criminal case, families in a civil case may recover money damages for the loss of their loved one.  Read more about the criminal charges pending against these nursing home employees here.

Related Nursing Homes Abuse Blog Entries:

Hypothermia Confirmed As Cause Of Death In Nursing Home Wandering Case

Elderly Woman Wanders From Her Convalescent Home To Her Death

Woman Dies From Hypothermia After Wandering From Assisted Living Facility

Alzheimer's Resident Dies Hours After Escaping From Illinois Nursing Home

Nursing aide to be charged with injury: kxan.com

Frustration is likely to blame for an episode of elder abuse at a Texas nursing home where a CNA attacked an Alzheimer's patient she was trying to get dressed.  Staff members at Wesleyan Nursing Home, notified nursing home administrators when they saw the CNA grab the patient and put him in a 'head lock' after he was slow to follow instructions.

Though the patient did not sustain injuries that are permanent in nature, the CNA was fired from her position and will face criminal charges of: injury to the elderly and disabled reckless bodily injury.

Caring For Patients With Alzheimer's

Ok, let's face it.  When it comes to being a caregiver for a person-- old or young-- it can be difficult, sometimes thankless work.  When it comes to caring for a person with dementia or Alzheimer's it really takes a special--- and incredibly patient-- person.  Unlike other patients who may be re-directed to the task at hand, caregivers for patients with Alzheimer's may simply have to wait until the person is ready to do what ever the task may be. 

Too often, a poorly trained or unsuitable caregiver may snap in frustration and take out their anger on the patient for who they are responsible for caring.  Recognizing that combativeness is part of the disease, is important for all caregivers to acknowledge. 

When selecting a nursing home for a patient with Alzheimer's, families should ask the facility the following questions:

• How many Alzheimer's patients do you have?
• Have staff received any specialized Alzheimer's training?
• Are staffing levels increased for Alzheimer's patients?
• Do you have a plan for when patients become combative?

It's a pretty thin line many assisted living facilities must walk between giving their patients freedom to go as they wish and protecting them from--- well,... themselves.  

Today, I'm noticing that there are many assisted living facilities that simply view monitoring their patients as an afterthought and many residents who likely require supervision aren't getting as much as they require for their optimal functioning.

Sure making a determination as to: how, if, or when an assisted living resident can leave the facility is not easy. Yet, there may be no more important decision when it comes to the safety of assisted living patients. Certainly, as residents needs change, the staff needs to reconsider the safeguards it has in place for the patient as well.

I began thinking of this balance between giving patients freedom and ensuring their safety when I read about a man who wandered from a North Carolina Assisted Living Facility to his death.  Just one day after Dallas Sherwood 'Sweet' Stevens walked from Aversboro Assisted Living Center, he was found dead in a small pasture. 

Reports of his death indicate that 62-year-old Stevens had a cognitive impairment  and required medication.  Yet the Aversboro facility allowed the man to stay at their facility which was known to have an 'open door' policy, referring to the ability of residents to come and go as they wish.

Certainly, no one wants to unnecessarily restrain a person against their wishes, but it seems like the facility is certainly in a better position to assess the needs of a patient than any one else. 

And one more thought...

Civil liability issues aside, when it comes to situations where a patient wanders from a nursing home or assisted living facility, I strongly feel that the facility should bear the costs associated by law enforcement when they conduct extensive searches for missing patients.

In the case of the search for Mr. Stevens, a Silver Alert was issued and more than 50 law enforcement officers and police equipment were diverted in the search for Mr. Stevens.

Related Nursing Homes Abuse Blog Entries:

Nursing Home Patient Dies When Struck By Car In Busy Street. What Was He Doing There?

Lack Of Door Alarms Allows Assisted Living Patient To Wander To Her Death

Assisted Living Facilities Need To Re-Evaluate If They Are Capable Of Caring For Dementia Patients

Woman Dies From Hypothermia After Wandering From Assisted Living Facility

While not a common problem, wandering from nursing homes puts particularly vulnerable patients at risk for harming themselves when they find themselves in the outside world with no one to look after them.

Just 200 feet from the doors to the nursing home where she was a patient, a 92-year woman left the facility without the knowledge of the facility staff and managed to fall into a shallow puddle nearby and drown.  Authorities from the North Carolina Division of Health Service Regulation have issued a $20,000 fine against, Bradford Village of Kernersville, the facility that was to be supervising the woman.

In the course of the agencies investigation, it was determined that the facility made numerous errors when it came to ensuring the safety of the woman.  In particular, the investigation revealed:

• The staff at the facility failed to conduct regular inspections of the woman's room to help track her whereabouts.
• Numerous code violations regarding errors made the physical environment, personal care and supervised.
• Door alarms at the facility were de-activated to allow staff to easily exit the facility to smoke cigarettes.
• Supervisors at the facility unaware of safety protocols.
• Staff failing to appreciate the fact that the woman suggested that she wanted to leave the facility earlier in the evening

Certainly, tragedies such as this, are reminder of the necessity of all facilities that care for patients who have dementia or other medical conditions that make them unable to appreciate their surrounding dangers. 

Having worked on a number of nursing home wandering cases, I always encourage families to report the situation to the state department of health so an into the incident can be investigated in a timely manner. 

Given the fact that many nursing homes have extraordinarily high staff turnover rates, conducting a timely investigation and obtaining statements from staff is especially important.  Frequently, I cite these early investigations as a primary reason why some cases can be resolved early on as opposed to protracted litigation.

Related:

Hypothermia Confirmed As Cause Of Death In Nursing Home Wandering Case

$821,000 Awarded To Family Of Deceased Assisted Living Patient Who Wandered From Facility

Wrongful Death Lawsuit Ensues After Nursing Home Patient Is Struck By A Freight Train

Chicago Nursing Home Cited For Multiple Violations Following Drowning Death Of Patient

The disturbing conclusions about the unnecessary medicating of nursing home patients was recently made public in a 48-page report released by the Office of the Inspector General.   The report paints a picture of nursing homes broadly using anti-psychotic drugs to treat conditions such as dementia-- a condition for which these drugs have not been approved-- and have conclusively established to pose additional dangers to patients.

Commonly prescribed anti-psychotic drugs such as: Risperdal, Zyprexia and Seroquel have been used by the nursing home industry as a form of chemical restraint for patients with dementia in an attempt to calm their behaviors and make them easier to care for.  The nature of drugs may cause rapid physical and psychological decline in many of these patients as well.

The government report concluded that in most circumstances (88% of the cases) not only were the drugs not intended to treat patients with dementia, but the drugs carried a severe warning of health risks--- including death--- for dementia patients who were taking these medications-- as these medications do nothing to treat the underlying condition.

The pervasive use of anti-psychotic drugs in nursing homes was so concerning to the officials at OIG who initiated the study that they devised suggestions for CMS (Medicare) to implement to help reduce the rate of unnecessary drug use by:

• Creating a systemic process to analyze the use of anti-psychotic medications in individual nursing homes
• Hold nursing homes accountable when medications are wrongfully administered
• Changing the nursing home survey and certification process to address use of anti-psychotic medication
• Educate facilities on the proper uses for these medications

Given the widespread use of off-label use of anti-psychotic medications in nursing homes, I certainly support the suggestions made by the OIG. 

Additionally, I believe it is important for families to insist upon seeing the list of their loved ones medications to see if they are being improperly medicated.  As more families become aware of the prevalence of this type of chemical sedation, nursing homes may be forced to provide the necessary care to patients as opposed to just dispensing unnecessary drugs.

Related Nursing Homes Abuse Blog Entries:

Half Of Nursing Home Residents Wrongly Drugged

Pile On The Medication

Nursing Home Employees Plead 'Not Guilty' To Charges Related To The Intentional Chemical-Sedation Of 22 Elderly Residents

A preliminary autopsy demonstrated that the patient suffered from a fractured neck that apparently happened as the woman was wrangling her way through a window to the outdoors.

As inspectors examine the circumstances surrounding this incident, news reports verify that Springfield Skilled Care Center has had troubles in the past.  With a one out of five star health inspection rating, Springfield has had troubles relating to its 'special care unit' for patients with Alzheimer's and dementia when doors wouldn't open after fire alarms were activated.

In response to situations such as this, some facilities that cater to patients with Alzheimer's have implemented the use of specialized safety devices such as: window and door alarms and specialized hardware to prevent patients from leaving the facility without the knowledge of the staff.

Related:

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

Fall Leaves Dementia Patient With Broken Neck At Assisted Living Facility

"Escape Plan" Tragedy At Chicago Nursing Home

The October 28^th incident apparently resulted when staff were in the process of repairing a lock on a kitchen door that enabled the woman to access the freezer unit in the kitchen.

Fortunately, the woman was located in the freezer after the facility initiated a facility-wide search when she was discovered missing.

This incident comes months after an employee at the assisted living facility was sentenced to life in prison following a conviction for torturing patients at the facility during his employment there.

Isolated Events Or A Facility Teetering On Danger?

Everyone can have a bad day—a slip up now and again.  However, we frequently see a disproportionate number of incidents at facilities with real underlying problems related to poorly trained or dissatisfied staff.

In the case of facilities caring for patients with Alzheimer’s and dementia patients, even minor errors can have especially devastating results for the patients, as they frequently remain unable to appreciate the danger the defective condition poses to them.

Additionally, many dementia patients remain very mobile and physically healthy despite their mental decline.  For this reason, forgetting to close a door or leaving dangerous materials accessible can have devastating consequences for the patient.

Facilities caring for dementia and Alzheimer’s patients should implement safeguards to protect their patients from the potential types of self-inflicted harm.  The following safeguards can be crucial to protecting this fragile population: 

• Keeping doors and windows secured
• Install alarms on doors
• Use locks on rooms containing potentially dangerous materials such as chemicals, sharp objects, open flames and other devices
• Routinely conduct inspections of the facility to ensure potential hazards are safeguarded
• Regularly assess patients to see who may be prone to wander or may be unable to appreciate harm

Related:

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

Swallowing Foreign Objects Is No Laughing Matter For Dementia Patients In Nursing Homes

Big Verdicts Against Nursing Homes

Assisted Living Facilities Need To Re-Evaluate If They Are Capable Of Caring For Dementia Patients

Certainly, not to make light out of a serious issue, there are similar swallowing-related dangers facing patients who may not be able to appreciate the dangers.  I have worked on a number of cases involving disabled patients who have swallowed foreign objects during admissions to nursing homes, hospitals and group homes. 

Most of these foreign-object cases involve patients with Alzheimer’s and other psychiatric conditions who remain unable to appreciate the dangers associated with swallowing materials that may be on hand in their rooms.

Commonly encountered swallowed foreign objects including:

• Plastic knives and forks
• Food packaging
• Sterile gloves
• Pens
• Toothbrushes
• Coins
• Razorblades
• Dental implants / dentures

What makes many of the foreign object ingestion cases particularly horrific for the patient is the fact that many of the foreign objects are extremely dangerous is the fact that many objects go undetected by staff until a problem manifests itself in the form of a severe medical complication -- such as choking or internal bleeding.

Given the prevalence in ingesting foreign materials or objects amongst Alzheimer’s, dementia and psychiatric patients, facilities need to be mindful of this real tendency and take steps toward minimizing the chances a patient can access these materials:

• Facilities should take steps towards identifying which patients have a history of ingesting foreign materials
• Medical devices should be kept under locked conditions
• Staff should remove non-edible food wrappers and coverings from meals prior to serving staff
• Staff should supervise patients with a swallowing proclivity

Due to the fact that many of these patients are simply unable to perceive the dangers associated with ingesting foreign objects, facilities need to be mindful of the inherent risks associated with keeping materials accessible to their patients and implement safeguards to prevent patients susceptible to this type of behavior from accessing materials.

Resources:

Intentional Swallowing of Foreign Bodies and Its Impact on the Cost of Health Care, Science Daily, November 4, 2010

Foreign body aspiration in dentistry- a review (PDF) The Journal Of The American Dental Association 1996;127;1224-1229 by SM Cameron, WL Whitlock and MS Tabor

CT Features of Esophageal Emergencies (PDF) Radiographics by Catherine A. Young, MD, JD • Christine O. Menias, MD • Sanjeev Bhalla, MD • Srinivasa R. Prasad, MD (2008)

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

Two years later-- not much has changed at this Brookdale assisted living facility.

Authorities found similar problems during the investigation of the death of a 93-year-old resident at the facility. The elderly man was able to access the unsecured dishwasher and access the area where the detergent was stored and ingested it.  

Eighteen hours later the man died from complications related to the chemical burns in his esophagus.

As a result of this incident, Brookdale has agreed to pay a $7,500 fine and re-implement guidelines regarding the storage of chemicals and cleaning products.  Last year, Homewood Residence paid  fines of $3,000 fine when 10 residents at the facility contracted norovirus and $1,500 following the development of bed sores on on resident.

Safety For Dementia Patients

Many dementia patients lack the ability to appreciate danger to themselves or the people in their surroundings.  Making matters even more difficult is the fact that many dementia patients remain physically strong even as their mental faculties decline.

Consequently, nursing homes and assisted living facilities need to secure their facility as though they were caring for a toddler.  All patient rooms and common areas should be evaluated on an ongoing basis to ensure that dangerous objects are removed.

Access to areas where patients need not access-- kitchens, utility areas and laundry rooms should be secured to prevent dementia patients from accessing powerful machinery.

Related:

Delray Beach assisted living facility fines in residents poisoning death, South Florida Sun-Sentinel, November 13, 2010 by Jon Burnstein

Assisted Living Facility Submits Corrective Plan After Dementia Patient Falls From Window

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

Nursing Homes For Alzheimer's Patients. What To Look For?

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

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

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

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

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

Related:

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

Feeding Tubes May Be Over-Used In Dementia Patients

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

According to Jim Jones, a spokesman for the North Carolina Division of Health Service Regulation, the facility submitted a corrective plan after the officials investigated the incident and found multiple state and federal violations relating to patient care.

According to the assisted living facilities corrective plan:

• Staff must check on all patients at least every two hours
• Staff must know each patients specific care needs

In order to assure that the facility is correctly implementing is corrective care plan, regulators from the state will make unannounced visits to the facility.  Read more about this corrective care plan at a North Carolina Assisted Living Facility here.

Forest Heights Senior Living Community in Winston-Salem, North Carolina, is owned by Five Star Quality Care. Five Star is a healthcare and senior living services provider that operates independent and assisted living facilities, skilled nursing facilities, rehabilitation hospitals, institutional pharmacies and outpatient health rehabilitation clinics throughout 30 states.

Am I missing something?  Why doesn't this corrective care plan implement special screens on on the windows to prevent similar incidents from occurring?  Similarly, shouldn't this facility consider housing their dementia patients on the ground level of the building?

Related:

Nursing Home Fails To Intervene In Case Involving Dementia Patient With A Known Suicidal Propensity

Chicago Nursing Home Lawyer, Jonathan Rosenfeld, Interviewed Regarding Preventing Patients From Wandering

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

What Can Nursing Homes Learn From Jails?