Nursing Home Injury Laws: Maine

Number of nursing homes in Maine: 107

Patients living in Maine nursing homes: 6,164

Occupancy rates of Maine nursing homes: 91.7%

Average number of deficiencies at each Maine nursing home: 9.4

Percent of Maine nursing homes with serious deficiencies for actual harm to patient: 19.6%

Most common deficiencies at Maine nursing homes: Professional Standards, Comprehensive Care Plans, Unnecessary Drugs, Food Sanitation

Distribution of ownership of Maine nursing homes: 70 % for profit, 29% non profit, 1% government

Most populated cities in Maine: Portland, Lewiston, Bangor, South Portland, Auburn, Augusta

Staffing levels at Maine nursing homes (daily hours): Above average, 4.5 total staff, 1.4 licensed nurse

Visit Nursing Home Injury Laws to learn more about Maine nursing homes and your legal right

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Resident Interviews Proving To Be Too Burdensome For Nursing Home Staff

Sure, it may seem obvious that in order to do an assessment as to how a person is doing--- you would ask the individual himself.  However, according to a report from McKnight's, nursing home staff are ignoring essential resident interviews-- which are to be conducted as part of each patient's assessment process at the facility.  

While not all patients may be of sound mind or physically capable of articulating how they feel or what they need, a recent conference call initiated by Thomas E. Dudley, MS, RN of Centers for Medicare & Medicaid Services (CMS) reported;

CMS has received reported from some state surveyors that some facilities are not completing interview when residents are capable.  Providers will be cited when such a practice is verified.

According a nursing home resident assessment tool (MDS 3.) mandated by the government, every nursing home patient must initially be evaluated in order for the facility to tailor a plan of care that takes into account each patients needs.  MDS protocols suggest that each patient be evaluated on: their cognitive ability, mood, routine, activities and levels of pain.

When patient needs get blatently ignored, can it realy be much of a surprise that so many nursing home patients feel alone and unhappy? 

Little Evidence That Poorly Performing Nursing Homes Are Improving

While I imagine that there are a host of reasons behind the implementation of Medicare's Nursing Home Compare--- and star-rating system, I propose that a paramount reason was to 'encourage' poorly performing nursing homes to change the way that they operate.  It would make sense that the impact of market conditions would force troubled nursing homes to clean up their act or risk an inevitable decline in the number patients filling beds at their facility.....theoretically.

Despite Medicare's clearly identified label for the most poorly performing nursing homes-- one-star facilities-- as being 'much below average' compared to other facilities within the state, the dubious distinction doesn't seem to be like much of an impetuous for facilities to improve.

A recently USA Today article, "As nursing home care improves, some problems slow to mend" followed nursing home rating for facilities over the lifetime of Nursing Home Compare system.  While the authors did note that the percentage of poorly rated facilities has decreased since the programs inception, a distressingly large number of facilities have elected to follow their own inferior course. 

564 nursing homes providing care for upwards of 73,000 patients have consistently received the one-star rating during every inspection cycle of the program.  Not surprisingly, many of the facilities in this category share some similarities in that the majority (66%) of them are 'for-profit' facilities.  Similarly, a sizable contingent of poorly rated facilities are parts of large nursing home chains, such as ManorCare or Golden Living.

Why all of these poorly performing nursing homes?

Some experts associate the consistently poor rating with a high rate of staff turnover.  In this light, a pilot program has been initiated by a health policy foundation, The Commonwealth Fund, to help provide more consistency in the care that is provided to patients.

From my perspective--- even with the widely distributed rating system, many of these consistently poorly rated nursing homes continue to exist-- simply because the operators refuse to invest the necessary work needed to improve the care they provide to their patients.  As we consistently see with nursing home operators, as long as these facilities continue to remain profitable, the likelihood of improvement is dim.

Related:

Lots Of Information On Nursing Homes Is Out There--- It Frequently Is A Matter Of Knowing Where To Look

More Detailed Nursing Home Information Now Available Online

How Do I Begin The Search For Care Options?

More Improvements At Medicare's 'Nursing Home Compare' Website

Continue Reading

Nursing Home Injury Laws: Louisiana

Number of nursing homes in Louisiana: 286

Patients living in Louisiana nursing homes: 25,617

Occupancy rates of Louisiana nursing homes: 71.4%

Average number of deficiencies at each Louisiana nursing home: 12.1

Percent of Louisiana nursing homes with serious deficiencies for actual harm to patient: 24.5%

Most common deficiencies at Louisiana nursing homes: Accident Environment, Comprehensive Care Plans,  Food Sanitation

Distribution of ownership of Louisiana nursing homes:  74% for profit, 18 % non profit, 6 % government

Most populated cities in Louisiana: New Orleans, Baton Rouge, Shreveport, Lafayette, Lake Charles

Staffing levels at Louisiana nursing homes (daily hours):Above average, 3.6 total staff,  1.5 licensed nurse

Visit Nursing Home Injury Laws to learn more about Louisiana nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Legal Blogs Offer Insight On Elder Abuse & Beyond

The proliferation of legal blogs has really taken hold on the legal community over the past several years. While there are indeed blogs written with little focus or insight on relevant legal issues clogging up the web.  However, I tend to see some of the more established attorney-bloggers generating some real quality content and offering some provoking insight.

Below are some of the best attorney-blogs that I have come across.  I strongly urge you to look at them both for their tpocial nature and for their real insight. 

1) South Carolina Nursing Home Blog by Ray Mullman of Polikoff & Associates

http://www.scnursinghomelaw.com/

One of the most diligent bloggers around, Ray does a tremendous job keeping us updated on the ongoings regarding nursing home abuse both in South Carolina as well as the rest of the country.

2) Legal Medicine 

http://legalmedicine.blogspot.com/ 

by Dan Frith and Lauren Ellerman of Frith & Ellerman Law Firm. Dan and Lauren are Virgina attorneys who do a tremendous job clearly explaining complex issues in medical malpractice and nursing home negligence cases.

3) Jere Beasley Report 

http://www.jerebeasleyreport.com/

Not many lawyers have an influential reputation like Jere Beasley-- nor could they pull off a blog with their name in the domain and get the type of volume that Jere does with his blog. In addition to nursing home abuse, Jere writes about mass torts, environmental disasters, recalled products and the latest news in the field of personal injury law.

4) Messa & Associates

http://www.minfirm.com/category/blog

http://www.messalaw.com/blog/

With offices in New Jersey and Philadelphia Joe Messa and John Mininno have incorporated a blog as an extension of their firm's websites that concentrates on negligence committed in a nursing home and hospital setting along with timely topics such as the DePuy hip recall.

5) Maryland Nursing Home Lawyer Blog

http://www.marylandnursinghomelawyerblog.com/

I always enjoy the thoughtful entries by the lawyers at Lebovitz & Mzhen concerning nursing home abuse in Maryland. Unlike some lawyer websites, Maryland Nursing Home Lawyer Blog does a great job providing information as opposed to just re-playing the news.

6) Bed Sore FAQ 

http://www.bedsorefaq.com

Ok, I may be somewhat biased, but we continually receive kind words regarding the content published on the Bed Sore FAQ website from both legal practitioners as well as family members searching for information regarding one of the most prominent examples of neglect in nursing homes and hospitals.

7) California Nursing Home Abuse Lawyer Blog

http://www.nursinghomeabuselawyerblog.com/

One of the more established nursing home abuse blogs around, The Walton Law Firm produces a consistently excellent blog concentrating on educating the publis regarding their legal rights when it comes to mistreatment in a nursing home.

8) Massachusetts Nursing Home Abuse Lawyer

http://www.nursinghomeabuse-lawyerma.com/

Bernard Hamill is a Masachusetts personal injury lawyer that concentrates in representing victims of nursing home abuse and neglect.

9) Pennsylvania Nursing Home Abuse Lawyer Blog

http://www.pennsylvanianursinghomeabuselawyerblog.com/

Michael O'Conner & Associates are lawyers in Pennsylvania that represent victims of nursing home abuse and neglect. Blog topics include: bed sores, neglect and under-staffing.

10) North Carolina Nursing Home Abuse Blog

http://www.lawmed.com/nursinghome/

Henson & Fuerst, well respected North Carolina Personal Injury Attorney, assemble an interesting array of topics relating to nursing home care. I particularly enjoy how the firm incorporates many stories not traditionally associated with nursing home abuse on their frequently updated blog.

11) Litigation & Trial

http://www.litigationandtrial.com

Maybe I'm saving the best for last? Max Kennerly of Philadelphia's Beasly Firm generates some of the most insightful legal commentary that I've ever come across.  You name the topic--- from legal advertising to complex injury litigation--- and Max not only has a provoking thought-- but explains the issue with such depth that you'll feel like you've just read a textbook!

No Training Will Prevent Situations Involving Stupidity From Occurring At Some Nursing Homes

Recognizing that staff may lack training in certain areas essential to patient care, many nursing homes have begun to implement training programs at their facilities to help teach proper protocols-- and hopefully improve patient care.  While the training can be quite effective in terms of improving the satisfaction of patients and prevention of medical errors, no amount of training will suffice in order to prevent situations involving harm to patients stemming from a basic lack of common sense or carelessness.

I began thinking about how many common errors involving injuries to patients in nursing homes derive not from improper medical care-- but from an even more alarming situation--- when staff fail to utilize some of their basic sensible skills that they (hopefully) have accumulated over the course of their lives.  

After seeing a news blurb about the death of a patient at a California nursing home--- I truly wonder how some people not just obtained advanced degrees--- but made it past the fourth grade!

While I'm certain there are many, many, deaths at nursing homes every day, I strongly doubt that there many deaths as senseless as one involving the passing of an 81-year-old patient at Seton Medical Center who died from suffocation when a nurse tending to her left the cap on breathing tube that was placed into the woman's trachea.  

Following an investigation into the incident by the California Department of Public Health, the agency determined that at the time of the incident, the nursing home did not have a policy in effect for properly inserting the breathing tube--- commonly known as a 't-piece'. 

Policies are great when it comes to complex issues or discretionary acts, but remembering to remove the cap on a patient's breathing tube? Come on, if the staff member involved in this incident can't remember to remove the cap to a breathing tube, do we really want to given him / her another shot caring for disabled patients after they have had an opportunity to review a policy?

Related Nursing Homes Abuse Blog Entries:

What Good Is Medical Technology When It Is Not Used Properly?

Staff Must Be Diligent In Order To Avoid Clogged Breathing Tubes Amongst Nursing Home Patients

Failure To Clean Trach Tube Leads To Lawsuit

Nursing Home With History Of Problems Now Faces Wrongful Death Lawsuit Related To Poor Care of Patient With Tracheostomy Tube

Nursing Home Injury Laws: Kentucky

Number of nursing homes in Kentucky: 282

Patients living in Kentucky nursing homes: 22,990

Occupancy rates of Kentucky nursing homes: 90.0%

Average number of deficiencies at each Kentucky nursing home: 7.6

Percent of Kentucky nursing homes with serious deficiencies for actual harm to patient: 21.6%

Most common deficiencies at Kentucky nursing homes: Accident Environment, Food Sanitation, Professional Standards

Distribution of ownership of Kentucky nursing homes:  70% for profit,  27% non profit, 2 % government

Most populated cities in Kentucky: Louisville, Lexington, Owensboro, Bowling Green, Covington, Frankfort

Staffing levels at Kentucky nursing homes (daily hours): ): Above average,  4.1 total staff,  1.6 licensed nurse

Visit Nursing Home Injury Laws to learn more about Kentucky nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Family Resources To Assist With The Aging Process--- And Beyond

No one ever said that getting old was easy-- for the person--- or their family.  As we age, our physical and psychological needs change dramatically. Understanding these changes and providing for these needs is imperative for every person to live life to its fullest.

Even with the best care, the certainty of life's end is also something that we all must face.  Coming to terms with death and the accompanying issues in an important concept for the individual and family.

Below are some carefully selected resources that relate to senior health and the complex legal and emotional issues that come about at the end of life.

1) Mama’s Health 

http://www.MamasHealth.com

Mama’s Health provides tools that help educate people to lead healthier lives which makes people lead happier, more productive and lower stress lives.

2) The Health Care Blog

http://www.thehealthcareblog.com/the_health_care_blog/

All issues of healthcare are discussed by a multitude of authors. Topics range from the healthcare costs, family responsibility to patient safety.

3) Dementia Support Group

http://www.dailystrength.org/c/Dementia/support-group

A range of support groups to help those family members and caregivers of people with dementia. Discussions include support, treatments, discussions and life to life dealings.

4) Eldercare Expert Blog by Cheryl Mathieu, Ph.D., M.S.W.

http://www.agingpro.com/blog/

This blog helps teach caregivers and family how to know signs and symptoms of some of the elderly diseases and what to do if they are recognized. Cheryl shares ideas and ways to work with/for the elderly.

5) Retirement Living Sourcebook 

http://www.retirement-living.com/

A resource to help those in the Washington D.C. and surrounding area know, compare and contrast all the retirement, assisted living and nursing homes. Also allows those in the community become actively involved in the retirement/elderly community.

6) Ask Liza: Everyday Estate Planning by Liza Weiman Hanks

http://www.estateplanninglawblawg.com/

Liza gives information on how to go about writing and using wills, trusts, powers of attorney, living wills, estate taxes and probate court. It is an online resource to help people navigate the legalities of this sort of planning. 

7) Wills, Trusts, and Estates Prof Blog by Gerry Beyer

http://lawprofessors.typepad.com/trusts_estates_prof/

This teaches families and the elderly population how to plan their finances. It shows all aspects of wills, trusts and estate planning. 

8) Seniors for Living 

http://www.seniorsforliving.com/blog/

Discussions range from funding assisted living, independent living, alzheimers care, continuing care, retirement living and home care. It assists family members in choosing what is appropriate for their loved ones.

9) The Q Family Adventures Travel Blog by the Q family

http://www.theqfamilyadventures.com/

This is the real life travels and vacations of a suburban Atlanta family. It gives helpful advice, strategies and stories of travel with families and spouses. 

Gentle Massages Help Seniors Feel Less Pain; More Connected: Techniques You Can Learn To Calm Your Loved One


                                      

[Photo Caption: Giving your loved one a simple hand massage can brighten his or her day.]

As a lawyer who makes frequent nursing home visits, I’m still amazed by the impersonality of it all - the blipping machines; the scary tubes; the bland, institutionalized food. I’ve always felt a profound sense of isolation during these visits - a fraction of what nursing home patients must feel on a daily basis.

While medicine and machines might not go away anytime soon, I’m encouraged by the growth of another, more gentle, healing modality: massage for seniors.

In a recent Chicago Tribune article, called “Thriving Through Touch,” several massage experts say seniors experience dramatic emotional boosts from massage.

“We know that just the touching of a person to another person, just the warmness, creates a sense of calmness and security,” said Tara Cortes, executive director of the Hartford Institute for Geriatric Nursing at New York University.

Massage also helps seniors get physically stronger: touch stimulates special receptors under the skin, which reduces the stress hormone cortisol.

But best of all is the fact that massage can be safely administered by loved ones, in an atmosphere of trust and caring. With just a bit of patience and learning, family members can master basic skills.  

Sharon Pusczko, owner of the Day-Break Geriatric Massage Insitute in Indianapolis, offers the following beginning exercises for family members:

  • Arms: Wrap both of your hands around your loved one’s wrist, and gently compress and release. Slowly work your way up the arm with the same gentle motion, always keeping in mind to massage toward the heart.
  • Hands: Using your thumbs, massage the palms with circular strokers. Try working your way up each finger with the same squeeze-and-release motion. Take care not to massage the top of the hand, as that skin’s particularly thin.
  • Feet: Again using your thumbs, massage the soles of the feet in an outward circular motion. This movement helps loosen up connective tissue.
  • Back and shoulders: Have your loved one sit on a chair. Gently place your palm on your loved one’s sacrum area at the base of the spine. Make circles on the muscles on either side of the spine, being careful not to massage any bone.


The article reminds family members to check with doctors before attempting any massage. Some medications, like blood thinners, might make skin bruise more easily.

Resources:

Hand Massage Enhances Nursing Home Residents’ Comfort and Satisfaction With Care March 24, 2009 Massage Magazine

Nursing Home Injury Laws: Kansas

Number of nursing homes in  Kansas: 337

Patients living in Kansas nursing homes: 18,786

Occupancy rates of Kansas nursing homes: 83.2%

Average number of deficiencies at each Kansas nursing home: 15.2

Percent of Kansas nursing homes with serious deficiencies for actual harm to patient: 31.8%

Most common deficiencies at Kansas nursing homes: Accident Environment, Comprehensive Care Plans, Unnecessary Drugs

Distribution of ownership of Kansas nursing homes: 50 % for profit,  38% non profit, 13 % government

Most populated cities in Kansas: Wichita, Overland Park, Kansas City, Topeka, Olathe

Staffing levels at Kansas nursing homes (daily hours):Above average, 3.8 total staff,  1.3 licensed nurse

Visit Nursing Home Injury Laws to learn more about Kansas nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

10 Resources To Help Families Transition Their Loved One To A Nursing Home

The transition to a life in a nursing home or assisted living facility usually a difficult process for both the individual involved as well as their family.  Even the most well laid plans for transition to a skilled nursing facility are usually accompanied by many questions that may never have presented themselves until the family has had time to appreciate the change in circumstance.

While transitions such as this will never be easy, there are many different resources to assist with all different aspects as people begin new aspects of their lives.  Below are 10 resources that many of our clients have found to be especially helpful for them as they take on new endeavors.

1) Caregiver list 

http://www.caregiverlist.com/blog/Julie/Default.aspx

This blog gives updates on important health care information for the elderly. It helps those who are caregivers properly care for the elderly.

2) ElderLaw Answers 

http://www.elderlawanswers.com/

This gives an array of answers to some of the legal questions that are faced by the elderly population in the United States. It also gives people information on elder law attorneys across the nation.

3) Silver Innings – Blog for Senior Citizens 

http://silverinnings.blogspot.com

This is a universal blog about the elderly, family and caregivers that show what the elderly community around the world is like.

4) Nurse Virginia Blog by Virginia Garderding, R.N.

http://www.nursevirginiablog.com

Virginia talks about elderly care and what the caregivers should expect and how the caregivers should treat those they are caring for. Through her blog and book, Virginia shows how to care for the elderly with dignity.

5) Hospice and Nursing Homes Blog by Frances Shani Parker

http://hospiceandnursinghomes.blogspot.com/

Frances writes about anything associated with elder care, hospice, palliative care, nursing homes, dementia, caregiving and seniors. She keeps topics up to date.

6) Hospice and Caregiving Blog 

http://blog.hospicefoundation.org/

This blog describes level of care and options for the caregiver during hospice and the end of life experience.

7) Boca Home Care Services

http://www.bocahomecareservices.com/blog/understanding-medicare-home-care-benefits/

Boca Home Care Services provides different levels and types of care for the elderly in the Boca Area. They tailor their staff to meet specific needs of patients.

8) Vida, Inc. Senior Resource 

http://www.vidaseniorresource.com/

Vida Inc. Helps connect seniors with senior care specialists who help in caring for specific needs. They provide home care, assisted living and senior care resources.

9) Care Trak – Home Care LLC 

http://www.caretrakhc.com/elder-care-blog-caretrak-home-care/

Care Trak helps people in their own homes. They provide safety and foster independence.

10) Skilled Nursing Facilities.org 

http://www.skillednursingfacilities.org/blog/

This blog incorporates many realms of elder care and needs. This is a nationwide directory that provides quality ratings to facilities across the United States.

The influx of felons into main-stream nursing homes. It may be legal, but does it pose a threat to granny?

In California, the never ending quest to chop money from state budgets has taken a new turn as state prison officials have initiated a new medical parole program which allows medically incapacitated felons to utilize the services of private nursing homes. 

Starting in 2010, the California Correctional system placed 29 inmates--- not parolees or people whom have already served their time--- but real, hardened criminals--- whom have suffered form some type of medical incapacity that they now require medical care; into the hands of skilled nursing facilities throughout the state.

Under a medical parole policy chronicled recently in a New York Times' article, "When the Nursing Home Resident in the Next Room is a Convicted Criminal", a state board determines if the patient is indeed medically incapacitated and eligible for placement at facility in the state. Once placed, the inmate is treated just like any other patient at the facility and can go about his daily activities without the supervision of any of the security detail offered in a jail.

While most of the inmates placed in skilled nursing facilities outwardly appear incapable of perpetrating any of the violent acts that may have caused them their original problems, the Times article highlights how the subjectivity involved in determining an inmates disability has resulted in several situations where some inmates may still be capable of physically or psychologically imposed themselves on other patients or staff.

While the medical parole plan, saves the state more than $19 million annually, the other real winners in this situation are the facilities where these inmates are placed.  Rather than being completely reliant on government stipends, the medical parole program explicitly allows the state to pay a 30% premium over standard Medicare rates as a method of enticing facilities to participate.

As a lawyer who has seen the devastation firsthand when violent people are permitted access to exceptionally vulnerable nursing home patients, I am somewhat skeptical about the long-term viability of this program.  While in theory many of these inmates may be completely incapacitated, what happens in the exceptional case when the patients makes a significant recovery and is able to physically or psychologically bully another patient or staff.  Worse yet, without any ongoing monitoring, what's to keep the inmates 'friends' or 'associates' from paying a visit?

Time will tell, but my guess is that this program's duration is limited.

Related Nursing Homes Abuse Blog Entries:

Registered Sex Offender Attacks Fellow Resident in Iowa Nursing Home

Where Will Criminals Go When They Need Skilled Nursing Care?

What Can Nursing Homes Do To Protect Patients From Violence Within Facilities

Is Assisted Living Facility To Blame For Murder Of Patient?

Nursing Home Injury Laws: Iowa

Number of nursing homes in Iowa: 445

Patients living in Iowa nursing homes: 25,676

Occupancy rates of Iowa nursing homes: 80.3%

Average number of deficiencies at each Iowa nursing home: 9.0

Percent of Iowa nursing homes with serious deficiencies for actual harm to patient: 20.9%

Most common deficiencies at Iowa nursing homes: Professional Standards, Accident Environment, Food Sanitation

Distribution of ownership of Iowa nursing homes:  53% for profit,  43% non profit, 4 % government

Most populated cities in Iowa: Des Moines, Cedar Rapids, Deavenport, Sioux City, Iowa City

Staffing levels at Iowa nursing homes (daily hours):Above average,  3.5 total staff,  1.3 licensed nurse

Visit Nursing Home Injury Laws to learn more about Iowa nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

New Facility Promises To Put the "Home" in "Nursing Home"





[Caption: The Highpointe Nursing Home in Buffalo, NY, hopes to make rooms like this one obsolete.]

Whenever I think of the typical Western nursing home room, I picture coldness and sterility. Though medically efficient, most nursing home rooms I see lack any sense of real human warmth.

So I was happy to read about a brand-new facility in Buffalo, NY, that’s putting an emphasis on residents’ comfort and well-being. According to a story in the Buffalo News, the $64 million “Highpointe on Michigan” will make residents seem truly “at home.”

“The driving principles were to promote the residents’ dignity...and to give them an environment that’s friendly, full of green space, and full of life,” said James R. Kaskie, CEO of Buffalo-based Kaleida Health.

To Kaleida executives, that meant courtyards, fireplaces, warm colors and a deluxe Jacuzzi. It also meant changing unit names to familiar-sounding locations, such as Hamlin Park and Kaisertown.

It’s long been known that immediate surroundings have a powerful effect on nursing home residents. In a report from 1985, the NIH notes that:

“Awareness that interior design does indeed impact on overall quality of life should lead the nursing home administrator to collaborate with residents, staff and families and to share their input with professional design consultants.”

While most nursing homes still have a long way to go, there seems to be a national movement toward more “humane” design. I’m thinking in particular of the “Green House” project, which so far has more than 100 homes in 27 states.

While it’s vitally important to design homes based around patients’ health, I think it’s equally important to remember that surroundings themselves can impact a patient’s well-being dramatically.

Resources:

Reformers Seek to Reinvent Nursing Homes June 22, 2005 NPR

Nursing Home Injury Laws: Indiana

Number of nursing homes in Indiana: 495

Patients living in Indiana nursing homes: 38,778

Occupancy rates of Indiana nursing homes: 80.8%

Average number of deficiencies at each Indiana nursing home: 12.8

Percent of Indiana nursing homes with serious deficiencies for actual harm to patient: 39.8%

Most common deficiencies at Indiana nursing homes: Accident Environment, Clinical Records, Comprehensive Care Plans

Distribution of ownership of Indiana nursing homes: 66% for profit,  25% non profit,  9% government

Most populated cities in Indiana: Indianapolis, Fort Wayne, Evansville, South Bend, Gary

Staffing levels at Indiana nursing homes (daily hours): ): Above average, 3.8 total staff,  1.6 licensed nurse

Visit Nursing Home Injury Laws to learn more about Indiana nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Nursing Home Injury Laws: Illinois

Number of nursing homes in Illinois: 789

Patients living in Illinois nursing homes: 75,218

Occupancy rates of Illinois nursing homes: 78.6%

Average number of deficiencies at each Illinois nursing home: 9.3

Percent of Illinois nursing homes with serious deficiencies for actual harm to patient: 42.7%

Most common deficiencies at Illinois nursing homes: Accident Environment, Professional Standards, Quality of Care

Distribution of ownership of Illinois nursing homes: 70% for profit,  26% non profit,  4% government

Most populated cities in Illinois: Chicago, Aurora, Rockford, Joliet, Naperville, Springfield

Staffing levels at Illinois nursing homes (daily hours): ): Above average, 3.6 total staff,  1.4 licensed nurse

Visit Nursing Home Injury Laws to learn more about Illinois nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Terms To Better Understand Your Nursing Home

For families seeking information on a particular nursing home or additional information about a specific event, the need for such information usually comes at a time when external pressures abound.  In order to fully appreciate such information, it is important to have a complete grasp of the terms involved. 

I was happy to find concise definitions of many nursing home terms that pop up both in the nursing home selection process and beyond recently published by the Detriot Free Press. I frequently receive inquiries from blog readers about such terms, so I decided it would be worthwhile to include them here.

Violations: Though nursing homes face federal and state violations, the violations in this database track federal violations only. They can range from unacceptable noise levels to dangerous food or water temperatures to staff abuse.

Serious violations: Federal citations that caused "actual harm" to residents or placed residents in immediate jeopardy of serious injury or death.

CMS 5-star rankings: The federal rating system for nursing homes, based on health inspections, staffing levels and quality measures. Scores range from 1 (much below average) to 5 (much above average). Each of the three measures is combined for an overall star-rating.

Overall: Geared for consumers, this overall rating by the U.S. Centers for Medicare & Medicaid Services (CMS) is based on a number of variables drawn from health inspections, how well a facility is staffed with nurses, and information about residents' health and well-being.

The rating should be used only as a starting point when choosing a nursing home. Follow up with questions and at least one visit, preferably more, before making a choice. 

Health inspection: To receive Medicare or Medicaid funds, nursing homes must meet over 180 regulatory standards designed to protect nursing home residents. An inspection team makes regular inspections and responds to complaints.

Staffing: This is based on numbers of registered nurses, licensed practical nurses and nurse aides who worked in the two weeks before an inspection. It does not include other staff, like clerical or dietary aides.

The rating takes into account that some nursing homes have sicker residents who may require more care.

R.N. staffing: This star rating is based on the number of hours worked by registered nurses each day in two weeks before an inspection.

The rating takes into account that some nursing homes have sicker residents who may require more care.

Quality measure: Nursing homes must regularly assess residents about health, physical functioning, mental status, and general well-being.

Certified: Often used in connection with a "certified" bed or facility, this means that the home follows standards developed by state inspectors and the U.S. Centers for Medicare & Medicaid Services (CMS) and therefore may accept Medicare and Medicaid funds to pay for resident care.

Resident and family councils: Resident or family councils meet with nursing home staff to discuss problems and exchange ideas for quality improvement.

Rank in state: Rankings are generated by U.S. Centers for Medicare and Medicaid Services (CMS) in June 2011 based on three years of health violations and site visits. Two Michigan homes have not yet been ranked.

Continuing care retirement community: A community or complex that includes a range of services for the aging, from assisted living that offers minimal help to seniors to around-the-clock skilled nursing to end-of-life care. Often, seniors may move here while still independent, and remain for the rest of their lives.

Special focus facility: A watch list of troubled nursing homes as determined by states and the U.S. Centers for Medicare & Medicaid Services (CMS). It places the facility under greater scrutiny by inspectors. In Michigan, there are four. If one is added to the list, another "graduates."

Medicare: In nursing homes, these funds are generally used for short-term stay residents undergoing rehab.

Medicaid: In nursing homes, these funds can cover extended stays for those who are financially-eligible. 

Civil money penalties: Fines levied against nursing homes for violations.

Denial of payment for new admissions: One of the ways to leverage better care from nursing homes, the U.S. Centers for Medicare & Medicaid Services will temporarily or permanently cut off funds to nursing homes as they take in new residents.

Total number of residents: This is drawn from a two-week period prior to inspection. 

Total number of staff hours per resident per day: These hours are based on licensed staffing levels -- registered nurses and licensed practical nurses -- in a two-week period prior to an inspection. Certified nurse aides are not licensed. 

The hours are reported by nursing homes to the state.

Number of CNA hours per resident per day: These hours are based on certified nurse aide staffing levels in a two-week period prior to an inspection. The hours are reported by nursing homes to the state.

Number of RN hours per resident per day: These are based on registered nurse staffing levels in a two-week prior to inspection.

These hours are reported by the nursing homes to the state.

For more information about nursing home terms, check out the glossary at our Nursing Home Injury Laws site.

Nursing Home Injury Laws: Idaho

Number of nursing homes in Idaho: 79

Patients living in Idaho nursing homes: 4,422

Occupancy rates of Idaho nursing homes: 71.8%

Average number of deficiencies at each Idaho nursing home: 13.4

Percent of Idaho nursing homes with serious deficiencies for actual harm to patient: 49.4%

Most common deficiencies at Idaho nursing homes: Accident Environment, Food Sanitation, Unnecessary Drugs, Quality of Care

Distribution of ownership of  Idaho nursing homes:  58% for profit,  16% non profit, 18 % government

Most populated cities in Idaho: Boise, Nampa, Meridian, Pocatello, Idaho Falls

Staffing levels at Idaho nursing homes (daily hours): Above average,  4.6 total staff,  1.9 licensed nurse

Visit Nursing Home Injury Laws to learn more about Idaho nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Do highly rated nursing homes give families a false sense of security?

quality controlYesterday I was contacted by the daughter of a nursing home patient who died after suffering a fall in the bathroom of a well-known-- and highly rated-- nursing home in Chicago

After several minutes of discussion about her her father's physical condition and her recollection of safeguards that were to be implemented by the facility to prevent falls, she then began to question if the facility really did anything wrong-- in light of its fine reputation.  

Sure, having a good reputation is an important thing for any business--- nursing homes included-- but as a patient or family member, it is important to remember that a facilities fine reputation in the past does not mean that the facility gets to automatically maintain that reputation in the future.  Further, even the most highly regarded facilities are staffed by ordinary humans--- who do make mistakes when it comes to patient care.

As a lawyer who sees incidents stemming from negligent care--- at both --highly rated--- as well as facilities that may not have such great track records, I always suggest to families that each incident should be reviewed independently of the nursing home or hospitals rating or reputation in the community as it really has little bearing on the incident at issue.

When medical mistakes are made at more esteemed facilities-- nursing home and hospitals, I do see more of these facilities recognize the error for what it is and make and effort to evaluate meritorious claims with an eye towards resolution.

The bottom line is that while a nursing home's reputation may be excellent, it should not be a deterrent when it comes to pursuing claims involving poor care-- isolated incident or not. 

Below is a list of Chicago-land nursing homes that deserve recognition for receiving a 5-star overall rating from Medicare.

Continue Reading

Nursing Home Injury Laws: Hawaii

Number of nursing homes in Hawaii: 48

Patients living in Hawaii nursing homes: 3,871

Occupancy rates of Hawaii nursing homes: 93.0%

Average number of deficiencies at each Hawaii nursing home: 10.7

Percent of Hawaii nursing homes with serious deficiencies for actual harm to patient: 10.4%

Most common deficiencies at Hawaii nursing homes: Infection Control, Food Sanitation, Quality of Care

Distribution of ownership of Hawaii nursing homes:50% for profit,  29% non profit,  21% government

Most populated cities in Hawaii: Honolulu, Hilo, Kailua, Kaneohe, Kapolei

Staffing levels at Hawaii nursing homes (daily hours): Above average,  3.9total staff,  1.3 licensed nurse

Visit Nursing Home Injury Laws to learn more about Hawaii nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Nursing Home Injury Laws: Georgia

Number of nursing homes in Georgia: 355

Patients living in Georgia nursing homes: 34,516

Occupancy rates of Georgia nursing homes: 87.6%

Average number of deficiencies at each Georgia nursing home: 7.2

Percent of Georgia nursing homes with serious deficiencies for actual harm to patient: 18.0%

Most common deficiencies at Georgia nursing homes: Quality of Care, Accident Environment, Housekeeping

Distribution of ownership of Georgia nursing homes: 65 % for profit, 28 % non profit,  6% government

Most populated cities in Georgia: Atlanta, Augusta, Columbus, Savannah, Athens

Staffing levels at Georgia nursing homes (daily hours): Above average,  3.6 total staff,  1.4 licensed nurse

Visit Nursing Home Injury Laws to learn more about Georgia nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Nursing Home Injury Laws: Florida

Number of nursing homes in Florida  : 673


Patients living in Florida nursing homes: 71,373


Occupancy rates of Florida nursing homes: 87.8%


Average number of deficiencies at each Florida nursing home: 10.7


Percent of Florida nursing homes with serious deficiencies for actual harm to patient: 8.2%


Most common deficiencies at Florida nursing homes: Professional Standards, Food Sanitation, Comprehensive Care Plans


Distribution of ownership of Florida nursing homes: 71 % for profit,  26% non profit, 2 % government

Most populated cities in Florida: Jacksonville, Miami, Tampa, St. Petersburg, Orlando, Tallahasse


Staffing levels at Florida nursing homes (daily hours): Above average,  4.6 total staff,  1.6 licensed nurse


Visit Nursing Home Injury Laws to learn more about Florida nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Nursing Home Injury Laws: District of Columbia

Number of nursing homes in District of Columbia: 19

Patients living in District of Columbia nursing homes: 2,519

Occupancy rates of District of Columbia nursing homes: 92.8%

Average number of deficiencies at each District of Columbia nursing home: 22.0

Percent of District of Columbia nursing homes with serious deficiencies for actual harm to patient: 21.1%

Most common deficiencies at District of Columbia nursing homes: Food Sanitation, Housekeeping, Quality of Care

Distribution of ownership of District of Columbia nursing homes: 47 % for profit,  42% non profit, 11% government

Staffing levels at District of Columbia nursing homes (daily hours):Above average, 4.4 total staff, 1.8 licensed nurse

Visit Nursing Home Injury Laws to learn more about District of Columbia nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Elder Care Resources

grandparents.jpgWhile the focus of my Nursing Homes Abuse Blog is on nursing home care-- shocking, I know-- today seniors have more options than ever when it comes to selecting a living arrangement for their individual needs and preferences.  

Below, I have attempted to highlight several websites that focus on elder rights from the perspective of both professionals as well as from caregivers themselves.  If nothing else, many of these websites can offer support for seniors and caregivers alike as they learn that the issues they face are not necessarily unique.

1) Eldercare ABC Blog 

http://eldercareblog.com

This blog deals with all sorts of issues in caring for the elderly ranging from financial elder abuse, aging parents to average nursing home costs.

2) Elder Abuse by David Kessler 

http://elder-abuse-cyberray.blogspot.com

David discusses the prevalence and problems with elderly abuse in society today. He discusses ways to detect and report the abuse. 

3) Senior Living Information Blog 

http://www.seniorlivinginfo.com

Lisa Sneddon heads this Chicagoland area blog and describes the process of aging and finding home placement for the elderly when needed.

4) National Center for Creative Aging – NCCA

http://www.creativeaging.org/creativity-and-aging-blog/

This helps seniors and everyone else review the older adults as an asset to society. It focuses on accomplishments and potential in what older America can do for the rest of America.

5) Elder Care Diary 

http://www.eldercarediary.com/

This blog is written by Marianne and Ken Smith who chronicle their personal experience in watching and caring for the parents who are aging. They have a forum for others to participate in discussions. They also provide a resource directory from community involvement to living placement.

6) Senior Care Blog 

http://www.101eldercare.com/blog/

A comprehensive look at resources on the internet for senior citizens, family members and caregivers. There are also links to current events, articles and service providers that seniors can use.

7) DeathCare.com 

http://www.deathcare.com/about

This site and blog comprehensively covers the death care industry and current events. People who are interested in learning about death preparations, legal ramifications, living placement, etc. would find this blog helpful.

8) CareCrunch – Empowering Family Caregivers

http://www.carecrunch.com/blog/

The caregivers of seniors find this very useful because they have up to date information on new trends and ideas on caring for their clients. Most caregivers provide care for many years and this enlightens them to new ideas so they do not get into the monotony of day to day caring.

9) Inside Elder Care 

http://www.insideeldercare.com/reviews/senior-care-blogs-best-of-web-2011/

Ryan Malone, blog author, helps inform the readers to make elder care experiences a positive influence. Ryan has a very personal history of his mother suffering a stroke and the process of recovery after with complications.

10) Home Care Assistance 

http://www.homecareassistance.com/content/?c=86

This blog allows professionals in the elderly care industry to discuss events, news, problems, that arise within the homecare and nursing home industries. It allows for open and honest communication for people with hands on experience.

Nursing Home Injury Laws: Delaware

Number of nursing homes in Delaware  : 48

Patients living in Delaware nursing homes: 4,245

Occupancy rates of Delaware nursing homes: 84.6%

Average number of deficiencies at each Delaware nursing home: 16.9

Percent of Delaware nursing homes with serious deficiencies for actual harm to patient: 39.6%

Most common deficiencies at Delaware nursing homes: Quality of Care, Comprehensive Care Plans, Accident Environment

Distribution of ownership of Delaware nursing homes:  52% for profit,  38% non profit,  10% government

Most populated cities in Delaware: Wilmington, Dover, Newark, Pike Creek, Bear

Staffing levels at Delaware nursing homes (daily hours): Above average, 4.2 total staff,  1.8 licensed nurse

Visit Nursing Home Injury Laws to learn more about Delaware nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Are Protective Agencies Doing Enough To Protect Nursing Home Patients?

When it comes down to it, absent situations involving serious crimes where police are involved, it is up to regulatory agencies-- primarily those within the state--  to ensure that nursing home patients are properly looked after when they are in a facility.  But, what happens when the agencies with this important responsibility fail to properly do their jobs and situations involving poor care are permitted to exist-- or even flourish after the agency has supposedly disciplined the facility.

I suspect that if you ask Tom Masseau of the Michigan Protection and Advocacy Services (MPAS), he'd suggest that the state's regulatory agencies need to take a much stronger position when it comes to both overseeing fragile nursing home patients and ensuring that facilities actions necessary to eradicate unacceptable conditions at their facilities.

Highlighting two episodes of horrific patient care involving Michigan nursing homes, Masseau chronicles how nursing problems are allowed to persist even after state surveyors note their violations.  In particular, two episodes involving severely neglected nursing home patients with maggots literally infesting the patient were documented by state officials during inspections, yet no follow-up was done to assure that these filthy conditions were rectified. 

Maggots, yes maggots...

The first repulsive example of neglect involves a female patient living in a Michigan nursing home with maggots in her genitalia and an undiagnosed / untreated hip fracture.  Similarly, another disturbing incident the MPAS report highlights involves an episode where maggots were allowed to infiltrates a patient's tracheotomy tube.  In fact, the trach had become so full of maggots that they needed to be suctioned by staff.

While both of these unacceptable conditions were documented by officials with the state's Department of Licensing and Regulatory Affairs in the form of written reports, the MPAS report notes little follow through on the part of the state state to ensure that the situations were properly corrected--- or that other patients were not suffering from similar plights.

While I sympathize with the plight of many agencies that recently have had their budgets slashed by lawmakers, I find the mere existence of this conditions simply unacceptable.  As the regulatory agency essentially responsible for policing nursing homes, it is essential that these conditions are both properly documented by surveyors and forcibly corrected to ensure that other patients don't suffer similar plights.  If these agencies don't correct these dangerous problems then who will?

Learn more about the critiques of Michigan nursing homes here.

Related Nursing Homes Abuse Blog Entries:

Learning About Nursing Homes, Part 1: Nursing Home Surveys

Who Regulates Nursing Homes?

Nursing Home Surveyor Explains Applicability Of Federal & State Nursing Home Regulations

Happy Thanksgiving Wishes From The Nursing Homes Abuse Blog

turkey.jpg

Hard to believe, but Thanksgiving officially marks the start of the holiday season.  As I thumb through the last few sheets on my desk calendar for 2011, I truly have many things to be thankful for: family, friends, colleagues, clients ---- and let's not forget blog readers!  

Thank you for your comments, emails, suggestions and constructive criticisms! it is through the interaction with many readers that we continue to modify-- and hopefully improve this site.  Again, best wishes and warm regards during this joyous time.  

As Budgets Get Slashed, Regulation Of Long Term Care Facilites Takes Back Seat

A disturbing example of the the fall-out from state budget cuts, will be the escalation of unregulated skilled nursing and assisted living facilities caring for seniors and the disabled.  Delayed inspections--- or inspections of facilities that simply never occur--- will become the new 'norm' in many states that simply do not have sufficient manpower to regulate facilities within their state.  

Just recently, Maryland's layoffs at the state's Office of Health Care Quality, has made it physically impossible for officials from the state to conduct mandated surveys of long term care facilities within the state.  According to a state investigation, more than one-half of assisted living facilities and more than three-quarters of facilities caring for the disabled were not inspected for patient safety in 2010.

In addition to the lack of facility oversight by state officials, an article in the Washington Examiner revealed how Maryland erroneously issued many (157 ) CNA certificates to people who did not meet the standards or who never applied for the position. 

As a nursing home lawyer, I see the fallout of similar state budget reductions on a daily basis as episodes of patient injury and neglect fail to get investigated on timely basis.  Without any quick fix for this issue, I fear that more people living in long-term care facilities will face a new era of living in facilities where regulations have little practical meaning and facilities will begin dispensing care with the understanding that there's little repercussion for their acts.

In addition to the harm inflicted on the individuals, hopefully state officials will soon recognize that staffing reductions are simply not cost effective in the long term.  As more residents suffer harm, many of them will look to aid from the states to assist with their hardship.  Without sufficient investigative power, the responsible parties will most likely evade paying for such care as they are required to do under the law.

Related Nursing Homes Abuse Blog entries:

Ongoing Nursing Home Abuse Results In Closure Of Dangerous Facility

Maybe The Negative News Headlines Are Beginning To Get Inspections Of Long-Term Care Facilities Ramped Up

40 Violations In A Year, Yet Nursing Home Disputes Safety Concerns & Fights To Remain Open

Who Regulates Nursing Homes?

Nursing Home Injury Laws: Connecticut

Number of nursing homes in Connecticut  : 241

Patients living in Connecticut nursing homes: 26,139

Occupancy rates of Connecticut nursing homes: 90.3%

Average number of deficiencies at each Connecticut nursing home: 11.3

Percent of Connecticut nursing homes with serious deficiencies for actual harm to patient: 34.9%

Most common deficiencies at Connecticut nursing homes: Professional Standards, Quality of Care, Accident Environment

Distribution of ownership of Connecticut nursing homes:  78% for profit,  20% non profit,  1% government

Most populated cities in Connecticut: Bridgeport, New Haven, Hartford, Stamford, Waterbury

Staffing levels at Connecticut nursing homes (daily hours): ): Above average, 4.0 total staff,  1.5licensed nurse

Visit Nursing Home Injury Laws to learn more about Connecticut nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Nursing Home Injury Laws: Colorado

Number of nursing homes in Colorado  : 212

Patients living in Colorado nursing homes: 16,358

Occupancy rates of Colorado nursing homes: 82%

Average number of deficiencies at each Colorado nursing home: 16.4

Percent of Colorado nursing homes with serious deficiencies for actual harmto patient: 42.5%

Most common deficiencies at Colorado nursing homes: Accident Environment, Professional Standards, Quality of Care

Distribution of ownership of Colorado nursing homes:  62% for profit,  20% non profit,  9% government

Most populated cities in Colorado: Denver, Colorado Springs, Aurora, Lakewood, Fort Collins

Staffing levels at Colorado nursing homes (daily hours): ): Above average,  4.0total staff, 1.7licensed nurse

Visit Nursing Home Injury Laws to learn more about Colorado nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Wisconsin To Ease Nursing Home Penalties

wisconsin.jpgWhen it comes to ensuring that nursing homes are compliant with regulations to protect patients, the enforcement of such provisions falls primarily on agencies within the state.  When violations are discovered agencies have several options available to them in their arsenal including issuing a written citation that could become part of the facilities permanent record--- and issuing fines. 

Theoretically, imposing these sanctions would provide enough encouragement for poorly performing facilities to clean up their act.  That is, unless the nursing home is located in Wisconsin.

A new bill (Assembly Bill 302) that has been passed by the Wisconsin Assembly and Senate would lessen some of the regulatory bite in the arsenal that the Wisconsin Department of Health Services has to enforce infractions discovered in nursing homes within the state.  

The new bill would limit the Department of Health Services from issuing citations and fines stemming from a singular incident to either federal or state law--- not both as is currently the practice in the state.  In addition to the reduced penalties, the new legislation would also give nursing homes more time to pay the levied fines.

While I appreciate the argument that facilities shouldn’t be subjected to duplicative sanctions, I fear that the reduced penalties may not be enough of an incentive for some nursing homes to improve the care they provide to their patients.

Read more about this bill impacting Wisconsin nursing homes here.

Related Nursing Homes Abuse Blog entries:

What good are nursing home fines when they're not enforced?

Shouldn't Nursing Home Fines Be Reflective Of The Type Of Violation Committed?

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

Heat Likely To Blame For The Death Of Nursing Home Patient In Wisconsin

Study Suggests That Surgery Has Limited Use On Nursing Home Patients

elderly in hospital.jpgPerhaps nursing home patients are more frail and vulnerable than we already thought? A recent study published in the Annals of Surgery essentially concluded that nursing home patients are significantly more vulnerable to complications following a surgery than their peers living in the community.  

The study looked at sample groups of both nursing home patients and elderly people living in the community and the differences between the two groups are striking.  For example when researchers looked at surgical procedures, they discovered:

  • Nursing home patients were six times more likely to die within a month following the removal of their appendix
  • Surgery for bleeding ulcers claimed the lives of 42% of nursing home patients, while the same procedure only claimed 26% of the lives of patients living in the community
  • Colon surgery death rates were more than 50% higher for nursing home patients compared with their peers, claiming 32% of nursing home patient lives vs. 13% of their community peers.

In addition to significantly higher mortality rates, researchers similarly found that nursing home patients had more post-operative complications and required more rehabilitative treatment than similarly situated people living outside of skilled nursing facilities.  According to Dr. Emily Finlayson, the studies lead researcher, "[p]atients who survived had to undergo invasive procedures after surgery which means more time on the ventilators, more people getting feeding tubes and more time in the ICU."

Certainly, this study demonstrates both the extreme vulnerability of the nursing home population in general and how many seemingly common ailments may need to be addressed differently by the medical community when treating this group.  Similarly, treating physicians need to be realistic about treatment option with the families of nursing home patients as their prognosis may be far more grim than that of other patients with similar procedures.

Related:

Failure To Properly Treat Surgical Wounds Results In Settlement Of Wrongful Death Case With Nursing Home

States Move To More Transparency Regarding Medical Malpractice & Hospital Errors

Nursing home residents face greater surgery risks, November 4, 2011 Reuters.com

Never Event #6: Foreign Objects Left In During Surgery

Nursing Home Injury Laws: California

Number of nursing homes in California  : 1,226

Patients living in California nursing homes: 100,578

Occupancy rates of California nursing homes: 84.8%

Average number of deficiencies at each California nursing home: 12.6

Percent of California nursing homes with serious deficiencies for actual harm to patient: 11.8%

Most common deficiencies at California nursing homes: Food Sanitation, Quality of Care, Comprehensive Care Plans

Distribution of ownership of California nursing homes:  80% for profit,  16% non profit,  4% government

Most populated cities in California: Los Angeles, San Diego, San Jose, San Fracisco, Fresno, Sacramento

Staffing levels at California nursing homes (daily hours): Above average, 4.0total staff, 1.4 licensed nurse



Visit Nursing Home Injury Laws to learn more about California nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Nursing Home Injury Laws: Arkansas

Number of nursing homes in Arkansas  : 231

Patients living in Arkansas nursing homes: 17,822

Occupancy rates of Arkansas nursing homes: 72.8%

Average number of deficiencies at each Arkansas nursing home: 12.2

Percent of Arkansas nursing homes with serious deficiencies for actual harm to patient: 32.5%

Most common deficiencies at Arkansas nursing homes: Accident Environment, Quality of Care, Food Sanitation

Distribution of ownership of Arkansas nursing homes:  82% for profit,  14% non profit,  4% government

Most populated cities in Arkansas: Little Rock, Fort Smith, Fayetteville, Springdale, Jonesboro

Staffing levels at Arkansas nursing homes (daily hours): Above average, 4.2 total staff, 1.4 licensed nurse

Visit Nursing Home Injury Laws to learn more about Arkansas nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Nursing Home Injury Laws: Arizona

Number of nursing homes in Arizona  : 135

Patients living in Arizona nursing homes: 11,788

Occupancy rates of Arizona nursing homes: 76.7%

Average number of deficiencies at each Arizona nursing home: 17.8

Percent of Arizona nursing homes with serious deficiencies for actual harm to patient: 29.6%

Most common deficiencies at Arizona nursing homes: Professional Standards, Clinical Records, Quality of Care

Distribution of ownership of Arizona nursing homes: 79 % for profit,  20% non profit,  1% government

Most populated cities in Arizona: Phoenix, Tucson, Mesa, Glendale, Chandler


Staffing levels at Arizona nursing homes (daily hours): Above average, 4.0 total staff, 1.7 licensed nurse

Visit Nursing Home Injury Laws to learn more about Arizona nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Where Will Criminals Go When They Need Skilled Nursing Care?

Like it or not, many of us will rely on skilled nursing facilities-- commonly known as nursing homes-- to provide us with the medical care that we may not be able to provide for ourselves at some point in our lives.  Similarly, there is a sizable group of convicted felons who will require similar care for their needs.  So where will they go? 

In most jurisdictions, the answer is quite vague and generally simply ill-addressed as most states have not squarely addressed the issue.  The result of this delay and denial is that many convicted felons--- even those with particularly repulsive backgrounds--- may be living side-by-side with your family member. 

Just recently, I read about how officials in Kansas discovered seven registered sex offenders living at one nursing home alone! 

While it may be perfectly legal for nursing homes to admit people with criminal backgrounds--- including sex offenders, facilities still have a responsibility to provide a safe environment for all residents and visitors.  Given that most states require sexual offenders to register their location with the state, most nursing homes can easily do a search to determine if their patient is on such list.

As a lawyer who has represented people whom have been sexually abused by other residents and staff at nursing home with criminal records, I find these acts both disgusting and indicative of a culture of corporate greed that seeks to maintain maximum occupancy rates and paying staff the lowest wages possible.  Sadly, I think many nursing homes continue to skirt by by doing as little as they are required to do under the law.  Hopefully, victims of such horrendous incidents will come forward and demand safety changes that are direly needed.

Related Nursing Homes Abuse Blog Entries:

Never Discount The Real Impact Of Sexual Abuse On The Disabled

Chicago Nursing Home Patient Sexually Assaulted By CNA

Convicted Sex Offender Pulls From His Old Bag Of Tricks While Assaulting Elderly Nursing Home Patient

The Real Devastation Associated With Sex Abuse In Nursing Home Will Never Be Known As Most Acts Go Unreported & Unprosecuted

Nursing Home Injury Laws: Alaska

Number of nursing homes in   Alaska  : 15

Patients living in   Alaska   nursing homes: 625

Occupancy rates of   Alaska   nursing homes: 87.3 %

Average number of deficiencies at each   Alaska   nursing home: 7.5

Percent of   Alaska   nursing homes with serious deficiencies for actual harm to patient: 13.3%

Most common deficiencies at   Alaska    nursing homes: Food sanitation, Professional Standards, Infection Control

Distribution of ownership of   Alaska   nursing homes:  13% for profit, 40 % non profit, 47 % government

Most populated cities in Alaska: Anchorage, Fairbanks, Juneau, College, Ketchikan


Staffing levels at   Alaska    nursing homes (daily hours): Above average, 5.5 total staff, 2.1 licensed nurse

Visit Nursing Home Injury Laws to learn more about Alaska nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Nursing Home Injury Laws: Alabama

Number of nursing homes: 230

Patients living in Alabama nursing homes: 23,202

Occupancy rates of Alabama nursing homes: 86.8%

Average number of deficiencies at each Alabama nursing home: 6.2

Percent of Alabama nursing homes with serious deficiencies for actual harm to patient: Below national average, 15.7%

Most common deficiencies at Alabama nursing homes: Food sanitation, Accident Environment, Professional Standards

Distribution of ownership of Alabama nursing homes: 78% for profit, 14% non profit, 7% government

Most populated cities in Alabama: Birmingham, Montgomery, Mobile, Huntsville, Tuscaloosa

Staffing levels at Alabama nursing homes (daily hours): Above average 4.1 total, 1.5 licenced nurse

Visit Nursing Home Injury Laws to learn more about Alabama nursing homes and your legal rights.

**Data based upon 2009 CMS data, U.S. Department of Health and Human Service

Patient Advocates Provide An Extra Line Of Protection For Patients & Families In Nursing Homes

patient advocate.jpgThousands of regulations, countless different types of facilities---- ever-changing patient needs--- sometimes the best thing a family can do is to seek out the services of a patient advocate to help in exploring different options to to help ensure the rights of the patient are not compromised.

Below is a list of patient advocate sites that offer a variety of different services along with valuable information for families.

1) American Association for Homecare 

http://blog.aahomecare.org/

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

2) Pathway Medical Staffing 

http://pathway-medical.com/blog

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

3) Jacqueline’s Patient Advocacy Blog 

http://jacquelinespatientadvocacy.wordpress.com/

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

4) Suzanne Gordon 

http://www.suzannegordon.com/

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

5) RN Patient Advocates, PLLC 

http://patientadvocates.com/

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

6) Healthcare Whisperer 

http://healthcarewhisperer.com/Blog/

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

7) Nursezone.com 

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

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

8) North Carolina Estate Planning Blog

http://www.ncestateplanningblog.com/articles/nursing-homes/

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

9) California Health Advocates 

http://www.cahealthadvocates.org/pro.html

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

10) My Elder Advocate 

http://myelderadvocate.typepad.com/blog/

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

Nursing Home Documentary Shows What Life Is Like For Millions

The Patron Saints (Trailer) from Pigeon Projects on Vimeo.

I still recall my first visit to a nursing home--- the smells, the furnishings, the medical equipment--- and yes, the people!  While many of us have visited familiy or friends at a nursing home, we really have little appreciation for what life is like when the visitors go home.

A new documentary premeiring at the Toronto Film Festival aims to give us an idea of what nursing home life is really about.  Created by Brian Cassiday and Melanie Shatzky, the film promises to be a real eye opener.  While I won't be able to attend the festival, I look forward to its broader distribution.

Ohio Nursing Homes To Improve Patient Care Or Risk Receiving Lower Pay From State

institution.jpgPerhaps the biggest stigma associated with nursing homes is that they are large institutions that have little regard for personal preferences. 

Unfortunately, at many facilities this stigma is indeed accurate and reinforced on a daily basis as patients are essentially molded into complying with a program that is geared towards efficiency and cost-reduction.

Could the institutional approach to nursing home care be on the way out?

A new program proposed by an advisory counsel aims to improve the quality of life for many patients living in Ohio Nursing Homes by encouraging nursing homes to incorporate quantifiable quality measures or risk a reduction in their reimbursement rates.

Many of the proposed quality improvements include:

  • Flexibility as to bed time and wake up
  • Flexibility with bathing or showering
  • Limit the use of facility-wide paging to emergencies
  • Varied meal times

While the proposals obviously seem to empower patients with more options, officials are optimistic that the quality measures will also serve to promote better patient care with lower rates of staff turnover, a systemic problem that is commonly associated with patient abuse and neglect.

For nursing homes that receive payments from Medicaid (which funds about 70% of Ohio nursing homes) the plan would penalize facilities that opt not to comply with the proposals.   As proposed, facilities failing to achieve at least five of the quality measures would lose $16.44 in government funding per day for each patient.

I look forward to monitoring this important proposal that aims to improve the quality of life for thousands of nursing home patients in Ohio.  Hopefully, other states will take notice and begin to incorporate similar measures as the need to improve patient care has never been greater.

Related Nursing Homes Abuse Blog Entries:

Nursing Home's New Approach To Alzheimer's Care Promises To Improve The Quality Of Life For Patients

New Program Focuses On Staffing To Improve Patient Care In Nursing Homes

More Care Options for Seniors Leaves Some Nursing Home Operators Crying Poor

Insight On Nursing Homes From The Director Of An On-Line Community For Senior Care Professionals

Will Steep Reimbursement Cuts To Nursing Homes Jeporadize Patient Care?

The nursing home industry is set to become a little less profitable for nursing home operators as the government seeks to trim reimbursement rates by approximately 11%.  Set to take place next year, the proposed reductions cut out a huge billing opportunity that presently allows nursing homes to seek reimbursement for intensive treatments without actually proving the elevated level of care.

In the article reported in Bloomberg.com, the proposed cuts to funding from Medicare, nursing homes will be required to detail more of the treatments they provide to patients.

The closure of the billing bonanza will save taxpayers an estimated $3.87 billion in payments made to nursing homes. 

Tough times for the nursing home industry?

Shortly after the new reimbursement provisions were announced, nursing home giants Skilled Healthcare Group Inc. (SKH) and Kindred Healthcare (KND) were down 16% and 14% respectively.

7 Steps To Reduce The Stress Associated With Moving To A Nursing Home

A move into a nursing home is perhaps one of life's most stressful events.  After all, a transition into a nursing home not only accompanies major changes in every feasible aspect of the person's life: environment, schedule, people--- and yes, the realization that things will never go back to the way things were.

If the stress on the nursing home patient wins first prize, the stress put upon the family must be a close second!  Feelings of guilt abound out of the fact that some family may feel inadequate about their inability to care for a parent or grandparent under their own roof.  Additionally, in today's troubled economy, many families are further burdened with the extraordinary bills that accompany many living arrangements like nursing homes and assisted living.

Understanding that much of the stress associated with a nursing home move comes with the territory is an important initial step for families.  Additionally, here are some great stress reducers as proposed by Hanns Pieper, a professor of sociology and gerontology at the University of Evansville:

  1. Take parents concerns and questions seriously.  Recognize that a transition to a nursing home is a big deal.
  2. Get you parent in touch with the residents' council at the nursing home, this will help if issues arise after they move in.
  3. Help your parent navigate the facility.  Take them on a walk and show them where important areas are: bathrooms, cafeteria, activity rooms
  4. Establish a regular visiting schedule early on. This will help bring some predictability into your parent's life.
  5. Keep your visiting schedule.
  6. Encourage your parent to be as active as they are comfortable with--- and no more.  Do not make them feel guilty for not engaging in activities
  7. Be an advocate for your parent

As a nursing home lawyer who frequently sees problems after they develop, I can attest to the importance of advocating for family and friends.  Too often I see family intimidated because they may lack medical or nursing experience.  Don't be!  

As an advocate, all you need is your good sense.  If something doesn't look or sound right-- its probably not!  Catching a problem in the early on will not only demonstrate to the staff that mistakes are not acceptable, but will also ensure that your parents will remain as vigorous as possible as long as feasible.

Related:

Nursing Home Visits Are Likely Awkward For You & Your Loved One.... But It's Ok

The View Of Nursing Homes From The Eyes Of A Patient

Tips For Rewarding Nursing Home Visit

Short-Term Nursing Home Admission Proves Too Much For Elder Advocate

Twenty-four hours was enough for Deb Holtz at a Minnesota nursing home.  The 55-year-old cut short her admission to Langton Place after what she felt were repeated insults to her privacy by staff at the facility.  Like many nursing home patients, Holtz was intending on receiving short-term rehabilitation following a shoulder replacement.  

What makes Holtz different than your average nursing home patient is that she runs Minnesota's Ombudsman program for Long-Term Care.

What Holtz experienced during her recent nursing home stay was chronicled by the Star Tribune in a recent article, "Nursing home stay an eye-opened for advocate for elderly", describing the series of personal offenses during her stay that made her feel particularly vulnerable and dehumanized.

It was a little scary because you are part of a larger system.  I didn't feel like I had control of my environment or possibly my body.

While Ms. Holtz certainly had both the personal skills and the legal knowledge to advocate on her own behalf, the article quickly made me appreciative of how the rights of an elderly or disabled person could be trampled on by facilities soon after their admission.  

If there is anything positive to gain from Ms. Holtz's experience, hopefully her dissatisfaction with the patient experience will catch the attention of nursing home workers and administrators and cause them to reevaluate the way the treat patients.

Ironically, Minnesota's Ombudsman program for Long-Term Care received 2,500 complaints last year, with nearly half of the complaints centered around alleged violations of patients' rights at the facility.  Read more about the ordeal encountered by this nursing home advocate here.

Related Nursing Homes Abuse Blog Entries:

Nursing Home Ombudsmen Making A Difference In Patients' Lives

More Improvements At Medicare's 'Nursing Home Compare' Website

State Of Nursing Homes From A 'Nursing Home Reform Activist'

Are nursing home patients protected under federal law?

Happy Fourth Of July From The Nursing Homes Abuse Blog

Happy 4th of July!  As with all holidays, it's important to remember friends and relatives who may be unable to join in the fun due to illness or immobility.  Take a few moments out of your day and visit--- or at least call-- your family in a nursing home or assisted living facility.  

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Does Nursing Home Owners Judgment Need To Be Called Into Question When An Adminsitrator Is Hired That Has Track Record Of Substance Abuse?

The fentanyl-overdose death of a central Illinois nursing home administrator really called into question the judgment of the owners of Timbercreek Rehab & Healthcare Center for me.  Apparently, the owners of the Pekin, IL  facility weren't too concerned the fact that their administrator was on probation with the Illinois Department of Professional Regulation for 'substance abuse' issues at the time of his hire.

Despite a background, which would likely call into question the individuals judgment around controlled substances, the owns of Timbercreek put their administrator in charge of a lock box at the facility that was used to store narcotics and other medications for patients at the facility.

Apparently the temptation was a bit too much, as a coroner's investigation has now determined that the man stole fentanyl patches from patients and accumulated used medications rather than throwing them away to satisfy his compulsions.  The nursing home administrator apparently self-medicated himself on the job as he was found dead in his office at the nursing home.  During an investigation, detectives found remnants of fentanyl patches in the man's sock.

While we can look at incidents such as this as isolated events, to me, occurrences such as these scream a lack of basic judgment on the part of the facility owners.  How could this person's judgment not be impaired by the fact that he was taking strong pain medication in an uncontrolled manner?  How many patients' needs were neglected during this episode? Certainly, let's hope that this situation is a bit of a wake up call for nursing home management companies to select more appropriate people to fill roles as administrators at their facilities.

Related:

Fentanyl Overdose Leads To 1.6M Nursing Home Settlement

Drug Dealing Nursing Home Worker To Serve 3 Years In Jail

Morphine Intoxication Of Nursing Home Patient Results In Significant Jury Verdict

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Should Communication Classes Become Mandatory For Nursing Home Workers?

phoneI tend to harp on specific instances of misconduct where a nurse or nursing home employee makes and error that results in harm to a patient. 

While many of these occurrences are the result of poor judgement and inadequate training, I'm beginning to think that a deeper issue may be behind many instances of injuries in nursing homes-- a lack of basic communication skills.

After all, each patient's care is provided by a team of professionals whom very much rely on the effective oral and written communication of on another for the effective ongoing care of patients.

Theoretically, think about the disastrous consequences that could arise if a doctor fails to write specific orders about a patients care or a nurse fails to note how and when such care was provided to the patient.

Bad communication is blaimed for a series of errors made at a New York nursing home that resulted in injuries to patients.  Citing a state investigation into the incidents, it was recently reported that the underlying problem behind patient injuries was a breakdown in the lines of communication. 

In one incident, where a patient fell and broke her arm during a day visit with her family, the nursing home staff acknowledged that they never instructed the family on how to care for their loved one-- while she required specialized care for transfers.

Lack of communication is also to blame for a situation where a patient was injured due to improper restraints that the family applied during a brief outing to visit the family at home.   Despite the fact that the facility knew that the patient required specialized restraints, no documentation was given to the family.

Yet in other circumstances, a breakdown in communications amongst staff at the facility is believed to be at least partially responsible for the progression of a patients bed sore on her heel.  Despite documentation that an early stage pressure sore was evident on the patient, the facility provided no documentation as how the symptom were to be treated.

Given the fact that communication lapses occur on a daily basis at nursing homes, it is important for nursing home and other medical facilities to recognize these potential problems and implement ways for staff to reconcile these issues.  Unfortunately, until communication skills are given the priority that they deserve, all the education, re-education and staffing courses will have little impact towards improving patient care.

Related:

2 Residents Fall From Wheelchairs With 2 Days At Nursing Home

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

Breakdown In Communications To Blame For Birth Delivery Complications In Mom And Baby

Current Hospice System Provides Little Incentive For Agencies To Provide Necessary Care For Patients Comfort Needs

It appears as though big business has inched its way into the hospice industry-- the system intended to provide holistic medical care for patients with terminal conditions.  Rather than provide services to ease the physical pain of patients and the emotional strain of their families, a recent study published in the Journal of Law, Medicine and  Ethics reveals how hospices desire for profits has eroded the fundamental principals behind the hospice movement.

With more than half of all hospices operating to turn a profit, some hospice operators look at Medicare's reimbursement program as an opportunity to line their pockets by capturing as much of the government's $143 daily payment rate--- regardless of the type or scope of services provided.

The study's author's, Joshua E. Perry, assistant professor in the Department of Business Law and Ethics at Indiana's Kelley School of Business and Robert C. Stone, an emergency medicine physician and assistant medical director at Indiana University Health Bloomington Hospital Hospice essentially conclude that the current system provides an incentive for hospices to provide minimal care-- as it would cut into the hospices profit margin. 

Similarly, many hospices intentionally seek out patients with chronic conditions such as dementia as opposed to acute and rapidly progressive conditions such as cancer, because the there is an incentive for facilities to keep patients alive as along as feasible-- and utilize the hospice annuity system that's currently in place to rack up more profits.

Presently, there is little opportunity for families to learn the type of ownership behind the hospice operation as many operators have discretely infiltrated nursing home and have developed relationships where patients are routinely funnelled into their facilities. 

Unfortunately, during a time when families should be focused on caring for their loved one, questions may need to be asked about the ownership configuration of the facility in order to secure the most competent and compassionate care for their loved one.

Resource:

The Big (and Profitable) Business of Dying, Marlys Harris, CBS MoneyWatch.com May 21, 2011

 

Nursing Home Administrator Pleads Guilty To Fraud After Lying About Genuineness Of Patient's Signature

In my world involving allegations of nursing home abuse and neglect, one of the more disturbing trends I'm seeing and influx of cases involving altered and forged records.  Sure, there are cases where we consult with a forensic document examiner, but having every set of medical records examined by a forensic expert, just isn't practical from a time or economic perspective.

In cases where we are able to demonstrate that the patients chart was indeed altered, this little tidbit of information can be incredibly powerful both from a position of negotiation or used at trial to really incite a jury.

Unfortunately, the cases where my office is able to connect the dots with the forged records with supporting documentation, come about relatively infrequently.  The majority of cases I see where altered records never get discovered simply because the party involved is incapable of testifying or deceased.

In a somewhat unusual situation, a former nursing home administrator has pleaded guilty to charges related to obstruction of justice stemming from an incident where she intentionally mislead federal officials conducting a criminal investigation relating to a the authenticity of an admission document that was (wrongfully) signed by a patient.

Kimberly Boccacio, the former nursing home administrator at Haven health Center of Jewett City (Connecticut) involved in the incident was sentenced to three years of probation for her crime.

Despite the relative infrequency with which these incidents occur, anytime there is even an allegation of altered or destroyed medical records, I feel as though these occurrences pose a significant blow to the credibility of the medical field and form the basis of mistrust amongst patients and medical facilities.  Hopefully, as more of these document destruction occurrences come to light, it will act as a deterrent at other facilities encourage them to accurately preserve patients' charts.

Related:

Nursing Home Settles Lawsuit After Fraudulent Records Discovered

New York Jury Punishes Nursing Home Where Man Develops More Than 20 Bed Sores

Is It Time For Nursing Homes To Embrace Electronic Medical Records?

Nursing Homes Abuse Blog Makes Its Inter Alia Debut

In the digital age when websites come and go, its always nice to get a bit of recognition.  I was honored to have my Nursing Homes Abuse Blog recognized recently by Tom Mighell's Inter Alia blog as the blog of the day.  I strongly suggest taking a look at Inter Alia for high quality legal sites that are featured on a daily basis.

Maybe The Negative News Headlines Are Beginning To Get Inspections Of Long-Term Care Facilities Ramped Up

I guess most people read the newspaper-- or at least glance at its online version--- during their day.  While most of the news stories may be good for short discussions at work, every once in a while the power of the pen really does get people to act on what they read. 

Last year a series of reports by the Chicago Tribune documented dangerous criminals living freely amongst patients in Illinois Nursing Homes.  The result? Ongoing crackdowns by the Illinois Attorney General at nursing homes throughout the state arresting these known criminals.

Recently, the Miami Herald documented how many injuries and deaths at assisted living facilities never get investigated by authorities from Florida's regulatory agencies in a series, "Neglected to Death".  The article certainly shouted at the need for much more regulatory muscle to be flexed when it comes to injuries that could be easily prevented. 

Miraculously, just weeks after the articles were published spot inspections were recently performed at several Florida assisted living facilities with long track-records of questionable patient care. 

Coordinating several state agencies, the Florida Attorney General, conducted a two-day sweep at six different assisted living facilities in the Lauderhill area known as 'ALF Row'.  During the spot raids, records were checked at patients were interviewed to see if they had any concerns that needed to be quickly addressed.

While none of the findings discovered during the inspections appear to require any immediate action or facility closures, several of the facilities may receive sanctions in the coming weeks after authorities have had an opportunity to review their findings.

My guess is that these inspections were initiated by the investigative series.  In the end, who cares?  However, let's hope that the concern over the safety of Florida Assisted Living residents has some lasting power to protect these vulnerable people so another expose series will not be necessary.

Related:

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

Jury Blames Assisted Living Facility For Fall-Related Death Of 99-Year-Old Woman

Illinois Attorney General Continues To Keep Nursing Homes On Their Tippy Toes With Spot Raids

Nursing Home Ombudsmen Making A Difference In Patients' Lives

Part supervisor, part enforcer, part friend, nursing home ombudsmen commonly play an important role in the well-being of nursing home patients.  Generally run as non-profit groups, nursing home ombudsmen help ensure patients rights are protected and resolve issues--big and small-- as they arise. 

Kentucky.com had a heart-warming story about, Nursing Home Ombudsmen Agency of the Bluegrass, an agency that will soon mark more than 30 years serving the nursing home community.  In the article, long-serving ombudsman, Madge Lynn recounts how many of her experiences vary drastically according to the unique circumstances of each patient. 

While there are circumstances where a patient may be mistreated at a nursing home, her primary role may be serving as a confidant for patients who may be uncomfortable talking directly to staff at the nursing home or family members.  As Lynn says;

I believe in what we do.  I believe empowering residents to resolve their own concerns.  I believe in alerting the community to the needs of nursing home residents and I love to hear their stories.

As part of the agencies pearl anniversary, the former ombudsmen, public officials and family members will gather to help educate people about long-term care facilities.

Certainly, as someone who see some of the nightmares associated with long-term care facilities, I always encourage patients and families to seek out local ombudsmen when issues arise.  In many cases, simple problems can be resolved without any formal disciplinary action is required and before any adverse impact on the patient occurs.

Related:

Nursing Home Injury Laws: Kentucky

Nursing Home Ombudsman Honored For Dedication To Seniors In Illinois

How can nursing home ombudsmen help with problems encountered in a long-term care facility?

Nursing Home Watchdogs: Ombudsmen

Nursing Home Visits Are Likely Awkward For You & Your Loved One.... But It's Ok

After visiting several family members in nursing homes over the past few years, I frequently find myself a bit anxious; before, during and after our visit.  Part of me feels guilty that I'm talking about my busy life in the outside world while my family member likely spends their days bored and depressed.  Yet, another part of me finds myself asking "is that what I have to look forward to?"

Though probably not discussed as much as it should be, nursing home visits are an important part of the lives of both patient and their friends and family.  I recently saw a very good article about the importance of nursing home visits-- and just how many of the feelings we experience as visitors are indeed normal. 

Martha Bauman's article in the Sentinel Source, "Visiting nursing homes doesn't have to be draining" made me feel a lot better about my mixed feelings and provides some terrific tips for anyone planning a visit to a friend or family member in a nursing home.  Amongst Ms. Bauman's suggestions for beneficial nursing home visits:

  • Talk about happenings with the family
  • Learn about the activities and facilities that the nursing home provides
  • Participate in activities at the nursing home
  • Get to know the staff and ask about your loved ones care and condition
  • Bring photos and basic games to help involve and stimulate your loved one
  • When visiting from out of town, try to break up visits over a couple of days

Certainly, these are some suggestions that anyone can benefit from.  However, I think one of the broader themes of Ms. Bauman's article which particularly resonated with me is to modify our expectations of the entire experience.  As a spouse, son or friend, it is important to be realistic about your familiy members current condition-- they likely are not as active, talkative or energetic as the person we once may have known. 

Understanding that the liklihood that these changes will come about is crucial to our visiting expectations and will likely increase the value of the visits for both visitor and family memer and perhaps---  do away with some of the feelings of shame and guilt on both ends.

Related Nursing Homes Abuse Blog Entries:

Nursing Home Visits. An Opportunity To Conduct Your Own Inspection.

Tips For Rewarding Nursing Home Visits

Holiday Nursing Home Visits Can Prove To Be A Major Spirit Booster For Patients

How Much Do Nursing Home Need To Be Fined In Order To Clean Up Their Acts

Many of my blog entries focus on sad incidents where a nursing home patient has received seemingly horrific care during an admission to a nursing home.  Many of these incidents indeed get investigated by state agencies and--- in some cases-- the facilities receive a fine. 

Most nursing home fines are controlled by individual states.  However, even within each state, the fines are indeed arbitrary.  I mean what is the cutoff between a nursing home getting fined $5,000, $10,000 or $20,000?  Sure there may be varying degrees of patient injury or culpable behavior on the part of the facility, but ultimately the fines imposed may have little impact on their intent--- to punish facilities for past events and to deter future problems.

Sadly, for some nursing home operators, the fines--regardless of their size-- have become part of doing business.  However, my guess is that at some point-- when the fines begin to grow in their significance, facilities would start to take notice and perhaps act with greater care?

I suggest this because many of the fines imposed are simply inadequate for their intentions-- to improve patient care.

California has some of the highest fines imposes against nursing homes, yet the troubles in California nursing homes have not been put to rest.

Just recently, officials from the California Department of Public Health hit San Francisco Nursing Center with a $100,000 fine for failing to protect a patient at their facility.  The incident involved a CNA who suffocated an elderly patient with a pillow at the facility.  Most disturbingly, this was the CNA's first day working at the nursing home.

There's no doubt that $100,000 is indeed quite a bit of money, but is the fine enough to force the way this facility-- and others-- handle freshly hired employees  at their facility?  Perhaps requiring all new employees to undergo sensitivity training and undergo a shadowing period where they accompany a senior employee for an extended 'break in' period? 

My guess is 'no', but I'm curious as to your thoughts about the need for stiffer nursing home fines.  Dare I suggest that if the fine were $250,000 or $500,000 or more, we would likely see more facilities scrambling to improve their care or be forced to shut their doors.

Related:

Illinois Nursing Home That Turned 'Blind Eye' To Sexual Assaults Now Faces Fines

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

California Nursing Home Issued Most Severe Citation After Patient Fall And Death

Dementia Patient Chokes To Death On Ketchup Packet In Nursing Home

Take a look at my blog posts on Silver Planet!

I encourage you to take a look at some of the discussions going on at Silver Planet.  I will be periodically doing some writing on legal topics commonly encountered by families and seniors in nursing homes and other long-term care facilities. You can take a look at my most recent post here.

Silver Planet is a service that helps baby boomers guide their parents to age in place by providing services and products related to aging at home and housing options.

Rosenfeld Injury Lawyers Announces iPad 2 Giveaway As New Website Is Rolled Out

Its been a tremendously exciting Spring at Rosenfeld Injury Lawyers as we continue to expand our practice with the introduction of a new firm website!  Our new home on the web seamlessly integrates all of our web-resources: Nursing Homes Abuse Blog, Child Injury Law Blog, Nursing Home Injury Laws and of course, Bed Sore FAQ's.

As with all useful web-tools, ease of use is incredibly important for readers to quickly access information they desire.  Our new home allows readers to quickly access the latest developments in frequently sought after areas such as: child injury, nursing home injury, pressure sores injury, medical malpractice, motor vehicle injury and as well as specific personal injury resources.

Make no mistake, even as our practices continues to expand, we remain committed to the needs of societies most vulnerable-- children and the elderly.  Rosenfeld Injury Lawyers will remain a leader in the field of nursing home litigation with specific practice pages dedicated to:

Lastly, as our way of just saying thanks, we've put together a great assortment of prizes to to drawn and awarded to people who participate in our iPad 2 giveaway.  Get your entry in today and come see why Rosenfeld Injury Lawyers is one of the most respected personal injury law firms around.

Nursing Home Patients Take Backseat In Priorities For Iowa Legislators

IowaRecent budget cuts imposed by Iowa's Governor Terry Branstad have almost immediately cut the number of nursing home inspectors in the state by 25%.  

Now, just 28 inspectors will be responsible for investigating patient complaints and facility compliance with federal and state regulations at the state's 442 facilities.

Axing the ten nursing home inspectors will save the state and estimated $125,000 as the bulk of the inspectors salaries is derived from federal funding. 

While there are other employees in the state's Department of Inspection and Appeals that are technically licensed to conduct the work of the terminated employees, I find it unrealistic to expect the existing workload to be quickly spread to others without any detriment to the 30,000 Iowans currently living in nursing homes.

Related:

Nursing Home Surveyor Explains Applicability Of Federal & State Nursing Home Regulations

Nursing Home Inspectors To Seek New Jobs Following Discovery Of Dangerous Living Conditions

Pesky Government Regulations No Problem For Assisted Living Facility In Iowa

Nursing Home Injury Laws: Iowa

Nursing Home Inspectors Miss Major Problems

Iowa trims 10 nursing home inspector jobs, Chicago Tribune February 16, 2011

Elder Abuse Can Affect Anyone-- Even Mickey Rooney

Mickey Rooney took a courageous step recently when he stepped before congress to discuss his personal problems related to elder abuse.  Amazingly, this legendary actor discussed how he and his family have been impacted by elder abuse for years.

Hopefully, the publicity brought on this important topic will be the impetuous to encourage others to step forward and begin standing up for both themselves and others who are victims of elder abuse.

Florida Nursing Home Earns Spot Amongst Nations Worst

If you are a nursing home operator, I suspect you'd cringe when you hear about Medicare's list of Special Focus Facilities.  Special Focus Facilities (SFF) are nursing homes identified by Medicare that have a pattern of problems related to poor patient care. 

Earning a spot on the SFF list really should be a major wake up call for the facilities to quickly improve patient care or risk losing funding from Medicare and Medicaid--- the primary source of all nursing home funding.  Put another way: improve your care or go out of business.

Oak Manor Healthcare & Rehabilitation Center, a Florida Nursing Home, is the latest facility to be named to this dismal list.  The SFF designation for Oak Manor comes after officials inspected the facility and discovered dangerous conditions such as: unsupervised smoking and broken call bells for patients to alert staff of problems.

Oak Manor joins five other Florida nursing homes on the Special Focus Facility List.  Hopefully the designation of Oak Manor as one of the poorer performers will be an impetuous for change at the facility from management as well as from patient families.

Related:

Special Focus Facilities: The Worst Nursing Homes Of All

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

Call Lights. How Should Staff Respond?

Largo nursing home placed on list of nation's worst, By Richard Martin, St. Petersburg Times

Nursing Home Injury Laws: Florida

New Program Focuses On Staffing To Improve Patient Care In Nursing Homes

I recently read about The Critical Access Nursing Home Project, a program initiated to help ‘at risk’ nursing homes in urban areas in Indiana, Illinois, Ohio and Georgia improve the quality of their care.

Though participation in the program is voluntary facilities must meet criteria applicable to the composition patient demographics such as: operating in an urban area, a large percentage of minority patients on Medicaide and a large percentage of patients with serious health problems.

The primary focus of the program is to focus on staffing retention and morale to improve patient care.

All nursing homes are understaffed.  We’re trying to work with a group of loyal employees through a better pattern of communication and scheduling to manage more effectively so residents get everything they need, acknowledged John Grimm an administrator of a nursing home participating in the program.

While improving staffing levels may be  a start, it is not the end to all staffing issues.

According to Carol Benner executive director of Commonwealth Fund to the American Association of Homes and Services for the Aging (the sponsor of the program) “Over the course of a single day 22 people may work with one resident to feed, bathe or administer medication.  I’d be cranky if that happened to me.”

Certainly programs such as this should be commended for acknowledging a widespread problem facing nursing homes.  However, until nursing home owners and operators begin to place a financial premium on retaining quality staff members, I fear most of these problems will persist.

You can read more about The Critical Access Nursing Home Project here.

10 Nursing Home Articles Every Family Should Read

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

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

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

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

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

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

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

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

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

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

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

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

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

4) Children In Nursing Homes: Truly The Most Vulnerable

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

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

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

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

A September inspection of Emeritus revealed:

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

Continued....

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

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

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

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

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

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

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

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

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

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

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

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

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

Welcome To The Mean Streets Of The Nursing Home. Now Gimme Your Jewelry!

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

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

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

My take:

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

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

Become A Fan Of The Nursing Homes Abuse Blog On Facebook Today!

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

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

Nursing Homes & Jails. Why Are We Putting A Premium On Caring For Criminals?

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

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

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

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

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

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

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

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

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

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

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

Happy Thanksgiving From The Nursing Homes Abuse Blog

thanksgiving.jpg

From our family to yours, we wish you a very Happy Thanksgiving.  As always, please take a few minutes out of your day to pay a visit in person or on the telephone to friends and relatives who may be unable to attend festivities. 

I am a big believer in giving back to the community-- especially during these times of the year! Here are some causes worth looking into:

Meals On Wheels: Provides meals to seniors who are disabled or poor and unable to leave their home

Alzheimer's Association The largest non-profit group dedicated to Alzheimer's research

Catholic Charities Food, clothing and shelter for needy seniors

Little Brother Friends of The Elderly Provides support to seniors 60 and older including medical transportation

The Senior Source Proving companionship services to senior to help keep them living independently

Have a charity that is dear to you?  Please pass it along and I will highlight it in upcoming blog posts. 

Home Care Nurse Mishap Results In Brain Injury To Patient

 

There's been a lot of internet chatter regarding the home-video of a quadriplegic British man who suffered a brain injury after his home care nurse shuts off the life-support system and is unable to switch it back on.  What makes this situation so tragic is that the man was so concerned about the poor care he was receiving that he had a video camera mounted in his room to document his care.

If anything, I hope this video serves as a reminder to all caregivers that they should be aware of how to care for their patients in cases of emergencies.  At the very least, all caregivers should be familiar with the medical equipment their patients use and know how to revive them in emergencies.

Related Nursing Homes Abuse Blog Entries:

Videotape Reveals Abuse In Kentucky Nursing Home

Videotape Confirms Resident Murdered By Peer At North Carolina Facility

Nursing Home Abuse: Hidden Camera Catches Nurse Yanking The Wheelchair Of A Disabled Patient

Government Report Calls For More Transparency Regarding Nursing Home Ownership

Despite inviting signs perched in front of many nursing homes indicating the name of the facility, knowing who the real owner of the nursing home is likely a mystery to most patients in the facility as well as their families.

Situations involving distant, corporate ownership of nursing homes is becoming increasingly common as many investment conglomerates seek to cash-in on an expanding elderly population. 

While knowing who the true owners of a nursing home may seem like a novelty, there are situations when knowing the ownership of a facility is important. 

For example, families selecting a facility may be interested in knowing the ownership of a facility due to the fact that studies repeatedly demonstrate that corporate, for-profit facilities continually provide inferior care when compared to their peers.

Similarly, in situations where a problem may arise with care, it can be important for families to know just where to send their complaint. 

Between 1998 and 2008, 1,876 nursing homes were aquired by private investment companies with 10 firms accounting for 89% of the acquisitions.

A new Government Accountability Office (GAO) report entitled, "Complexity of Private Investment Purchases Demonstrates Need For CMS to Improve the Usability and Completeness of Ownership Date" requested by Senate Finance Committee Chairman Max Baucus (D-Mont.), Ranking Member Chuck Grassley (R-Iowa) and House Ways and Means Subcommittee on Health Chairman Pete Stark (D- CA) call far easier ways of ascertaining who the real owner of a nursing home is.

This report provides further evidence of what we already knew -- that the federal government needs to do a better job giving nursing home residents -- including Medicare beneficiaries -- complete, accurate and timely information so they can make the right choices when choosing a nursing home.  I'll continue my vigorous oversight to hold the system accountable.  We owe that to the nursing home residents. Said Chuck Grassley

As as nursing home lawyer, I strongly support all efforts that make ascertaining nursing home ownership easier.  No longer will large corporations be able to shield their identities from the consumer.  In the end, this pushing this issue will hopefully prompt better patient care as corporate owners will no longer be able to distance themselves from poorly run facilities.

Related Nursing Homes Abuse Blog Entries:

Corporate Ownership Putting Profits Over People

Surprise! Large Nursing Home Chains Put Profits Over The Care Of Residents

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

Do Nursing Home Inspectors Need To Exercise More Regulatory Muscle With Dangerous Facilities?

 

 

We recently discussed the case of Donald Brown, a nursing home patient who had a prolific life as an attorney and legislator in Texas.  Despite Mr. Brown’s professional accomplishments, he found himself in a situation encountered by folks from all walks of life—neglect in a nursing home. 

Now, his daughter is pursuing a nursing home lawsuit against the facility (Willis Nursing and Rehabilitation) where he developed advanced stage bed sores and subsequently died.

A Texas television station now has look deeper into the complaints made against this facility and skilled nursing facilities across the state of Texas.  An examination of nursing home complaints, certainly leaves one with the impression that the Department of Aging and Disability Services takes little regulatory action on the complaints it receives..

According to the 11-News report related to Texas nursing homes in 2009:

  • 16,000 complaints were registered against the approximately 1,100 Texas nursing homes
  • Just 37 out of the 16,000 nursing home complaints resulted in administrative penalties against the facility
  • A lonely 1 out of 16,000 facilities had their license revoked following nursing home inspection findings
  • No nursing home had its license suspended following the state inspections

While I imagine that there is a noticeable contingent of nursing home complaints made by disgruntled families who may file a complaint due to an issue to with an employee or simply out of frustration with their loved ones physical problems. There certainly appears to be a very cautions approach by the agency while inspecting these facilities.

For every complaint made relative a ‘minor issue’, I am certain that there are many well-grounded complaints my by families with a legitimate grievance.  Case in point, Mr. Brown’s daughter Celia Brown, who was genuinely alarmed by the rapid onset and deterioration of bed sores her father developed during his rehabilitation stay at Willis Nursing and Rehabilitation. Yet an investigation by officials determined there were no violations on the part of the facility.

Given the track-record of weak enforcement, you really can’t be surprised by the fact that Texas officials did not cite the facility for any of the negligent care alleged.  As a lawyer who represents families in nursing home abuse and neglect matters, I urge all regulatory agencies to re-evaluate how they handle the complaints they receive.

Until regulatory agencies decide to flex some muscle with respect to disciplining facilities, there is little hope of improved care.  I humbly believe that unless facilities fear both sanctions from regulators as well as accumulating a series of violations on their record, poor care will endure.

Related:

Director Of Nursing Cleared Of Charges Alleging That She Interfered With Nursing Home Inspection

Nursing Home Abuse Blog Readers Highlight Issues Facing Many Patients & Families

Inspection Report Confirms Unsanitary Living Conditions In Florida Nursing Home

Nursing Homes Abuse Blog Named To List Of 40 Top Nursing Home Blogs For Families

Thanks to Change of Address blog for naming Nursing Homes Abuse Blog to its list of 40 top Nursing Home Blogs for families. There are some great reccomendations on the list and I suggest you check them out. Here's what they had to say about the Nursing Homes Abuse Blog:

If you bookmark one blog from this list, make sure it is this one if you want to stay on top of all news surrounding nursing home abuse. This blog is always kept current and full of real world examples that drive the point home regarding the need for oversight in our nursing homes.

Thanks for the kind words!

Lawyers Provide The Best Protection For Our Seniors Living In Nursing Homes

The American Association for Justice (AAJ) recently published “Standing Up for Seniors: How the Civil Justice System Protects Elderly Americans” which does a tremendous job personalizing many of the common problems facing elderly in nursing homes:

Unfortunately, as our population ages, more and more people will become reliant on a nursing home system that is geared more towards returning handsome profits to corporate owners than to proving quality medical care. 

The influx of corporate owners of nursing homes, many of which have no nursing or medical background, knows that two main factors drive nursing home profits: 1) keeping occupancy rates as high as possible, and 2) reducing staffing levels.  This dangerous combination of more nursing home patients and fewer staff to care for them is a driving force behind the problems enumerated above.

Statistics demonstrate the trouble with corporate ownership and understaffing.  Corporately owned nursing homes have 32% fewer nurses and 47% higher deficiencies that their non-profit counterparts.

The desire to put profitability over patient care, encourages many corporate owners to maintain the status quo as long as feasible.  Meager regulatory fines further provide little economic incentive for owners to make changes to improve patient care.  As the AAJ article stresses, private enforcement of nursing home negligence though our court system provide the most effective road to improving patient care—across the board.

Related:

Standing Up For Seniors (PDF)

The Revamped Nursing Homes Abuse Blog

Perhaps you've noticed?  We've done some major re-configuring here at the Nursing Homes Abuse Blog.  Of course, all of my original entries will remain, but the site has been reconfigured to make navigation easier both on the blog itself as well as on our sister sites: Nursing Home Injury Laws and Bed Sore FAQ

The most noticeable feature includes links to individual state resources for laws, support agencies as well as related blog entries pertaining to the state.  The response has been extremely positive, but as always I welcome additional suggestions to improve both the layout and content of my blog.  Thanks!

Director Of Nursing Cleared Of Charges Alleging That She Interfered With Nursing Home Inspection

I was frankly disturbed when I came across an article in the Press-Citizen by Clark Kauffman regarding a director of nursing at an Iowa nursing home who obviously bullied her employees into keeping quiet regarding poor care they may have witnessed at the facility.

Karen Etter, the former director of nursing at Windmill Manor Nursing Home, was charged with attempting to impede or interfere with state inspections at the nursing home she was responsible for overseeing.  Despite Ms. Etter's admission that she told employees at the facility that they would be fired if they reported dangerous conditions to state nursing home inspectors as opposed to herself or other administrators at the facility-- she was acquitted of the charges.

The judicial magistrate that determined Ms. Etter should be acquitted based its conclusion on the fact that the comments were not applicable to an immediate investigation that the state was conducting as was seemingly the intention of the law. 

Not surprisingly, Windmill Manor has a history of violations related to health and safety violations and is facing $92,400 in state and federal fines related to the pattern of poor care. 

As far as I am aware, Iowa is one of only a few states that makes the interference of a nursing home inspection a crime.  Under the terms of the 1957 law, officials can impose fines or criminal prosecution in cases where an individual or company interferes with the inspection.

Although this particular nursing home employee may have evaded criminal charges, I admire Iowa legislators for having the foresight to create such a law.  Unfortunately too many nursing home employees knowingly disrupt or interfere with investigations at their facilities out of perhaps fear of personal liability or fallout from the facility administration.  I hope other states legislate to assure nursing home investigators can do their job.

Related:

Iowa Nursing Home Cited For Inadequate Care Of Pressure Sores

Pesky Government Regulations No Problem For Assisted Living Facility In Iowa

Your Nursing Home Has Likely Been Cited For Violations

Nursing Home Inspectors To Seek New Jobs Following Discovery Of Dangerous Living Conditions

What Brings You To The Nursing Home? The Answers May Surprise You?

Unknown to many, there are people in nursing homes that require skilled nursing care for reasons aside from old-age and de-conditioning.  A substantial number of nursing home patients require short-term and long-term care due to various types of personal injuries and conditions related to negligence of others. 

In some circumstances, we have successfully prosecuted many ancillary cases despite the fact that we may have been initially contacted to investigate a situation involving nursing home abuse or neglect. Below is a sampling of the personal injury matters we have prosecuted on behalf of nursing home patients.

Medical Malpractice:

Errors made by physicians and hospital staff can permanently cripple and similarly cause complications that require ongoing care.  In addition to general negligence on behalf of a physician, medical malpractice may encompass: surgical errors, pharmacy errors, hospital mistakes and nursing negligence.

Automobile / Trucking Accidents:

Despite strides in automobile design safety, automobile accidents continue to be a major source of serious personal injury-- particularly amongst the younger population.  Drivers, passengers and pedestrians involved in automobile accidents remain susceptible to orthopedic and neurological injuries. 

Industrial Accidents:

Hard working men and woman are injured on the job everyday. A sizable contingent of working people may suffer a significant injury due to a fall, electrical shock or due to the negligence of another worker on the job site.  Some of these situations result in serious injuries such as: brain injuries, burn injuries and paralysis.  Industrial accidents may give rise to a lawsuit under a theory of general negligence or may be maintained under a law specific to the industry such as: FELA, workers compensation, Jones Act or Federal Tort Claims Act. 

Asbestos Exposure:

Some nursing home patients require specialized breathing treatments due to a condition called Mesothelioma. Mesothelioma is a unique type of cancer in the lining of the lungs that is almost exclusively found in people who have been exposed to asbestos.  Many cases of Mesothelioma are not diagnosed for decades after the exposure period.  Many laborers in the following industries are frequently diagnosed with Mesothelioma: automobile industry, steelworkers, ship builders and insulation to name a few.

Products Liability:

Unsafe products continue to make their way into our homes and workplace.  In some circumstances the manufacturer is aware of how they can improve the safety of the product, yet they are hesitant to due to because of the increased cost.  In some cases where a manufacturer is negligent in the design, manufacture or in providing warnings related to product usage and a person is seriously injured all medical expenses-- including nursing home case can be recovered as part of the claim.

Do you have a viable case against another party?

While not every accident-related matter may be compensable, it is important to contact a personal injury lawyer as soon after an incident as feasible.  Many cases must be filed within a specific statute of limitations that varies according to jurisdiction.  However, in the cases of a disabled person, the statute of limitations can be extended beyond the 'normal' statuary period to allow a lawsuit even after the time for filing a case has expired.

Assisted Living Facility Allows Worker With Criminal Past To Work At Facility. The Results? A Bad Decision.

I was shocked when I saw this new clip below in which the administrator of a South Carolina Assisted Living Facility acknowledges that she was a aware of an employees fraudulent check writing background--- yet she choose to hire her anyway!  Does this make any sense? 

The acknowledgment from the administrator comes after the arrest of two employees at the Eden Terrace Assisted Living Facility in South Carolina.  Samantha Nicole Bishop and Tammy Gail Jernigan have been charged with stealing credit cards and jewelery from patients at the facility.  Jernigan has a criminal record going back more than ten years with similar incidents.

Why on earth should a person with an extensive history of criminal fraud be working in an environment with particularly susceptible people?  

 

Is Your Nursing Home Making you Sick? Long-term Care Facilities Provide An Ideal Environment For Communicable Diseases

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

Disease Prevention

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

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

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

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

Steps To Prevent Disease In Nursing Homes

In order to prevent communicable diseases, nursing homes should:

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

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

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

Proper hand washing techniques

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

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

Types of Communicable Disease

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

Common bacterial diseases:

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

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

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

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

Common viral diseases:

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

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

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

Common fungal infections:

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

Common parasites:

  • Head lice

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

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

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

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

Sources:

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

New York State: Department of Health – Communicable Disease Reporting

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

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

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

The New York Times: MRSA Infection

Stanford: Use Proper Handwashing Techniques – Protect Your Health

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

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

 

84-Year-Old Crowned Ms. Nursing Home Alabama

Ok, not everything I post on the Nursing Homes Abuse Blog about is super serious issues--- here's something in the 'just for fun' category. Below is a picture of 84-year-old Opaline Harper being crowned Ms. Nursing Home Alabama by the current regular Miss Alabama Ashley Davis.  Ms. Harper was chosen the winner from 67 contestants in the pageant from across Alabama.  Well done Ms. Harper!

As noted, this photo is from The Birmingham News.

Rather Than Improve Poorly Performing Nursing Homes, Why Not Just Re-Categorize Them?

Last fall, we discussed the problems state inspectors found at Emeritus at Crossing Pointe, a Florida nursing home, that posed an immediate threat to resident safety.  During an inspection at the nursing home, inspectors discovered:

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

The living conditions were so poor that Florida officials banned the facility from accepting new patients.

Now, it seems Emeritus officials have officially thrown in the towel at this facility.  After months of attempting to improve the living conditions at the facility, Emeritus officials have elected not to re-new the facilities nursing home license.  Now, the skilled nursing facility will transition to a 'senior housing' facility. 

Although the change in facility designation may seem like a minor change, the reality is that the change in designation of the type of facility is significant from a regulatory standpoint.  As a senior living facility, the facility will no longer be subject to any of the regulation imposed by the state of Florida on nursing homes such as inspections.

No word yet as to whether the Emeritus Corporation will retain control over the facility as it transitions to a less structured care environment. 

As a nursing home lawyer, I continually see poorly performing facilities attempt to re-name, re-organize and re-categorize themselves as problems arise.  In some cases, the re-vitalization of the facility provides a fresh start.  Unfortunately, most situations involving freshening up sub-par facilities simply means a change in window dressing.  Too often, I see these re-newed facilities continue with the pattern of poor care that got them in trouble originally. 

Consequently, it is important for families to learn as much as they can about nursing homes and assisted living facilities before placing a loved one there.  In addition to researching the corporation itself, it is important to ask direct questions to administrative staff regarding the history of the facility.

Read more about this Florida nursing home here.

Related Nursing Homes Abuse Blog Entries:

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

Another Iowa Assisted Living Facility Chooses To Abandon Its License

Pesky Government Regulations No Problem For Assisted Living Facility In Iowa

Now That We Rate Nursing Homes, Is It Time To Rate Other Adult-Care Facilities?

What causes bed sores?

Sometimes Complications With Nursing Home Patients Are Not Disclosed Until They Arrive At A Hospital

Some of my angriest clients contact me after a loved one was transferred from a nursing home to another nursing home or hospital only to learn of serious medical problems their loved one likely acquired during their original admission.  

Of course, breaking disappointing news is difficult for anyone to do.  Yet, in the case of nursing homes-- this is something they simply are required to do under the law.  Similarly, nursing homes must notify the patients doctor if their condition deteriorates.

I see many cases where there is no doubt an intention on the part of the original facility to cover up change in condition-- but also injuries related to situations involving improper care.

This situation of a dangerous condition being discovered only after the patient was transferred to a hospital was highlighted in a recent lawsuit filed against an Illinois Nursing Home, Alhambra Care Center.  Part of the lawsuit alleges that the patient lived that the nursing home with multiple health problems, but the staff at the facility failed to notify the family of the conditions including:

  • Stage III decubitus ulcer
  • Multiple stage I and II decubitus ulcers on the patients feet
  • Dehydration
  • Urinary tract infection

None of the conditions were disclosed to the family until after the patient was admitted to a local hospital.  

In cases such as these-- perhaps more alarming than not notifying the patients family as the various problems their loved one has developed-- is the fact that the facility allowed the conditions to develop in the first place.  My guess is that the facility was so ashamed of the condition they allowed their patient to get into that they failed to document the conditions during the patients stay at the facility either.

Some of these situations may give way to a claim against the nursing home where the condition developed.  In addition to contacting an attorney to discuss your legal options, you should give serious consideration to locating another facility for your loved one following their discharge from the hospital.

Related:

Dehydration & The Development Of Bed Sores In Nursing Home And Hospital Patients

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

Why do nursing homes describe pressure sores according to 'stages'?

Are bed sores on the heels common? Bed Sore FAQ

Happy 4th Of July From The Nursing Homes Abuse Blog

Best wishes for a happy and safe 4th from the Nursing Homes Abuse Blog.  Remember to visit your nursing home patients during this holiday weekend.

Thoughts On Nursing Home Care From The Eyes Of A Caregiver

Over the past several months, we have attempted to gather as many different perspectives regarding nursing homes and the care they provide from people with varying backgrounds. 

Today's interview is with Mary Nix of EldercareABC.

Q: What are some positive trends (if any) in the nursing home industry?

A: The positive trends we have noticed would be the Green House movement created by Dr. William Thomas. You can read more about it here: http://www.cga.ct.gov/2005/rpt/2005-R-0618.htm

Q: What are some negative trends (if any) in the nursing home industry?

A: I think the amount of abuse of the elderly in nursing homes that we see popping up in the news around the country and the fact that nursing homes are businesses and often the bottom line is a profit and not the care of the individuals.

Q: What correlation do you see with respect to the national trends in the nursing home industry and the impact on patient care?

A: Again-- since so much of staffing, resources and care depends on Medicare, Medicaid and other business factors, it is frightening that many individuals may be neglected simply because the funding is not what it should be. I am sure that most nursing homes are going above and beyond the call of duty to work around funding losses, but still it is the most quiet, non-verbal individual who cannot speak up that may feel the funding troubles the most.

Q: How would you compare the nursing homes of today vs. those of 20 years ago?

A: It seems that they have become more institutionalized rather than less. I hope that Green Houses might catch on and change that.

Q: What suggestions do you have for families when it comes to selecting a facility for their loved ones?

A: Visit at unexpected times, ask for references and see what the home offers. What is the staff to patient ration? What are the costs? I would suggest if a family has a complicated situation, that they consult with someone like yourself or a Geriatric Care Manger to make sure all aspects of the choice are studied and all resources utilized for your loved one.

Special Focus Facilities: The Worst Nursing Homes Of All

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

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

A facility typically earns a spot on this list primarily after the both federal and state inspectors survey reports on the facility come to light. SFF typically have:

  • More general problems than your average facility
  • More safety and injury-related problems than your typical facility
  • A pattern of serious problems that have persisted over a long period of time

No doubt, event the best facilities have episodes where the care they provide can be characterizes as abusive or neglectful.  However, these SFF have more than their share and at the very least patients and families should be aware if they have a loved one who is a patient at a facility on this dubious list.

Below is a compilation of all nursing homes currently on the SFF list organized by state.

Here are some observations from the SFF list:

TOTAL NUMBER OF FACILITIES = 126

STATE WITH THE MOST NUMBER OF FACILITIES:

STATES WITH 5 SFF FACILITIES:

NEW YORK
NORTH CAROLINA
OHIO
PENNSYLVANIA
TEXAS

STATES WITH 4 SFF FACILITIES:

FLORIDA
ILLINOIS
IOWA
MASSACHUSETTS
MICHIGAN
MINNESOTA
MARYLAND
TENNESSEE
WISCONSIN

TOP 5 SFF FACILITIES ON THE LIST FOR THE LONGEST PERIOD (REALLY THE WORST!):

63 MONTHS:

International Nursing and Rehab Center
4815 South Western Ave
Chicago, IL 60609

Luther Home
831 Pine Beach Rd
Marinette, WI 54143

Hidden Hills Health and Rehab Center
3110 Scott Circle
Omaha, NE 68112

Palace Rehabilitation and Care Center
Rt 38 and Mill Road
Maple Shade, NJ 08052

38 MONTHS:

Deseret Nursing and Rehabilitation at Colby
105 East College Drive
Colby, KS 67701

Continue Reading

Happy Memorial Day From The Nursing Homes Abuse Blog. Visit Your Elders!

Before you head out the door for a barbecue, take a few moments and give thanks to those in the armed services who sacrificed on our behalf. 

Given the Memorial Day Holiday, I guess it was sort of sickenly ironic that I saw a story regarding the financial exploitation of a patient in a Florida VA nursing facility today.

After stealing a credit card from an 89-year-old resident at Haley's Cove and heading out for a shopping spree, Tampa police arrested Maxima Jackson.

Ms. Jackson was arrested after someone reported her whereabouts to police after recognizing her photo from a bulletin distributed by police. Jackson is charged with grand theft and exploitation of the elderly.

Read more about this episode of financial exploitation of an elder here.

Leaders Speak Out Regarding Nursing Home Care

If you haven't checked out our most recent series of interviews with various thought leaders in the nursing home industry, here's a chance to look at what they had to say regarding the what the industry is doing correctly and how it can improve.

I've learned a from these folks!  I look forward to future rounds of similar interviews.  If you've got ideas let me know.

The View Of Nursing Homes From The Eyes Of A Patient

Nursing Home Insights From The Director Of A Therapeutic Recreation And Activity Consultant

Insight On The State Of Nursing Homes From The Director Of Michigan Disability Rights Coalition

Thoughts On Nursing Home Care From A Nursing Home Psychologist

State Of Nursing Homes From A 'Nursing Home Reform Activist'

Nursing Home Impressions From A Healthcare Marketing Expert

Insight On The Nursing Home Industry From A Registered Nurse

 

Happy Mother's Day From The Nursing Homes Abuse Blog

The Nursing Homes Abuse Blog wishes everyone a very happy mother's day 2010! Best wishes to all mothers, grandmothers and mothers-to-be.  Take some time out of your day and call or visit your mother where ever she may be. 

The View Of Nursing Homes From The Eyes Of A Patient

Seems obvious.  But perhaps the best person to ask about the state of nursing homes is someone living in one.  Kathleen Mears is a resident at an Ohio Nursing Home.  Kathleen is a fellow blogger at Long Term Living.  Check out her latest entries here.

Who are you and what kind of work do you do?

I have been a nursing home resident for 14 years. I came here when I was 47 years old and I am 61 now. I am a writer and have been writing a column in Long Term Living Magazine since September of 2009.

What are some positive trends (if any) in the nursing home industry?

That is a difficult question for me to answer. The only positive trend that I can see is ' person centered care'. Our last administrator believed in that philosophy and it seemed like we had a better relationship with her.

I do think they are trying to change the design of the newer nursing homes. But since I do not live in that type of facility, I do not know how it would impact me as a resident.

What are some negative trends (if any) in the nursing home industry?

I think that would be the building ideas that come about. I personally do not like the Main Street idea. It just seems like window dressing to me. What really needs to be changed as a way that care is delivered.

What correlation do you see with respect to the national trends in the nursing home industry and the impact on patient care?

I think that most nursing home owners realize that nursing homes must get ready for the baby boomers who will be arriving in a few years. Nursing homes will no longer have the patient population born between 1900 and 1930 that will wait for their care. I know that care in nursing homes is definitely changing where I live. Maybe it is only one person at a time but it is changing.

How would you compare the nursing homes of today with those of 20 years ago?

Many nursing homes today are physically virtually unchanged from the way they were in 1990. Many of them are still styled in the way that they were built in the 70s. The biggest changes would be in the newer nursing homes featuring the Main Street design. They would definitely be prettier to the potential residents eyes.

Residents are treated with more respect today. The whole nursing home industry knows that they are being watched by visitors and others who enter their facility.

What suggestions do you have for families when selecting a nursing home for their loved ones?

I would suggest that family members to their own research into the facility's background. They should make visits unannounced. They should not take the PR given out by the marketing person at the facility as gospel. They should ask hard, tough questions. They should visit the units to see how they look, how they sound, and how they smell. They should taste the food to find out what it is like. If possible, they should read a few books about nursing home life and check out the New York Times Blog " The New Old Age".

Three words to describe nursing homes:

Custodial Care Homes

Oral Health In The Elderly Nursing Home Population: A Widely Ignored Threat To Patient Health

Most people never associate dental care with with nursing homes.  To be honest, I never really did either until I was contacted by a family regarding a nursing home patient who developed a horrible infection in their mouth that went untreated for months.  By the time the infection was diagnosed, it had progressed to the point that the man's jaws had become infected.  Within weeks of the diagnosis, the man died from the infection.

While the above situation is certainly a case of extreme neglect, dental care of nursing home patients is an issue that deserves more attention than it currently receives.

Poor oral health and untreated dental conditions are a serious problem for nursing homes, especially because older Americans are more prone to tooth decay. Roughly 23% of adults between the ages of 65 and 74 have severe periodontal disease. Despite the high percentage of dental problems, adults aged 75 or older represent the adult age group with the lowest percentage visiting a dentist within the past year (U.S. Department of Health and Human Services – Oral Health Report 2002, Table 7.1.1). 

Figure 7.1.1. Percentage of the U.S. population that visited a dentist within the past year by age group

 

While bad teeth might seem like a relatively minor problem when compared to the many medical issues affecting nursing home residents (including disease, illness, neglect, mental illness, and isolation), untreated dental conditions can cause residents severe pain, malnutrition, social isolation, and severe dental disease. 

Furthermore, poor oral health can actually affect overall health (recent studies show a correlation between gum disease and heart disease, and periodontitis shares risk factors with several chronic degenerative diseases such as ulcerative colitis and lupus).  And, some diseases have oral symptoms, so proper monitoring of oral health can provide indicators for serious diseases and conditions (while examining patients’ teeth, gums, and tongues, dentists have found evidence of heart or liver disease, eating disorders, diet deficiencies, diabetes, arthritis, osteoporosis, and some autoimmune diseases).

Oftentimes, dental disease is caused by bacteria and fungus.  Nursing home staff members need to ensure that residents properly clean their teeth in order to decrease the number of bacteria and fungus.  This can be accomplished by having residents brush their own teeth, using fluoride (fluorinated water, fluoride in toothpaste, or fluoride lozenges), and having residents chew gum after meals.  However, chewing gum should be used with caution because many residents have difficulty swallowing and gum can create a choking hazard. 

Many residents require assistance with dental care and oral hygiene because they are unable to brush their own teeth because of weakness, arthritis, limited range of motion, illness, dementia, or diminished mental capacity.  Therefore, staff members must ensure that residents are able to properly and thoroughly clean their own teeth or provide the assistance necessary to achieve and maintain good oral hygiene.  Nursing home staff members should assist with brushing, flossing, and checking for canker sores and abscesses. 

Dry mouth is one of the most common dental problems for older people because it is a common side effect of many medications.  Dry mouth, besides just causing discomfort and irritation, can also increase gum recession, which can lead to root area cavities.  Dry mouth can be treated with increased liquid intake, rising the mouth out with water, using a commercially available saliva substitute, avoiding dry and salty foods, and sucking on sugarless hard candies. 

Illinois (through the Illinois Department of Public Health (IDPH) Steering Committee on Illinois Oral Health in response to the 2002 U.S. Oral Health Report) has recognized that efforts need to be made to improve statewide oral health education and awareness programs for at-risk populations (including the elderly).  Also, training programs for medical professionals who work with these at-risk populations need to be trained to recognize oral health disease.  The resources, nursing home dental health programs, and the staff members or professionals who provide dental services must improve before any widespread improvements will be seen in dental health in nursing homes. 

Many nursing homes focus on medical care to the detriment of their residents’ oral health.  It is important to achieve and maintain good oral health for nursing home residents because it can improve overall health and reduce health complications.  If you notice that a family member has decaying teeth, is not eating as much food, or having trouble chewing, they might be suffering from severe dental problems.  It is important to ask the nursing home about what dental services are being provided in order to ensure that your family members stay healthy and receive proper care.  

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

Resources:

Dentistry.com: Oral Care in Nursing homes

A Place for Mom: Healthy Mouth, Healthy Body: Senior Dental Problems

Family Gentle Dental Care: Nursing Home Oral Health Care

Medical News Today: Case finds oral health of residents in nursing homes needs more attention, USA

TheFreeLibrary.com: Nursing-Home Patients Need Better Dental Hygiene

Academy of General Dentistry: Nursing Home Oral Health Care

Department of Health and Human Services: Oral Health U.S. Report, 2002

Nursing Home Insights From The Director Of A Therapeutic Recreation And Activity Consultant

Today's question and answer session regarding nursing home care is from Kimberly Grandel, the director of Re-Creative Resources.  Thanks Kim!

Who are you and what type of work do you do?

My name is Kimberly Grandal. I am the Executive Director of Re-Creative Resources Inc., a LTC Therapeutic Recreation and Activity Consultant/Educator

What are some positive trends (if any) in the nursing home industry?

Increased person-centered approaches to care

Increased interdisciplinary approaches to quality of life

What are some negative trends (if any) in the nursing home industry?

I see more and more facilities adopting the culture change movement, which in theory is a wonderful approach to care. With this trend however, I also hear more and more stories that certified and qualified Activity Professionals and Recreational Therapists are being replaced by the "universal worker". Often times you'll see more domestic type activities in these culture change homes, which is fine for some residents, but not for all-I fear that we will abolish the field of therapeutic activities and recreation in LTC based on the assumption that uncertified, unqualified individuals can facilitate meaningful activities.

How would you compare the nursing homes of today vs. those of 20 years ago?

I see that nursing homes are much cleaner, more homelike, have higher quality food, more interdisciplinary approaches to meet the needs of the residents, more resident choices for food, activities, preferences and such, better staffing in terms of qualifications and numbers, and a much more pleasant atmosphere than many years ago.

What suggestions do you have for families when it comes to selecting a facility for their loved ones?

I always tell families to interview the residents of the facility they are considering. I also inform them to tour on weekends and evenings as well. Of course staffing, food, activities, laundry, doctor services, therapy, should be considered as well.

Three words to describe nursing homes: ____, _____, _____

Care, life, corporation

Insight On The State Of Nursing Homes From The Director Of Michigan Disability Rights Coalition

The most recent portion of my attempt to get insights on the state of nursing homes comes from Norm DeLisle, the Executive Director of Michigan Disability Rights Coalition.  Norm has an extensive background advocating for seniors in Michigan.  Thanks Norm!

Who are you and what type of work do you do?

My name is Norm DeLisle, and I am the Executive Director of Michigan Disability Rights Coalition. MDRC is a training and policy impact organization. We have collaborated with senior advocates for nearly a decade in advancing nursing home and long term care reform in Michigan.

What are some positive trends (if any) in the nursing home industry?

Some of the larger providers have begun to understand that institutional care is no longer necessary or financially viable as a long term care solution, and they are moving toward much smaller congregate and community based real homes. As interim solutions, the move toward "Eden" and similar movements will make some remaining institutions safer and more home like. But the real measure of progress is, and will remain, expanding choice for individuals and their families.

What are some negative trends (if any) in the nursing home industry?

Fiscal and regulatory pressure is forcing institutional providers to make a choice. One the one hand, they can choose to move to community based models. On the other, they can try to squeeze the last drop of profit or efficiency from their declining fortunes (as is the case with equity and hedge fund takeovers) from the institutional model. The later choice will, overall, increase the misery of those persons who by circumstance or lack of understanding of the possibilities, are forced to be the commodities in the pursuit of purely business outcomes.

What correlation do you see with respect to the national trends in the nursing home industry and the impact on patient care?

Those policy forces attempting to improve institutional models will lose out for better or worse to the lack of financial viability of the institutional model.

How would you compare the nursing homes of today vs. those of 20 years ago?

Overall, they divide into two camps. Those that are far better than even the best of 20 years ago, and those that are far worse than even the worst of 20 years ago. There are some exceptions on the worst side. Some specialized nursing homes for persons with developmental disabilities more than 20 years age were worse than any I have run into today.

What suggestions do you have for families when it comes to selecting a facility for their loved ones?

Be aware of all the options. This means early planning for LTC. Don't let a crisis, or bullying discharge planners force you into an instant, fear driven decision.

Three words to describe nursing homes:

Institution, institution, institution.

If you are involved in any aspect of nursing homes, I want to hear from you!  We are in the process of assembling a broad range of perspectives on the state of nursing homes and your opinions are important to the discussion related to improving patient care.  Please email me if you would like to participate. 

Thoughts On Nursing Home Care From A Nursing Home Psychologist

I've been getting some great feedback from blog readers regarding our series of interviews regarding the state of nursing homes-- positive and negative.  I've made efforts to get responses from people with a variety of backgrounds to get a more balanced perspective.  If you or a colleague are interested in participating in this series or in upcoming matters, feel free to shoot me an email.  Thanks.

Who are you and what type of work do you do?

Eleanor Feldman Barbera, PhD, nursing home psychologist and founder of My Better Nursing Home, a website focused on bringing psychological insights to nursing home life.

What are some positive trends (if any) in the nursing home industry?

Nursing homes are more aware now of the need for person-centered care. As a psychologist talking with residents, staff, and families, it's clear to me this is a good idea not just for the residents, but for all involved.

Nursing homes have been slow adaptors of technology, but the increased use of technology will improve the efficiency and experience of workers, and the satisfaction of residents and family.

What are some negative trends (if any) in the nursing home industry?

Financial fears, and a lack of creativity and cooperation in overcoming financial hurdles. I believe each nursing home is a community with the potential to thrive, and, by utilizing the skills and ideas of all its members, we can overcome many financial challenges. For instance, imagine a financially struggling nursing home that had a bake sale, craft sale, and other events to raise money for a computer for the residents, with the nursing home providing the IT support, and community volunteers teaching the residents how to use the computer. This would foster ownership and community within the nursing home, empower and create a sense of hope for those involved, and increase the visibility of the individual nursing home within the larger community.

What correlation do you see with respect to the national trends in the nursing
home industry and the impact on patient care?

There are many people engaged in innovative and exciting programming in the nursing home industry, but more of this needs to occur in average facilities that haven't necessarily committed themselves to Culture Change, for example. Like an adolescent with a punitive parent, many nursing homes are afraid to make changes because they don't want to "get into trouble" with surveyors. The more regulators lead, support, and encourage changes, the more likely we'll be to implement the kind of programming that will make a difference in the lives of the residents.

How would you compare the nursing homes of today vs. those of 20 years ago?

Today nursing homes are much more fast-paced, with an increased number of short-term rehabilitation beds, and residents who are more ill than those of the past. This presents challenges in meeting resident needs. At the same time, there are many positive changes in the nursing home environment, particularly the person-centered care movement. We still have a long way to go to make nursing homes somewhere I'd want to live by the time it's my turn, but it's an exciting period to be involved with long-term care because there is so much potential for positive change.

What suggestions do you have for families when it comes to selecting a facility for their loved ones?

I'd look for a facility that:

  • Doesn't have glaring deficiencies listed on the medicare.gov site; they should be well-rated
  • Is conveniently located for maximum visitation by family
  • Good at whatever illness I have (ie; if I'm prone to pressure ulcers, I'd want a place that was good at preventing/healing them; if I had MS, I'd want other people there with MS (or Alzheimer's, or another illness)
  • For me, I'd want computer access, and pleasant and easily accessible outdoor space.
  • Consider individual preferences.
  • Offered food that's halfway decent, with numerous options if I don't like the main meal, and at least a four week rotation on the food schedule
  • Provided interesting recreational activities

Three words to describe nursing homes:

Community, Home, Opportunity
 

State Of Nursing Homes From A 'Nursing Home Reform Activist'

Sometimes it's important to gain insight on topics from people who have lived though experience.  Today's entry regarding the state of nursing homes comes from a person who has channelled his personal frustration with nursing home care into helping others.  

Who are you and what type of work do you do?

My name is Dave Poland and I'm the son of a mother who suffered much
during the nearly five years she lived in nursing homes in Kentucky
and Indiana. I consider myself a "nursing home reform activist" and
maintain a blog to challenge the status quo of the nursing home
industry (nursinghomereality.wordpress.com). My mother passed away
January 1, 2009 and I believe nursing home neglect directly
contributed to her death. The day before my mother passed away, I
promised her that I would work tirelessly for improvement in the
quality of nursing home care so that no other nursing home resident
would have to suffer like she did.

What are some positive trends (if any) in the nursing home industry?

The Eden Concept of nursing home care has the potential to improve the
quality of care of residents because is clearly is
resident-centered/focused, but because it advocates smaller facilities
(with 20 residents or less), I fear that the big, greedy long-term
care corporations will never get on the bandwagon and create nursing
homes in this style.

What are some negative trends (if any) in the nursing home industry?

The biggest negative trend has to be the growth of large, multi-state
for-profit nursing home chains. They've gobbled up many excellent
facilities that were previously either non-profit or at least not
driven to produce MORE profit than these big corporations. Whenever a
large for-profit corporation is involved it appears the quality of
care suffers, especially in states (like Indiana and Kentucky) where
there are no minimum staffing requirements for nurses and CNAs.

What correlation do you see with respect to the national trends in the
nursing home industry and the impact on patient care?

The trend, if you want to call it that, is placing facility profit above quality of care.

How would you compare the nursing homes of today vs. those of 20 years ago?

The impression I get is that 20 years ago they were better staffed (in
terms of resident-to-staff ratios) and were controlled more locally
rather than by some outrageously large and impersonal out-of-state
corporation.

What suggestions do you have for families when it comes to selecting a
facility for their loved ones?

Talk to your local long-term care Ombudsman BEFORE you make a decision
-- if you have the time to talk to them first (often times circumstances don't allow talking to them first). Ombudsmen often know all the important things that need to be known about nursing
homes within their service area.

Three words to describe nursing homes: ____, _____, _____

Greedy. Impersonal. Dishonest.

You can learn more about Dave Poland and the work he does at his blog Nursing Home Reality. Thank you for your thoughts Dave!

Nursing Home Impressions From A Healthcare Marketing Expert

Today's glimpse into the world of nursing homes comes from Anthony Cirillo, FACHE, ABC, a leader in healthcare marketing and patient management.  Learn more about Anthony and his important work at his website and blog, Who Moved My Dentures? Thanks for these great responses.

Who are you and what type of work do you do?

I am a strategic healthcare marketing and patient/resident experience
management professional who fell into a mission for seniors when I went to
sing in a nursing home. My mission is to bring respect and dignity to
seniors while educating everyone about aging issues before they become a
crisis.

What are some positive trends (if any) in the nursing home industry?

The introduction of F tags around dignity has at least made organizations
start to pay more attention to resident experience. The Green House and
Eden approaches are commendable but really out of reach of most.

What are some negative trends (if any) in the nursing home industry?

Most are only giving lip service to experience management. The industry
does little to call attention to the positive it work it does or reach out
to the community as a vital partner. That adds to the already bad
perception they have. Reimbursement is declining. And worse, most of the
aging industry seems to want to will nursing homes out of existence. When
you see that we are 37th in the World Health Organization and plagued with
chronic conditions, it is quite clear we will need nursing homes.

What correlation do you see with respect to the national trends in the
nursing home industry and the impact on patient care?

I am not sure I can make that correlation unless perhaps you can list 2-3
trends and I can respond. CMS calls the shots here so much is driven by
F-tags. I do not see any consistency nationwide for how nursing homes are
surveyed. Five Star Ratings, while controversial, will be here to stay and
nursing homes need to be able to tell their story around them because the
public will be paying attention to them. Transparency will be key because
consumers have more and more information at their fingertips to research
organizations.

How would you compare the nursing homes of today vs. those of 20 years ago?

Honest to goodness, they have not improved much. There is still rampant
fraud and abuse. Activities have progressed slightly. Many residents are
lonely and depressed and have no visitors. The biggest change has been a
focus on rehabilitation work, which contributes to the bottom line but also
contributes to organizations paying less attention to the full time
residents who are living the final chapters of their lives inside these
homes.

What suggestions do you have for families when it comes to selecting a
facility for their loved ones?

I have an entire resource section in my book, Who Moved My Denture,
regarding this. Would be happy to share.

Three words to describe nursing homes:

sterile, lonely, depressed

Three words to describe what nursing homes should be:

home, compassion, healing places

Insight On The Nursing Home Industry From A Registered Nurse

This is the first in a series of interviews I have done with professionals in the medical, legal and caregiving communities related to the current state of nursing homes in the United States.  I am always in favor of getting different perspectives from professionals as to their perceptions and suggestions.  I hope you find these interviews as informative as I do.

Who are you and what type of work do you do? 

Angela Morrow, RN, BSN, CHPN.  I'm a registered nurse with a specialty in hospice and palliative care.  I care for patients and their loved ones at the end of life.  I'm also a writer and the Guide to Palliative Care for About.com.  As the Guide to Palliative Care, I write articles about hospice, palliative care, end of life concerns, the dying process, and grief and mourning.  I hope that my articles, blog, and community forum help patients who are trying to make informed decisions about end of life care and supports their loved ones.

What are some positive trends (if any) in the nursing home industry?

I'm finding that nursing homes are becoming more proactive in end-of-life/comfort care.  They are working hard to build relationships with hospice agencies to provide comprehensive end-of-life care to their patients.  Nursing homes are also trying hard to create a home-like environment for their residents rather than a hospital-like environment for "patients".

What are some negative trends (if any) in the nursing home industry?

Profits have always been important but especially during this time of proposed healthcare reform and drastic Medicare cuts, nursing homes want to maximize their bottom dollar.  Unfortunately, this often means cuts to staffing levels and important programs.

What correlation do you see with respect to the national trends in the nursing
home industry and the impact on patient care?


I see patients on hospice care receiving top-notch care, above and beyond what "skilled" or "custodial" patients are receiving.  Families notice the extra care hospice patients receive and are requesting hospice care sooner for their loved one.   This is a positive trend for patients that qualify for hospice but it is unfortunate for those who do not.  Current staffing levels in nursing homes mean many patients have to wait a long time to get needs met, or may not get their needs met at all.

How would you compare the nursing homes of today vs. those of 20 years ago?

Nursing homes today recognize the importance of focusing on the "person" not just the "patient".  As such, they provide important activities to promote exercise, socialization, and general well-being, whereas nursing homes 20 years ago were simply infirmaries for the elderly and disabled.  

What suggestions do you have for families when it comes to selecting a
facility for their loved ones?


Choose a facility that feels like home.  It should be warm and inviting and include activities that will stimulate and entertain your loved one.  The staff should be attentive and caring - notice how long call lights stay on before they are answered and how residents are treated in the hallways and common areas.  The nursing home should also have a good relationship with hospice agencies so when your loved one is nearing the end of life, you can rest assured they are receiving maximum care.

Three words to describe nursing homes:

Necessary, Understaffed, Underappreciated

Many thanks to Angela for her insights.  You can read more about Angela's work at her Guide to Palliative Care.

Why would someone want to become a nurse?

Well if you ask Jennifer Johnson at Nurse Practitioner Schools, there are many reasons-- 100 to be exact-- why people should consider a career in nursing.  I hope people may read this list and realize that nursing career can be mutually beneficial for both the nurse and patients.  Well done Jennifer!

Related:

Nursing Home Cuts Jobs Of 14 Nurses

The Keystone Of The Nursing Home: Nurses

High Staff Turnover Rates Plague Most Nursing Homes

Nursing Home Patients Have More Post-Surgical Complications Than Their Peers

In the ever mounting pile of problems facing nursing home patients, we can now add another-- nursing home patients are more likely to die following gastrointestinal (GI) operations than their peers living independently.  A study compared the mortality rates for nursing home patients who underwent six types of GI operations including: bleeding GDU's, benign colon disease, colon cancer, cholecystitis and appendicitis.

After evaluating data from 30,721 nursing home patients and 1.18 million Medicare beneficiaries, the studies authors determined that nursing home patients are more than three times more likely to die following the surgical procedures than those living in the community.

The dramatic differences in the surgical outcomes are believed to be the result of a variety of factors that the study was unable to assess including poor conditioning and malnourishment.  

Despite the obviously disappointing data, surgeons are still convinced that GI surgery is necessary for some nursing home patients as that many of these conditions have almost certain mortality when left untreated. 

Now that the medical community knows that this problem exists, they must work to develop a plan to minimize some of these health known problems.  "If we can tease these things out, that's when we can try to design interventions that would optimize outcomes in terms of preparing these patients for surgery and developing pathways and interventions postoperatively," said senior author Emily Finlayson, MD, MS, an assistant professor of surgery at the University of California, San Francisco.

Though I would never hold myself out as an expert post-surgical care, my experience has been that orthopedic injuries such as hip fractures and limb fractures that require surgery are particularly devastating for nursing home patients.  Sadly, I see many of these people deteriorate physically and emotionally after this trauma.  Perhaps this research would be useful for orthopedic patients as well?

Resource:

Nursing Home Patients Suffer Higher Post-op Mortality Rates, General Surgery News, March, 2010

Long-Term Care Hospitals: More Profit, Less Staff

There's been a lot of discussion recently regarding a New York Times article that details patient care at long-term acute care hospitals-- a relatively new type of medical facility for patients requiring long-term medical care.  Although these long-term care hospitals have many similarities to traditional nursing homes, they are structured to take advantage of Medicare reimbursement rules that pay higher rates of reimbursement for treating chronically-ill patients. 

The Times, article chronicles, Select Medical Corporation and Kindred Healthcare, publicly traded companies that run long-term hospitals across the country.  While long-term care hospitals may be more profitable than traditional facilities, the facilities are littered with problems related to patient care:

  • In 2007 and 2008 Select Hospitals were cited for serious Medicare violations at a rate four times higher than regular hospitals.
  • In the last three years, Medicare inspectors found 22 serious violations at 12 Select Hospitals
  • More patients who develop bed sores during their admission
  • More serious infections during their admissions-- In 2006, 9 out of 1,000 Medicare patients developed serious infections while during a stay at long-term hospitals compared with an infection rate of fewer than 3 out of 1,000 patients in more traditional hospital settings

In addition to using Medicare reimbursement to their advantage, the key to long-term hospitals profitability stems from stripping staff levels to bare-bones levels.  For example, unlike traditional hospitals, most Select Specialty Hospitals do not have physicians on staff.  Select Medical recently advised investors that it improved margins by 'monitoring staffing levels and lowering supply costs'. 

Recognizing the profitability of long-term care hospitals, the industry has rapidly expanded.  Today there are more than 400 long-term hospitals compared with just 10 in the 1980's.  Similarly, long-term hospitals are expected to bill Medicare $4.8 billion compared with just $400 million in reimbursements in 1993.

Rather than impose more regulations on long-term hospitals, Medicare implemented a three-year moratorium on new  long-term care hospitals in 2007.  The moratorium will expire in December of this year.  In the meantime, let's hope this profit-drive industry receives more regulation.  

Related:

Hefty Fine Imposed On A Kindred Nursing Home For Failing To Report Potential Abuse To Authorities

Caring For The Elderly Pays... Especially If You Own The Nursing Home

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

Select Medical Corporation Response To New York Times Article: Select Medical v. The New York Times: Here are the Facts

Professor Devotes New Book To 'Oscar The Cat'-- The Feline With The Ability To Predict Death

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

 

 

Diabetic Ketoacidosis Is An Under-Appreciated Danger Facing Many Nursing Home Patients

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

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

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

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

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

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

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

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

Diabetes in the Elderly

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

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

Resources:

Medicine Net: Ketoacidosis

Diabetes Disease: Ketoacidosis

Journal of Geriatric and Gerontology: Diabetes in the Elderly

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

Nursing Homes Abuse Blog:

Nursing Homes Must Be Prepared To Handle Diabetic Patients

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

Report Shows: Hispanic Nursing Home Patients Are Living In Inferior Facilities

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

Amongst the studies findings:

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

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

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

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

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

Related:

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

Blacks Receive Inferior Care At Most Nursing Homes

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

"Home Care Nursing" Doesn't Mean "No Care Nursing"

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

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

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

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

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

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

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

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

Sources:

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

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

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

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

Nursing Home Injury Laws: Illinois

Ohio Supreme Court Uphold Nursing Home Arbitration Agreement In Negligence Case

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

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

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

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

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

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

The Cause Of Many Nursing Home Patients' Injuries May Be Related To An Underlying Medical Issue

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

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

Clostridium Difficile / C. Diff

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

Stevens Johnson Syndrome

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

Legionnaires Disease

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

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

Subdural Hematoma

A subdural hematoma is a type of intracranial bleeding (hemorrhage), caused by head injury. Subdural hematomas occur when blood vessels burst in the space between the brain and the outermost membrane that covers the brain (dura mater). The collection of blood forms a hematoma, which puts pressure on the brain tissue.


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

Hypotension

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

Sepsis

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

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

Amyloidosis

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

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

Impacted Bowel

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

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

Is It Time For Nursing Homes To Embrace Electronic Medical Records?

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

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

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

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

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

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

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

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

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

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

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

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

Resources:

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

B-net: Electronic records in long-term care

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

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

An Inspirational Story Of A Young Man Who Regained His Independence After Living In A Nursing Home

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

Happy New Year From The Nursing Homes Abuse Blog!

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

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

 

Jonathan

Mentally Disabled Patients Composing A Larger Portion Of Nursing Homes Population. Is Your Loved One At Risk?

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

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

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

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

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

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

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

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

What can you do?

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

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

Sources:

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

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

MSNBC: Mentally Ill Endanger Nursing Home Patients

US News: Health Buzz: Mentally Ill in Nursing Homes

Illinois Nursing Home Safety Task Force

Associated Press: Task Force Targets Violence in Illinois Nursing Homes

Golden Living Partners With Microsoft To Help Manage Patient Medical Records

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

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

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

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

Read more about this new technology here.

About Golden Living:

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

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

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

Investigation Concludes: Most Nursing Home Administrators Are Never Disciplined For Poor Care

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

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

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

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

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

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

Resources:

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

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

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

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

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

Disabled Nursing Home Patient 'Dumped' At A Homeless Shelter

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

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

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

Can nursing homes do this?

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

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

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

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

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

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

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

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

(vi) The facility ceases to operate.

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

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

Holiday Nursing Home Visits Can Prove To Be A Major Spirit Booster For Patients

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

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

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

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

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

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

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

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

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

Give your mum a manicure or hand massage.

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

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

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

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

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

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

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

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

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

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

Investigations May Not Always Hold The Answers To How A Nursing Home Injury Or Death Occurred

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

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

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

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

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

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

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

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

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

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

Related:

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

Falls Amongst The Elderly Can't Be Ignored

Nursing Home Watchdogs: Ombudsmen

Nursing Home Inspectors Miss Major Problems

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

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

A September inspection of Emeritus revealed:

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

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

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

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

Great.  

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

Emeritus Corporation

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

Resources:

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

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

7 Cases Of Legionnaires Disease Attributed To Assisted Living Facility

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

What is Legionnaires Disease?

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

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

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

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

Resource:

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

Yes, Good Nursing Homes Do Exist!

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

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

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

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

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

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

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

Finding A Good Nursing Home In Your Area

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

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

Related:

High Staff Turnover Rates Plague Most Nursing Homes

Eden Or A Warehouse? You Choose.

Nurses Admit To Problems At Nursing Homes

A Word To The Wise- Stay Out Of Illinois Nursing Homes

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

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

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

 

 

Expand the federal program monitoring nursing homes. 

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

Use a national comparison for nursing homes. 

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

My take

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

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

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

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

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

Resources:

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

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

Related Nursing Homes Abuse Blog Entries:

The Worst Nursing Homes In America

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

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

Nursing Homes Must Be Prepared To Handle Diabetic Patients

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

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

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

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

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

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

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

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

Sources:

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

MayoClinic: Type 2 Diabetes

CDC: National Nursing Home Survey (NNHS)

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

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

Diabetes Care: Diabetes in Nursing Homes: United States 2004

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

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

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

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

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

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

Nursing Homes Duty To Provide Pain Relief

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

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

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

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

Recognition and Management of Pain

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

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

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

Source:

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

Related Posts:

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

Fentanyl Overdose Leads To 1.6M Nursing Home Settlement

Woman Poses As Nurse To Steal Medication From Nursing Home Residents 

Continue Reading

Nursing Homes Can Improve Patient Care. How A Veterans Facility Turned Itself Around.

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

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

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

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

1) Make providing quality patient care a priority.

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

3) Reduce the number of patients.

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

5) Hire more staff and specialists.

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

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

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

Veterans Administration Nursing Home Fails To Protect War Heros

If our government can't provide a proper environment for members of our armed forces to receive skilled nursing care-- changes must be made...immediately. 

Today, many veterans who bravely fought in battles to defend our country are reliant on the Veterans Administration for care necessitated by injury, disability and old age. Unfortunately, abuse and neglect still occurs in these VA operated facilities-- just as is does in privately controlled counterparts.

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

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

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

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

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

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

Related Nursing Homes Abuse Blog Entries

Feds Investigate VA Nursing Home For Dangerous Care

Nursing Home For Veterans To Shut Down

Feds Allege Veterans Nursing Home Provides Inadequate Medical & Nursing Services

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

Let's Stick To The Facts About Healthcare Reform & Medical Malpractice

Some politicians have thrown 'tort reform' into the mix of President Obama's new health care plan under the guise of saving money.  Several states already have full-fledged tort reform measures in place where the state legislature has set caps on the amount of money an injured person can recover.  

Years after many of these damage caps have been put into place, neither physician malpractice premiums nor individual health insurance rates have declined.

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

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

For more information, go to www.peopleoverprofits.org

Related Nursing Homes Abuse Blog Entry

Who Benefits From Damage Caps In Nursing Home Lawsuits?

Daughter Banned from Philadelphia Nursing Home After Taking Pictures Of ....

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

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

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

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

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

Resources:

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

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

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

Nursing Home Spotlight: NHC Healthcare, Bristol, VA

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

The Virginia Department of Health is in charge of licensing for Virginia nursing home facilities.  The facilities are inspected every two years for state licenses and every twelve months under Medicare/Medicaid certification. 

According to the Medicare report, the facility was given a rating of two out of five, meaning minimal harm or potential for actual harm in the following areas:

  • Give each resident care and services to achieve the highest quality of life possible
  • Give professional services that meet a professional standard of quality
  • Make sure that each resident’s nutritional needs are met
  • Develop a complete care plan for each resident
  • Do a new assessment after any major changes in resident’s physical or mental health
  • Make sure that the nursing home area is free of dangers that cause accidents

The sixteen health deficiencies in the past year contributed to the facility receiving one out of five stars.  These many deficiencies are a major concern for the health and safety of residents. 

Related Article:

Did an NHC nursing home let a serial molester run free for seven years? Nashville Scene, April 8, 2009

 

 

Make More Room. Nursing Home Population Set To Explode

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

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

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

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

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

Resources:

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

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

U.S. Census - An Aging World: 2008

The Most Important Job In America.... Nursing Home Surveyors

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

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

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

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

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

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

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

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

Related Nursing Homes Abuse Blog Entries

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

State Inspectors Find Safety Violations In Indiana Nursing Home

Who Regulates Nursing Homes?

Nursing Home Spotlight: Devon Gables Health Care Center, Tuscon, AZ

The Devon Gables Health Care Center is a very large, 312 bed nursing home in Tucson, Arizona. 

As of May 20, 2009, the Arizona Department of Health Services gave the nursing home a quality rating of “A,” which is Excellent.  However a closer look into the facilities recent past reveals problems that threaten patient safety.  On June 22nd, the nursing home agreed to pay $1,450 in civil penalties for failure to implement their own policies on skin care, change of condition, and wound monitoring for one resident.  During a state investigation, inspectors discovered sixteen violations of state and federal rules. 

The state inspection report included violations for:

  • Failing to get a resident timely treatment for a skin problem that developed into a serious pressure sores
  • Giving narcotic drugs to a resident who was known to be allergic to narcotics
  • Failing to develop a post-discharge plan for a resident who was released to an unsafe environment
  • Failing to report an allegation of abuse involving one resident to the state
  • Failing to document nursing assessments before and after three residents had dialysis

According to the government’s Medicare website, the facility received two out of five stars, which is a below average rating.  In the past year, the nursing home had eighteen health deficiencies, which is six more than the average number of health deficiencies in Arizona and ten more than in the United States.  The number of health deficiencies increased over the past two years.

An April 2009 inspection resulted in twenty-one citations for failing to provide reasonable accommodations, allowing residents to develop pressure sores, and failing to keep the premises free of dangerous situations. 

The nursing home inspection also revealed that Devon Gables failed to file laboratory reports in one resident’s clinical records, which violates the requirement that a record be kept of all medical services for residents.  The resident, who suffered from renal disease, had blood tests, but the results were not in the resident’s file. 

Devon Gables failed to keep its facility free from a condition or situation that could cause a resident physical injury when it failed to equip a shower room with a nurse call system. 

Also, due to safety concerns, the nursing home is required to store medications in locked compartments.  This requirement was not met when Devon Gables left a treatment cart unlocked and unattended for almost an hour. 

Lastly, nursing homes are required to provide all residents with reasonable accommodations to ensure the highest level of physical and psychological well-being.  In this respect, Devon Gables failed to provide two residents with wheelchairs with foot pedals to help properly positioning in the wheelchairs.   Also along these lines, Devon Gables was cited for failing to provide appropriate care and treatment to one resident with limited mobility.  The resident was admitted to the facility with a risk for skin breakdown.  Later, the resident developed an area of compromised skin caused by the foot rubbing against a wheelchair pedal.  This area of skin developed into a Stage IV pressure sore

The numerous citations and recent fine for civil violations calls into question Devon Gable’s ability to provide adequate care for its residents.  If your family member is a victim of poor care at Devon Gables, I would honor the opportunity to discuss your situation.  As always, our legal services are completely free if there is no recovery for you.  Speak to our experienced nursing home lawyers today.  (888)424-5757.

Sources:

Arizona Daily Star – Nursing Home in Tucson to Pay $1,450 State Fine

Arizona Department of Health Services – Devon Gables Health Care Center

Medicare – Devon Gables Health Care Center

Nursing Homes Abuse Blog - Coincidence? Two Lawsuits Recently Filed Against Same Nursing Home

Special thanks to Heather Keil, J.D. for her assistance with this entry

 

Social Worker Indicted After Financially Exploiting Tennessee Nursing Home Resident

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

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

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

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

Financial Abuse In Nursing Homes

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

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

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

Wrongful Burial In Chicago At Burr Oak Cemetery

 

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

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

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

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

Pesky Government Regulations No Problem For Assisted Living Facility In Iowa

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

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

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

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

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

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

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

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

Can Nursing Home Patients Expect Any Privacy?

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

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

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

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

Related Nursing Homes Abuse Blog Posts:

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

New Law May Improve Privacy In Nursing Homes 

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

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

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

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

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

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

Life Care Centers

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

 

Source:

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

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

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Blacks Receive Inferior Care At Most Nursing Homes

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

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

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

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

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

Resources:

Disparate Nursing Home Care, by Jeff Kelly Lowenstein

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

Related Nursing Homes Abuse Blog Articles

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

Chicago Nursing Homes Not Making The Grade

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

See the Alden facilities below:

Continue Reading

Lockdown: New Admissions Suspended At Tennessee Nursing Home

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

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

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

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

Nursing Homes Abuse Blog Related Posts

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

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

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

Color Coded Bracelets Could Help Staff Comply With Residents' Last Wishes

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

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

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

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

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

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

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

DNR Orders

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

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

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

Here is an example of a DNR order.

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

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

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

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

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

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

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

About Extendicare

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

Related Nursing Homes Abuse Blog Posts

Videotape Reveals Abuse In Kentucky Nursing Home

Nursing Home Negligence Lawsuit Filed Against Extendicare

2009 National Nursing Home Week, "Nurturing A Love That Lasts" Runs This Week

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

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

Source AHCA

District Attorney Endorses Use Of Video Cameras In Nursing Homes

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

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

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

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

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

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

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

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

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

Related Nursing Homes Abuse Blog Entries:

Hidden Camera Reveals Caretaker Abuse By Nursing Home Worker

Videotape Reveals Abuse In Kentucky Nursing Home

Video: New York Nursing Home Worker Caught On Tape

Why Didn't I Think Of This?

Nursing Home Worker Faces Up To 386 Years In Prison Related To Identity Theft Charges

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

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

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

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

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

Nursing Homes Responsibility In Identity Theft Cases

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

Engagement Ring Stolen From The Hand Of Disabled Resident In New York Nursing Home

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

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

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

Theft In Nursing Homes

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

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

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

Web Resources Regarding Theft In Nursing Homes

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

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

State Inspectors Find Safety Violations In Indiana Nursing Home

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

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

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

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

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

Was the inspection worthwhile?

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

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

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

Web Articles Regarding Royal Oaks

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

Related Nursing Homes Abuse Blog Articles

What Are Signs Of Nursing Home Abuse?

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

Minimum Nurse Staffing Ratios

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

Man Who Crashed Car Into St. Louis Nursing Home Had History Of Problems

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

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

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

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

Nursing Home Safety

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

Web Resources:

Car crashes into Florissant nursing home, Stltoday.com

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

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

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

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

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

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

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

Department of Heath & Human Services Report

Young, Mentally Ill Residents Pose Significant Threat To Nursing Home Residents

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

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

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

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

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

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

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

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

Related News Article:

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

Related Nursing Homes Abuse Blog Posts:

Update: Lawsuit Filed Against All Faith Pavilion

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

Brooklyn Nursing Homes Fined For Failing To Provide Safe Living Conditions

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

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

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

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

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

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

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

Nursing Homes Abuse Blog Articles On Staffing:

Nursing Home Cuts Jobs Of 14 Nurses

High Staff Turnover Rates Plague Most Nursing Homes

Nursing Shortage Is A Crisis

Now Blogging For Long Term Care Living Magazine

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

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Iowa Nursing Home Cited For Inadequate Care Of Pressure Sores

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

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

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

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

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

Staffing In Nursing Homes

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

Nursing Homes Abuse Blog Entries On Staffing

Minimum Nursing Staffing Ratios

The Correlation Between Staff Satisfaction And Patient Care

Nursing Shortage Is A Crisis

High Staff Turnover Rates Plague Most Nursing Homes

Nursing Home Injury Laws: Iowa

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

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

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

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

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

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

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

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

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

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

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

Related Nursing Home Abuse Blog Entries:

Assisted Living Facility Lets Resident Walk Out Door and Into Semi

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

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

Young, Middle Aged & Seniors. Nursing Homes Struggle To Care For An Increasingly Diverse Group Of Residents

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

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

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

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

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

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

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

South Carolina Nursing Home Settles Claims Of Injury, Illness & Death

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

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

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

According to Grace Chung Becker, acting attorney general for the Civil Rights Division of the U.S. Justice Department, "[t]his agreement establishes systems to ensure that nursing home residents receive adequate services to meet their needs."  Additionally under the terms set forth between the government and the state; the facility must keep the government informed as to staff training, reporting and evaluation. 

The settlement further requires staff to pay special attention to residents weight, food intake, pressure sores, pain management and report all deaths at the facility to the federal agency.

Read more about this settlement of nursing home investigation here.

Nursing Home Injury Laws: South Carolina

CNA Charged With Elder Abuse In Connection With Identity Theft Of Alabama Nursing Home Resident


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

Feds Allege Veterans Nursing Home Provides Inadequate Medical & Nursing Services

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

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

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

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

Read more about these allegation of improper nursing care here.

Nursing Homes Not Prepared To Handle Diabetic Residents

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

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

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

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

Related Posts From The Nursing Homes Abuse Blog:

Poorly controlled blood sugar in nursing homes.

Nursing Homes Not Prepared To Care For Obese Residents

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

Maryland Nursing Home Fined For Neglecting Patients

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

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

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

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

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

Bad Nursing Home Records. Scribble, Slop, Scribble.

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

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

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

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

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

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

Recent Deaths Lead Officials To Shut Down Assisted Living Facility With Questionable Past

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

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

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

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

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

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

Even In Death, Assisted Living Facility Mistreats Its Residents

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

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

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

Forwarded Email From A Perfect Cause Re: Abuse At Albert Lea Nursing Home

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

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

Here’s your call to action!

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

Nelson’s office number is 507.377.5192.

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

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

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

What do we want?

1.       Felony Charges filed against the alleged assailants

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

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

Why?

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

2.       Nelson has

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

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

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

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

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

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

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

Background on the case

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

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

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

More to Come

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

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

Here’s what the media had to say about…

Last Night’s TOWN HALL MEETING

Star Tribune

Families sound off on abuse at Albert Lea nursing home

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

Albert Lea Tribune

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

Advocate stirs debate on elder case

KIMT

Good Samaritan Abuse Charges Get National Attention

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

FOX 9

Town Hall Meeting Addresses Albert Lea Nursing Home Abuse

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

KXMC

Minn. nursing home hit hard by abuse allegations

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

WCCO

Nursing Home Hit Hard By Abuse Allegations

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

KSTP

Minn. nursing home hit hard by abuse allegations

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

KAAL

Family Members Speak Out on Nursing Home Abuse

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

KTTC

Family member appalled over nursing home charges

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

KARE 11

Albert Lea community speaks out about nursing home allegations

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

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

Many thanks for all!

Wes

Wes Bledsoe

Citizens’ Advocate & Founder

A Perfect Cause

1501 N. Broadway Blvd., Bldg B

Oklahoma City, OK 73103

C – 405.308.3858

C – 405.802.2903

Wes@APerfectCause.org

www.APerfectCause.org

Our Mission - To End Needless Suffering & Preventable Deaths

 "A Perfect Cause must produce a perfect effect."

Science of Mind, Dr. Ernest Holmes

State Settles Nursing Home Lawsuits For Exposure To TB

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

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

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

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

Information on Tuberculosis from Web MD can be found here.

Arizona Nursing Home Fined For Multiple Safety Violations

 

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

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

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

Ohio Nurisng Home Cited For 'Immediate Jeopardy' Violations

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

Read more about this dangerous Ohio nursing home here.

New Nursing Home To Be Built For Sex Offenders

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

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

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

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

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

Nursing Home Injury Laws: Oklahoma

Specialization Of Nursing Home Care For Diabetes Patients

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

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

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

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

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

 

Faulty Handicapped Lift Blamed For Nursing Home Death

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

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

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

This Ain't No Party. This Ain't No Disco. This Ain't No Nursing Home.

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

 

 

Is There A Double Standard For Nursing Home Safety?

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

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

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

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

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

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

California To Cut Back On Nursing Home Inspections

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

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

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

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

State Of Ohio To Take Over Nursing Home Inspections Following Dangerous Conditions

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

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

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

Nursing Home Facility Problems

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

 Nursing Home Staff Violations

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

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

Your Nursing Home Has Likely Been Cited For Violations

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

  • For-profit facilities had a higher percentage of violations than other nursing homes-94% of for-profit nursing homes surveyed were cited for deficiencies, compared to 88% of not-for- profit and 91% of government nursing homes
  • The most common violations related to improper storage and distribution of food, accident hazards and lack of services necessary for residents' mental and physical well-being
  • The rate of violations differed by state, with every nursing facility surveyed in Alaska, the District of Columbia, Wyoming and Idaho reporting citations compared with a low of 76% in Rhode Island.

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

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

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

More Information About Patient Care In Metron Nurisng Home

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

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

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

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

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

Feds Investigate VA Nursing Home For Dangerous Care

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

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

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

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

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

Medicare & Medicaid Funding Pulled From Nursing Home With Violations

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

 

Wanted: 20-30 year old female, 5-foot-2 to 5-foot-6, 130 to 160 lbs, brown hair and acne scars on her face

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

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

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

Even The Worst Nursing Homes Can Turn It Around

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

 



Nursing Home Injury Laws: New Mexico

Physical Therapy Injuries

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

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

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

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

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

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

Cocaine Kingpin Found In Florida Nursing Home

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

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

Erratic Driving Lands Nursing Home In Court

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

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

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

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

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

Are Nursing Homes Just Self Serve Drug Counters For Employees?

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

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

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

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

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

Nursing Home Inspectors To Seek New Jobs Following Discovery Of Dangerous Living Conditions

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

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

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

Nursing Homes Learn Valuable Lessons From Hurricane Katrina

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

 

Government Pays $3.2M Annually To 'Crack House' Nursing Home

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

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

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

Facility Problems

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

Staff Violations

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

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

 

Packing On The Pounds Won't Kill You--Only Makes Elderly's Lives Less Enjoyable

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

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

Read more about the study on overweight elders here.

Michigan Court Dismisses Charges Against Nursing Home Workers Playing With A Corpse

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

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

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

Report Documents Problems With Nursing Home Oversight

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

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

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

World's Tallest Woman Dies In Nursing Home

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

 

Get Out Of Here!

Evictions of nursing home residents are on the rise according to a recent article in the Wall Street Journal. As many nursing homes face budget cuts, they are seeking to reduce the number of Medicaid residents in favor of higher paying Medicare or self-pay residents that pay the facility a substantially higher daily rate.  Under federal law, nursing homes can only involuntarily discharge patients for the following reasons:
  1. If the resident is well enough to go home.
  2. Discharge the resident for care only available elsewhere.
  3. Danger to the safety of other residents.
  4. Danger to the health of other residents.
  5. Failing to pay bills.
  6. If the facility shuts down.
Most states provide little guidance for nursing home residents facing eviction.  Moreover, there is little guidance for what procedure residents can take to contest their evictions.  Even if a person can persuade the nursing home to continue to let them remain at the facility, it is probably not a good enviornment for the person to remain.  Think about it, would you really want to live in a place where it is obvious you are not wanted?  Will you really be receiving the most attentive care?  Is the staff really going to look out for your best interest.

If you are faced with eviction from your current facility it is best to contact your state ombudsman.

How Feasible Is Home Based Nursing Care?

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


Dangerous Facilities Forced To Turn Away New Residents

Poor quality care is preventing some nursing homes in Tennessee from accepting new residents.  In the past several years, there has been a substantial increase in the number of complaints directed to health and safety of the residents.

Accusations of serious safety violations are getting attention from state inspectors.  At Nashville's RiverPark Health Center, a complaint of a resident fall caught investigators' attention.  The complaint alleged that following the fall, the nursing home staff ignored the resident's cries for help.  It turns out the resident had broken his neck and eventually died from his injuries.  The investigation revealed that not only did the staff act improperly following the fall, the staff conducted no internal investigation to determine if its employees acted improperly.

As the result of the above incident, the state suspended admissions at RiverPark.  In 2007, the State of Tennessee suspended admissions at 16 different nursing homes.  State investigators say their forceful actions are the result of directives from the Centers for Medicare and Medicaid Services. 

Suspending admissions is important in that it forces nursing home owners to correct violations in order for them to stay in business.  Most nursing homes are 'for profit' facilities are are paid a daily stipend for each resident.  A diminished resident population, means lower profits. 

Nursing home investigators in all states have difficult jobs.  Often they enter facilities where administrators and nursing home employees work together to cover up past wrongdoings.  Further, many of the victims of the safety violations are unable to communicate or may be severely injured or dead.  The investigators role is crucial to promoting the health and safety of the particularly susceptible nursing home residents.  Click on the news clip below for more information about nursing home violations in Tennessee.

Watchdog Report Documents Serious Problems With Nursing Homes

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

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

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

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

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

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

Nursing Home For Veterans To Shut Down

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

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

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

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

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

Read more about VA nursing homes here.

Flu Outbreaks Can Be Controlled

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

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

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

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

Lead study author, Miriam Nuno, states:

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

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

Emergency Preparedness Plan

In the case of a fire, hurricane, tornado or terrorist attack what will happen to your loved one? 
Will they be protected? 
Does the facility have an emergency plan in place?

Federal law requires that all nursing homes have comprehensive emergency plans in the event of a natural or man-made disaster.  The emergency plan must suit the location of the facility and type of resident is serves.  Most importantly, both nursing home staff and residents should be aware of the plan and should know what to do in the case of an emergency.

If no 'emergency plan' has been discussed, it is important for both residents and their families to speak up and ask the administrator the following questions:

What is the plan in case of emergency?
Is there enough staff on duty to carry it out on all shifts?
Is there a contingency plan in place to move residents to alternative facilities?
How much food and medical supplies are kept on hand specifically for emergencies?
Does the facility hold drills for residents and staff to address emergency preparedness?
How will the family be notified of an emergency?
What is the nearest exit?

Like all aspects in selecting a facility, you are entitled to ask as many questions as you desire.  You are entitled to considerate responses from nursing home staff.  If your concerns are not answered, alternative facilities should be investigated.

Read more about emergency preparedness here.

The Need For A Centralized Department Of Aging

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

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

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

Young People In Nursing Homes

The face of the typical nursing home resident is changing --- and becoming less wrinkled.  Today, more young people are entering nursing homes and long-term care facilities in their 30's and 40's.  More than 15% of nursing home residents nationwide are under 65 compared with 12.3% under 65 in 2003. 

The number of younger nursing home residents is expected to grow as our society continues to have inadequate facilities to care for younger people who require extensive care and rehabilitation.  Young people with traumatic brain injuries, extensive orthopedic injuries and chronic disease have few alternatives to traditional nursing home care.

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

Related:

Nursing Home Injury Laws: New Jersey

About Jonathan Rosenfeld

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Jonathan Rosenfeld is a lawyer who represents people injured in nursing homes and long-term care facilities.   Jonathan has represented...

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