Nursing Homes Abuse Blog - By Jonathan Rosenfeld

[Photo Caption: Lori Del Hierro is charged with criminally neglecting her 86-year-old mother-in law. (Photo courtesy of the Las Cruces Sun-News)]

Two Las Cruces, New Mexico women have been charged with criminal neglect after police found their elderly relative trapped in a trailer, with her toes gnawed off by animals.

“[The animals] had completely eaten or removed all parts of the toes,” said Deputy District Attorney Steven Blankinship. “There was very little blood left. I imagine it was extremely horrific for her to go through that and not have anybody there who was going to help her.”

The Las Cruces Sun-News reports that Maria Najera’s primary caretakers were her daughter, Angelique Del Hierro, and her daughter-in-law, Lori Del Hierro. Lori Del Hierro claimed that her mother-in-law “felt no pain” from the animal bites, since her lower extremities were mostly numb. According to the Sun-News, Lori Del Hierro was a former nursing home employee with a record of criminal activity.

Authorities found Najera in an “extremely filthy” trailer, with an “odor of urine,” and “holes in the floors where animals could come and go as they please,” said Blankenship. Najera was in a diaper when authorities discovered her, on Dec. 20, 2010. Najera died of pneumonia on Dec. 30.

Along with the elder abuse charges, the Del Hierros also face federal fraud charges. Both women allegedly used Najera’s Medicare and Social Security payments to pay their own bills.

On January 17, New Mexico will decide whether to earmark additional money for its 71 nursing homes, after a cut in funding in October. I can only hope this tragic story illuminates the state’s need for better elder care programs.

Resources:

New Mexico Gov. Wants Cash to Help Nursing Homes Jan 5, 2012 The New Mexican

A somewhat unusual news story was forwarded to me over the weekend that involved police intervention in a case involving a severely neglected nursing home patient.  Apparently, staff at a Via Christi Hospital (Kansas) called police after a nursing home patient was taken to their hospital for care. 

Immediately after they began treating the man, it was readily apparent that that man was not in good condition as hospital staff noticed maggots and open sores on his feet when they removed his shoes.  According the the news report, police have initiated an investigation into the care provided at the Desert Health Group facility.

Police involvement?

Though certainly not a common occurrence, there are some situations involving extreme neglect or abuse of a nursing home patient that deserve to be investigated by police or other law enforcement officials.  Particularly if an incident has not received proper attention for the nursing home ombudsman or state department, the family may wish to escalate the investigation by contacting police.

Further, when a crime has occurred at nursing home, family may wish to contact the local police department.  In addition to securing the scene and removing the dangerous individual(s) from the facility, a timely performed police investigation holds the possibility of safely securing the physical evidence from the scene for potential use in both criminal and/or civil proceedings.

As a nursing home lawyer who has counseled frustrated families with compromised legal options following an episode of extreme neglect or abuse, I find myself continually wishing that these families took it upon themselves to contact some agency or police so that the conditions could at least be documented by a third-party. 

Related:

Lawsuit Aginst Nursing Home Alleges Maggot Infestation Contributed To Patient's Death

Abusive Events In Adult Homes Go Unreported & Unprosecuted

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

A Midwestern heat-wave is likely to blame for the death of a 69-year-old man at a Wisconsin nursing home.  Though no official cause of death has been established, prolonged heat exposure appears to be primary cause of the man's death.

WISN.com is reporting that emergency personnel were called to Sunrise Care Center, after the man was discovered by staff sitting unresponsive in his wheelchair. 

Apparently, the physically disabled man had been brought outside by staff at the facility earlier in the day and remained outside in the 97-degree heat for more than three hours.

Two hours after the man was discovered, his body temperature was 101.4!

To me, cases such as this are a disturbing reminder of just how poor the care at many nursing homes truly is.  The fact that a nursing home worker brought a patient outside and left him unattended in such extreme heat is absolutely inexcusible. 

While investigators look further into the circumstnaces surrounding this incidnet, I hope prosecutors consider charging the individual(s) responsible for supervising this man are held fully responsible.  I can only imagine if this situation were to occur with a young child, the caregiver would already be in custody in jail?

Perhaps Abiodun Oke should be shoveling asphalt or a similar occupation where a person's compassionate side is not necessarily crucial to the job?

On the other hand, as a licensed practical nurse (such as Mr. Oke)--- or really any profession responsible for caring for the elderly-- I would suggest have substantial dose of compassion as they are the ones who are responsible for providing the daily care necessary for some of the most fragile members of society.

The reason I suggest that Mr. Oke look for a more physical type of work is that he faces criminal charges relating to the neglect of an 81-year-old Pennsylvania nursing home patient.  In addition to suffering from dementia and pneumonia, the patient was also ventilator dependent.

Specifically, it is alleged that on August 13, 2009, Mr. Oke intentionally walked out of the room of a ventilator patient he was responsible for caring for and refused to re-attatched her ventilator tube.

The incident was reported to authorities and nursing home management by a respiratory therapist at the facility who witnessed the incident and stepped in to reattach the patient to the respirator.  When confronted by the respiratory therapist, Oke said, "I connected her twice, now I want to see her suffer" as the patient began to turn blue from the lack of oxygen.

In addition to the testimony from the respiratory therapist, prosecutors also have a video showing Mr. Oke in the hall of the facility.

Surely, criminal issues aside, the world would be better off without people like Mr. Oke responsible for providing hands-on care to such a vulnerable group.

Related:

Nursing Home Fined For Negligent Care Of Resident On Ventilator

Elderly Patients Are At Higher Risk For Developing Aspiration Pneumonia When Facilities Fail To Account For Patient Needs

PA Nursing Home Lawsuit Claims Facility Failed To Supervise & Implement Wheelchair Precautions

Nurse charged with neglect, By Keith Phucas Times Herald, January 24, 2011

Nursing Home Injury Laws: Pennsylvania

A Minnesota family cites repeated neglect as being responsible for the death of their mother, 91-year-old Esther Rannow. 

The poor care started when Ms. Rannow entered the Benedictine Living Community in St. Peter, MN in February 2007.  In addition to developing a urinary tract infection that went untreated, the family also identifies episodes of poor nursing that cumulatively took a toll on their mother—and eventually claimed her life.

Specifically, the family identifies an episode in October 2007 when a CNA dropped their mother as she was attempting to place her into a bed from a hospital gurney.  The dropping incident occurred just one month after Ms. Rannow was injured in a similar incident. The second incident occurred when one CNA attempted to transfer their mother to a wheelchair while the ‘care plan’ required a two-person assist.

The family’s reports of neglect at the nursing home were reported to the Minnesota Department of Health, but the agency was unable to substantiate the neglect based on their findings.

Not satisfied with the Department of Health’s investigative findings, the family has elected to pursue a wrongful death lawsuit against Benedictine Living Community and its parent company Benedictine Health Dimensions.

In the lawsuit, attorneys for the family will likely have an opportunity to ask questions of the employees who have knowledge of this incident. Oral questioning or depositions, as they are commonly known, allow an attorney to ask questions of a witness under oath. 

In many nursing home injury cases, a skillfully taken deposition can not only provide clarification as to how an incident may have occurred, but frequently can be effective in getting cases resolved—particularly, when facts that are unfavorable to the facility are disclosed by current or former employees.

As this lawsuit moves through the discovery phases, we will soon learn whose interpretation of events is more accurate. 

Related:

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

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

'Poor Judgment' To Blame For CNA's Failure To Implement Fall Precautions In Minnesota Nursing Home Death

Wrongful Death Lawsuit Filed Against St. Peter Nursing Home by Dan Nienaber The Free Press, December 7, 2010

If you're looking for another prime example of nursing home neglect, you need look no farther than to take a look at a news story in The Palm Beach Post regarding an elderly patient at Gainesville Health Care Center, a Florida nursing home. 

After losing an eye to cancer, the patient was admitted to Gainesville for medical care that included changing the dressings covering the eye socket. 

Despite physician orders to change the dressings twice daily, staff apparently failed to do so claiming that that patient wouldn't cooperate.  During an examination at a Veterans Administration facility, following a stay at Gainesville, staff discovered that the man's eye had become infected and maggots were also found in the empty socket. 

The situation was so severe, Veterans Administration authorities filed a report with the Adult Protective Services unit of the Florida Department of Children and Families who confirmed the mistreatment.  Despite the patient's refusals to allow staff to change his dressings, the facility never notified the man's physician or family.

A Facilities Duty to Provide Care vs. A Patient's Wishes

As a nursing home lawyer, I frequently see situations where facilities fail to provide medical care due to the fact that the patient is refusing such care.  In situations where a patient truly does not want the medical treatment prescribed, nursing homes still must notify the patient's physician and family of the situation.

In situations where the patient's lacks the capacity to make such decisions, staff should notify the patient's power of attorney and determine how they wish to proceed.  Failure to contact the patient's power of attorney in these situations certainly exposes facilities to liability for failing to follow the patient's care plan.

Related Nursing Homes Abuse Blog Entries:

Lawsuit Against Nursing Home Alleges Maggot Infestation Contributed To Patient's Death

Nursing Home Cleared Of Neglect Charges In Case Where Resident Had Maggots In His Eyes

Nursing Home Injury Laws: Florida

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

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

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

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

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

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

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

Related Nursing Homes Abuse Blog Entries:

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

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

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

Why Would Anyone Want To Work In A Nursing Home?

Since its inception, Nursing Home Injury Laws has become a trusted resource for caregivers and families seeking reliable information in a time of need.  Nursing home injury laws provides a comprehensive compilation of state-by-state nursing home contacts, a glossary for common legal terms, resources and legal information should the need arise.

In addition to important links to important developments within each state, Nursing Home Injury Laws provides has important information on the following commonly encountered nursing home injuries:

• Bed sores / decubitus ulcers / pressure ulcers / pressure sores
• Falls
• Medication errors
• Neglect
• Sexual abuse
• Wandering
• Wrongful death
• Physical abuse
• Nursing home FAQ

Continue to check out Nursing Home Injury Laws on a regular basis as more information continually gets added.

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.

Thousands of children with disabilities end up living in nursing homes because of insufficient coverage for in-home care by state governments and a shortage of skilled home care workers. In 2000, the Centers for Medicaid and Medicare Services estimated that 4,886 children lived in nursing homes; of these children, 1,222 suffered from mental retardation or a developmental disability. 

Medicaid guarantees long-term care for all people with disabilities, including children. However, many disabled children, who would be adequately served by proper in-home care, end up in nursing homes despite higher costs for nursing home care than in-home care. 

The University of Minnesota Research and Training Center on Community Living reported that home and community care cost about $26,000 per year while the state of Georgia spends about $81,000 per year on each patient in nursing homes. Although some federal and some state funding has been increased to help remove disabled children from facilities with four or more disabled persons (congregate settings), the number of institutionalized children has remained largely unchanged. 

Many disabled children end up in nursing homes because of insufficient state resources. About 93,000 special needs people are on waiting lists for home and community based services. However, there are not enough skilled nurses, therapists, and home health care workers to support the people who most need their help. In many cases, the family’s private insurance won’t cover the cost of medical equipment, and in-home nursing and therapy. This leaves many families with only one choice, nursing home care. 

Most nursing home care is focused on older adults because elderly residents constitute the majority of the resident population. As expected, treatment and health concerns differ for older adults and children. Also, children often spend more years living in nursing homes than the elderly adults they are surrounded by because of the age difference. This means more years spent living in a nursing home, away from their family, usually costing Medicare more money than if the child were able to live at home receiving in-home support services. 

However, until states step up funding to improve in-home care resources, these children will remain stuck in nursing homes, hardly a suitable environment for most children, especially when their families would prefer them to be living at home. 

Nursing Homes, Group Homes & Day Care Facilities Responsibility To Care For Children

The foreign environment of a nursing-home-world created for adults, leaves many children at risk for abuse and mistreatment at the hands of caregivers and other patients.  I have successfully prosecuted cases on behalf of many of these children and young-adults in the following types of cases:

• Sexual Abuse
• Physical Abuse
• Neglect
• Molestation
• Food Poisoning
• Medication Errors

Working side-by-side with some of the most respected authorities on the long-term effects of abuse on young people, we have successfully secured money to provide for the future.  Many of the sexual abuse and molestation cases we work on can be resolved prior to the filing of a lawsuit, in a confidential manner-- with minimal impact on the individual. 

If you believe a young person suffered from an injury, abuse or neglect in a nursing home, foster home, day care, group home or any other structured setting, we would honor the opportunity to speak with you.  As always our services are free if we do not recover on your behalf. (888) 424-5757

Resources:

Medical News Today: Wall Street Journal Examines Nursing Home Care for Children with Disabilities

VirginiaSpecialNeeds.com: Thousands of Children with Special Needs Are Living in Nursing Homes 

Research and Training Center on Community Living: Number of Children in Nursing Homes 2002

Wall Street Journal: Babes Among Elders, Nursing-Home Kids

Related Nursing Homes Abuse Blog Entries:

Alden Village North Charged With Neglect After Child Dies Due To Inadequate Nursing Care

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

Child Injury Laws: Nursing Home Abuse: The Deaths Of 13 Children Linked To Poor Care At Chicago Nursing Home

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

In cases involving nursing home abuse and neglect, filing a complaint with a state agency regarding the incident can be incredibly important with respect to getting answers about how an incident occurred and securing valuable information should the matter be litigated in the future.

John Kormanik who produces an excellent Nursing Home Abuse Advocate Blog, recently made some extremely useful suggestions before initiating the complaint with your state agency.  Here are John's suggestions:

• Provider / Facility Name and City
• Name of Patient/Resident
• Detailed Statement of Care Provided And Any Negative Outcomes
• Names of Witnesses
• Your Name and Contact Information; unless you wish to remain anonymous.

Of course, if I may add my own two cents, I would add the follow:

Report the incident as soon as feasible

Reporting an incident as soon after it occurs provides investigators with the best opportunity to access records, witnesses and staff with knowledge.  In many circumstances, facilities have such high staff turnover that, a witness to an incident may be long gone-- within months of an incident.

Be as succinct at possible

After fielding calls all day, do you really think the men and women on the other end of the line want to hear all the details of your favorite sushi restaurant or how Grandma Sue is a huge Cubs Fan?  

Seriously, report the information that is relevant to the event and stop.  Too much information will just detract from the seriousness of your complaint.

Above all, I strongly encourage people to report all situations involving questionable care or injury to your state's department of public health or ombudsmen program.  

Related:

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

Nursing Home Watchdogs: Ombudsmen

Where To Report Elder Abuse

Ombudsmen In Nursing Homes

State investigators have set an October 25th deadline for the Englewood Health Care center to correct conditions deemed to be unsanitary.  During a recent inspection, investigators found mold and leaking water in several patient rooms.  These unsanitary conditions were particularly bothersome to inspectors due to the fact that a substantial portion of the nursing home patients suffered from 'respiratory illness".

A report from the non-profit group, Protection and Advocacy for People with Disabilities, paints an ugly picture of the living conditions found in South Carolina assisted living facilities.  The report entitled "No Place To Call Home" was completed after a 14 month investigation into assisted-living and analysis of state documents and resident complaints.

After reading the report, most assisted living facilities bear no resemblance to any home-like environment.  The report completed by volunteers details the following findings:

• Residents abused by facility staff, a two-by-four was used to physically abuse a resident.
• Unsanitary living conditions, at one facility buckets of used hypodermic needles were seen in a main living area.
• Convicted 'sex offenders' working at the assisted living facilities.
• Faulty equipment, no door knobs on doors that consequently allowed people to be locked in the facilities.
• Faulty air-conditioning systems, some residents were forced to sleep in bedrooms that were 82-degrees.

"Our hope is to prevent even more people from living in squalor, suffering abuse and neglect or even dying due to lack of oversight," said Gloria Prevost, executive director of Protection and Advocacy for People with Disabilities.

Currently, there are more than 16,000 South Carolina residents living in about 500 assisted living facilities.

Assisted Living Centers vs. Nursing Homes

Most assisted living facilities provide a community living environment for seniors where the facility provides some level of supervision and meal preparation. Unlike nursing homes (that provided skilled nursing services), most assisted living facilities provide only a limited amount medical care.  Consequently, most states provide far less regulation of assisted living facilities compared to their nursing home peers.

Resources:

Problems found in care centers, The Post and Courier, July 22, 2009

No Place to Call Home, Protection and Advocacy for People With Disabilities

When It Comes To Governmental Oversight, Assisted Living Residents Are On Their Own, Nursing Homes Abuse Blog, February 5, 2009

California has one of the strictest and most severe policies when it comes to dispensing fines to nursing homes who provide poor or dangerous care.  Say what you like about regulation of nursing homes, the reality is that fines really do help improve care and living conditions for nursing home residents.

The state imposed substantial fines against two Orange County nursing homes for providing inadequate resident care.

$100,000 Fine

A $100,000 fine was handed to Alamitos West Health Care Center for allowing an 82-year-old resident to die from dehydration and acute kidney failure.  Less than a month after her admission to the facility, the unnamed woman was admitted to a local hospital and treated for a urinary tract infection, dehydration and an 'altered mental status'.  The woman died on Christmas day.

The California Department of Health investigation revealed that the facility ignored physician orders requiring the facility to monitor the woman's fluid intake and urine output every shift. 

$80,000 Fine

Huntington Valley Healthcare  Center was fined $80,000 for failing to call 911 when a resident was suffering from a heart attack because the facility mistakenly believed the man had do-not-resuscitate orders.  In reality, the resident's chart had an order completed by the resident stating, "I DO WANT CPR' in an emergency situation.  By the time paramedics arrived, the man was covered with a sheet with no evidence the staff had taken any steps to initiate CPR.

I guess the time will tell if their fines do anything to improve the care rendered at these facilities...

Read more about these fines imposed against California Nursing Homes here.

Nursing Homes Abuse Blog Entries Related To Fines

Judge Limits Fines For Poor Nursing Home Care

Maximum Fine Levied Against Nursing Home For Failing To Supervise Resident While Smoking

Failure to Follow Orders Results In Death Of Patient & Hefty Fine

Labels frequently get tossed around when describing nursing home lawsuits.  Admittedly, some of these descriptors such as 'abuse' or 'neglect' get overused by people who may have a 'vested interest' in the matter-- family members, friends and attorneys.  When an independent investigator applies 'neglect' to his findings, more people should take notice.

"Nursing home neglect" resulting in dehydration is what a Tennessee Medical Examiner ruled as the cause of death following the autopsy performed on 46-year-old Linda Carter.  Carter died on March 27th at the at the University of Tennessee Medical Center following a nine day admission to Hillcrest North Nursing Home.  Carter was admitted to Hillcrest for rehabilitation from injuries sustained in a car accident.

When Knox County Medical Examiner,  Darinka Mileusnic-Polchan, examined Carter's body he noted the following visible signs of dehydration:

• Poor skin turgor
• Sunken eyes
• Concentrated urine
• Empty stomach and proximal small intestine

These autopsy results will not doubt provide added ammunition to the wrongful death lawsuit filed by Carter's children.  The lawsuit against Hillcrest seeks $7 million in compensatory damages and $28 million in punitive damages.  

Currently, the Tennessee Bureau of Investigation (TBI) is conducting its own investigation into the death.  TBI spokeswoman, Kristin Helm indicated that criminal charges may be filed against Hillcrest as well.  "We are looking into it as a suspicious death," Helm said.  " We met with the (Attorney General) and he asked us to look into it more, to review it and come back and meet with him again."

Read more about the medical examiner's finding here.

View The Final Autopsy Report 

Related Nursing Homes Abuse Blog Posts

Damages

Appellate Court Orders Retrial In Nursing Home Negligence Case With $29.8M In Punitive Damages

Family Seeks Punitive Damages Against Nursing Home For Death Involving Malnourishment Of 84-Year-Old

Tennessee Legislature Attempts To Limit The Rights Of Injured Nursing Home Residents

Occasionally I receive emails and comments from blog readers asking what 'really' constitutes nursing home neglect.  Its easy to point to definitions, but the best explanations usually come by way of example.

Yesterday, I was reviewing the chart of a 70-year-old lady who resident who died in a Chicago nursing home.  The lady who died from complications following a severe burn on her leg due to contact with a wall-mounted radiator. 

An investigation by state nursing home investigators verified that the woman's bed was jammed so close to the radiator that it had repeatedly come in contact with the bed, mattress and the woman's body (there were several burns noted on her right side). Despite the facilities own documentation of problems due to keeping the bed too close to the radiator, the bed was kept in place for months before the woman sustained a severe burn.

Four months after the 'radiator problems' had been initially noted, this woman sustained a third-degree burn to a large portion of her lower leg. Conservative burn treatment was unsuccessful in healing the large leg burn and ultimately the woman required a skin graft. 

The woman underwent several weeks of successful burn treatment in a hospital.  However, the woman was ultimately moved back to the original nursing home where she was injured and quickly contracted an infection. Within two weeks of moving back to the nursing home, the woman died.

In this case, the nursing home resident was a victim of neglect on so many occasions, it is literally difficult to keep track.  Nonetheless, the point is not how many times the facility failed to properly care and assess the patient, but rather how easily preventable the injury and subsequent death were.

Related Nursing Homes Abuse Blog Posts On Nursing Home Burns

Resident Who Smoked & Used Oxygen Suspected Of Causing Fire At Assisted Living Facility

Unsupervised Nursing Home Resident Dies From Burns

Burns In Nursing Homes

Web Resources For Burn Victims

American Burn Association

Alisa Ann Ruch Burn Foundation

A case case of horrific nursing home neglect (perhaps more accurately nursing home abuse) has been reported in New Mexico.  The owner of an Albuquerque Nursing Home, has been found guilty of in the death of resident who was left sitting on top of a bedpan for more than 24-hours. 

The incident occurred on Christmas day, 2005, when the owner of the facility placed the bedpan under 76-year-old Richard Gerhardt and disappeared.  Gerhardt was bed-bound at the time because he was recovering from a broken hip.  By the time the incident had been discovered, the bedpan had become embedded in Gerhardt's skin.  An open wound soon developed and became infected that ultimately led to his death five days later.

The nursing home faces a possible $5,000 fine and/or loss of federal funding (Medicare).  “Nursing home[s] and care facilities are paid to provide round the clock care to those who cannot care for themselves… Protecting this population is of paramount importance to the New Mexico attorney general and similar violations will be prosecuted vigorously,” said Elizabeth Staley, director of the New Mexico attorney general Elder Abuse and Medicaid Fraud Division.  Read more about this incident involving the death of nursing home resident here.

Sentencing for the case is set for March 13.

Related Article

Nursing Home Owner Convicted in Bedpan Death
2009-02-22 05:40:37 (GMT) (WiredPRNews.com - Law, News)

The Chicago Tribune reported that Morris Lee Brinkley, a 73-year-old home care nurse, has had her nursing license suspended.  According to Illinois Department of Financial and Professional Regulation, Ms. Brinkley's nursing license was suspended for, "failing to adequately treat bedsores and other signs of neglect on a 13 year-old home health care patient who subsequently died and for failure to report suspected child abuse or neglect as required by the Abused and Neglect Child Reporting Act."  

The 13-year-old boy the Department of Professional Regulation is referring to is Jaylen Brown.  Due to cerebral palsy, mental retardation and severe scoliosis, Jaylen relied on his home care nurses for all of his daily living needs.  

The nurses did not do their job.  In March, Jaylen's mother brought him to  the University of Chicago's Comer Children's Hospital with dangerous medical conditions.  According to reports, Jaylen was presented to the hospital he had pressure ulcers on his shoulder, ear, legs and hand.  A pressure ulcer on his back had advanced so far, that the his bones were visible.  In May, 2008 Jaylen died from sepsis.  His death has been ruled a homicide.

Home health care nurses are commonly used to provide medical treatment to home-bound people of all ages.  In addition to providing medical treatment, home care professionals must report instances of suspected abuse or neglect back to authorities.  Amazingly, Morris Brinkley had more than 20 year nursing experience.

Forest Park LLC, the corporate owners of Pavilion of Forest Park nursing home have plead guilty to felony gross neglect charges that stem from the death of a long-term resident.   The guilty plea follows a 2005 grand jury indictment of Forest Park LLC and Jason Garti, the medical director and wound-care physician of the nursing home.

Specifically the criminal charges related to Shirley Massey, 48, who died from pressure sore complications after a four month stay at Pavilion of Forest Park.  Massey was taken to Loyola Hospital in Maywood, IL where she was diagnosed with severe bed sores and tissue damage eroded to the bone.

Cook County Circuit Judge James Schreier ordered the company to pay a $25,000 fine and $75,000 in investigation and court costs. The company also was sentenced to the maximum sentence of 30 months conditional discharge. The nursing home was sold to another company in July 2007.  The case against Dr. Garti remains open.

According to Cook County Clerk of Court records Massey's Estate filed a wrongful death lawsuit against Pavilion of Forest Park, its parent company Care Centers and Dr. Garti in 2003.  A mere three years after the case was filed, the lawsuit was settled.  

 Read more about this case of nursing home neglect at a Chicago nursing home here.

Episania Fitzgerald was charged with abuse and neglect of an elderly person when she decided to leave her post as night nurse at an assisted living facility.  Fitzgerald told the sheriff's office investigating the matter that she left the assisted living facility with another resident in charge to provide home health care services elsewhere. 

Fitzgerald was gone for more than two hours, leaving the 21 elderly residents completely unattended.  During, nurse Fitzgerald's leave an 88-year-old resident fell on the bathroom floor requiring paramedic assistance.  It is unknown what, if any action the facility will take as discipline for this nurses inexcusable behavior.

This incident demonstrates the importance of selecting a well staffed facility.  It is important for families to specifically ask how many nurses, physicians, and CNA's are on duty throughout each shift.  While state and federal laws set staffing minimums, it is generally not a good idea for any one person to be solely responsible for the care of a large number of residents.  

Read more about this situation involving nursing neglect here.

Glenwood Gardens, a California retirement community was fined $100,000 by the California Department of Public Health following the death a resident who choked to death on a ketchup packet in 2006.  The 84-year-old man lived at the facilities skilled nursing facility because he suffered from dementia and had breathing difficulties.  The ketchup packet was wedged in the back of the man's throat by a mortuary embalmer.  Investigators determined the staff at the facility were aware of the man's propensity to eat non-edible objects and failed to formulate a plan to prevent the man from ingesting the ketchup packet.  Read more about this incident involving nursing home neglect here.

What makes this incident particularly inexcusable is that it occurred at a facility that concentrates in providing skilled nursing care to Alzheimer's and dementia patients.  It is a common problem for Alzheimer's Had the facility taken the basic precaution of removing non-edible objects from the residents meal tray this incident would likely not have occurred.  Moreover, had the staff properly monitored this man as he ate, the choking should have been caught and the ketchup packet removed from the man's throat.

Glenwood Gardens is part of Brookdale Senior Living communities.  Brookdale is the largest owner and operator of senior living communities in the United States.  Brookdale owns more than 550 senior living and retirement communities and houses more than 50,000 residents.  There are many Brookdale facilities throughout Illinois.

 The second most frequently encountered 'never event' is an infection from a central venous catheter.  Infections due to improperly maintained and inplanted central venous catheters accounted for 29,536 cases in hospitals in 2007.  A central venous catheter is a tube usually inserted in an arm or chest and threaded through a vein until it reaches a large vein close to the heart.  Central venous catheters are used to administer medication, supply nutrition or blood products.  

There are three main types of central venous catheters:

• PICC Line: A 'peripherally inserted central catheter.'  PICC's are the most common type of central venous catheter accounting for more than 50% of the vascular catherizations because it may be inserted relatively easily.  PICC's are inserted into a vein in the arm as opposed to the neck or chest.
• Tunneled Catheter: A surgically inserted catheter in the neck or chest and is passed under the skin.  Only the end of the catheter is visible through the skin.  Passing the catheter under the skin allow people greater mobility and helps the catheter stay in place.
• Inplanted Port Catheter: Similar to the tunneled catheter, but the entire catheter is left under the skin.  Medication must be injected through the skin and into the catheter.

More than 40% of bloodstream infections are accounted for in people with central venous catheters. An estimated 1% to 5% of people with central venous catheters who get an infections die from them. In order to reduce the likelihood of infection, the following should be done:

• Use sterile technique when working with a person who has a central venous catheter.
• Clean the exposed area of the catheter on a regular basis.
• Dressings should be changed at a minimum of every week.
• The catheter should be flushed regularly.
• The exposed end of the catheter should be routinely check for inflammation and discoloration--the early signs of a potential infection.

Basic maintenance and observation should be part of all hospital and nursing home patients routine.  If you have acquired a blood infection during your hospital or nursing home stay, do not assume that your condition was inevitable.  For more information on infections of central vascular catheters this is a useful article.

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The criminal case against two Portland nursing home employees gave me chills.  This case goes beyond nursing home neglect and enters the realm of nursing home cruelty. According to reports, a nursing director is being charged with two charges of criminal mistreatment and a certified nursing assistant (CNA) is being charged with reckless endangerment for their inaction following the fall-related injury to a resident at the Gateway Care and Rehabilitation Center.

The nursing home employees allegedly waited five days before sending a 59-year-old resident to the hospital for medical treatment for her broken legs sustained in a fall.  The nursing home resident apparently fell while being transferred from her wheelchair to her bed with a lift. 

The nursing home staff tried to hide the incident from the resident's family.  Federal and state nursing home regulations were ignored as no incident report was completed following the fall.  Despite the fact that the nursing home resident was screaming in pain and nurses could hear popping sounds coming from the badly broken legs, no medical treatment was provided.  After five days of living in pain the resident was taken to a hospital where she died.

These criminal charges against the individual nursing home employees are separate from a lawsuit for wrongful death that the estate of the deceased woman is entitled to bring.  If these claims of nursing home neglect prove to be true the nursing home and its owners should be held fully responsible for fostering an environment where nursing home employees hold a code of silence to protect each other.

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.

A certified nurses assistant (CNA) is now behind bars following a brutal episode at Ashley Manor, a Colorado nursing home.  According to local police, 23-year-old Kalen Randolph stuck an Alzheimer's patient multiple times before fleeing the facility altogether and leaving all the residents of the facility unattended.  The 74-year-old victim suffered injuries to his head, ear and hand.  Mr. Randolph is charged with eight counts of neglect and one count of second degree assault.  Read more about this incident of nursing home abuse here.

How do things like this happen in facilities today?  How can a facility allow one person to care for all the residents by themselves?  What would happen if this were a medical emergency or fire and the sole nursing home employee was responsible for the care and safety of all residents?  No one is asking me, but having a facility staffed by one person seems like trouble on so many fronts.

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

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

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

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

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

A man admitted to Azalea Court Nursing and Rehabilitation Center for rehab for a broken leg, soon realized he was getting more than rehab at the facility he chose to help him- maggots.  The maggots were seen in an open wound during a dressing change.  Azalea Court's complaint and inspection reports from the past several years did not reveal any glaring problems. Investigators from the State Attorney’s Office visited Tuesday.  Read more about the maggots here.

This is a prime example of neglect nursing homes.  Nursing homes are required to provide the best care possible for their residents.  The failure to clean and open wound is a clear case of patient neglect.

Related:

Nursing Home Injury Laws: Florida

Where else can a business treat customers without any respect in run-down environment and continue to stay in business?

The answer is: The nursing home industry in America.

Nursing homes funded by Medicaid receive a daily payment from the government for each resident every day. The government pays the facilities regardless of the quality of service provided. As a result, many nursing home owners; will put off facility repairs, serve lousy food and hire some of the most inept people to run their facilities to maximize profit. Of course, fines may be imposed and facility closure may be threatened  The reality is that it is difficult to relocate nursing home residents to other facilities. Nursing home owners know this. Paying fines has become part of the nursing home business. The reality is the fines probably only result in even further reductions services to the residents of the facility.

An example of a nursing home choosing profits over the needs of its residents appeared here. Westside Health Care Center, an exclusively Medicaid funded facility, provides nursing home care to 40 residents in Ohio.  After health workers and police from the Ohio Department of Public Health found 27 housing and fire code violations, the Department attempted to shut down the facility. The inspectors described the facility as 'worse than any crack house they had come across.' (emphasis added)

To combat the potential closure of his facility, the administrator filed an injunction to keep the nursing home open. A judge ruled in his favor and has set the matter for hearing later this month. Meanwhile, the 40 residents of Westside will continue to be the real losers of the situation as they continue to live in an obviously deplorable facility.

Related: Nursing Home Injury Laws: Ohio

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

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

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

The complete poll results are here.

Blog readers occasionally ask: what really constitutes 'neglect'?  The best answer is given by example.  Once readers hear specific examples of how neglect occurs everyday in nursing homes they begin to appreciate it’s the severity of the situation.

Currently, my office is prosecuting a case of severe neglect involving a paralyzed man who is a long-time Foley Catheter user.  During the course of his stay at a Chicago-area nursing home, the staff failed to properly clean the catheter and our client developed an infection in the urinary tract and kidneys.  The infection was ignored for so long that our client required months of hospitalization and surgical removal of his testicles. 

Many nursing home residents use catheters.  Generally, a catheter is a tube inserted into the body where you urinate and into the bladder.  The end of the tube is connected to a collection bag.  Its purpose is to drain urine from the body. Catheters may be used in the following circumstances:

•    For doctors to monitors how much urine you are producing
•    If you are unable to control you bladder
•    If you can not empty your bladder when urinating
•    If you have severe illness or are unable to physically move to the bathroom
•    If you have pressure sores or open wounds

Many residents of nursing homes receive catheters when they have none of the above conditions.  Often nursing home staff will unnecessarily catheterize a resident to avoid physically assisting a resident to the toilet.  

Once in place a catheter requires maintenance and monitoring.  The following must be done to assure proper catheter care:

•    Monitor the amount of urine in the bag
•    Make sure the person drinks lots of fluids (6 – 8 glasses of water per day)
•    Empty the drainage bag at least every 8 hours
•    Wash the area where the catheter enters the body at least 2 times per day
•    Check the skin where the catheter enters the body for infection and irritation