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

Douglas McGregor, a CNA at an assisted living facility for dementia and Alzheimer's patients, stands accused of raping a 71-year-old woman with whom he was to assist in dressing.  According McGregor, the elderly woman was 'tugging' on his waist line and the button on his pants broke, thereby exposing his genitals because he wasn't wearing any underwear.

The incident, which is to allegedly have occurred on February 17th at Weatherly Inn at Lake Meridian, is currently under investigation by officials at the Washington Department of Health.  Nurse McGregor is in custody at the Norm Maleng Regional Justice and is scheduled to return to court on March 25th, when a trial date may be set.  If convicted, Mr. McGregor may face up to a lifetime sentence. 

Am I the only one who finds the fact that a male CNA is responsible for dressing a female patient a bit unusual?  Perhaps I'm a bit old fashioned, but allowing male employees to dress (and presumably undress) female patients seems to be a violation of their privacy-- not to mention adding an inherent amount of sexual tension.

Read more about this sexual assault in an assisted living facility here.

Related:

Nursing Home Supervisor Admits To Abusing 100 Residents

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

Nurse Charged With Rape Of Disabled Patient

Lawsuit Claims That Nursing Home Failed To Intervene In Case Involving The Sexual Abuse Of A Patient

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

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

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

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

Read more about this new technology here.

About Golden Living:

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

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

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

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

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

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

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

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

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

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

Finding A Good Nursing Home In Your Area

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

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

Related:

High Staff Turnover Rates Plague Most Nursing Homes

Eden Or A Warehouse? You Choose.

Nurses Admit To Problems At Nursing Homes

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Right on the heels of Dubuque Retirement Community, formerly Iowa's largest assisted living center, Jefferson Point Assisted Living Center has announced it will no longer operate as an 'assisted living facility'.  Operators of Jefferson Point will now operate the facility as an apartment complex.  Residents who require medical assistance may elect to remain in the building and pay for 24-hour medical care.

Jefferson Point has a history of failing to meet minimum standards of care and has received multiple fines from Iowa regulators. Ann Martin of the Iowa Department of Inspections and Appeals believes these assisted living centers' actions legal but unprecedented.  According to Martin, there will be no oversight of the centers' care of their residents.

I hope the current residents and families at these facilities appreciate the impact of these changes.  With no regulation or oversight, the residents are essentially at the mercy of these operators when it comes to the quality of care provided.  My guess is that these Iowa facilities may be starting a dangerous trend with respect to the de-regulation of assisted living facilities across the county.

Read the details regarding this Iowa facility here.

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

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

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

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

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

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

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

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

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Following a trial and appeal, the family of Alice Limbrick has reached a settlement with the assisted-living facility where she was a resident.  In the lawsuit (Roy Limbrick et al v. Mariner Health Care, Inc.), the deceased woman's family claimed both the assisted living facility where she was a resident and a hospital where she underwent medical treatment, were negligent in allowing her to developed pressure sores that ultimately led to the amputation of her legs. 

Following the fall and resulting hip fracture at Green Acres Parkdale, Limbrick was admitted to Baptist Hospitals of Southeast Texas where she underwent medical treatment for her hip fracture.  It was during admission to the hospital, Limbrick developed pressure ulcers and blisters on her heels and left leg. 

Despite the pressure ulcers, Limbrick was discharged from the hospital and sent back to Green Acres for rehabilitation of her hip.  At Green Acres, the pressure ulcers on Limbrick's heels worsened, necessitating a re-admission to Baptist Hospital with a diagnosis of gangrene on both heels.  As a result of complications related to the pressure ulcers, both of Limbrick's legs were amputated below the knee. 

At trial the assisted living facility argued the family was partially responsible for their mothers medical condition because they did not sent her to an acute facility.  Additionally, the facility claimed the amputations were unpreventable as Limbrick suffered from a variety of debilitating medical conditions such as: a weakened immune system, diabetes, poor circulation, Alzheimer's and general old age.

Despite the assisted living facilities arguments, a jury recognized the the facilities negligence in failing to properly treat the pressure ulcers and awarded the family $80,000 for past mental anguish, $20,00 for past medical expenses and $300,000 for past disfigurement and impairment damages.  It is unknown what the actual settlement between the parties entered into during the appeal process.  The case against the hospital was resolved prior to trial. 

Cases involving elder neglect and abuse commonly involve multiple parties.  When proceeding in a claim against multiple parties it is important to put together a time-line to differentiate what facility was rendered care to the individual at the particular time.  It is also helpful to consult with an expert, such as doctor or nurse, to determine what the individuals condition was both at the time of admission and the time of discharge from the facility.

Read more about this lawsuit involving a Texas nursing home here.

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The discussion on administration of medication at assisted living facilities at Inside Assisted Living, caught my attention.  Inside Assisted Living is an extremely useful blog dedicated to helping residents and their families transition into assisted living facilities.  A reader of the blog asked:

'Ryan, my parents are now in an Assisted Living Community. I’ve been told that they must turn over administration of their meds to the Nurse. Problem is, that there is constantly problems with the meds given by the nurse, ie. meds from another patient, not given at proper time, cannot identify the pill, not all prescriptions given. They tell me that this is a Federally mandated law that my parents cannot self administer, is this true?'

Ryan, the blog administrator gives some excellent advice when addressing this frequently encountered situation dealing with medication errors.  If the resident of an assisted living facility is capable of administering medication, they should generally be able to do so.  I must agree, with Ryan that once a facility takes on an important responsibility, such as the administering medication they must do so in a safe manner. 

If an assisted living facility or nursing home is dispensing the wrong medication or is administering the doses at improper intervals, the situation should be brought to the attention of the facility administrator and / or the state department of public health.

Studies have shown that medication errors occur with up to 50% of nursing home and long-term care residents.  The following are important criteria to evaluate to assure your loved one is the the recipient of a medication error.

Review each medication with a physician to determine its necessity

• Make sure the list of medications is complete
• Identify the condition for which each medication is prescribed
• Determine the potential for any drug vs. drug interactions
• Determine potential for any drug vs. disease interactions
• Can the drug regimen be simplified?
• Are there any new, safer drugs available to substitute with current medication?
• Is it possible to discontinue any medication? 

New medication tips

• Is the diagnosis correct?
• Can the condition be treated without medication?
• Can a lower dosage be used?
• Could the symptoms be related to another medication?
• Can one drug be used to treat multiple conditions?

Inappropriate medication use

• Don't try to treat every condition. It is impossible to treat every physical condition
• Don't try to treat the side effects of medications
• Try to have one physician prescribe all medications
• Make sure each all physicians involved in a patients treatment are aware of each other

Bottom line is that given the frequency of medication errors and the serious medical complications that may arise from their complications it is best to speak up immediately if you suspect even a minor deviation from the physician prescribed medical protocol.

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The family of an assisted living resident has filed a wrongful death lawsuit against the facility. 83-year-old, Luveda Fern Kessler, fell and cut her leg as she got out of bed at her Laguna Hills assisted living apartment. Ms Kessler did as she had been told to do: Press a personal emergency response call button, according to a recent lawsuit filed by her family.

The assisted living employee waited 24 minutes before calling 911.  During the 24 minutes Ms. Kessler lay bleeding and unassisted with any staff.  By the time the paramedics arrived, Ms. Kessler lay on her stomach, non-responsive. She was later pronounced dead at a local hospital.

Villa Valencia did not report the Aug. 23, 2007, incident to the state.  The incident led to a wrongful death lawsuit filed in Orange County Superior Court last month against Villa Valencia and its owner, Sunrise Senior Living Inc.  "They let my mom bleed to death,'' said Kessler's daughter, Joanne. "I thought that was the best place for her. … Her death was completely preventable."

Assisted living facilities are not intended to provide the same level of care as nursing homes.  Nonetheless, assisted living facilities are required to conduct assessments as to residents medical needs and provide assistance to residents who require it.  In this case, not only was there not a nurse to provide help, there was no staff to provide basic life saving assistance.  Read more about this incident involving assisted living under-staffing here.

Here is a transcript of 911 call regarding Kessler's injury, which was made at 1:57 a.m. Thursday Aug. 23, 2007.  The family should use this as evidence of the assisted living facilties neglect in court.

911:Fire emergency.

Caller:Yes, I have a resident in Villa Valencia and she fell off the floor - - she is bleeding on the floor.

911:Okay what is the address, please?

Caller:It's 25, sorry hold on - - - get that address for me quick - - just a moment - - are you there?

911:Uh-huh.

Caller:Hello?

911:Yes.

Caller:Oh, it's - - can you hear me?

911:I can, go ahead.

Caller:24552 Paseo de Valencia.

911:OK, which room number?

Caller:Sunrise, it's 226 A building.

911:Room number 226 in Building A.

Caller:Yes, 226.

911:OK, and the telephone number you are calling me from, please?

Caller: Pardon me?

911: The telephone number, please.

Caller:The phone number for here?

911: Yes, the one you are calling me from.

Caller:949-581-67 - -

911:No, the number you are calling me from, ma'am.

Caller:OK, I'll have to get her number.

911:Is there a nurse with the patient?

Caller:No, there's not a nurse here right now.

911:Who's with the patient?

Caller:I'm with the patient right now, and I don't know her direct number, I'm using the number for the - -

911:OK, I have help on the way for you. How old is she?

Caller: I don't know her age right now - -

911:- - give me your best guess.

Caller: Can you - -

911:- - give me your best guess.

Caller:Around 81.

911:81. Is she conscious?

Caller: She's conscious.

911:Is she breathing OK?

Caller: She's breathing. Get her …for me quick.

911: OK. And what is she - - she fell off the bed?

Caller:Yes, she fell off the bed.

911:And she's bleeding from where?

Caller: Her foot. She always has problems with her foot.

911:OK, are you able to control the bleeding (2:15) with some pressure.

Caller:I'm trying to find it right now.

911:You're trying to find what right now?

Caller: The bleeding, where it's coming from.

911:OK.

Caller: I just walked into the room not too long.

911:OK.

Dispatch:This is 18 we don't need to go, right

911: No.

Dispatch: All right, I'm going to disconnect.

911:All right. Thanks.

911:What you need to do is find several clean, dry cloths, apply direct continuous pressure to her foot

Caller: Yeah, OK.

911: - - to control the bleeding. Are you able to do that for me?

Caller:Yes, yes.

911: OK. All right, we should be there in a few minutes if anything changes (2:45) call us right back.

Caller: OK.

911:Thank you.

Caller:Bye-bye.

Sun Rise Senior Living is a publicly traded company that runs 445 senior centers internationally including 23 in Illinois.

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According to a new study published in the Journal of the American Geriatrics Society, the likelihood of a medication error is low.  The authors of the study looked at 12 long-term care facilities in 3 states.  The results of the study are surprising considering that many long-term care facilities use aides who no formal training in the administration of medication.  Among the studies findings are:

• Overall error rate of 28.2%
• Timing errors were the most common (70.8%).  The resident did not receive the medication within an hour of the scheduled time.
• Wrong dosage 12.9% of the time
• Skipped dosage 11.1% of the time
• Extra dosage 3.5% of the time
• Unauthorized drug 1.5% of the time
• Wrong drug .2% of the time

None of the timing errors were related to medications where timing is critical to the health of the resident.  Medications such as insulin and warfarin must be administered very consistently in order to avoid serious physical injury to the individual. 

Once the 'time' factor was removed from the study, results show that medication errors were made 8.2% of the time. 

Where else would an 8.2% error rate be acceptable?  Can you imagine a bank teller with an 8.2% error rate in giving out cash.  How long would a bank keep a person like that around? 

Read more about medication errors in assisted living facilities here.

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