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

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 healthcare 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
• 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 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

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Respite Care means the intermittent and temporary care for frail or disabled adults on behalf of the primary caregiver in order to provide relief and support. It is an important aid for families who care for older family members so that they can run errands, work, take care of personal matter, or even give them some time off to relax. This allows you to care for family members without having to institutionalize them. 

Caregiving requires large amounts of time, emotion, and money. It can be very stressful, which can lead to situations of abuse, neglect, financial exploitation, or even feelings of resentment. This is why having programs that offer respite care are so important to ensure that you give your family members the care they deserve while allowing you some time to yourself. 

Respite care comes in many forms; it can be managed through national organizations such as The Arc, Easter Seals, and United Cerebral Palsy, provided by local organizations such as churches, schools, and non-profits, or even arranged with neighbors or people the family knows. The services provided depend on the provider, the needs of the family, and available funds. In addition, respite care can be planned or provide emergency relief to the caregiver. 

In-home respite care means care provided by a trained paid worker providing short-term intermittent care, supervision, or companionship to the frail or disabled adult in the home while relieving the caregiver. In-Home respite care can consist of:

• Home-based services
• Sitter-companion services
• Parent-trainer services

Out-of-Home respite can consist of:

• Family Care Homes
• Respite Family Day Care
• Respite in Corporate Foster Home Settings
• Residential Facilities
• Parent Cooperative Model
• Respitality Model
• Hospital-Based
• Camps

It is important that respite care workers receive proper training in order to provide quality care and assistance to your elderly or disabled family members. Elderly persons are at risk for abuse, neglect, and financial exploitation, which makes it even more important to take care when choosing respite care workers. You must have peace of mind when leaving your loved ones with a respite care worker, so you know that they are receiving 

In Illinois, the Respite Program Act (320 ILCS 10) acknowledges the importance of respite care and helps provide affordable and appropriate in-home respite care services. The Director of the Illinois Department on Aging (IDOA) is in charge of administering a program of assistance to persons in need to deter the institutionalization of frail or disabled adults. The Act provides that respite care workers should be appropriately trained to provide in-home supervision and assistance to a frail or disabled adult. 

As part of the 2000 National Family Caregiver Support Program, Illinois was given $4.7 million to develop the Caregiver Support Program, part of which is intended to lead family caregivers to respite care to enable them to be temporarily relieved from their caregiving responsibilities. There are Caregiver Resource Centers (Region 12 – City of Chicago) across the state which can help you located services. In 2009, the Illinois Department on Aging received a $200,000 federal grant to improve the state’s respite programs.  Also in 2009, the IDOA implanted its three-year Lifespan Respite Project in collaboration with the Illinois Respite Coalition and other state and private organizations in order to improve respite care by establishing a statewide listing of respite services and train respite providers and volunteers. 

Deciding whether or not to institutionalize a family member is a difficult and personal choice. If you do decide to offer care to an elderly or disabled family member in your home, there are respite care programs that can offer much needed relief and support. 

As lawyers who frequently represent the elderly, I see many individuals mistreated or neglected in a respite-care-setting.  The majority of the time we see an injury occurring in these situations, is probably due to an unfamiliarity between the temporary caregiver and the patient. 

In order to make respite stays as easy on the facility and the individual, I suggest the following:

• Visit the respite care facility on your own and with your loved one (if possible) before the respite visit
• Make sure the facility regularly handles respite care stays
• Try to be consistent with the facilities or individuals you use for respite care
• Communicate your loved one's needs to the staff
• Bring photos or other familiar keepsakes to the respite care facility
• Don't hesitate to make a brief phone call to check in during the respite stay

Sources:

ILGA: Respite Program Act

DHHS: Respite Care

Illinois Department on Aging: Caregiver Support Program

Administration on Aging: Lifespan Respite Care Program

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Emergency medical and transportation services are a necessary component of a comprehensive medical care program. Ambulance services can be provided by: volunteer, municipal, private, independent and institutional providers. All providers must meet requirements set by State and local laws in order to ensure adequate services and safe transport. 

According the U.S. Census Bureau, the population of people 65 and older is expected to double between 2000 and 2030. In the year 2020, there will be 10,000 people each day turning 65. As the population of people age 65 and older increases, there will be more people who require emergency medical and non-emergency transport services. Because many seniors have disabilities or limited mobility that make them particularly susceptable to injury during transport, it is important that companies strictly adhere the applicable standards of care. 

Many seniors rely on medical transportation provided by nursing homes and private ambulance companies to get to vital services such as:

• Physical therapy
• Dialysis
• Surgery
• Doctors appointments

Some state legislatures, such as Illinois, have attempted to address the need for medical transportation in rural areas by passing legislation to increase the resources available for emergency and non-emergency transportation. The Illinois General Assembly (ILGA) passed the Regional Ambulance Services Law (55 ILCS 110) to improve the delivery of health care services in rural areas. This law allows regional ambulance systems the right to use private ambulance services to expand the regional ambulance services. 

Private ambulances provide emergency medical and transport services. They transport patients from one hospital to another, to a nursing home, to another special-care center, from hospital to home, and they also answer emergency calls. In addition, some hospitals and nursing homes operate their own ambulances. Many private ambulances will deliver people to the hospital of their choice, unlike city ambulances which usually have to take people to a designated hospital, typically the nearest.

The only transportation service that Medicare (under Medicare Part B) pays for is ambulance services in severe medical situations such as life-threatening emergencies or when dealing with bedridden patients. However, Medicaid may pay for transportation services to get you to a medical appointment if you are eligible. In Chicago, the Chicago Department of Senior Service’s Transportation Program assists older adults who need medical transportation to receive life-sustaining treatments. 

According to the Medicare Benefit Policy Manual, ambulances must be designed and equipped to respond to medical emergencies and transport patients in non-emergency situations. These ambulances must contain: a stretcher, linens, emergency medical supplies, oxygen equipment, other lifesaving emergency medical equipment and be equipped with: emergency warning lights, sirens, and telecommunications equipment.

Basic Life Support (BLS) ambulances must be staffed by at least two people, at least one of whom is certified as an emergency medical technician (EMT). Advance Life Support (ALS) vehicles must also be staffed by at least two people, one of whom is certified as an EMT-Intermediate or EMT-Paramedic. The ambulance must submit a statement and documentary evidence that the vehicle and crew meet all Medicare, State, and local requirements. 

In order for Medicare to cover ambulance transport, the ambulance services must be “medically necessary and reasonable.” Ambulance transport is medically necessary when no other method of transportation could be used without endangering the health of the patient. This includes transport for patients who are bed-confined, which means that the patient is unable to get out of bed without assistance, unable to ambulate, and unable to sit in a chair or wheelchair. In addition, the medical transport must be to obtain or return from a Medicare covered service.  

Furthermore, Medicare only covers ambulance transports to the nearest appropriate facility, as well as return transport. This means that you cannot always be transported to your personal physician or hospital of choice, if it is not the closest reasonable facility. Medicare covers transport to the following destinations: hospital, critical access hospital (CAH), skilled nursing facility (SNF), beneficiary’s home, and dialysis facility. 

The Medicare Fee Schedule (FS) applies to app ambulance services including volunteer, municipal, private, independent and institutional providers. The FS equals a base rate for the level of service plus payment for mileage and applicable adjustment factors. 

Oftentimes, ambulance transport of nursing home residents qualifies under Medicare coverage because the transport is medically necessary or the resident is confined to a bed. Medicare does not have a pre-authorization process for ambulance services to determine whether Medicare coverage may apply. Therefore, nursing home facilities must be familiar with Medicare requirements to ensure that a resident does not incur additional costs. 

Regardless of the circumstances in which you utilize medical transport services, you have a right to be transported safely.  If you believe that your injury is related to negligence during medical transport, we will use the applicable laws in your area to work for you.  Put our experience representing people who have suffered an injury during medical transport to work for you today.  Free consultations with experienced lawyers.  (888) 424-5757

Thank you to Heather Keil, J.D. for her assistance with this Nursing Homes Abuse Blog entry.

Resources:

Illinois General Assembly: Regional Ambulance Services Law

Medicare: Transportation Services Overview

New York Times: Private Ambulances, When to Use Them

U.S. Department of Labor: Bureau of Labor Statistics: Emergency Medical Technicians and Paramedics

Medicare Benefit Policy Manual: Ch. 10 Ambulance Services

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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

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For families and individuals who provide care for older adults, adult day care centers or adult day services can be an important tool in providing adequate care. Providing round-the-clock care for an elderly loved one can be a huge, but worthwhile time commitment.

Adult day care centers can provide a much needed break for caregivers, while offering elderly adults therapeutic services.

Adult day service is the direct care and supervision of adults 60 years of age and over in a community-based setting for the purpose of providing personal attention and promoting social, physical, and emotional well-being in a structured setting.

Adult day care can serve an alternative to nursing homes depending on the focus of the facility (social or health services). These facilities provide services to adults with physical or mental impairments for the purpose of restoring or maintaining their ability to care for themselves. They can serve as an alternative to nursing home care when 24-hour nursing care is not medically necessary or when nursing homes are against the wishes of the individual or the family.

The State of Illinois does not require licensing or certification for adult day care providers. The Department on Aging Community Care Program (CCP) does not include provision for adult day care other than those stated in the Administrative Code (building, fire, health, and safety codes and standards, environmental barrier codes, and food service sanitation and vehicle codes).

In addition, the Illinois Department of Public Health has the authority to conduct performance reviews of adult day care centers in Illinois. The Provider Performance Review includes reviewing a sample of client and employee files to evaluate compliance with administrative rules and ensure that the center adheres to policies and procedures set by the Department.

The following are services that the Department requires adult day care centers to provide:

• Activities of daily living (ADL) assistance
• Health education and counseling
• Health monitoring / health-related services
• Medication administration (administered by an appropriately licensed professional)
• Nursing services
• Social services
• Transportation

Optional services include:

• Physical therapy
• Occupational therapy
• Speech therapy
• Skilled nursing services

Illinois, like most states, does not stipulate a specific staffing requirements for adult day care; only require only that each adult day service provider have adequate personnel in number (at least two people) and skill to provide for program and financial administration, nursing and personnel care services, nutritional services, planned therapeutic/recreational activities, and transportation to and from the service site. There are suggested staffing ratios: two staff for every 1-12 clients, three staff for 13-20 clients, four staff for 21-28 clients, and one additional staff person for each 7 additional clients.

As the population of older adults increases, the use of adult day care services can help provide necessary services to improve their the lives of older adults without having to institutionalize them in nursing home facilities.

For more than 30 years we have championed the rights of the elderly in all settings: hospital, nursing home, assisted living and day care.  If you or a loved one was injured or abused in an adult day care setting, you may have legal rights that include a claim for monetary damages.  Let us put our experience to work for you. 

Free consultation.  A track record of results for people like you. (888) 424-5757

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

Resources:

U.S. Department of Health and Human Services – Regulatory Review of Adult Services
U.S. Department of Health and Human Services – Regulatory Review of Adult Services: Illinois
National Respite Network & Resource Center: Adult Day Care 

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As winter weather sets in, the city is often covered in a blanket of snow and ice. While the slippery weather conditions present a danger to all of us, snow and ice are particularly dangerous for older adults who are already more likely to suffer from a fall and also more likely to suffer bone breaks and injuries.

Nursing home residents rely on the nursing home property owners (nursing home operators and manager) to provide a facility free of dangers that might cause dangerous falls or accidents. This responsibility includes the removal of snow and ice, which creates a serious risk of falling.

In Illinois, according to the Premises Liability Act (740 ILCS 130), owners or occupiers of land owe invitees and licensees a duty of “reasonable care under the circumstances regarding the state of the premises or acts done or omitted on them.” An owner or lessee must provide a reasonably safe means of access to its business. If you bring a premises liability claim, you, the plaintiff, have the burden of proving that your injuries were caused by a condition on the property that was not reasonably safe that the owner knew or should have known of by the exercise of reasonable care.

However, this duty of reasonable care is different in the case of snow and ice on property. In Illinois, absent a contractual obligation, if you are walking down the street and happen to slip and fall on a snow or ice covered sidewalk or parking lot, the property owner owes you no duty to remove the natural accumulation of snow, water, or ice. (Illinois Snow and Ice Removal Act – 745 ILCS 75).

The Act states that it is undesirable for any person to be liable for damages due to his snow removal efforts, unless his actions amount to “clear wrongdoing.” Illinois follows the natural accumulation rule, where a property owner is only liable for a snow or ice related accident only if their alleged misconduct was willful and wanton or there was an unnatural accumulation of snow or ice or a natural condition that is aggravated by the owner. (McBride v. Taxman Corp., 327 Ill.App.3d 992 (1st Dist.2002); Ziencina v. County of Cook, 188 Ill. 2d 1 (1999)).

Natural accumulation is the result of natural weather conditions; whether accumulation is natural or not is oftentimes a difficult factual question. Examples of natural accumulation are: a sidewalk that has not been shoveled, puddles of water inside buildings from melting snow, ice formed by snow being packed down by pedestrians. Unnatural accumulation would be any actions by the property owner that cause snow or ice to accumulate in a specific location. One exception to the natural accumulation rule is if there is a contractual obligation to remove snow or ice; for example, if the property owner or manager has a provision in a lease providing that the owner agrees to remove snow or ice. If this is the case, the owner may be held liable.

Nursing home facilities must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of its residents. Part of this responsibility is ensuring that “the resident environment remains as free of accident hazards as is possible” (Requirements for States and Long Term Care Facilities – 42 CFR 483).

Therefore, nursing home operators owe residents a higher level of duty than a regular invitee or licensee, which under premises liability would only require them to exercise ordinary or reasonable care in maintaining the premises in a reasonably safe manner. Nursing home residents are more vulnerable than the regular invitee or licensee, and the degree of care owed is greater in recognition of that vulnerability.

Absent any dangerous winter weather conditions, nursing home residents are already more vulnerable to dangerous slips and falls, which can lead to serious injuries such as broken hips and head injuries. Even minor falls can be dangerous because elderly people are more susceptible to bone fractures than younger people because as bones age, they lose the ability to resist the formation and growth of cracks which can lead to bone breaks. The federal code regulating nursing homes is sensitive to nursing home residents’ vulnerability to falls, even specifying a standard for flooring; “the facility must have floors that have a resilient, nonabrasive, and slip-resistant surface.”

Therefore, nursing home operators must take extra precautions to make the nursing home facility premises safe for elderly residents. This includes installing slip-resistant flooring and removing dangerous snow and ice. Nursing home operators have a contractual duty to make the premises free of accident hazards, including hazards posed by snow and ice.  

Unnatural Accumulation Of Snow & Ice

If the nursing home operator removes snow or ice in a negligent manner or creates an unnatural accumulation of snow or ice, they may be liable for the resident’s injuries.  Similarly, if you are visiting a family member at the nursing home and happen to slip and fall on snow or ice, you may bring an action against the nursing home even though you are not a party to the contract because you are a foreseeable user of the premises.  

If you or a member of your family has suffered a dangerous fall because of dangerous snow or ice accumulation at a nursing home, you have the right to hold the nursing home owner or operator responsible for those injuries. The nursing home is obligated to provide a safe environment for all residents, and that includes an environment free of dangerous snow and ice.

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

Resources:

Illinois General Assembly – Nursing Home Care Act 210 ILCS 45
Illinois General Assembly – Premises Liability Act, 740 ILCS 130
Illinois General Assembly – Snow and Ice Removal Act, 745 ILCS 75

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It never ceases to amaze me how some nursing home operators would rather incur fines for continually providing inadequate care rather than make necessary changes. However, when the cost of the fines is not sufficient to improve patient care, I guess that some business manager is making a conscious business decision that it's easier (and cheaper) to continue with the game plan and pay the consequences---  when-- and if they get caught.

Case in point, Golden Moments Senior Care Center.

The Jacksonville, IL nursing home has agreed to pay $6,500 in fines to the state in relation to complaints connected to mistreatment of the elderly.  For Golden Moments, this most recent fine is just the latest hiccup along the way to providing quality care.  Among recent fines:

• May, 2009- The facility was fined $20,000 after an investigation revealed that Golden Moments failed to intervene in incidents where patients were verbally, mentally and physically abused.
• October, 2009- The Illinois Department of Health imposed $3,050 per day fine for an 11 day period where the facility failed to make corrective changes related to patient care. Specifically, the facility failed to follow its own policy with respect to patients who require assistance while eating.
• November, 2009- As of November 23rd, Golden Moments received approximately $40,000 in fines for failing to comply with federal regulations.

Sure, $40,000 is a lot of money.  But my guess is that the cost of paying the fines is relatively cheap compared with making the necessary changes that would be necessary if the facility actually chose to improve patient care.  Until states begin to impose more substantial fines, I predict nursing home patients will continue to receive much of the same poor care that leads to severe injury and death.

Read more about these fines against Golden Moments Senior Care Center here.

Related:

Aide identified in alleged nursing home abuse, The State-Journal Register, August 28, 2009

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

Choking Death Just Latest Problem At California Nursing Home

Hefty Fine Imposed On A Kindred Nursing Home For Failing To Report Potential Abuse To Authorities

Judge Limits Fines For Poor Nursing Home Care

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The most dangerous part of the day for many nursing home patients may be getting out of bed in the morning.  When staff fail to supervise or provide proper assistance to nursing home patients during transfers, patients are at risk for falls or being dropped by staff.

Disabled nursing home patients and those with physical limitations must be carefully monitored to avoid injuries while being transferred from one device to another.  Some of the commonly encountered situations where patients are injured include:

• Bathing: facilities failing to provide assistance or provide specialized bathing equipment including chairs, stands and grips
• Transfer into and out of bed
• Failing to take extra-precautions with patients who may have uncontrolled muscle movement: many times these patients require special restraints during transfers
• Failing to take patient medications into the equation: some commonly prescribed medications can make patients dizzy or cause blood pressure spike or drops when patients are moved
• Failing to engage locks on wheelchairs
• Allowing patients to wear socks or improper footwear during transfers
• Failing to monitor patients with walkers

Although facilities like to claim that these incidents are isolated events, a dropped patient is usually indicative of poor staff training and chronic under-staffing.  Most of these transfer-related incidents occur due to:

• Poorly trained staff: Some facilities do not properly train staff in how to use equipment
• Under-staffing: Facilities sometimes to not have enough man power to safely perform transfers as they were intended
• Wrong equipment: facilities must have the proper equipment for the job
• Faulty equipment: facilities must keep equipment in proper repair.  This includes getting replacement parts from the manufacturer
• Failing to provide timely assistance to patients who request it

Cases involving injury or death during transfer are particularly important to investigate as quickly as feasible after the incident in order to preserve the condition of equipment and to obtain statements from witnesses others who may have knowledge of the event.  

If your loved one suffered an injury or died as a result of a fall or being 'dropped' by staff, we would honor the opportunity to speak with you.  Our nursing home litigation team is always available for consultation. (888) 424-5757

Related Nursing Homes Abuse Blog Entries:

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

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

Faulty Handicapped Lift Blamed For Nursing Home Death

Improper Transfer Leads To Fall & Ultimately Death Of Rehab Patient

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It only is a matter of time before another nursing home fire claims the life of another patient.  While less publicized, hundreds of elderly people receive burns every year during their admission to skilled nursing facilities. Anyway you look at the situation, fires in nursing homes remain a real-- yet under-appreciated threat to nursing home patient safety.

According to the Government Accountability Office (GAO), from 1994 to 1999 approximately 2,300 nursing homes reported some type of fire at their facility each year.    Equally alarming is that the GAO has found the number of severe fire deficiencies in nursing home has increased steadily from 2004 through 2007.

In response to this safety threat, Centers for Medicare & Medicaid Services (CMS) now requires a smoke detector in every patient room and in public areas.  Additionally, automatic fire sprinkler systems must not be installed in new facilities and retrofit in existing facilities over the next four years.

While compliance with CMS regulations may help reduce the chance of fires in skilled nursing facilities, owners and administrators should evaluate all activities and determine what policies may be implemented to further promote patient safety.

Step #1: Eliminate Smoking In Nursing Homes

Smoking in nursing homes can at best be considered counter-productive to patient health.  Perhaps more accurately, smoking in nursing homes is threat to all patients and staff. Even when monitored, there is an increased risk of fire in nursing facilities that permit smoking compared with those that do not allow it.  Therefore, I propose nursing homes force patients to toss out their cigarettes or seek alternative facilities.

In addition to safety concerns related to fire, allowing patients to smoke in a nursing home diverts staff resources to the supervision of patients who choose to smoke and away from the task of providing skilled nursing care. 

According to The National Fire Protection Association, elderly people are more than three times more likely to suffer a smoking-related injury than their younger counterparts.  One need not look far to see examples of smoking accidents in nursing home and assisted living facilities:

• Dallas, Texas- Woman dies in a fire at an assisted living facility.  The fire inspector determined the fire started due to 'improper use of smoking material'
• Chicago, Illinois- Two patients died at Hampton Plaza Nursing Home from smoke inhalation. The fire department concluded that the fire was started by smoking materials stored in a patient's closet.
• Whittier, California- A nursing home patient with dementia ignited himself while attempting to light his cigarette.  A investigation into the matter revealed the staff was unaware that the man was even outside of the facility.
• Lebanon, Indiana- An oxygen dependent patient started a fire at an assisted living complex when the oxygen tank exploded as she smoked.  

I doubt we will nursing homes flocking to change their policies to 'smoke free' overnight.  In the meantime, facilities should take steps to develop a smoking policy that is both realistic to implement and enhances patient safety.  Here are some suggestions for developing a smoking policy:

• Designate a smoking area for patients that is supervised and well ventilated.
• Ban all smoking in patient rooms.  Studies have shown that the risk of fire increases when people smoke in bed.
• Establish an evacuation policy in case of a fire or emergency.  Similarly, inform all staff and patients as to the location of fire extinguishers and teach them how to use it.
• Keep all smoking materials including lighters and matches in possession of staff and locked at all times.
• Provide ashtrays and smoking aprons (outerwear made from fire-proof material that reduces the chance of a stray ash igniting a patients clothing) 
• Develop a smoking cessation program.
• Make sure your facility has smoke detectors and a sprinkler system
• Allow patients to smoke only when supervised by staff members.
• Develop a set of consequences for patients who fail to follow the policy.
• Write down your facilities smoking policy and give a copy to all patients and their families.

While the above guidelines may reduce the chance of fires in nursing homes, eliminating smoking remains one of the easiest ways to improve the overall living conditions for all patients and nursing home staff.

Resource:

GAO Report, Fire Safety In Nursing Homes- Recent Fires Highlight Weaknesses in Federal Standards and Oversight, July, 2004

Nursing Home Compare-  See how your facility measures up with respect to fire safety

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The family of a Sunrise Senior Living resident has filed a lawsuit against the company for their failure to supervise the woman during an outing with the facilities activity director.  The lawsuit alleges that on December 2, 2007, Margaret McCauley went with other residents to a concert at a Chicago-area high school.  During the concert McCauley wandered from the concert hall and sustained multiple injuries.  The lawsuit claims the staff from Brighton Gardens Assisted Living of Orland Park, failed to:

• Supervise the resident-- despite the fact that they knew she had a propensity to wander
• Conduct proper wandering assessment
• Provide adequate staff to supervise
• Take adequate steps to locate the missing woman after her absence was discovered

McCauley was discovered eight hours after leaving the concert hall.  She was laying on nearby train tracks.  Read more about this nursing home lawsuit against Sunrise Assisted Living here.

Eloping Nursing Home Residents

Within 14 days of admission, new nursing home residents must be evaluated by the nursing home staff for the purpose of conducting a Resident Assessment Instrument (RAI) under the Nursing Home Reform Act of 1987 (contained in the Omnibus Budget Reconciliation Act, OBRA 1987) and specifically codified at 42 CFR 483.20 (b)(1)(i)-(F272). 

Part of this codified evaluation requires an assessment to be completed regarding each residents propensity to elope or leave the facility.  Residents who are deemed to be at 'high risk' for elopement should have safeguards in place to help protect them from the dangers of the outside world.  All staff caring for the resident should be ware of the residents elopement assessment and help enforce regulations to minimize risk of elopement from the facility.

Residents suffered from dementia or Alzheimer's are particularly susceptible to eloping from a facility.  The following are common safeguards that may be utilized to ensure the safety of residents who are at high risk for eloping:

• Have properly working door alarms
• Window locks
• Door locks
• Bracelets that track each resident's location
• Adequate staff at the facility to look after residents
• Have contingent plans to locate residents who may wander from the facility

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A private ambulance was recently stolen from a Chicago nursing home resulting in a six car accident with multiple injuries.  The ambulance was taken from Clark Manor Nursing Home located on the 7400 block of North Clark Street and was driven north on Chicago Avenue into Evanston where the the ambulance was involved in a crash.

According to Evanston Police Commander, Tom Guenther, there were several injuries due to the ambulance crash.  "He just kept going at a high rate of speed.  He was driving erratically and it is possible the driver was impaired," Guenther added.

Witnesses said the driver of the stolen ambulance activated the sirens and mars lights on the vehicle as it erratically.  "He ran the red light and just plowed through three cars," said Robert Skertich of Chicago.

No nursing home residents where in the ambulance at the time of the crash.  The suspect is in custody of Evanston Police as he awaits formal charges.

Read more about this Chicago ambulance crash here.

Ambulance Responsibility For Injuries Sustained In Crashes

When evaluating cases relating to injuries sustained in an ambulance collision, it is important to know: the purpose for operating the ambulance, what entity was operating the vehicle and if the sirens and flashing lights were engaged at the time of the crash. These factors will help in making a determination if 'tort immunity' applies to the case or if the case can proceed under a general negligence theory.

"Tort immunity' refers to laws that insulate government entities and their employees from liability.  The reasoning behind 'tort immunity' is that the services provided are so essential to the public's well-being, that the government and its agents should not be held responsible for mere negligence.  Rather, in many cases involving government entities, an injured party must establish a higher standard of conduct, 'willful and wanton', to successfully recover.

Most nursing home residents are transferred from the facility to doctors appointment or medical procedures via ambulance.  As lawyers who are accustomed to handling injuries that occur during the transportation of elderly people, we can evaluate your situation and help make a determination how best to proceed and under what potential theories to maximize you recovery.  You can always speak to our injury lawyers for a free consultation and learn more about your rights.  All consultations are kept in the strictest confidence.

Nursing Homes Abuse Blog Related Entries

Transportation In & Out Of Nursing Homes: Ambulance Responsibility.

Medical Helicopter Safety

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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.

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The U.S. Department of Health and Human Services has sent Medicare and Medicaid investigators to the Champaign County Nursing Home late last week.  The investigation was prompted by an anonymous complaint.  While the nature of the complaint remains unknown, Medicaid fraud investigators look into provider fraud and patient abuse and neglect. The Champaign County Nursing Home has been in the headlines recently when State of Illinois investigators found multiple deficiencies.  The deficiencies put a stop to Medicare / Medicaid reimbursements for new patients until the problems could be corrected.  Read more about this investigation of Medicare fraud here.

State records show that numerous complaints have been made against Champaign County Nursing Home in 2008.  Copies of all complaints are not currently available, but records indicate that there are complaints on file relating to significant resident injuries.  You can view some of the complaints against Champaign County Nursing Home here.

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A woman was killed in a fire at the Lebanon Manner Village assisted living complex in Indiana when a fire broke out in her apartment. The other buildings in the complex were evacuated. It took firefighters more than an hour to put out the flames according to Lebanon firefighter Wheat. Thirteen apartments were damaged by flames and almost the entire building sustained some kind of damage, Wheat said.  Most of the residents at the assisted living facility will remain out of their apartments due to smoke and water damage.  Officials did not release a cause of the fire, but friends said the victim smoked and was on oxygen.

If the operators of this facility knew that this woman had a tendency to smoke and use oxygen they should be ashamed of themselves.  Not only did they literally set this woman up to die they also put all of the other residents at this facility in jeopardy.  Nursing homes and assisted-living facilities must ensure their residents' safety during fires, this includes: conducting drills, having a fire safety plane in effect and in my humble opinion not permitting people to smoke around oxygen tanks.

Read more about this assisted living facility fire here.

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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.

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Following my recent post on the frequency of hip fractures in nursing homes, I received several responses from blog readers who asked me about the effectiveness of hip pads in preventing injury and hip fractures to nursing home residents.  For those that don't know, hip pads are usually similar to underwear with built in plastic and foam pads.  The overwhelming evidence suggests that hip pads do little to prevent hip fractures amongst the elderly.  In fact, a recent study of 1,000 nursing home residents was terminated because the hip pads were so ineffective in preventing fracture.

According to the study's author, Dr. Douglas Kiel, of Harvard Medical School, 'In the United States, nearly 340,000 hip fractures occur per year, more than 90 percet of which are assiciated with falls, and the number of hip fractures may double or triple by the middle of this century.' Further, 'The highest incidence rates of hip fractures have been reported in nursing home residents, where 50 percent of residents fall each year.' 

So the question remains, why do nursing homes and facities use hip pads in the first place?  I really con not think of any reason other than the fact that some nursing homes would rather use a device to take the place of staff involvement and supervision of their residents.  The only effective way to prevent nursing home falls is to identify people who may be prone to falls and to provide adequate assistance to residents throughout their daily living activites.

Read more about hip pads in nursing homes here.

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Unfortunately for many nursing home residents, their trip to the nursing home or out for a doctor's appointment can be riddled with problems during transport and is a frequent source of injury (while being transported via: ambulance, medicar or medivan). 

Like nursing homes themselves, ambulances and paramedics are regulated by Medicare.  Ambulances and their crews must also comply with state and local laws.  Ambulances transporting nursing home residents must:

• Be capable of transporting people for in acute medical conditions
• Must contain: stretcher, linens, emergency medical supplies, oxygen equipment, warning sirens, 2-way voice radio or wireless telephone
• Must be staffed by trained personnel

Ambulances and their crews must trained to deal with a variety of both critical and non-critical situations.  Nonetheless, common ambulance / paramedic injuries include:

• Dropping patients
• Medication errors
• Untimely response time for critical incidents
• Failure to follow protocol for specific incidents
• Failure to have required equipment
• Failure to properly make initial assessment
• Failure to monitor vital signs
• Helicopter accidents
• Automobile accidents
• Wheelchair-lift incidents
• Physical abuse

If you believe you or a family member is a victim of paramedic negligence, you should contact an attorney who concentrates in cases involving paramedic / ambulance injury to learn your rights under Federal and State law.

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A 'transfer' in a nursing home setting generally refers to moving a patient from a bed to a wheelchair.   Transfers are usually done two ways: using nursing assistants or mechanically (Hoyer lift).  The type of transfer depends mainly on the patients physical condition.  If a patient is capable of providing some assistance, a staff lift (one or two person transfer) is generally done.  However, if a patient is paralyzed or suffers from physical disability, the use of a mechanized lift may be required to safely transfer the patient.

The choice of how to transfer a patient from a bed to a wheelchair is up to the facility.  A determination of the type of transfer should be part of the evaluation when a person is admitted to the facility and for quarterly reviews of nursing home patient needs.  It is crucial for the staff at the facility to use the properly predetermined transfer technique or the nursing home resident is at risk to injury. 

Below are videos demonstrating the proper transfer technique for both the 'manual' method and using a Hoyer lift.

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• About 1800 people die each year due to falls in nursing homes
• 10 to 20% of nursing home falls result in serious injury, 2 - 6% of falls result in fractured bones
• 3 out of 4 people living in a nursing home will fall this year
• Most people are 'repetitive fallers'- After a first fall, there is a substantial likelihood that you will fall again
• Most falls go unreported

• Muscle weakness and walking or gait problems. (24% nursing home falls)
• Hazards in the nursing home- wet floors, poor lighting, improper be heights, improperly maintained wheelchairs, equipment left out of place (16 - 27% nursing home falls)
• Medications.  Drugs that effect the central nervous system, such as sedatives and anti-anxiety drugs (psychoactive drugs)
  
• Improperly fitting shoes or incorrect walking aids
• Frequent use of restraints

• Conduct a fall-risk assessment for every resident to determine who may be at risk for falls.  This puts the staff on notice as to who may need special attention.
• Install safety devices such as grab bars, adjustable height beds and handrails
• Review all prescribed medications to assess what residents may be a fall risk due to the nature of the medication
• Install alarms on on beds and chairs for residents who are at a particularly high fall risk.
• Remove clutter from walkways

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