The Journal-News reported on the rape of a nursing home resident by a mentally incompetent resident.  Gary Eugene Earls, who has limited mental capacity, was arrested by police after a incident at Close to Home.  Earls was indicted by a Butler County grand jury on two counts of rape in December.  Earls admitted to physically penetrating the 95-year-old woman during the early morning hours of Nov. 17. He said he went into the woman’s room and pulled down his pants. The woman was naked, Earls said.  The 95-year-old woman died just weeks after the incident. She suffered from dementia but was alert.

Prosecutors fought to keep control of the case to ensure Earls would not be placed in a facility where he could potentially assault another person. The issue surrounding what to do with Earls was “a black hole of the justice system,” Butler County Prosecutor Michael Gmoser said.

“(The judge) ultimately has to make a determination that the evidence established that he committed the acts to constitute the criminal offense,” Gmoser said. “It is also a serious offense and the public has an interest in respect to public safety … the state is asking for her to approve his commitment to a mental facility equipped to handle these type of offenders.”

The rapist was committed to a psychological facility, Summit Behavioral Health, a facility for mentally ill adults.  In addition to the cognitive problems, Earls has a history of alcohol and drug abuse.

 

 

Authorities are investigating the strangulation death of 75-year-old Rebecca Eudy, who was found April 5 at Open Fields Assisted Living in Tarboro.  Open Fields is an adult care facility, which houses the elderly and also some people with severe and persistent mental illness.

No arrests have been made yet.  Her death certificate says Eudy asphyxiated and suffered traumatic injuries to her neck.  Eudy was charged with assault in December after a fight with a 46-year-old man living at Open Fields who allegedly exposed himself to her.

Eudy’s daughter has filed a complaint with the state Department of Health and Human Services after learning that her mother’s death was being treated as a homicide.

A scabies outbreak at Longmeadow Nursing Care nursing home in south Arkansas spread throughout the facility and into the community after those in charge failed to act. According to a government report, management told nursing staff in some cases not to leave any documentation indicating they were treating residents for scabies, the Arkansas Democrat-Gazette reported. Residents with scabies weren’t isolated and proper procedures were neglected, causing employees to contract the bugs that spread outside the facility.  Scabies is a highly contagious skin condition caused by mites, according to the U.S. Library of Medicine.  The facility neglected to treat staff members who developed scabies, which eventually spread to their relatives, according to the report.

State regulators cited the facility in July for failing to properly address a smaller infestation affecting a few residents, just weeks before the condition struck every resident at Longmeadow. A nurse told inspectors the facility didn’t document the outbreak because of instructions from higher authorities.  The state Office of Long Term Care gave the violations the most severe rating.

Kelly Holland said her husband, Ralph, suffered from the scabies infestation.

“You could see where he had clawed them, trying to get to the itch,” said Holland.

She says the nursing staff tried to convince her that the itching was not caused by scabies.

“They kept saying ‘Oh it’s a side effect from one of your medications,’ … that was a lie … the whole thing was a lie,” said Holland.

“It was just torture for both me and for him,” said Holland.

Even though the facility has a way to track outbreaks like scabies, a worker told state inspectors higher’s up “Didn’t want us to document the residents had scabies on any of the paperwork, but that’s what we were treating them for.”

State records reveal that in some cases, nursing staff said they were told not to leave a paper trail and did not record whether its 28 residents received a topical cream prescribed by a physician during the December outbreak.

 

 

The Washington Post reported on a nursing home resident Rebecca Zeni who was “eaten alive” by scabies. Parasitic mites had burrowed under her skin, living and laying eggs all over her body. By the time she died, vesicles and thick crusts had formed on her skin. Her right hand had turned nearly black, and her fingers were about to fall off.  The scabies that infected Zeni’s body had become so severe that bacteria seeped into her bloodstream causing her wrongful death.  Zeni died June 2, 2015. An autopsy found that she died of Staphylococcus aureus septicemia due to Norwegian crusted scabies, a severe form of scabies that affects people with weak immune systems, such as the elderly.

Zeni’s death is now the subject of a lawsuit filed against PruittHealth, a for-profit company that owns dozens of nursing homes, including Shepherd Hills in LaFayette, Ga., where Zeni lived for five years until she died. Shepherd Hills, a nursing home that had multiple scabies outbreaks in recent years and a history of health violations, failed to follow policies and procedures to prevent the occurrence and spread of the highly contagious disease.  Instead of providing the care that Zeni desperately needed, the lawsuit alleges that the nursing home allowed her to die an agonizing death.

A lawyer for the company, Jeffrey Braintwain, argues that, among other defenses, injuries may have been caused by people PruittHealth cannot control. This includes Puryear and Zeni herself.  The nursing home is blaming the resident!!!

Federal health inspection records paint a troubling picture of the company, which describes itself as the “regional leader” of providing long-term health care to the elderly in the southeast. In August 2013, according to the Georgia Department of Public Health, 10 residents and 10 staff members were affected by scabies. In October 2014, the home’s internal infection log shows, at least six patients were affected. In May 2015, according to the Department of Public Health, 20 residents and another 15 staff members were affected.

Many PruittHealth-owned facilities have similarly dismal records. Nineteen other facilities in Georgia, seven in South Carolina and one in North Carolina received one- and two-star ratings from Medicare.  Of the 56 nursing homes owned by Pruitt in Georgia, nearly half (46%) are rated “below” or “much below average.” In total, Pruitt’s one and two-star facilities collected $221 million from Medicaid in 2016 and 2017.

Zeni’s death raises crucial — and familiar — questions about for-profit nursing homes that have long been accused of sacrificing patient care to minimize costs and maximize bottom lines. Nursing homes owned by big corporations and private investment firms consistently performed poorly in terms of quality of care and are more likely than nonprofit and government facilities to be cited for “serious deficiencies” that harm residents, according to 2011 and 2016 reports by the Government Accountability Office. Staffing levels are usually lower, meaning trained nurses spend less time with residents each day.

Human scabies results when an adult female human itch mite burrows into the top layer of your skin, otherwise known as the epidermis. There the mite can hang out, poop, and lay eggs. The eggs can then produce new mites, leading to more and more mites in your skin. Each mite can live a couple months in your skin. That is the Circle of Mites.

Image result for scabies mites picture

When the infestation is ignored, thousands of mites may be reproduced.  Norwegian or crusted scabies tends to occur when your immune system is weak, allowing the mites to reproduce more. With so many mites, the skin forms crusts that are thick, gray, and crumbly.

The mites are so small that you can’t see them. A simple view from a microscope will allow caregivers to figure out if a resident has scabies.  Tthey can be passed unknowingly from person-to-person via skin-to-skin contact. Transmission only occurs via human-to-human contact.  The contact has to be prolonged and intimate.   This should not happen in a nursing home since caregivers are required 1) to wear sterile gloves before caring for a resident, and 2) wash their hands before caring for a resident.

The mite can survive on objects such as a blanket, other bedding, clothes, and furniture for about 3 to 4 days, so you could catch scabies from such items. Therefore, make sure you thoroughly wash (using the hottest temperature possible) or seal in a bag for at least a week any object that may be affected.

Symptoms can take anywhere from a few days to 4 to 6 weeks to appear. The itching tends to be worse at night and can keep you awake. The classic appearance of the rash is a line of little bumps, as described by the American Academy of Dermatology. The rash can become scaly and look a bit like eczema.

Image result for norwegian scabies crusted

Scratching can convert the rashes into sores. Sores can lead to infection. Infections can potentially lead to death, especially if you are in a weakened condition.  An elderly person’s immune system is weaker and won’t attack the mite as vigorously. If not treated, the mites will multiply indefinitely. A patient can have thousands of mites in his or her body. They form crust on the skin. The crust sheds, carrying mites and eggs with it. The outbreak spreads.  Tomorrow, we will discuss a recent nursing home case involving scabies.

 

Fox40 had an article about for-profit nursing home chains in California that illegally prioritizes some patients over others based on how much of a payout insurance will pay the individual nursing home for each.  As soon as a resident goes from Medicare (where reimbursements are high) to Medicaid (where the nursing home gets a flat fee), the chain tries to get rid of them.  These chains discharge residents without proper notice or a legal reason.  It’s called patient dumping and it’s illegal.  Under California law, nursing homes need to notify patients 30 days before they’re let go.

“What’s happened is the money’s gotten the best of the providers,” Tony Chicotel, a spokesman with the California Advocates for Nursing Home Reform,  said. He urges consumers to follow the money. “Medicare pays a significantly higher rate per day for nursing home care than [MediCal] or even private pay dollars do,” he said.  According to Chicotel, the problem is Medicare only provides a few months’ worth of nursing home care to patients. When that runs out, he says some nursing homes rush to fill her bed with someone else on Medicare.  “The more you occupy your beds with Medicare residents, the more money you’re going to make. Sometimes three or four times as much.”

He’s working on a class action lawsuit filed against SavaSeniorCare, a national for-profit billion dollar chain.  SavaSeniorCare has over 200 facilities nationwide including 4 in South Carolina.  SavaSeniorCare is also part of a False Claims Act case in Tennessee.  See Hayward doc 59.

“It’s a very widespread problem. It involves dozens of nursing home chains in California, hundreds of individual nursing homes. It’s a problem that’s affected northern, central, southern California. We hear about it everywhere,” Chicotel said.

A representative from Mission Carmichael, a care facility owned and operated by Sava, did respond to the lawsuit, saying only that they’re “aware of the case” and “cannot comment about the specifics”

 

6ABC reported on the recent audit by the Federal Government which found an alarming number of nursing homes failing to report suspected abuse, including sexual abuse.  Action News Investigative Reporter Chad Pradelli has been investigating the nursing home industry in Pennsylvania for the past year.  Pradelli looked at every state inspection report in the 5 county region for 2016 and 2017.

He found dozens of cases where nursing homes failed to properly investigate and report neglect, abuse or possible abuse both physical and sexual.  The investigation found state inspectors cited nearly half of all nursing homes in the 5 county region for either failing to investigate and/or properly report possible abuse and neglect in 2016 and 2017. 85 facilities in all were cited.

Attorney Sam Brooks of Community Legal Services of Philadelphia said, “It’s not in the nursing homes interest to properly report issues and enforce regulations because it affects their bottom line.

Sam Brooks is a nursing home advocate who’s been investigating nursing home abuse. He says not only are facilities failing to report abuse or possible abuse, they do not adequately investigate.

He blames both nursing home staff and the State Dept. of Health that is responsible for overseeing them. He looked at every inspection report of nursing homes in Philadelphia from 2012-2014.

“We found 9/10 if you filed a complaint against the facility the Department of Health was not substantiating that complaint. So hundreds and hundreds of complaints were dismissed,” said Brooks. “What we were shocked by is over 3 years of complaints in Philadelphia we didn’t find one violation for sexual abuse or purposeful harm,” said Brooks.

Slate had an interesting article discussing how and why the uninsured rate has gone up after Trump’s sabotage of ObamaCare.  But there’s an odd political caveat: At the moment, the uninsured rate only seems to be rising for Republicans.

The share of working-age adults without health insurance has increased for the second year in a row, according to a new report by the Commonwealth Fund. In the group’s latest annual tracking poll, 15.5 percent of Americans between 19 and 64 said they lacked coverage, up from 14 percent last year and 12.7 percent during President Obama’s final lap in office, when the uninsured numbers hit a historic low.

The Commonwealth Fund isn’t the only organization to find a drop in health coverage. Gallup’s last tracking poll found that the uninsured rate had risen 1.7 percentage points since the end of 2016. To some extent, that’s not surprising. The White House’s attempts to undermine Obamacare have driven up the sticker price of health plans sold on the individual market, which has surely led some people to drop their coverage. What’s somewhat more puzzling is that both Gallup and Commonwealth find that the biggest drops in coverage have occurred among lower-income households, who typically qualify for subsidies under the current health law. Commonwealth found that the entire decrease in coverage last year occurred among households making less than 250 percent of the poverty line.

Rising uninsured rate
Commonwealth Fund

That’s a bit odd because, for the most part, lower-income families should not have seen the cost of their insurance go up much, if at all, since the Affordable Care Act caps their premiums at a percentage of their income. In fact, the cost of insurance ended up dropping for many subsidized insurance customers this year, because of how states reacted after Donald Trump cut off certain payments to insurers. And while it’s true that Republicans repealed the individual mandate as part of their tax law, that change doesn’t take effect until 2019. At the moment, Americans are still required to buy coverage as before.

 One of the most puzzling findings in the Commonwealth Fund report is that, last year, the uninsured rate only increased among Republicans. That’s surprising, since even in deep red states that didn’t expand Medicaid, many low-income minority communities where people are at risk of falling into Obamacare’s coverage gap tend to vote Democrat. And yet, Commonwealth found no statistically significant change in the uninsured rate among Democrats or independents; among Republicans it rose 4 percentage points.

Uninsured rate by party
Commonwealth Fund

CNN Money published an article on the lack of available positions in nursing schools despite the nursing home industry’s repeated complaints of a nursing shortage.  Schools are turning away thousands of qualified applicants as they struggle to expand class size and hire more teachers for nursing programs.  In America, experienced nurses are retiring at a rapid clip, and there aren’t enough new nursing graduates to replenish the workforce. At the same time, the nation’s population is aging and requires more care.

There are currently about three million nurses in the United States. The country will need to produce more than one million new registered nurses by 2022 to fulfill its health care needs, according to the American Nurses Association estimates.  Robert Rosseter, spokesman for the American Association of Colleges of Nursing, said  “There’s tremendous demand from hospitals and clinics to hire more nurses,” he said. “There’s tremendous demand from students who want to enter nursing programs, but schools are tapped out.”

In 2017, nursing schools turned away more than 56,000 qualified applicants from undergraduate nursing programs. Going back a decade, nursing schools have annually rejected around 30,000 applicants who met admissions requirements, according to the American Association of Colleges of Nursing.

Forbes had an article about the difficulty of relying on nursing homes to take care of our loved ones.  “When your loved one is admitted to a nursing facility, you are at their mercy. There is a significant imbalance of power in many ways and many families may find themselves feeling completely lost.”

We expect that the people with the most experience will hold our hands and help us through this difficult period, however, this is not always the case. Unfortunately, the situation for seniors continues to deteriorate and, as family members try to grapple with mounting issues it can take a toll on their relationships.

Poor Organization

One of the first things you should determine is whether there is a clear chain of command at the nursing home. Immediately find out who you should contact with all of your questions. If they rattle off different names in different departments, INSIST that you work with ONE person to avoid confusion. 

Not only are there a lot of moving parts in nursing homes but there may be a high turnover rate among employees. Who you spoke to yesterday may be gone tomorrow. As such, try to maintain contact with the highest level staff member and know who you need to go to as a backup.

Misinformation

In workplaces where employees come and go, you may notice that a lot of people are confused about their own roles. Whether the staff members are new, poorly trained or even disinterested in their job, this is problematic because you are relying on these people for information.

To combat this issue, again, try to discuss things with one person and document every single interaction. To make this easier, consider making email your primary mode of contact. You will have a written record of everything that has been said which may come in handy if a dispute ever arises (and it probably will).

Staffing Issues

Not to sound like a broken record but nursing homes really do struggle to keep employees, especially the good ones. You may quickly discover how much this affects the quality of care at many different levels.

From poorly maintained rooms to poorly maintained records, an understaffed senior residence can be a dangerous place but there may be little that you can do. Sadly, this isn’t an uncommon issue and seniors could be left feeling neglected. Be friendly with the staff and show them you are invested. This will send the message that you are kind but also vigilant.

Medical Malpractice

In the worst-case scenario, a nursing home resident can be physically or mentally harmed by negligent medical care. This, unfortunately, can have permanent consequences and may even result in their death.  As a result, the anger and pain that stem from these situations can tear a family apart. By being proactive, however, you can improve your odds of a better experience.

What You Can Do

I’ve mentioned it once but I’ll say it again – document EVERYTHING. Do your best to keep important conversations restricted to email but, if you do have an in-person discussion, you can always follow-up with that person and recap everything that was said. Again, this provides you with a paper trail.

Do some research and contact every senior resource in your area including the Department of Social Services, Medicaid, Medicare and everything in between. Get the correct information from the source and double-check anything the nursing home tells you.

You can also enlist the help of the local Ombudsman and/or an attorney that specializes in elder law. Not only can they help you navigate this confusing time in your life but they can be especially helpful if anything goes wrong.

No matter what, understand that this is going to be a stressful chapter in your family’s history. Any problems that already existed could easily deepen under these circumstances. Try to always give each other the benefit of the doubt, listen with an open heart and focus your energy on making memories with your aging loved one. Everything can change in an instant so make the most of every moment.

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