A $750,000 settlement between a Pennsylvania nursing home and Francis X. Ounan has been approved by a federal judge. Ounan filed suit against nursing home chain Sunrise Senior Living Services, Inc. on January 15, seeking damages for claims of negligence and wrongful death.

Ounan’s mother, Margaret Ounan Boyle, died in November of 2005 from injuries she sustained while wandering from the nursing home. The day after her admission, Boyle fell while wandering from the nursing home, sustaining head injuries. She was found with police assistance and taken to the hospital, where she was diagnosed with bleeding of the brain and died the next morning.

Ounan claims that the nursing home knew at the time of his mother’s admission that her Alzheimer’s made her a high-risk for wandering. Ounan claims that the nursing home was grossly negligent in failing to institute adequate measures to prevent its residents from wandering. Further, he claims, the nursing home failed to formulate a plan to address his mother’s tendency to wander.

In many of our depostions, defense counsel asks questions that border on the ridiculous and sometimes cross the line to inappropriate or harassing questions. I ran across this artice that talks about a Plaintiff’s attorney who did something about it.

A plaintiffs attorney sued his adversary for asking "inhumane" questions during a deposition that allegedly inflict "grievous emotional distress."   Bruce Nagel claims Judith Wahrenberger, his adversary in a medical malpractice case, acted tortiously by asking a husband whether he felt his wife had played a role in the death of their infant daughter by handling the child roughly.

"Wahrenberger’s unsupported and intentional attack upon the parents was beyond any acceptable behavior of a civilized human being," alleges Nagel, of Nagel Rice in Roseland, N.J.

"I would not be doing my job if I didn’t explore these areas," says Wahrenberger, of Springfield, N.J.’s Wahrenberger, Pietro & Sherman.

 

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New England Journal of Medicine has an article about Oscar, a hospice cat at the Steere House Nursing and Rehabilitation Center in Providence, R.I., who seems to have an uncanny knack for predicting when nursing home patients are going to die, by curling up next to them during their final hours.

His accuracy in 25 cases has led the staff to call family members once he has chosen someone. It usually means they have less than four hours to live.

The 2-year-old feline was adopted as a kitten and grew up in a third-floor dementia unit at the Steere House Nursing and Rehabilitation Center. The facility treats people with Alzheimer’s, Parkinson’s disease and other illnesses.

After about six months, the staff noticed Oscar would make his own rounds, just like the doctors and nurses. He’d sniff and observe patients, then sit beside people who would wind up dying in a few hours.

Oscar is better at predicting death than the people who work there, said Dr. Joan Teno of Brown University, who treats patients at the nursing home and is an expert on care for the terminally ill.

No one’s certain if Oscar’s behavior is scientifically significant or points to a cause. Teno wonders if the cat notices telltale scents or reads something into the behavior of the nurses who raised him.
Oscar recently received a wall plaque publicly commending his “compassionate hospice care.”

Poor conditions at a Tn nursing home prompted the state to prohibit the facility from admitting new patients.   The state suspended any new patients from being admitted to the Cornelia House.

A State Health Department review paints a different picture, detailing a successful escape this past April, in which a patient with dementia walked out a smoking door and was found down the street. 

Cornelia House is banned from admitting new residents because staff just can’t keep patients from wandering outside. The state said residents there are in "immediate jeopardy."

"There are specific things that are supposed to be done to prevent patients from running away, and those haven’t been done. So, all of these deficiencies have to do with operational issues," said Andrea Turner, TN Department of Health.

State inspectors also cite inadequate resident care plans, and failure by the staff to keep patients with feeding tubes from choking.   The state issued penalties in February of 2003, March of 2004, February of 2005, and August of 2006.

See article here.

There is a special place in hell for SOBs like Connie McCurry who steal from residents. 
The owner of a nursing home has been arrested after taking more than $60,000 intended for a resident in the home.   Connie McCurry was charged Tuesday with unlawful exploitation of a vulnerable adult.  (Is there such a thing as lawful exploitation?)

Police say McCurry cashed two Social Security checks, one worth about $41,000 and the other worth about $19,000, intended for a resident of Connie’s Residential Home and kept the money.

We have numerous cases where a resident suffered horrible painful pressure ulcers because of the lack of preventative treatment.  The nursing homes always claim that the pressure ulcers were "unavoidable" due to the age of the resident.  A new comprehensive study disproves that claim.

This article discusses the purpose and success of preventing pressure ulcers from forming when nursing homes provide preventative care.

The Pressure Ulcer Collaborative project had been aiming for a 25 percent reduction in new occurrences of bedsores by encouraging health workers to use proven strategies to prevent skin deterioration.  Instead, the 150 hospitals, nursing homes and home health care agencies participating reduced new bedsores on average by just over 70 percent between September 2005 and May 2007.

Bedsores, technically known as pressure ulcers, are painful, occasionally deadly skin lesions caused by unrelieved pressure  that can cause infection and destroy tissue, muscle and bone if not properly treated.  They also can trigger depression, affect a patient’s self-image and complicate treatment.

At the beginning of the New Jersey project, 18 percent of newly admitted patients developed a bedsore while receiving care. By the end, the rate had been cut to 5 percent of new patients, Holmes said.

Holmes said the preventive steps started with a prompt evaluation of each new patient, with every square inch of their skin examined and their risk of developing bedsores determined based on a standardized scale.

Hospitals then had to follow strategies to prevent development of bedsores. Options included shifting the patient to a new position every two hours, use of heel cushions and other padding for vulnerable pressure points, even use of special air mattresses that alternately inflate and deflate different areas, spreading pressure around.

Patients not eating or drinking enough water _ a common problem with older patients _ got a nutritional consultation because inadequate caloric intake or protein stores, as well as dehydration, can lead to skin tearing and breaking down.  Frequent follow-up examinations of the skin also were required, along with new ones for patients suddenly bedridden, as after surgery.

 

Choosing a nursing home for a loved one is one of the most emotional and stressful decisions a family will ever face.  With so many nursing homes out there and all of the stories we have heard about under-staffing, sub-standard care and neglect, how does one make an informed decision?  I recently came across an article that offers some really good advice on selecting a nursing home that I hope will help make this decision a little easier.  

First, visit the facilities you are considering.  Go often and unannounced.  Visit at different times during the day such as mealtimes and activities.  This will allow you to get a good idea of how the needs of the residents are addressed in different situations. 

The article also suggests to pay close attention to what your sense of sight and smell are telling you when you visit.  Is the facility clean?  Are the hallways clear and safe or crowded?  Does it smell clean?  If you notice foul odors from feces or urine, chances are residents are not being tended to quickly enough and it could be a sign of neglect. 

Check for resident call bells that go unanswered; that is a major red flag.  Also, talk to the staff.  Do they seem friendly and helpful?  Are they willing to answer your questions?  Are they attentive to the residents?

Hopefully, these tips will assist you in making a more informed decision about a nursing home.  If you are interested in seeing the complete article, visit this link: news.enquirer.com/apps/pbcs.dll/article

Several years ago, I was having dinner with a friend who had at one time worked in the same nursing home I had worked in.  We began talking about staffing and ways to ensure that you had good staff, and ways to hold the staff accountable.  She had recently suggested to the company that she was working for that the way to have consistently good staff was to offer good pay and benefits.  As you can imagine, that wasn’t the solution that the corporate representatives wanted to hear.  However, I agree with her.  If you take care of your staff, you can hold them accountable.  Further, if you take care of your staff, they will often perform better.  I’ve often thought about that conversation when sitting through depositions of overworked and underpaid nursing home staff.

This afternoon I have been looking around at other nursing home blogs, and I stumbled on this tidbit.  The Legal Medicine blog has lots of great posts, but this one in particular caught my eye.  It reminded me of the conversation with my friend . .

It seems that Nursing homes are concerned about immigration reform because it might hurt their staffing.  Think about that for just a minute.  The more immigrants they can hire, the less they have to pay them.  The less immigrants they hire, the more they have to pay.  Does everyone see that this has very little to do with staffing, and everything to do about the bottom line?

Yes, staffing is a problem in nursing homes.  However, often its more related to what the corporation is willing to pay for staff, rather than availability of people to fill staff positions.  And sometimes, you get what you pay for.

 

I saw this article on another website discussing the recent Cornell University study on physical abuse between residents.  Resident on resident abuse is underreported and mismanaged in the nursing home setting and most likely caused

Physical abuse in a nursing home may include staff or other residents.  According to a Cornell University Study, resident-on-resident violence in long-term-care facilities is far more prevalent than previously thought.  The authors of the study admit nursing home abuse is  woefully understudied.

The new study, funded by the National Institutes of Health (NIH), is only the second published report to look at patient-to-patient violence. Cornell University examined the records of 747 nursing home patients over the course of the study. Of those, 42 where involved in 79 incidents at nursing homes that actually required police intervention. The finding surprised researchers, especially because the study was not even focused on nursing homes. Rather, it looked at overall community crime, and nursing homes where just one area that was examined. 

Many nursing home patients suffer from varying degrees of dementia, and this often plays a factor in the violence.  Common triggers can be unwanted touching or disputes over television.   It is often the byproduct of a neglectful staff. Conflicts are far more likely to escalate to physical violence when patients are unattended. However, attentive staff can take steps to separate feuding patients before the situation deteriorates.

The report also questions the wisdom of housing dementia patients together. This is standard practice in most nursing homes, which generally have a dementia ward. But, because dementia often triggers violence, the report suggests it might be better to incorporate these patients into the general population as much as possible. 

As many as one in 20 nursing home residents are victims of nursing home abuse. Because there is no uniform system for reporting nursing home violence, experts on elder abuse concede that current estimates are probably just the tip of the iceberg.   There is no requirement to report resident-on-resident violence. In fact, the Cornell researchers only looked at cases that involved police calls. There were simply no records available to them detailing physical confrontations between residents that did not escalate to this level of violence.

Here is an article talking about another rape of a resident at a nursing home.  Where is the supervision? Where is the criminal background check? Wher eis the good ol fashioned judgment!?

Salt Lake Police arrested a worker at a nursing home today accused of raping an 85-year-old resident.  Jacob Bolith was arrested on suspicion of rape. The CNA is accused of raping a patient at St. Joseph’s Villa nursing village July 1.

Police said Bolith has worked at various nursing facilities in the Salt Lake Valley over the past decade. Bolith told police that he faced similar accusations in the past, according to a probable cause statement released by the jail.