Amanda Falcone has an article about Connecticut’s attempt to increase staff in nursing homes.  A  plan to raise the minimum staff-to-resident ratio in nursing homes was described as historic, necessary and long overdue at a press conference Wednesday.

The plan would provide $9.5 million in fiscal year 2008-09, which begins on July 1, to increase staff-to-resident ratios from 1.9 hours to 4.2 hours of care per day at nursing home throughout the state.   The increase for nursing homes will be sustainable, adding that after the coming fiscal year, it will probably take about $30 million in subsequent years to maintain the change.   Staffing levels at nursing homes have not been addressed in 25 years.

Nursing staffing levels are a problem across the country, and Connecticut is no exception, said Toby S. Edelman, a senior policy attorney for the Washington, D.C.-based Center for Medicare Advocacy.   Adequate nursing staff is critical to providing good care, she said.

Below is an excerpt from a great article from Dallas News about family councils in Texas.  The relatives of Texas nursing home residents have discovered there’s strength in numbers. Emboldened by a new state law, they’ve begun to organize more "family councils" at their nursing homes to advocate for better care.

"My mother was the one who taught me how to stand up and speak out, so it’s only fitting that I now step in for her," said Daisy Kincheloe, who knew she had to do something after her elderly mother fell at Doctors Healthcare Center in North Dallas.  Her mother’s accident was the last straw. Before that, she had discovered other problems that convinced her that some staff members weren’t paying enough attention.

Ms. Kincheloe and other families at Doctors have just formed the group to give each other moral support, act as added sets of eyes and ears around the nursing home, and bring grievances to the administration’s attention. By presenting a united front, family councils have persuaded nursing homes to respond more quickly to residents’ call buttons, improve the meals and even hire more staff.  Family councils are enjoying renewed attention nationwide because many of their newer leaders are baby boomers, whose generation is known for its activism.

Though administrators occasionally resist the councils at first, a growing number say they welcome the groups because they encourage family participation and accountability from staff.

Many families hesitate to bring up problems because they’re afraid the nursing home staff will retaliate against their relatives. Others complain but find their grievances fall on deaf ears.   A family council can add weight to a complaint, advocates say.

HOW TO ORGANIZE A FAMILY COUNCIL

1. Determine the need. As few as two or three families can organize a council.

2. Advise the administrator. By law, nursing homes must provide private meeting space for councils.

3. Notify other families. Meeting announcements can be posted on bulletin boards. Administrators may also offer to mail notices.

4. Ask advocacy groups and the local ombudsman for help. Advocates and the state ombudsman program’s local representative can explain nursing home residents’ rights.

5. Hold your first meeting. Discuss the council’s purpose, ask the ombudsman to talk about the grievance process and invite the administrator to speak.

There is a great article about the use of the game Wii to help residents with socialization and physical therapyin nursing homes.  Wii-hab is the name of the game sweeping nursing homes across the region.
Morrell Nursing & Rehab Center in Hartsville and Bethea Baptist in Darlington are among the long-term care facilities taking part in the craze, much to the delight of their residents.  The new Wii-hab program uses the Nintendo Wii to promote exercise at the facility.   

The favorite game is Wii bowling, because it allows the residents to exercise upper body despite physical  limitations.  Residents and staff alike gather in the center’s sunny activities room to both play and watch others play such Wii games as bowling, tennis, baseball and boxing.

Mary Etheredge, activities director at Morrell, is the person responsible for bringing the program to all three of Wilson Senior Care’s facilities in the Pee Dee. She said so far, the program has been a great success.  Etheredge said the biggest challenge so far has been getting the male residents to participate.  The exercise from the Wii-hab is deceptively easy for many of the residents, Etheredge said, almost tricking them into doing rehab to make their daily lives easier.

“When they’re doing this, they really don’t realize how much they are moving,” she said. “It has them concentrating. They have to watch their eye and hand movement. It really works.”
While the tournament was going on, residents and employees gathered around Hopkins and Woodham to cheer them on with yells and clapping.

Etheredge said that sort of involvement has become almost commonplace since the Wii-hab program began at the facility. She said the Wii-hab program has made a difference in the quality of life for residents and it’s a change she plans on keeping around for a long time.

Hopefully this will become standard practice at other nursing homes.

The Moultrie Observer reported a story about another nursing home employee who sexually assaulted a resident.  How can this happen if a criminal background check was done and RNs are properly supervising the staff?

Charles David Cone, 47, of 321 12th Ave. N.W. in Cairo, was charged with sodomy and sexual battery.   An employee at the Woodlands at Cobblestone on Cobblestone Trace reported Feb. 27 that Cone allegedly touched a 92-year-old male patient inappropriately. The patient stated there were two separate incidents, one on Feb. 25 and the other the next day.

According to a warrant for Cone’s arrest, he is accused of putting the patient’s penis in his mouth on Feb. 26. Cone allegedly fondled the patient’s genitals on Feb, 25,

Executive Director Joann Sloan said Cone was terminated from his job at Woodlands immediately after the alleged incident was reported.  “Our standard of practice and our goal is to provide a safe environment for our patients,” Sloan said.

WFTV in Florida had an article about a nursing home allowing one of their residents to fall NINE times from a her wheelchair.  This is neglect.  Why didn’t they try a safety device like a tray or belt?  I wonder if they were given her the right amount of medication or if they were using the medications as a chemical restraint?   Hopefully the family will get some answers during the lawsuit. 

The falls caused Ruth Boelke to prematurely die. The nursing staff failed to follow the doctor’s orders and best safety practices by failing to use a safety device to prevent Ruth from falling out of  her wheelchair.   The home’s director said it did call her doctor a few days before she died and sent her to the hospital. The family claims the nursing home should have called for help sooner.

Randy Ellis staff writer for NewsOk.com has a sad story about a neglected resident who did not get questions or compensation because the nursing home had no assets and no liability insurance.  Below are excerpts of the story:

The story refers to a family who received a telephone call that their mother had been injured at The Gardens nursing home in Sapulpa. Hospital X-rays revealed her mother had suffered spiral fractures to both legs.  Since that type of injury often is caused by abuse or neglect, the family sued the nursing home to get answers about what happened.  However, the nursing home had no medical liability insurance coverage. 

The number of nursing homes that have dropped medical liability insurance coverage has skyrocketed in recent years. There are now at least 56 uninsured homes with 6,621 beds, according to the Tulsa-based Oklahoma Center for Consumer & Patient Safety.
"Based on information provided to the Center, over 20 percent of the beds in Oklahoma are in nursing homes that refuse to carry insurance,” said Hugh M. Robert, executive director of the nonprofit group. "A state study last year speculated the number may be as high as 65 percent.”

Legislation introduced by Sen. Richard Lerblance, D-Hartshorne, would require nursing homes either to carry medical liability insurance or prove they have sufficient assets to pay substantial damages if they are found responsible for injuries caused by abuse or neglect.  It is difficult for consumers to discover that information on their own because nursing home owners often play a "corporate shell game."

One woman had maggots crawling out of her air cast because employees at her Oklahoma City nursing home had not cleaned beneath it and open pressure sores had developed. An Edmond nursing home patient was left on a bed pan so long her tail bone stuck to it, and a woman at a Frederick nursing home died after becoming so dehydrated that her tongue stuck to the roof of her mouth, attorneys said.

There is a great editorial by Tamara Hill in the Tennessean.  Here it is in its entirety.

Lawsuits are the only way some nursing homes will provide the services they’re supposed to offer

By TAMARA L. HILL   Tennessee Voices

In response to a letter to the editor by Debra Fish ("Nursing homes are pot of gold to lawyers," March 5):

Taxpayer money does not line the pockets of attorneys who sue nursing homes for providing negligent care. If the facility is found to be negligent because a civil justice attorney brings its behavior to the attention of the courts and jury system and the facility pays a judgment or settlement, Medicaid and/or Medicare, whichever paid for the negligent care, is reimbursed … meaning the taxpayers are reimbursed when a facility is found negligent, not that the taxpayers’ burden is increased.

It has also been suggested that lawyers "pile on huge sums of money that bankrupt nursing homes and keep money from being spent on improving care for the residents" on top of judgments allowed by judges and juries. This simply is not true. A lawyer cannot force the nursing home to pay more than the judgment or settlement amount.

As a former nursing-home nurse working in administration, there were multiple instances in which I had to beg corporate for things needed to provide basic patient care … soap, shampoo, gloves, bandages, dressings, towels, sheets, equipment and, of course, the staff to actually provide the care. I was often told that it wasn’t in the budget.

Sometimes the ONLY way I could get what I needed for the residents was to say "OK, but if I can’t get what I need for my staff to take care of them, then you are just buying a lawsuit." Then, suddenly, someone "found" money in the budget to get the things the patient needed. If there were caps, then it would become a cost-benefit risk analysis, weighing a known cost (about 75 percent of the cap) and the savings (benefit) by not providing the staff, supplies and care vs. the risk that someone would take the lawsuit with caps in place.

National HealthCare Corp. is using some of its money in two ways: One is to give bonuses to its corporate employees. Another is to pay lobbyists to convince your state legislators that it needs "liability reform" so that it can’t be held responsible for its negligence.

The proposed bill seeks to put a cap on so-called non-economic damages suffered by nursing-home residents, such as pain and suffering, emotional distress, disfigurement and death. It also seeks to make the cases much more expensive to pursue and defend by placing nursing homes under the Medical Malpractice Act.

Finally, the bill seeks to give nursing homes the ultimate immunity by forcing residents to sign away their right to access to the courts as a condition of admission. How does this protect patients? I submit to you that it does not. It protects nursing-home profits.

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 McKnight’s has an article about  the average price paid per bed for skilled nursing facilities hitting a new record in 2007. The average of $55,200 was 6% higher compared with the year before and 75% more than the notable low of 2003, according to analysis results from research firm Irving Levin Associates.

As more investment groups own long-term care properties, valuations and loan volume in the sector soared to record highs. The median SNF bed price leaped 15% in 2007 buoyed by billion-dollar deals involving major nursing home chains going private.

The average sales price for assisted living units also hit a new high $159,100 in 2007, 20% higher than the year before. Independent living unit prices also rose 20% in 2007, to $174,500 per unit, another record, according to the report.

Insurance companies, the Chamber of Commerce, and the American Medical Association attempt to advance tort reform (i.e immunity for their members) by making up frivolous cases and trying to convince juries that doctors are fleeing states without caps on damages for victims of negligence and abuse.

However, new information based on the AMA’s own data on the number of physicians practicing in the states proves that these disingenous Chicken Littles are flat wrong.  Some key findings include:

1)  The number of doctors is increasing across the country. There were 921,904 physicians in the U.S. in 2006, nearly 20,000 more than in 2005.  Despite the alleged "physician flight" crisis, the number of physicians rose in every state except Louisiana, which had a total decrease of seven doctors (mostly related to the economic devastation of Hurricane Katrina).

2)  The numbe rof doctors is increasing faster than the population growth. There were 303 physicians per 100,000 people in 2006, an all-time high nationwide.

3)  The numbe rof physicians per 100,000 resdients is much higher in states without caps on damages (311 vs. 280).  Since 2000, the physician-to-population ratio in states without caps has increased twice as much as in states with caps.

Do not be fooled by the propaganda of the insurance companies and for profit health care providers.  They are interested in what is best for them and their bottom lines and not what is best for the victims of their malpratice.

Santa Cruz Sentinel has an article about the tragedy that is all too common for many nursing home residents.  Nursing homes fail to train on what DNR status means, and far too often simple care is not provided that would save a resident’s life.  Below are excerpts from the article.

The Tragedy: On Sept. 11, 2007, a 71-year-old woman with cancer was transferred to Pacific Care Manor, a nursing home in Capitola. Just prior to her admission, the woman’s doctor noted that her patient was lucid and responsive and "could have years to live." Most importantly, the patient had also expressed a desire to live.

Shortly after her admission, the woman began refusing food, water and any treatment. Within two days, she was screaming and combative. On day three, the nursing staff suggested that lab work be ordered to determine the cause of the resident’s distress. The facility’s director of nursing overruled the suggestion because "once we know what is going on then we will have to treat her." Instead, the nursing director asked the facility doctor to prescribe pain medication and a "do not resuscitate" order. The doctor complied and, despite the woman’s documented opiate intolerance, he prescribed a Fentanyl patch, Haldol, morphine. He also wrote an order for "no CPR, no hospitalization." His patient cried out "you are all going to kill me" after the forcible administration of the prescribed medications. On Sept. 16, just five days after her admission, the resident died. 

All residents of nursing homes have the right to grant or withhold consent to any proposed treatment.  Residents have the right to refuse or consent to treatment and to receive all information relevant to making their treatment decisions. Providing such information is part of any responsible nursing home’s assessment and care planning process. Federal regulations also reaffirm residents’ rights to informed consent and to refuse treatment.

Regardless of a resident’s mental capacity, no facility may administer treatment unless the resident has agreed or has been specifically adjudicated incompetent by a state court judge. Even after a court has determined that a resident is incompetent, it must make additional findings before terminating a resident’s right to refuse treatment. Without a court order, the provision of any treatment over a resident’s express refusal is a violation of several residents rights and is criminal battery.

Similarly, doctors cannot order "Do Not Resuscitate" orders without the written authorization of their patients. For DNR orders, designated health care agents may sign for the patient. However, doctors may not unilaterally impose DNR orders without a resident or resident representative signature.

Nursing homes throughout California are accustomed to interposing their notions of a resident’s best interests over the expressed wishes of their residents. The Department of Public Health and resident advocates have been generally weak in preventing this illegal conduct. Hopefully, the tragedy in Capitola will serve as a warning to both facilities and advocates about the deadly consequences of disregarding residents’ critical rights to direct their own treatment.

Anthony Chicotel is an attorney for the California Advocates for Nursing Home Reform in San Francisco.