I have read several articles recently about how some cities like Cincinnati may stop conducting nursing home inspections.  That is fine with me since most inspectors in South Carolina are so overworked and underfunded that the inspectors don’t have the time and resources to properly insure that the nursing home is properly caring for the residents. 

Typically, the nursing homes know when they are coming and improve conditions before the inspectors get there.  We hear countless stories from ex-employees of nursing homes in the area that all repeat the same chorus.  "They increase staff and clean everything when they know the survey team will be coming in". 

I have not seen any complaints substantiated or any fines incurred against any of the for profit nursing homes. The inspectors in South Carolina seem to ignore violations, and the concerns of residents and family members. Instead, they criticize the county run nursing homes or the charitable organizations that run the mom and pop nursing homes.  I can’t tell if it is corruption or incompetence but certainly the inspection program in South Carolina isn’t doing anything to provide better care or oversight for the residents.

Below is a summary of a story by Dan Horn about Cincinnati dropping nursing home inspections

The Cincinnati Health Department is considering whether to drop its inspection program for nursing homes and residential care facilities. Budget cuts and retirements could soon leave the department unable to keep up with annual inspections. Cincinnati is the only city in the state that does its own nursing home inspections, a policy that city officials have said allows the city to react more quickly and aggressively to problems.   He said the program once operated with six inspectors and supervisors, but that number fell to four by the start of this year. Another retirement will drop the total to three employees by this fall.

 

 

 

The Fort Worth Star Telegram had an article about a tragic situation where an abused resident died before the grand jury was able to indict his tormentor. 

Elaine Doores, a retired biology professor diagnosed two years earlier with Alzheimer’s, struggled to find the right words to describe the abuse she survived.   "He has hurt me a lot. Every time he bathes me. He puts things in me.  . . . He had sex with me more than once. It’s all the time in the bath."

The 68-year-old woman’s statement led to the arrest of Donald Gene Shelby, a certified nursing assistant at the James L. West Alzheimer’s Center where Doores had been living.

Her daughter says the district attorney’s office stalled in handling the case.  "They sat on it while the victim got worse," Pitt said. "That’s the disservice they did to my mom and my family."

She believes that prosecutors dealing with victims who have dementia or Alzheimer’s should try to present the case to a grand jury without delay.

Elaine Doores was placed in a nursing home Jan. 23, 2007, two years after being diagnosed with Alzheimer’s.  Pitt said Doores had difficulty speaking and performing motor skills but recognized relatives.

Pitt said that on Feb. 18, Shelby told her that her mother was upset the day before because the pajamas that she wanted to wear were dirty. Pitt said she was puzzled because her mother had never seemed to care what she wore.  Later, during the same visit, Pitt said that when she suggested getting "Donald" to help Doores go to the bathroom, her mother became agitated. When questioned, Doores told her daughter that Shelby was "bad" and had done something "wrong."

Pitt said she sought the help of a floor nurse, who asked Doores whether Shelby had touched her. Doores answered, "Yes." When the nurse asked where, Doores replied, "Everywhere," Pitt said.

Pitt went home and told her husband, Deven Pitt, a Fort Worth police detective. At his suggestion, the two contacted Detective S.L. Schloeman, the on-duty investigator with the sex crimes unit, and filed a police report.

Afterward, Doores provided a statement to Schloeman, a copy of which Pitt gave to the Star-Telegram. Doores described Shelby as "scary" and said she was afraid of him. She said he made threats and told her not to tell anyone what he had done.

Schloeman, now a sergeant in patrol, said that to determine Doores’ mental state, she had asked Doores questions, including some about her daughter’s birth date, the current year and where she lived. Doores answered every question correctly, Schloeman said.

"She displayed symptoms of having just a minor case of Alzheimer’s," Schloeman said. "She was able to give me a clear, concise description of what had happened to her. She was able to identify the suspect in a photo spread and identify him by first name."

On March 2, 2007, Schloeman obtained an arrest warrant for Shelby on suspicion of aggravated sexual assault. The next day, Shelby surrendered at the Tarrant County Jail and was released after posting $50,000 bail.

Tarrant County court records show that Shelby was indicted in March 1987 on a charge of indecency/fondling. The state dismissed that case in January 1988 after the accuser, a male minor, committed suicide. 

How could he get a job at a nursing home when he had been arrested for abusing a vulnerable person?  Did the nursing home do a criminal background check?

 

 

 

The Post-Tribune had an article written by Mark Taylor about the negligent care provided to a resident in a hospital.  The article described the resident, Donna Durham, as an active, energetic widow with sparkling green eyes and silver hair who worked as a top real estate agent and home appraiser until June 12, the day she arrived at  the hospital for surgery. 

Prior to the surgery, the Dunham family had apprised hospital staff of their mother’s allergy to codeine and morphine.  It was entered in her medical chart.  It was identified on the red tag she wore on her wrist. And in the final presurgery meeting with physicians, Dunham’s children say they reminded anesthesiologist Dr. Nageswar Yelavarthi that their mother was allergic to morphine.

In spite of those warnings he allegedly ordered a nurse to administer the potent narcotic to which Dunham was allergic, according to Pinnacle medical records obtained by Dunham family attorney George Galanos. Yelavarthi allegedly told the nurse that he and the staff could deal with the expected allergic reactions, such as nausea and vomiting, a nurse’s note states.

By 12:08 p.m., Dunham was in respiratory arrest and having difficulty breathing.  Medical records indicate Pinnacle staff attempted to stabilize Dunham and around 12:30 p.m. began attempts to transfer her to an acute-care hospital. 

Dunham’s doctor, Dr. Kucharzyk,  did not complete a spine fellowship and does not have the additional training required to perform spinal procedures.  According to the Patient Compensation Fund of the Indiana Department of Insurance, Kucharzyk has been named in at least 14 medical malpractice lawsuits.  Kucharzyk never disclosed this information to the family.

Nonetheless, Kucharzyk held surgical privileges in back surgery at Pinnacle.

After Dunham went into respiratory distress at 12:08 pm., Pinnacle staff connected her to a ventilator to breathe for her.   Anesthesiologist Yelavarthi gave her an antidote to the morphine, but it didn’t work.

Kucharzyk was enlisted to attempt to transfer Dunham to Methodist or Saint Anthony. But he said he did not hold full privileges at Methodist or Saint Anthony and wasn’t successful in arranging a transfer. Kucharzyk soon after told Pinnacle staff, “He would not be following the patient,” according to Dunham’s medical records.

Khalid contacted Methodist to alert staff there about Dunham’s condition and the sequence of events, and at 1:01 p.m. Superior Ambulance arrived at Pinnacle to transport Dunham to Methodist.  Again at 1:20 p.m., Pinnacle staff contacted Methodist and were told that Methodist could not accept Dunham until case management reviewed her insurance “to make sure she was not a (patient) ‘dump’,” hospital slang for a patient unable to pay, according to Pinnacle records.

Patient dumping is when a hospital transfers a patient to another health-care facility because of the person’s inability to pay. It’s a practice that is illegal, as is delaying care while considering payment or insurance information.

The Pinnacle staff continued working on Dunham even as they attempted to transfer her to Methodist, a hospital with an intensive-care unit better equipped to handle such emergencies.

Finally at 2:30 p.m., nearly 150 minutes after Dunham had gone into respiratory distress, Superior transported her to Methodist.  Dunham arrived at Methodist still in distress and deteriorated rapidly.

Methodist’s ER staff worked on her until 3:30 p.m., when she was pronounced dead of heart failure.  A Methodist ER nurse asked the family if Pinnacle ever explained their mother’s condition when it transferred her.

Cheryl Harrell said Kucharzyk phoned that evening.   “He asked what happened and acted like he didn’t know anything had gone wrong,” she said. “He said when he left she was fine.”

 

Okay – I think I’d be filing a lawsuit too.  Actually, I think I’d have been raising all sorts of hell prior to filing this lawsuit.  I don’t have much information on this other than the Complaint, which doesn’t have a lot of details (probably because its not required), but I cannot imagine how this happened.  The injuries cited are "including but not limited to cellulitis in his scrotum and penis and gangrene in his penis which required the removal of his left testicle."  This complaint is against an Eldercare facility in Illinois.  My first question (and this is an unusual stance for me) is how on earth did this gentleman not complain long before he had gangrene?  And if he did complain, how on earth did no one do anything about it?  And of course, what could have been done?  What causes something like this?

Honestly, I think answers to those questions are far more than I truly want to know, but those are my first thoughts. 

Bottom line is, this gentleman was in a nursing facility, presumably because he needed nursing care – presumably because he needed assistance with activities of daily living, like bathing, dressing and using the bathroom.  What on earth were the employees doing (or not doing) that they could miss something like gangrene . . .

It boggles the mind.

David Krough wrote, for Portland’s kgw.com, an article stating that a nurse assistant at a nursing home was arrested for stealing narcotics from residents in other nursing homes.  Nursing assistants provide about 85-90 percent of all the care to residents.

The article is informative but does not provide key information such as prior arrests, employment history, knowledge of the mangement of the nursing homes regarding the missing narcotics or her conduct.  How could she get hired?  Was she a user or a pusher?  What safeguards do they hav ein place to make sure this doesn’t happen?  Below is a summary of the article.

Surveillance cameras caught a woman on camera, posing as a resident’s granddaughter, then as an employee. Administrators there said the woman snuck in and spent at least three evenings with one of their residents.

Theresa Smith was a nursing assistant who worked at nursing homes in the Portland Metro area.  Police listed Smith as a person of interest after a report of theft of Fentanyl patches at the Laurelhurst Village Nursing Home on SW Stark Street.  She was accused of stealing Fentanyl pain patches from nursing home residents while the residents were wearing the patches. Detectives said she stole from several patients at area nursing homes.

Detectives arrested Smith Wednesday while she was working at the Care Center East Nursing Home on NE Wielder Street.  Smith was charged with burglary, criminal mistreatment, possession of a controlled substance and theft. Police said she may face more charges.
 

Times Record-Herald had an article about a resident who wandered away from an adult home and froze to death.  These kinds of incidents are preventable if the home has well-trained and competent number of staff members supervising the residents.  A death from wandering is a sure sign that understaffing, inadequate training, and a lack of supervision exists in that nursing home.

The article mentions that Karen Preston walked away from the Roscoe Manor Adult Home. She stumbled into the woods about a mile away. She fell repeatedly. She walked in circles. She curled up under a pine tree. And that’s where police found her frozen body two days later – her socks next to her body, no shoes on her feet. A medical examiner ruled that she died of hypothermia.

Karen Preston was 54 years old and suffered from severe schizophrenia. She had lived in Roscoe Manor because she needed help with daily activities and supervion that an adult home is supposed to provide.

Preston’s tragic death underscores the deplorable conditions at many nursing homes.  The Times Record-Herald reviewed inspections at 22 licensed adult homes in Ulster, Sullivan and Orange counties from 2001-07 and turned up 846 violations deemed to directly affect the safety or well-being of residents – with two-thirds of those citations recorded at the seven adult homes operated in Sullivan County.

A year after Preston disappeared, another Roscoe Manor resident, Ella Maye, walked away from the home.  Maye, 78, had dementia and heart disease. State police believe she suffered a fatal heart arrhythmia while walking on Rockland Road early on Feb. 23. They believe she was trying to crawl back to Roscoe Manor when she collapsed on a neighbor’s front lawn and died.

The adult home was supposed to do hourly bed checks, but Roscoe Manor owner Charles Benson said at the time that an employee had failed to do so.  No one noticed Ella Maye was missing.

Adult home inspection reports and history documented by state agencies make it clear: Residents of some Hudson Valley adult homes are at a significant risk of illness, injury or even death due to carelessness or negligence on the part of the homes’ operators and staff.

Despite reforms over the past few years, state oversight has been ineffective in regulating these homes, which house a vulnerable population of the elderly, infirm and mentally ill. And anyone can end up in an adult home. All it takes is a medical crisis that renders someone unable to live on their own.

State documents paint a disturbing picture of homes where residents are left to sit in soiled clothing, are subjected to physically or verbally abusive staffers and repeated instances of mismanaged medications.

 

Sunrise Senior Living faces another neglect and negligence lawsuit (08/20/08 Orange County Register).  Sunrise was ordered to pay $2 million in damages after the death of a resident in May.  The family of Therese Sperry is suing Virginia-based Sunrise Senior Living which owns and operates Villa Valencia Health Care Center.

Sperry spent two weeks in Villa Valencia’s skilled nursing unit in January 2007. She developed avoidable pressure ulcers on her feet that were neglected and went untreated.  The lawsuit alleges negligence by Sunrise Senior Living and says the nursing home failed to provide adequate medical staff for ailing residents – despite five health and safety citations in the last decade by state health regulators.   The most recent violations, from last year, include sexual molestation of a patient during a bath and failure to change a patient’s catheter often enough to prevent infection.

After a brief hospital stay, she was sent to Villa Valencia for a week to gain strength.  Four days after her admission, she had redness on both heels, which later developed into ulcers that spread to her muscle and bone. Sperry’s family immediately transferred to a different nursing home, where she was properly treated for wounds.  She endured debilitating pain until her death.

The suit argues that the facility "carried out a scheme to place ‘profits over people’ … (and) intentionally underfunded and understaffed the facility in order to decrease expenses and increase profits."  Proof of understaffing arose in the trial over the death of Mary Kathleen Adams, who also developed pressure ulcers while at the center in February 2005. She died two months later.  In May, a jury ordered Sunrise to pay $2 million to Adams’ family for negligence and punitive damages.

"Big corporations like Sunrise cut down on costs and staffing at the expense of patients," said Kim Valentine, one of the lawyers representing the Sperry family, and who also represented Adams.  Valentine also said court testimony showed employees were quitting because of the poor quality of care – a finding reflected in a report by the independent California Nursing Home Search. The agency found that nursing staff turnover at Villa Valencia was 82 percent in 2006, much higher than the state average of 67 percent.

 

What an interesting concept – training called Xtreme Aging, which is designed to simulate diminished abilities associated with old age.  I just read this article about this program, which is apprently becoming a part of many nursing and medical school curriculums, and I think should be mandatory training for every nursing home employee, or for anyone who works with the elderly.

Here’s the idea, they put on glasses to blur their vision; stuff cotton balls in their ears to reduce hearing and their noses to reduce sense of smell; and put on latex gloves with adhesive bands around the knuckles to impede dexterity.  They even put corn kernels in thier shoes to approximate typical aches and pains.  And after all that, the subjects are put through a series of typically routine tasks like buttoning a shirt, finding a phone number in the phone book, dialing a cellphone and folding and unfolding a map.  Imagine – shirt buttons are so small, phone book print and cellphone numbers are so small, folding a map is a frustrating task  for me in my thirties!

The idea behind Xtreme Aging, of course, is to foster sensitivity both inside and outside medical facilities.  I generally don’t quote directly from articles, but this is something to think about.

To approximate the state of people entering a nursing home, she asked each participant to write down five favorite possessions, five cherished freedoms and three loved ones on Post-it notes. Then one-by-one she asked members of the group to part with a possession, a freedom or a person: a car here, a husband there, freedom of travel next — until all that anyone had left were two possessions.

“You guys just aged to the point of going into a nursing home,” she said, as participants made the last hard choice, invariably giving up contact with their children. “What did you give up? All your loved ones. All your privileges. And at most nursing homes you only get to bring two possessions.”

She asked, “How did that make you feel?”

Hands went up.

“Lost.”

“Like I want to die.”

“Like I failed.”

“Now,” Dr. Rosebrook said, “how many of you look forward to living in a typical nursing home?” No hands went up. “But this is what we do to people. If we’ve taken everything away, what have we done to the elders in society?”  Kim Hansen, 46, who works in the facility’s rehabilitation unit, said the hardest part of the exercise was giving up the people in her life. “I gave up my parents first,” she said. “Then it was between my husband and my kids. I gave up my husband. I got very emotional with that.”

There’s something to think about – yes, its a simulation, but a powerful one, and one that just considering it makes me very sad.  The participants get to go back to their lives, and their possessions, freedoms, and loved ones . . . but what happens when you’re no longer a participant?  Shouldn’t we strive to make the reality as pleasant as possible?

Prudential Study Sheds Light on the Increasing Costs of Long-Term Care.  Prudential website has a great tool to determine the cost of long term care in each state. 

According to the U.S. Census Bureau, by 2030 the number of Americans aged 65 and older will more than double to 71 million, comprising approximately 20 percent of the U.S. population. With an aging population boom, Prudential issued 2008 Long-Term  Care Cost of Care research report.  The study found an increase in the average cost of long-term care ranging from 5% to 13%, varying by type of service, in the past two years alone.

"Many Americans mistakenly believe that Medicare or private health insurance will pay for their long-term care needs. The reality is long-term care risk is substantial, and under current Medicare and Medicaid policy, much of it is the uninsured private responsibility of individuals who pay for care and of families who care for their relatives," said Andy Mako, Senior Vice President, Long-Term Care Insurance, Prudential.

Prudential’s Cost of Care study sheds light on the State-specific average costs associated with nursing homes, assisted living facilities, and home health care services.

The study related significant issues:

— Average costs for long-term care services increased over the past two years and are expected to continue to rise. The average daily cost for an assisted-living facility is now more than $100, or $3,241 per month. What’s more, the average daily cost of a private room in a nursing home is now $217, or $79,205 annually.

— Home health care experienced the smallest rate increase, rising just 5 percent over the past two years. The average hourly rate for a home health aide/certified nursing assistant increased by $1 in the past two years, to $21.

— Costs for long-term care services continue to vary significantly by location, with Alaska, New York City, and Stamford, CT consistently being the most expensive areas for nursing home and assisted living facilities, and Oklahoma City, St. Louis, and South Dakota being the least expensive.

In addition to the report being available to consumers on www.prudential.com, Prudential is also launching an updated interactive consumer cost of care mapping tool on its website at www.prudential.com/insurance/longtermcare, designed to provide more in-depth State-specific cost detail – and in some cases City-specific – aimed at arming consumers with essential facts to help them make better financial decisions. "While consumers understand the importance of planning for their financial future, they continue to have misperceptions about the costs of long-term care services and the benefits of long-term care insurance. Our resources can help them dispel these myths and put them on the right path to securing their retirement," added Mako.

 

The body of a nursing home resident was found dead,  The man had been missing from a Caroline County nursing home since Aug. 3.  The date and cause of death are still under investigation and how he exited the nursing home where he was supposed to be supervised. Additional information about where the body was found, and by whom, was not available from the sheriff’s office last night.

Richard Eddie Robertson was found Friday morning.  Cenk Kalemdaroglu, an administrator at Bowling Green Healthcare Center released a statement:  "We are deeply saddened to learn of the tragic outcome of the exhaustive search to find Mr. Robertson, Our sincere condolences go out to his family and loved ones. We would like to thank all of the individuals and volunteers that have assisted in this search effort."

Robertson suffered from dementia and was known to wander.  Wandering is a major problem in demented residents and why staffing and supervision are so important.  The nursing home should have had a Wanderguard on or even a simple GPS unit.  They are cheap and would not bother the residents.