The Herald-Review.com had an article about Certified Health Care Management Inc (which was the company that once managed Prairie View Care Center nursing home) and Dr. Carl Johnson.  They recently agreed to settle a lawsuit filed after a resident of the home died because of injuries he received there. The $700,000 settlement went to the estate of Donald McCormick Jr., who was only 43 years old when he died Nov. 24, 2002.   According to Levin & Perconti, the Chicago law firm that filed the lawsuit, McCormick was admitted to Prairie View on March 19, 2002. The firm said he suffered impairments and was dependent on nursing home staff for all activities of daily living.

McCormick’s impairments also made him unable to communicate his needs to nursing home staff, and from his admission until his discharge on May 12, 2002, he became severely malnourished, dehydrated and developed a massive bed sore.  The wound became so bad that it exposed a bone, and the injuries were caused by the nursing home and a doctor’s failure to provide adequate medical and personal care, leading to his death.

Case documents indicated that Certified Health Care Management agreed to pay $600,000 to McCormick’s estate, and Johnson agreed to pay $100,000. The lawsuit was filed in Cook County because that’s where the nursing home’s management company is located.

 

The Denver Post had an article recently about thieves dressing up as nurses to enter nursing homes and steal residents’ property.  Nursing-home residents are being targeted by a ring of male thieves who pass themselves off as female nurses to gain entrance to senior- living facilities.  The men enter the facilities wearing medical scrubs and then enter rooms and apartments and take credit cards.  The thefts occur while the residents are eating meals or participating in other activities.

Since May, the thieves have struck at least 20 times, with losses from fraudulently used credit cards estimated at $50,000 to $100,000.  The Colorado cases are believed connected to  a national crime ring, which has carried out similar thefts in Louisiana, Georgia, Texas, Kansas and Alabama.  So far, the Colorado investigation has focused on two individuals. One, Markinious Ketrell Hartfield, 28, was arrested last week in Colorado Springs and is out on bond. Hartfield was convicted of similar crimes in 2006 in Louisiana.

 

 

Diana Harden shot her disabled daughter and then killed herself.  One major factor was the treatment her brain-damaged daughter, Yvette Harden, received at the Oakland Springs Health Care Center, according to a detailed letter the mother wrote before ending both their lives Sunday night.  Diana Harden left a note indicating her daughter had been abused and mistreated by the staff at Oakland Springs and that the family’s frustration in dealing with the problems was the reason she resorted to taking her daughter’s life. The horrible care and treatment provided to her daughter is no excuse but after years of frustration and disappointment it must have seemed like the best way out of the terrible situation.

Yvette Harden was severely impaired by a auto crash in 1994. The accident left her partially paralyzed and with little impulse control and essentially no inhibitions because of brain damage, the mother wrote in a letter sent to KGO-TV’s ABC7 News before she fatally shot her daughter and then herself.   She complained in the letter that despite her efforts to educate staff of Oakland Springs Health Care Center about the brain injury, they treated her daughter like an "animal or non-person."   The certified nursing aides "tell her "… she’s a ‘Fat Pig’ and that they ‘hate taking care of her,’" Diana Harden wrote.  She wrote that the aides bathed Yvette "like a car," with cold water at times to punish her. When Yvette would scream, the aides would turn the hot water back on before the nurse in charge could arrive.   "There’s much more but you can ask my family. "… They can tell you. I can’t go on like this. She has been begging me to end it for two years," Diana Harden wrote. "My health is failing and I don’t want to leave her alone."

The California Department of Public Health has launched a vigorous investigation into Oakland Springs, according to spokesman Al Lundeen.  He said the department could not discuss the details of the investigation but added that the facility has been the subject of past complaints–48 that were substantiated since January 2008.

Because she was partially paralyzed, Yvette Harden could get around only with a wheelchair. But staff took away the motorized chair and gave her a manual chair that she had to be strapped into because it was too small and made the pain in her legs and back worse, according to Department of Public Health records.  She told her mother, "I want to die; I don’t want to live without my wheelchair," according to the Department of Public Health records.

Department of Public Health records show that the director of nursing at Oakland Springs confirmed the facility’s occupational therapist did not assess the appropriateness or fit of the wheelchair.   Limiting mobility can put patients at "risk for depression, emotional distress, accidents, harm, pain, and diminished mobility," a Department of Public Health investigator wrote in September 2008.

On May 19, 2008, an inspector found a resident having dinner in bed with a pillow case wrapped around his neck instead of a bib, Department of Public Health records show. An inspection of the linen closet revealed that the facility lacked clean towels, washcloths, nightgowns and bedding except for one or two isolated pieces.

During an annual survey in November 2008, inspectors found peeling paint on outside walls. Inside, several rooms reeked of urine, and there were smears of brown matter on bathroom floors.  The hot water heater was broken, leaving one side of the building with only cold water.   A review by inspectors of medical records indicated that a mentally disabled resident who needed total assistance with daily needs because he had a gastric feeding tube had not been showered for the entire month of September 2008 and only once in October 2008.

The inspector found the teeth of another resident yellow and decayed. His tongue was discolored, cracked and dry. Thick mucous had accumulated around his mouth, and he was unshaven. He still hadn’t been cleaned up when the inspector returned the next day.

When state Public Health Department inspectors arrived in May for an annual review, they found residents whose specific medical needs were ignored, according to the department’s inspection records. Oakhill Springs was one of the four facilities in Oakland that ranked among the lowest on the federal government’s one- to five-star rating system.   Oakhill Springs’ current one-star ranking is based in part on staffing levels and on the most recent annual inspection by Public Health Department inspectors.

 Despite the facility’s high-need patients, the majority of nursing is done by certified nursing aides. Patients saw a registered nurse only 15 minutes on average per day in May — half of the national or state average, according to Medicare, which analyzes data the nursing homes report to the Public Health Department. Certified nursing aides, who do not receive the level of training required of registered nurses, did the bulk of the work — more than two hours.  While it is difficult to assess how that ratio affected care based on the limited information, the total hours of skilled nursing care each resident received — 3.5 hours per patient per day — is just above the state minimum requirement of 3.2 hours, which is insufficient to address the needs of nursing home residents, said Kathryn Locatell, a forensic geriatrician who analyzes and investigates cases of suspected elder abuse as a consultant to the U.S. and California Departments of Justice.

Public Health Department documents also revealed that the ability of one woman at Oakhill Springs to move her legs deteriorated within six months because there were no care plans or rehabilitation services to assist the woman in maintaining her ability to use her legs. That put her at risk of a permanently reduced mobility.

Out of 10 patients, seven were not given proper diets and several lost weight because they received insufficient calories to promote weight gain important to their well-being — despite orders by their doctors to the facility.  One woman had lost nearly 8 percent of her body weight because she wasn’t given the puréed fortified diet her doctor had prescribed. The records show the physician was perplexed at why the woman continued to lose weight despite the health shakes he had ordered three times daily.   But the inspector found no record of the order having been implemented, or that diets were fortified with the high-calorie food to promote weight gain.   When an inspector asked the cook how she fortified the diets, she said, "I add thickener to the puréed food."

Patients suffering from kidney disease were given high-potassium foods, which could have worsened their kidney disease or could have become life-threatening.  Another resident was served fish despite a severe allergy to fish and shellfish that was recorded in the patient’s medical records.

In October 2008, nursing staff put an iron medication tablet into a resident’s feeding tube, which became clogged. The nurse in charge of medication said the required liquid iron had not been in stock for two weeks since the medication was ordered.

A 1998 analysis by the U.S. Government Accountability Office found that despite federal and state oversight, some California nursing homes are not being monitored closely enough to guarantee the safety and welfare of their residents. The GAO found that nearly one in three California nursing homes was cited by state surveyors for serious or potentially life-threatening care problems. Moreover, the GAO believes the extent of serious care problems portrayed in federal and state data is likely to be understated.

 

McKnight’s site had an article and Science Daily also ran an article about how nurses and relatives routinely fail to detect the severity of chronic pain among nursing home residents, especially those with cognitive impairments, according to a new study in the September issue of the Journal of Clinical Nursing.

The five-year study from The Netherlands followed 174 nursing home residents at six different facilities. A total of 171 nurses and 122 relatives also took part in the study. Researchers conducted interviews with the non-cognitively impaired residents to determine how much, if any, pain they had reported in the week prior to the interview. Relatives and healthcare staff find it hard to diagnose pain levels in nursing home residents accurately, especially if they are cognitively impaired with illnesses such as dementia or unable to speak, according to a study .

The findings have led experts from The Netherlands to call for nurses to be given more education about how to assess and treat chronic pain and encouraging greater mobility and providing soothing massages, to alleviate pain.

Previous studies have shown that some people with mild or moderate cognitive impairment are still able to use simple zero to ten scales, where zero is no pain at all and ten is the worse pain imaginable.   "When the team interviewed the residents without cognitive impairments they found that all of them reported pain in the last week, but that only 89 per cent of the caregivers and 67 per cent of the relatives were aware of that pain" says Dr Rhodee van Herk. "However, if they were aware that the patient had experienced pain, the nurses and relatives gave it a median score of six out of ten, with the same score reported by the patients."

Nurses and relatives were less unaware of pain levels when the patient was at rest. They gave their pain levels a median score of zero, compared with the patients, who gave it a median score of four out of ten. However relatives were more aware of pain issues than nurses, with their median scores ranging from zero to five, compared with nurses, who reported a median score of zero to two. 

In general, there was more agreement between residents and relatives on pain levels than between relatives and nurses.

Sylvia C.W. McKean, MD, FACP published an article in Journal Watch Hospital Medicine on March 17, 2008 discussing the inherent risks of hospitalization on the elderly popoulation.   Hospitalized elders are at risk for many iatrogenic complications, including delirium, malnutrition, pressure ulcers, falls, depression, infection, and adverse drug events. These complications often are referred to as "hazards of hospitalization" and can result in marked functional decline, additional medical or surgical interventions, prolonged length of stay, or even death.  Such complications also substantially increase the cost of medical care and negatively affect patient and family satisfaction.  Although interdisciplinary teamwork is required to allay potential harm from hazards of hospitalization, modifying patient risk factors invariably requires physician intervention.

This study highlights the need for better recognition of risk factors that can adversely affect older hospitalized patients. Training of healthcare providers as teams is a critical strategy for identifying risks for hazards of hospitalization and implementing appropriate interventions. Hospitalists are at the forefront of the patient-safety movement and, as role models, can be powerful motivators of behavioral change. 

This article proves the fact that hospitalized elders are at risk for many complications referred to as "hazards of hospitalization" which can result in marked functional decline.   It is logical that if you take an elder out of a LTC facility which has been their "home" because they have had a fall or some other adverse event that necessitated hospitalization, the elder would have increased risk for declining medical condition.
 

 

Oregonlive.com had an article about the $8 million in fines Oregon issued against Sunwest Management, several of its affiliates and former CEO, claiming the chain of assisted living centers misled investors, lied about the true condition of the company and used unlicensed salespeople to sell unregistered securities.

The Oregon Division of Finance and Corporate Securities issued civil penalties of $4.2 million against Jon Harder, co-founder and former CEO of the Salem company. It also levied fines of $3.8 million against Sunwest and several of its affiliate companies.  However, Oregon will hold off on collecting the money as long as Harder and the companies comply with the terms of any agreements or orders issued by U.S. District Court or the receiver appointed to oversee the case in March, after the U.S. Securities and Exchange Commission sued Sunwest and Harder making many claims similar to the state’s.  Harder and his team formed a company for each of the nearly 300 assisted living centers it acquired or built. Numerous subsidiary companies controlled by Harder offered other services. If the state actually recovers any money from Harder or the Sunwest companies, it intends to put the money into a restitution fund for investors.

 

 

 

A friend of mine who is interested in nursing homes sent me a link to Money-Driven Medicine: Patients for Sale.  I have not seen the movie but the trailer looks interesting.

Money-Driven Medicine provides the essential introduction Americans need to become knowledgeable participants in healthcare reform.   Based on Maggie Mahar’s acclaimed book, Money Driven Medicine: The Real Reason Health Care Costs So Much, the film offers a behind-the-scenes look at how our 2.6 trillion dollar a year healthcare system went so terribly wrong and what it will take to fix it.

The U.S. spends twice as much per person on healthcare as the average developed nation, fully one-sixth of our GDP – yet our outcomes, especially for chronic diseases, are very often worse.  The U.S. is the only industrialized nation that has chosen to turn medicine into a largely unregulated, for-profit business. 

In Money-Driven Medicine, Dr. Donald Berwick, president of the Institute for Health Care Improvement, explains: “We get more care, but not better care.” Our fee-for-service system channels resources into the high-tech, high-cost “rescue care” patients need after they become critically ill, while it skimps on the preventive primary care which could keep them out of the hospital in the first place. As a consequence, emergency rooms overflow while family practitioners are becoming an endangered species. Medical students explain that these perverse pay incentives drive them away from primary care into higher-paying specialties.

Medical ethicist Larry Churchill doesn’t mince words: “The current medical care system is not designed to meet the health needs of the population. It is designed to protect the interests of insurance companies, pharmaceutical firms, and to a certain extent organized medicine. It is designed to turn a profit. It is designed to meet the needs of the people in power.”

These businesses comprise the “medical-industrial complex” which has wrested power from physicians, turning healthcare into a commodity and patients into profit centers.   Although many uninsured and underinsured Americans receive too little care, the well-insured often get unnecessary, even risky care. More than two decades of studies by researchers at Dartmouth reveal that one-third of our healthcare dollars are squandered on useless tests and ineffective or unproven procedures no better than the less-costly ones they replace. The studies demonstrate that evidence-based, accountable care would be both more effective and less expensive. 

In Money-Driven Medicine frustrated doctors and outraged patients testify to the tragedies which can happen when profit trumps patients’ needs. Money-Driven Medicine will encourage health professionals and patients to work together to take control of American medicine back from the MBAs.

 

The American College of Health Care Administrators (ACHCA) is a defender and apologist for administrators of nursing homes.   The ACHCA gave their Excellence in Leadership Award to Forrest Preston, founder and chairman of Life Care Centers of America saying he has "made a great impact on long-term care . . .."   With all the well-publicized problems with facilities operated by Life Care Centers of America, it is incredible that anyone would give this crook an award.  See press release here.

The ACHCA has lost any credibility that others might have thought they should have by giving an award to the chairman of Life Care Centers of America.  Preston has been an active supporter of ACHCA for more than two decades, directing all Life Care executive directors to become paid members of ACHCA and to achieve certification through this organization.

 

“Life Care Centers of America sponsors an average of 40 people annually to become licensed administrators through its administrators-in-training program,” said Guy Crosson, board member of ACHCA and executive director at Life Care Center of Red Bank in Chattanooga, Tenn.

 

GAO released a Study of CMS’s Special Focus Facility Program.

What GAO Found:

According to the Government Accountability Office, almost 4 percent (580) of the 16,000 nursing homes in the United States could be considered "the most poorly performing" under CMS’s Special Focus Facility program. States currently identify some 755 nursing homes (the 15 worst in each state) as "candidates" for the program, and 136 are actually designated as SFFs. Under GAO’s methodology, the report says, the most poorly performing homes are distributed unevenly across states, with 8 states having no homes that actually qualify and 10 others having from 21 to 52.

 

The most poorly performing homes tended to be chain-affiliated and for-profit and have more beds and residents.

 

CMS has structured the SFF Program so that every state (except Alaska) has at least one SFF, even though the worst performing homes in each state are not necessarily the worst performing homes in the nation, according to the GAO. To identify the worst homes in the nation, GAO applied CMS’s SFF methodology on a nationwide basis and made refinements to the methodology that "strengthened" GAO’s estimate.

GAO found that the most poorly performing nursing homes had notably more deficiencies with the potential for more than minimal harm or higher and more revisits than all other nursing homes. For example, the most poorly performing nursing homes averaged about 56 such deficiencies and 2 revisits, compared to about 20 such deficiencies and less than 1 revisit for all other homes.

CMS established the Special Focus Facility Program in 1998. The SFF methodology assigns points to deficiencies cited during standard surveys and complaint investigations, and to revisits conducted to ensure that deficiencies have been corrected. CMS uses its methodology to identify candidates for the program–nursing homes with the 15 worst scores in each state–but the program is limited to 136 homes at a time because of resource constraints.