The Minnesota Star-Tribune reported the sad case of a resident who died when the nursing home staff  failed to recognize the obvious signs of a cardiac arrest.  State investigators concluded that the staff failed to act quickly enough to save the life of a resident whose condition was rapidly deteriorating. Sunwood Good Samaritan Society of Redwood Falls was found negligent in the death.  Specifically, the investigation found, the home failed to have formal processes in place for monitoring and reacting to significant changes in a resident’s condition.

 

The report states:

 

On Oct. 31 during dinner, the resident coughed and gasped while eating. A nurse sent a fax to a doctor saying that the woman was having breathing problems. There was no evidence that the doctor responded to the fax or that staff followed up with the doctor that day.

 

The next day, the resident’s breathing problems continued, she was lethargic and her appetite was poor.

 

That evening, the woman’s “condition further declined.” She exhibited symptoms of respiratory distress: Breathing became more difficult, her pulse was erratic and her fingertips turned dark blue. With a grimace on her face, she curled herself into a fetal position.

 

A nurse put her on oxygen and gave her a drug to ease her discomfort.

 

Additional faxes were sent to the doctor starting at 4:15 p.m. and marked “urgent.” The doctor responded at 5 p.m. after the third one.

 

At 5:15 p.m., a nurse called for an ambulance but did not say it was an emergency situation. At 6:25 p.m., a second call was made for the ambulance by the same nurse, again without mentioning the situation’s urgency.

 

By the time ambulance arrived at 6:30 p.m., the woman was in cardiac arrest. She died 26 minutes later. Her attending physician listed cardio-respiratory failure on her death certificate.

 

The physician said in an interview with the state that staff should have been quicker in notifying a doctor and in obtaining emergency medical assistance.

 

 

MSNBC.com had a great article on the new research and diagnostic standards on Alzheimer’s disease.  The research shows gradual disease progression starting with changes in the brain, then mild memory problems and finally progressing to full-blown dementia.  The National Institute on Aging and the Alzheimer’s Association issued the guidelines which officially recognizes mild cognitive impairment or MCI as a precursor to the disease.  

Additionally, a new research category known as preclinical Alzheimer’s which is the earliest stage of the disease was recognized.  This preclinical stage about 10 years before dementia sets in is seen as the best place to intervene in the disease. It is why new imaging agents for PET scans, spinal fluid tests and other so-called biomarkers that predict Alzheimer’s are becoming so important to researchers and drug companies.  Formally recognizing the earlier phases of the disease is important in advancing Alzheimer’s research.

The new guidelines break the disease up into 3 stages:

Preclinical: There is evidence signs of Alzheimer’s disease may appear 10 years before the disease is diagnosed. These include brain changes, such as the buildup of the protein amyloid-beta, nerve cell damage and brain shrinkage. Some of these biomarkers might be detected in brain scans and proteins in spinal fluid. 

Mild cognitive impairment: A portion of those diagnosed with mild cognitive impairment will go on to develop Alzheimer’s disease. Biomarkers such as the use of MRI to detect brain shrinkage might be able to distinguish those who develop the disease from those who don’t. In addition, once researchers have ruled out other cases of cognitive impairment, such as a stroke or a tumor, biomarkers could be used to confirm the diagnosis of Alzheimer’s disease. 

Alzheimer’s dementia: These criteria expand the concept of Alzheimer’s dementia beyond just memory loss to include declines in other areas, such as vision/spatial problems, and impaired reasoning or judgment.

 

 

Everyday Health had an article about the causes of dementia.  "Dementia is really a big umbrella term that covers a number of different conditions that cause dementia symptoms."

“There are many different types of dementia,” says Ross Andel, PhD, associate professor at the School of Aging Studies at the University of South Florida in Tampa. “The most common types of dementia are Alzheimer’s disease, vascular dementia, Lewy body dementia, and Parkinson’s disease. All types of dementia are characterized by abnormal neurodegeneration, that is, brain cells dying off in high numbers daily. In most cases, this leads to cognitive and behavioral deficits or, in Parkinson’s disease, to deficits in motor skills.”

Cortical dementia is likely to result in dementia symptoms such as loss of memory, loss of the ability to recognize people, and difficulty recalling the right words for things or concepts. Cortical dementias include:

 

Alzheimer’s disease. Alzheimer’s disease causes a loss of memory and ability to think clearly and typically leads to loss of ability to complete tasks of daily living.

 Frontotemporal dementia. This type of dementia results from degeneration of cells in the frontal lobe; it’s characterized by behavioral and language deficits at a relatively young age — as young as 40.

Wernicke-Korsakoff syndrome. This type of dementia is due to a deficiency in thiamine (vitamin B1) but is also often related to a history of heavy alcohol consumption or to having AIDS, or acquired immunodeficiency syndrome.

 Subcortical Dementia

Dementia symptoms associated with subcortical dementias include loss of motor skills and the ability to learn processes, resulting in a general sense of slowing down. These types of dementia include:

Huntington’s disease. A rare, inherited cause of dementia, Huntington’s disease leads to problems with motion such as twitches and lack of balance or coordination and may also lead to changes in mood, personality, and behavior.

Parkinson’s disease. Parkinson’s disease is characterized by the gradual loss of motor skills, or shakiness and tremors while in motion. People with Parkinson’s disease may eventually experience other dementia symptoms, such as loss of memory.

Vascular dementia. Vascular dementia occurs as the result of loss of oxygenated blood to parts of the brain. This can be the result of a single stroke or many small strokes, in which case it is called multi-infarct dementia. Evidence shows that subcortical vascular dementia also has effects in the cortex, leading to cortical dementia symptoms.

Some types of dementia appear to affect both cortical and subcortical areas of the brain such as Dementia with Lewy bodies. This type of dementia occurs because clusters of a certain type of protein called alpha-synuclein form in the neurons in various areas of the brain, leading to impaired memory, motor skills, and mood.

 

The Salem News reported the disturbing details of abuse and neglect at Masconomet Healthcare Center in Washington.  A recent report contends a dozen residents suffered various forms of verbal abuse and humiliation — including one patient with dementia who was recorded on a cell-phone camera answering questions in a confused manner, to the amusement of a nursing assistant who then shared the video with coworkers.  A group of four certified nursing assistants "routinely engaged in sexually explicit or otherwise offensive taunting of patients, sometimes about their physical or mental condition, and that some would deliberately provoke patients into an agitated state to avoid having to provide care for them during their shifts." The nursing home’s parent company is Whittier Health Network. At least seven other employees were aware of abuse but failed to report them 

The report concludes that the facility was providing substandard care, specifically by violating regulations requiring that patients be free from abuse or involuntary seclusion, that any such abuse be immediately reported and that the facility’s care and environment provide for quality of life.  The report proves an atmosphere "where the four accused nursing assistants regularly used profanities around patients; engaged in conversations about their personal lives, including sexual activities and illicit drug use, in front of patients; played loud music on their cell phones; and were at times more concerned with sending text messages to friends than providing care to patients, who were told to wait."

One vulnerable adult, suffering from dementia, was recorded on a cell phone answering a series of questions from a nursing assistant identified as "accused CNA #1" in the report, who can be heard laughing at the patient’s confused responses. That CNA went on to share the video with others at the facility.  Another employee admitted that same CNA regularly took photos in patient rooms. It is not known what became of those photos or whether they included patients.

Another patient was taunted by an employee who was overheard telling the patient that she was engaging in sexual relations with the patient’s husband and that "he tells me I am better in bed than you are" and that her husband was leaving her. The same accused CNA allegedly told another patient that she was going to die at the facility because her husband no longer loved her. That patient was also taunted about her weight by at least three of the accused CNAs. "Accused CNA #3" allegedly shoved a cookie into the woman’s mouth and called her a "pig," according to the report.

A male patient was allegedly taunted and mocked by all four fired workers for having a penile implant, which one of the group demanded that he use in her presence.

A woman patient was driven to tears by repeated requests to recount past domestic abuse. 

The workers regularly engaged in behaviors such as mocking and mimicking patients in order to get them agitated, which would then allow them to avoid caring for those patients, the report said.

Why didn’t the Administrator or Director of Nursing know about it, or did they jus tignore it?

 

 

 

The Toronto Star reported the arrest of a nurse at a long-term care facility for sexual assault after a 70-year-old female resident complained and another nurse corroborated the abuse.  Charged is Leonid Kozlov.  He is an employee who has worked as a registered practical nurse at the facility for the past five years.

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The St. Louis Today reported that a nursing home employee in Normandy has been accused of raping an elderly resident. Santonio McCoy is charged with forcible rape.  He is accused of attacking a woman at the nursing home. McCoy had worked at the nursing home for about a year. The sexual attack was finally stopped when three workers at the home walked by.

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Meanwhile in Philadelphia, a hidden camera caught 12 minutes of video showing a frail and vulnerable dementia patient at Quadrangle Sunrise Senior Living in Haverford standing naked while employees taunted and mocked her.  All three women, who were care managers, are accused of mocking and abusing a 78-year-old woman in her private room at the facility.

"Why do they keep picking on me?" Lois McCallister asked her family, who installed the hidden camera.

Employee Samirah Traynham was charged with aggravated assault, criminal conspiracy, harassment, and neglect of a care-dependent person.   Ayesha Muhammad was charged with aggravated assault, simple assault, criminal conspiracy, harassment, neglect of care-dependent person and reckless endangerment. Tyina Griffin was also arrested. See article at The Philadelphia Inquirer.

Traynham, Griffin and Muhammad ganged up on the elderly woman, taunting and mocking her as she stood without clothes from the waist up, trying to cover her breasts. Traynham was also physically abusive, authorities allege.

Muhammad admitted she and her co-defendants “did laugh and mock” the woman “as she struggled to hear and communicate due to her physical and mental condition.” She added that Griffin allegedly danced and “shadow boxed” in an attempt to play with the visibly upset woman, and that they restricted the woman from leaving her room on multiple occasions. Muhammad denied any physical abuse but she admitted that the woman was “upset and frustrated” during the incident.

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Tulsa World and NewsOK had articles about the former nurse who has come forward to expose the abuse and neglect at Woodland View Care and Rehabilitation in Tulsa, Oklahoma.  The company cut corners on patient care – even running out of feeding tube formula for one patient – and that the company should cease operating in Oklahoma.  State inspectors cited Woodland View for more than 40 violations over the past year, including six that placed residents’ lives in immediate jeopardy, records show.  Violations included failure to protect residents from abuse, failure to provide pain medications and other treatments as ordered, failure to adequately treat bed sores, failure to provide sufficient staffing and failure to provide supervision to prevent accidents.

"They cut corners every chance they get … It’s ridiculous for a billion-dollar, nationwide company," said Latricia Hamblin, a licensed practical nurse who worked for seven years at the facilty. The nursing home’s publicly traded parent company, Sun Healthcare Group Inc., operates more than 200 facilities nationwide and reported nearly $2 billion in revenue last year.

Woodland refuses to acknowledge errors and accept responsibility.  Instead, they filed a lawsuit and allege that the inspectors inserted documents into a patient’s file, essentially accusing a state employee of trying to frame the nursing home.

Hamblin now works at another nursing home and left Woodland View after she became concerned she was jeopardizing her nursing license by staying. She said the facility was so short of staff that she was not able to get medicine distributed to patients within the required time frame.  Woodland View once ran out of feeding tube formula for a patient, and administrators didn’t place an order for the correct formula for several days.  The report also states that "pain medicines run out and (are) not being re-ordered so residents aren’t getting meds for pain days at a time … Residents stated the nursing staff was good but were overworked, overwhelmed and did three people’s jobs and did not get breaks."

Sun Healthcare Group has a history of problem including pleading no contest in California to a felony elder abuse charge when two residents died and six became ill at one of its homes during a heat wave. In 2005, California fined Sun $2.5 million after the state said the company violated a court order requiring it to improve quality of care at its homes.

 

The Niagra Gazette reported details into a recent investigation of abuse at Northgate Health Care Facility.  Two employees “joined in humiliating, distressing and violating the dignity” of residents, according to state Department of Health documents.  One nursing assistant placed two elderly residents in the same bed while another nurse made sexual comments, apparently seeking to spur inappropriate interaction, and taking pictures.

CNA Alicia Clemens took cell phone camera pictures of the two elderly and impaired clients after she and another employee, Gloria Maxwell, placed them in the same bed together during their shift.  Clemens and Maxwell attempted to convince the pair they were husband and wife while the resident’s real wife watched. The male resident is legally blind and suffering from dementia. The man, who is described in documents as occasionally prone to sexually inappropriate behavior, was coerced to touch the woman’s shoulder despite her protestations, the papers continue.

Other employees who witnessed the incident failed to stop or immediately report it.  Some were fined $500.  That’s it.  None of the employees involved face criminal prosecution.

Nothing in the documents indicated the facility itself or the McGuire Group, the corporation that owned it at the time of the incident, was punished in the wake of the investigation’s findings.
 

The Senior Journal had an article about the rapidly increasing cost of long term care based on the John Hancock survey.  The annual cost of a private room in a nursing home has climbed to $85,775. The national average annual cost of other LTC is; $75,555 for a semi-private room in a nursing home and $39,240 for an assisted living facility. The average cost of care received at home is approximately $20 per hour.

An estimated 10 million have enough trouble performing acts of daily living – like bathing, dressing and eating – that they require assistance

John Hancock Financial released its 2011 cost of care study that was conducted by by LifePlans Inc. The company surveyed more than 11,000 providers, including nursing homes, assisted living facilities, and home health care agencies, in key cities across the country.

Specifically:

● The 2011 average cost of a private nursing home room ($235 a day/ $85,775 annually) has risen an average 3.5 percent per year

● The 2011 average cost of a semi-private nursing home room ($207 a day/ $75,555 annually) has risen an average 3.2 percent per year

● The 2011 average cost for a month in an assisted living facility ($3,270 a month/ $39,240 annually) has risen an average 3.4 percent per year

● The 2011 average cost for a home health aide ($20 hourly/$37,440 annually) has risen an average 1.3 percent per year

 

Fierce Health Finance had an article about the waste and fraud in the U.S. healthcare system.  $850 billion annually–one third of the entire nation’s healthcare costs–due to administrative inefficiency, unnecessary treatment, medical errors, fraud and other perennial blunders, according to a new report written by Robert Kelley, vice president of healthcare analytics at Thomson Reuters.

See press release below:

The U.S. healthcare system wastes between $600 billion and $850 billion annually, according to a white paper published today by Thomson Reuters.

The report identifies the most significant drivers of wasteful spending – including administrative inefficiency, unnecessary treatment, medical errors, and fraud – and quantifies their cost. It is based on a review of published research and analyses of proprietary healthcare data.

"The bad news is that an estimated $700 billion is wasted annually. That’s one-third of the nation’s healthcare bill," said Robert Kelley, vice president of healthcare analytics at Thomson Reuters and author of the white paper. "The good news is that by attacking waste, healthcare costs can be reduced without adversely affecting the quality of care or access to care.

"That’s the point of this report – to identify areas in the healthcare system that can generate game-changing savings," Kelley said.

Here are some of the study’s key findings:

Unnecessary Care (40% of healthcare waste): Unwarranted treatment, such as the over-use of antibiotics and the use of diagnostic lab tests accounts for $250 billion to $325 billion in annual healthcare spending.
Fraud (19% of healthcare waste): Healthcare fraud costs $125 billion to $175 billion each year, manifesting itself in everything from fraudulent Medicare claims to kickbacks for referrals for unnecessary services.
Administrative Inefficiency (17% of healthcare waste): The large volume of redundant paperwork in the U.S healthcare system accounts for $100 billion to $150 billion in spending annually.
Healthcare Provider Errors (12% of healthcare waste): Medical mistakes account for $75 billion to $100 billion in unnecessary spending each year.
Preventable Conditions (6% of healthcare waste): Approximately $25 billion to $50 billion is spent annually on hospitalizations to address conditions such as uncontrolled diabetes, which are much less costly to treat when individuals receive timely access to outpatient care.
Lack of Care Coordination (6% of healthcare waste): Inefficient communication between providers, including lack of access to medical records when specialists intervene, leads to duplication of tests and inappropriate treatments that cost $25 billion to $50 billion annually.
 

 

The Palm Beach Post reported that Florida’s Republican legislators are inserting language into the budget conforming bills that will lower the average number of hours a day that nursing homes are required to provide direct-care to patients.   The budget will lower the minimum weekly average of hours of direct-care that homes have to provide nursing care from 3.9 hours a day to 3.6 hours.  Nursing assistant staffing hours would also drop from 2.7 hours to 2.5 hours.

After the budget meeting, a union for nursing home workers blasted the move as an erosion of Florida’s once-heralded minimum-staffing requirement for nursing homes enacted in 2001.

"This can potentially endanger lives, kill jobs and hurt our economy. Without adequate hands-on care, nursing home residents run the risk of getting pressure sores, falling down or suffering from malnutrition," said Cloreta Morgan, a CNA at Unity Health and Rehab Center in Miami and member of 1199 SEIU United Healthcare Workers East.