Kentucky accepted a $3 million federal grant to create a system for more thorough background checks of nursing home employees.  The state Cabinet for Health and Family Services will purchase equipment to conduct digital fingerprint background checks on potential hires.  The National Background Check Program was created out of the Patient Protection and Affordable Care Act, or the federal health care reform law.

The live scan equipment will enable the use of fingerprints in both in-state and FBI criminal background checks of applicants for hire at nursing homes, intermediate care and Alzheimer’s facilities, personal and family care homes, home health agencies, hospice care providers, long-term care hospitals, personal services agencies, assisted living facilities, adult day care providers, intermediate care facilities for people with developmental disabilities and mental retardation and other long-term care providers.

Current state law requires long-term care facilities to conduct only name-based background checks on prospective employees.

The Kentucky Department of Community Based Services received 13,491 reports of suspected abuse of people older than 60 in fiscal year 2010, the largest number since the statistic was first recorded in 2006. Of those, the department investigated 7,365 of those complaints, of which more than 1,859 were substantiated, according to the 2010 Elder Abuse Report produced by the CHFS.

See articles at Kentucky.com and Bowling Green Daily News.

Kenny Malone at NPR had a great article on the suspicious deaths at care homes in Florida.  "In Florida, state regulators are failing to protect residents of assisted living facilities, according to an investigation by The Miami Herald and NPR member station WLRN."   Their analysis of records discovered dozens of questionable deaths in assisted living facilities.

Florida is a case study for how the country protects some of its most vulnerable citizens.

Aurora Navas drowned outside a Miami assisted living facility on Jan. 27, 2008, despite its security measures. In her early 80s, doctors diagnosed Aurora with Alzheimer’s disease. Not long afterwards, she moved to Isabel Adult Care III, a six-bed assisted living facility in Southern Miami-Dade County. Isabel Adult Care III with a lake closeby.

 "They had like a little chain-link fence that separated the lake from the property there," her son Alfredo says. "I did see a surveillance camera. You could see the alarm on the door. And there’s always a person there. So it — everything seemed fine."

The police report states on Jan. 27, 2008 at 3:45 a.m., Aurora Navas got out of bed.  She walked past an unconnected surveillance camera. She wandered out a door with an improperly set alarm. She shuffled through an unlocked back gate. Two on-duty caretakers failed to stop her. Police  determined that Aurora Navas drowned in around 18 inches of water.

A year-long investigation by The Miami Herald and WLRN has turned up at least 70 questionable deaths in Florida assisted living facilities. Herald investigative reporter Mike Sallah reads a list of deaths culled from thousands of state documents:

"Angel Joglar, 71; killed when left in a bathtub of scalding water."

"Gladys Horta, 74 years old; strapped so tightly the restraints ripped into her skin, causing a blood clot that killed her."

"Walter Cox, 75 years old; Alzheimer’s patient. Wandered out of a facility for the fourth time; his body was found torn apart by an alligator."

"And in almost all 70 cases, there were few or no consequences for caretakers. Florida, once a national leader in policing assisted living facilities, has fallen behind in enforcement, our investigation shows."

"Our investigation found that the agency is also taking longer to follow up on complaints: In 2009, AHCA took an average of 10 extra days to complete investigations into complaints compared to five years earlier.  And when facilities are found to have deficiencies, the agency rarely punishes them to the full extent of the law."

 

I have been following KZTV10’s reporting on the tragic abuse and neglect at Affordable Quality Care (Flour Bluff) in Corpus Christi.  The story and reporting is amazing.  The facility was shut down after credible evidence of physical and verbal abuse was found. Investigators found a situation that posed an immediate danger to residents.

The Affordable Quality Care Center had been investigated more than 20 times over the past five years. The facility has also received citations for being verbally and mentally abusive. The owner of the center is accused of calling residents things like liars, thieves and stupid. She also reportedly told patients their spouses are dead.

State documents include interview notes from staff and clients accusing Griffin of getting angry with patients when they soiled themselves– yelling at them in front of others.

The adult day care, Adult Loving Care, operated by the same group as Affordable Quality Care was not shut down and is still operating on the property.

Najmeh Nouri Griffin, owner of the center told us she didn’t know why they were being shut down. However, the State released a 42-page report of substantial evidence of why the faciliy was closed.

The report claims Griffin "…abused residents through physical abuse, verbal abuse, intimidation and humiliation."  The state also accuses Griffin of some startling punishments for patients in her care including making "[two patients] wear dirty diapers around [their] necks." And, forcing another resident "to clean up his own feces."

 

 

 

Erin Jordan from Eastern Iowa Government wrote an article regarding how Iowa taxpayers reimburse nursing homes for legal fees including fees defending abuse and neglect citations.  Eastern Iowa nursing homes sought Medicaid reimbursement for more than $2.2 million in legal fees, accounting fees and professional services in 2010.  The nursing homes get reimbursement even if they lose citation appeals or lawsuits.

All nursing homes receiving tax funds file annual cost reports requiring detailed information about revenue, expenses, equipment purchases, assets and employee statistics. The cost report allows nursing homes to claim expenses for legal fees. Legal fees are an allowable cost and are included in the calculation of the nursing home’s per-bed, per-day Medicaid reimbursement rate.

The Medicaid division of the Iowa Department of Human Services drafted a proposed rules change in late 2009 or early 2010.  The proposal would have forbidden reimbursement for legal fees when a nursing home is defending itself against a criminal or state civil action that it loses or when the Iowa Department of Inspections and Appeals succeeds in suspending or revoking the nursing home’s license.  The rules change also would have prohibited reimbursement for legal fees, expenses and costs for lobbying Congress or the Iowa Legislature.  No final draft has been published.

Medicaid also reimburses nursing homes for association dues for lobbying groups.  Membership dues accounted for more than $950,000 of the Iowa Health Care Association’s budget in 2009, according to the group’s tax report.

 

Athens Banner-Herald reported the arrest of Sherrye Dianne Huff, Administrator at the Winterville Retirement Center for five felony charges — three counts of theft and two counts of exploiting an elderly or disabled person — and one count of misdemeanor theft for stealing from the Alzheimer’s patient.

Donna Tower’s uncle told his family that someone was stealing his money, but the family didn’t believe him at first because the staff told them that he had Alzheimer’s.  In the end, Huff was taking his money, and his brother’s, but no one would believe him.  How frustrating that must be.

The investigator discovered while looking into the theft case that elder abuse is more widespread than people realize.  He arrested another Winterville Retirement Center employee on charges she punched another Alzheimer’s patient in the face. The resident died later and authorities are confirming the death was related to the assault.

Huff accepted a donated reclining "lift" chair from the son of a Winterville Retirement Center resident who died, and then sold it, and also pocketed contributions people made to the home in the resident’s memory, according to police.

Soon after, police say another employee of the Winterville Retirement Center stole drugs that had been prescribed for the patient who died, and police later found out the administrator was stealing money from other residents.

The three cases of abuse and financial exploitation happened in less than three months.

"More than likely, (elder abuse) it’s more widespread than we know," said Fulcher, who last week launched a fourth investigation into the possible theft of money from another Winterville Retirement Center resident.

"Elder abuse is one of the most unrecognized and under-reported crimes," said Ravae Graham, a deputy director with the state Department of Human Services. "Many abuse victims don’t realize it, don’t know what to do about it, or are too afraid to report their abuse or neglect."

The National Center on Elder Abuse estimates that for each documented case of neglect or abuse, five cases go unreported.

 

This article, headlined "Health Insurers Making Record Profits as Many Postpone Care," first appeared in The New York Times. The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care.

"Yet the companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends. Many defend proposed double-digit increases in the rates they charge, citing a need for protection against any sudden uptick in demand once people have more money to spend on their health, as well as the rising price of care."   And of course, they need tort reform!

The insurers’ recent prosperity — big insurance companies have reported first-quarter earnings that beat analysts expectations by an average of 30 percent — may make it difficult for anyone, politicians and industry executives alike, to argue that the industry has been hurt by the federal health care law. 

Melissa Trenway of Nursetini blog that concentrates on bringing readers the best mix of health, medical, and nursing news and insight sent us an article that was recently published.

If you are looking for general information on health care, you can visit these web sites. This information can include reference resources and tutorials related to general health care subjects. These great resources can help you become a better nurse.

Nursing: The Resources in Nursing guide from the UCLA library is a great place to start for tutorials and reference.

The “Virtual” Nursing Center: Martindale’s presents this nursing center complete with resources for different nursing specialties and more.

The Nursing Theory Page: The University of San Diego offers helpful information and tutorials about nursing theories.

Barbara Bates Center for the Study of Nursing History: Learn more about the history of nursing, see collaborations and projects and find out more information about nursing.

HIMSS: This is a site aimed at health care technology and informatics. Tutorials on informatics and more are available through this site.

Center for Nursing Classification & Clinical Effectiveness: General information on nursing, and how to increase effectiveness.

The Nursing Reference Center: Find out more about nursing, and get access to information and tutorials on a number of health care subjects.

Medscape Nurses: Tutorials, headlines, and general information that nurses are likely to find useful.

Nursing Center: Reports, general information, how-tos and tutorials related to nursing and health care.

The Learning Nurse:  Resources designed to help you with your development as a nurse. Tutorials, quizzes and more to help you improve your career.

Evidenced-Based Practice Tutorial: Penn State offers information on evidence-based nursing.

Nursing Tutorials: Information on how to dose, as well as other tutorials related to nursing.

Case Studies: Some of the best tutorials are in the form of case studies. Use these case studies to see how others have handled certain situations, and learn how you might respond in a similar situation. Great insights and practical advice.

Medical Case Studies: This open access journal allows you to read about different medical case studies.

National Center for Case Study Teaching in Science: A number of health care case studies, as well as other science cases.

Online Case Studies: Great tutorial insight from the University of Pittsburgh School of Medicine.

Pulmonary Case Studies: Tutorials that can help you learn about different pulmonary conditions and problems.

International Pathology Laboratory for Medical Education: Plenty of case studies and tutorials designed for health care professionals.

Integrated Medical Curriculum: Offers a look at case studies and tutorials — once you complete your free registration. Interactive and highly useful.

PRIME: Different case studies and resources related to different health care professions.

Teaching File: Case studies that nurses and other health care professionals can use. Focuses mainly on radiology.

Clinical Cases: Use these case studies to test your knowledge and abilities.

Free Case Study: Read about what others have done in the past. Great real life tutorials, as well as help on writing your own case study to help others.

Treatment Plans:  One of the things a nurse needs to know how to do is create a treatment plan. These sites provide tutorials on creating treatment plans, as well as information on how to take care of different conditions and help patients. Great for those looking to better treat their patients.

Nursing Care Plan: Nursing Crib offers care plan ideas and tutorials.

Careplan.com: Learn how to make nursing care plans, search the library, and get access to forms.

Comprehensive Nursing Care Plans: You can get access to free sample plans, as well as free documents. Learn everything you need to know about nursing care plans.

MS Patient: This great sample plan provides you with an idea of how to create your own nursing care plan for a patient with MS.

Nursing Care Plans: Acts as a tutorial in creating your own treatment plan. A great resource.

Nursing Care Plan Resources: Includes a great tutorial on how to write a nursing care plan, and other good information.

Nursing care plan sample: Scribd offers a great sample of a nursing care plan. Perfect for using as a template for your own.

Plan of Care and Treatment Plan Tutorial: Figure out the basics of treatment plans, and write your own as needed.

Clinicals: Care Plans: A helpful guide to creating a care plan, and doing it right.

Health Care Law, Policy, Ethics and Best Practices:  Tutorials on health care law issues, as well as information on ethics and best practices, can be useful for any nurse or health care worker. Learn about your liability, and what is expected of you. Make sure that you are following best practices. The following web sites will help you do just that.

Tutorials & Presentations: This great resource from Kaiser Family Foundation can offer you help in understand health care policy and law.

Race, Health Care and the Law: A free tutorial from ProProfs WebSchool.

The New Health Care Law: The Basics: Understand the basics of health care reform and the new law.

Health Care and Social Law – US: Learn more about health care law in the U.S., and its implications.

Health Care Ethics Research Guide: You can use this research guide and tutorial to learn more about ethics issues in health care.

Health Care Ethics: This research toolkit points you to tutorials, resources and more related to health care ethics.

Tutorial Videos: Great tutorials using dynamic modeling for health care.

Health Insurance Simplified: As a health care professional, you should know the basics of health insurance. This tutorial can help you see how it works.

10 Best Practices for Patient Safety: This great tutorial post from Nursing Notes offers insight into practices and ethics.
 

Sens. Al Franken (D-Minn.) and Richard Blumenthal (D-Conn.) and U.S. Rep. Hank Johnson (D-Ga.) recently introduced the “Arbitration Fairness Act of 2011,” legislation that would remedy a recent Supreme Court ruling and restore consumers’ rights to seek justice in the courts. The Arbitration Fairness Act, would ban forced arbitration clauses in nursing home admissions contracts.

 

The National Consumer Voice for Quality Long-Term Care released a statement in support.  Consumer Voice strongly supports the Arbitration Fairness Act and expresses our thanks to Senators Franken and Blumenthal and Representative Johnson for reintroducing this much-needed legislation to allow consumers to decide for themselves whether or not arbitration will provide a fair hearing and resolution of their complaint.

Consumers who are forced to sign predispute arbitration agreements in long-term care admissions contracts are at a critical disadvantage during a stressful and emotional event in their lives:
• Disadvantaged in the admissions process because they are under pressure to find a care facility as quickly as possible. Sixty percent of nursing home admissions are from a hospital.
• Disadvantaged in the arbitration process because the arbitrator relies on the provider for its business and because the process itself is costly and closed to public scrutiny.
• Disadvantaged because the facility knows that the agreement’s fairness cannot be challenged in an unbiased court of law with an open record of the proceedings.

Who are the people whose families are forced to sign arbitration agreements?
• William Kurth, 84, a World War II veteran from Wisconsin who was allowed to develop dehydration, malnutrition, and pressure sores so severe that his bones and organs were exposed—factors that led directly to his death.
• Vunies High, 92, the sister of the legendary boxer Joe Louis, who froze to death when she wandered outside her assisted living facility wearing only her pajamas.
• Ms. L.C. Gould, 85, a Florida nursing home resident who broke her hip in a fall when she was unattended in the bathroom. She subsequently died from complications of surgery for the broken hip, including the facility’s failure to assess and properly treat an infection.

Mandatory arbitration clauses protect providers of care for the elderly and disabled from accountability for neglecting them. By allowing the provider to pick the arbitration company with which it routinely does business and the rules of the arbitration, the system heavily favors the provider and denies justice to the injured.

Families should not be required to sign a contract containing a pre-dispute, binding arbitration clause as a condition of a loved one’s admission to a long-term care facility, nor be required to participate in an arbitration process that is heavily weighted in favor of the facility. The Consumer Voice is urging Congress to pass the Arbitration Fairness Act to end the practice that requires them to do so.

 

Masters in Health Care published an article called "15 Shocking Statistics on Nursing Homes".  None of them were surprising but all were depressing.

1.  More than 30% of all nursing homes experience some form of resident abuse: Nearly 1/3 of all nursing homes have residents that are subject to abuse, whether it’s by staff or other residents. These include malnutrition, physical abuse, psychological distress, exploitation, neglect, and sexual abuse.

2.  In 2005, almost all nursing homes had at least one deficiency: Statistics show that in 2005, 91.7% of America’s nursing homes were cited by health inspectors for at least one deficiency.

3.  90% of abusers are known: Nearly all of the time, those who abuse nursing home residents are not strangers. That means staff members, residents, or familiar visitors are almost always to blame for nursing home abuse.

4.  5,000 deaths in 1999 may be due to negligence: Red flags for nursing home negligence were listed on 5,000 death certificates of nursing home patients in 1999. These include starvation, dehydration, or bedsores as the cause of death.

5.  30 incidents of aggression can happen in one 8-hour shift: In one investigation, 12 nurses observed aggression between residents 30 times in an 8-hour shift.

6.  Only about 20% of abuse cases are ever reported: Many nursing home residents do not have the mental presence or confidence to report abuse for themselves, and it may go unnoticed by family and other caretakers, so often, nursing home abuse cases are not reported.

7.  92% of all nursing homes employ at least one convicted criminal: Nearly all nursing homes open their doors to at least one convicted criminal, and there are no national requirements for background checks for nursing home employees.

8.  One-third of all nursing home patients take antipsychotic drugs: It is suspected that older adults are being overmedicated with antipsychotic drugs in nursing homes, used to prevent combative behavior, agitation, and outbursts by dementia patients.

9.  There are not enough nursing home beds to serve the entire elderly population: In 2008, there were only 1.8 million total nursing facility beds, but there were 18.8 million people aged 65-74, and 14.7 million people aged 75 or older.

10.  More than 50% of nursing home residents don’t have close relatives: Many residents of nursing homes are without family support that can watch out for neglect or abuse.

11.  One nurse’s aid may care for up to 30 people: Often, the ratio of nurse’s aids to patients is 1:15, but it can go as high as 30. The recommendation is 1:3 during a meal and 1:6 during non-meal times.

12.  90% of US nursing homes have staff levels too low for adequate care: Statistics on abuse and neglect are not so shocking when you realize that 90% of nursing homes do not have the staff levels available to care for their patients effectively.

13.  The average annual cost for a private nursing home room may be $175,000 by 2021: The average cost for a room at a private nursing home in 2003 was $66,000, but that figure may rise exponentially.

14.  One out of four nursing homes is cited for death or serious injury to a resident: In 2001, one of of every four nursing homes received a citation for causing serious injury or death to a patient.

15.  Twenty complaints per nursing home were received in 2007: With 257,872 complaints relating to quality of care, facilities, staffing, and other factors, there was an average of 20 complaints per nursing home in 2007.