A press release published by Wiley-Blackwell on a new study discussing the benefits of physical therpay after hip surgery.  Researchers studied the results of patients who receive walking skills training following hip arthroplasty which showed increased mobility. This study was published in the journal: Arthritis Care & Research.   “The World Health Organization (WHO) estimates that 10% of men and 18% of women 60 years of age and older suffer from osteoarthritis.  In the U.S., the National Hospital Discharge Survey reported that 230,000 Americans had hip replacement surgery in 2007.”

Past studies reported patients desired pain relief and ability to move through daily functions and a normal lifestyle.  But improvements in pain and mobility were only temporary after surgery as people with hip replacements had more difficulty walking than healthier peers, they also experienced more pain.  Physical therapy was a major component being left out.

The study was conducted to see the effects of the walking skills therapy, and results show those who took part in the program had increased mobility and less pain. "The training program was well tolerated by patients and no complications were reports,” concludes Ms. Heiberg. “Our findings suggest physical rehabilitation helps improve mobility and function in patients who received hip replacements.”

 

Connecticut Law Tribune had an interesting article on the problem of falls in nursing homes.  When the elderly fall, they usually end up breaking bones, fracturing hips and even sustaining head injuries due to the frail nature of their bones.  These injuries are often fatal.  According to the American Academy of Orthopaedic Surgeons, there are about 380,000 hip fracture cases annually.   Many of these falls occur in nursing home facilities where the elderly should be monitored and carefully watched.

Nursing homes are expected to provide adequate care for elderly residents living in their facilities. Federal law mandates that nursing homes ensure that their facilities are “free of accident hazards as is possible; and that each resident receives adequate supervision and assistance devices to prevent accidents.”  To prevent falls, nursing home residents must be fully assessed by a qualified staff member.  A registered nurse or physician should conduct proper and periodic monitoring for all residents to determine their risks for falling.  If a resident is at high risk of falling, which most are, special accommodations and closer monitoring are required.

A variety of state and federal laws govern such facilities, including 42 CFR 483.1-483.75 (Requirements for Long Term Care Facilities); and various sections of the Social Security Act, 42 U.S.C §1302, §1395i-3(a)-(f), §1395x(j) and (l), §1395z, §1395hh, §1396a(a)(28), §1396d(a),(c), and (d) and §1396r(a)-(f) (Nursing Home Reform Act of 1987).

Yet, despite the safeguards in place, many seniors still experience preventable falls. Experts point to a number of reasons includiing: residents are not properly assessed by a qualified staff member; residents are simply left unattended and unsupervised; facilities fail to adequately equip residents’ beds with safety devices such as bed rails or lowering the bed closer to the floor; fail to install proper alarm systems or overlook the need for crash mats if slippery floors are present.

 

The Republic and The Kansas City Star reported the guilty plea of Melanie Morrison for tampering with and using patients’ morphine syringes to feed her addiction.  Morrison faces three years in prison and rehab.  Patients who were treated by Morrison at Holiday Resort Nursing Facility, who had been prescribed morphine sulfate for various, pain-related medical needs were instead given doses of sodium chloride, which is dangerous for patients with congestive heart failure and renal insufficiency.

The nursing home should never had hired Morrison. They knew or should have known that Morrison had a drug problem. Morrison was previously fired for stealing Percocet three months before beginning her employment at Holiday Resort.  Drug tampering continues to cause serious problems for nursing home residents across the country.   Random drug tests, background checks, regulating narcotics, and supervising employees would diminsh the problem dramatically.  

 

"Prescription drug abuse is the fastest growing drug problem in America," U.S. Attorney Barry Grissom said in a news release. "Even Health care professionals are struggling to prevent addiction within their ranks."

 

Critics say the federal drug tampering cases document serious gaps in regulatory enforcement that puts nursing home patients at risk.

 

Texas-Legal Eagle reported the arrest of Rose Munoz Rodriguez, a nursing home owner/operator accused of lying under oath during a civil suit involving the nursing home business she used to run.  Rodriguez operated The Rose Home — a series of small nursing homes throughout Bryan and College Station — and was accused in a January civil suit of improperly caring for a client, Danese Medders Maxwell.  Maxwell developed severe bed sores because of the insufficient care she was receiving while staying at The Rose Home. The lack of proper treatment, the family asserted, resulted in Maxwell dying sooner than she would have if she’d received adequate care.

Rodriguez faces three counts of aggravated perjury, a third-degree felony punishable by up to 10 years in prison. In addition, charges against the former caretaker for the elderly include tampering with evidence, also a third-degree felony, theft of property between $1,500 and $20,000 — a state-jail felony punishable by two years behind bars — and four misdemeanor charges.

According to the perjury and tampering with evidence indictments, Rodriguez lied three times under oath about incorrect information in Maxwell’s records when she knew that the charts were false.

Corporate owners of nursing homes often pressure their administrators and employees to cover up neglect and lie under oath.   Arrests for perjury are far too rare. 

 

Helping You Care is a great website with some great resources.  Recently they discussed the changes to CMS’ Nursing Home Compare website. 

"The current nursing home quality measures of the Compare tool will be replaced with new quality measures based upon a new version of nursing home resident assessments, starting in 2012.  The new measure will include input from the residents.  As part of the transition to new quality measures, the 5 Star Quality Rating that the tool has provided will not include the new measurement until April 2012. Starting in April 2012, findings of the new assessment measures will be part of the 5 Star Quality Ratings."

Some of the other measures of nursing home quality that have been included in the Nursing Home Compare tool include staffing data and data from health inspections.   As explained in a recent article, “Navigating the Health Care System,” by Dr. Carolyn Clancy, Director of the Agency for Healthcare Research and Quality (AHRQ), also part of HHS:

“Staffing and health inspection data add important information and will continue to be a factor in each nursing home’s overall rating. The staffing measure tells you the average staffing levels—such as the number of registered nurses, licensed practical nurses, and certified nursing assistants—for each resident each day. This is a good benchmark, but it has limits. It does not show the number of nursing staff present at any given time or describe the amount of care give to any one resident. The health inspection measure looks at many major aspects of care in a nursing home. This includes how medicines are managed, whether food is prepared safely, and whether residents are protected from inadequate care. Inspections take place about once a year, but they may be done more often if the nursing home has several problems to correct. ”
 

Several media outlets reported that Nichole Wright-Gore, a supply clerk at White Oak Manor in North Carolina had gotten what she called a “terrible haircut,” and continued to wear a hat on the job for a week.  Then White Oak Manor’s personnel director informed her that she was in violation of the organization’s dress code.   Really?  That is what they are concerned about?

Wright-Gore protested that other workers also wore hats at work; she refused to remove the hat and went home.  At a meeting the next day, she was issued a written warning for insubordination.  Later that week she took pictures of four co-workers who were dressed contrary to company policy: wearing hats and displaying tattoos. The facility administrator called Wright-Gore into his office and told her she was being fired for taking photos of co-workers “without their permission.”

“Indeed, Wright-Gore’s termination was the first time that White Oak had enforced the policy. Employees routinely took pictures of each other — at facility events or while ‘goofing off’ at work — and never asked for or received permission. “The company’s utter failure to enforce its picture-taking policy” undercut its argument for the employee’s termination, the judge said.  The company continued to fight, taking the case to federal appeals court. There, the judge agreed that Wright-Gore was engaged in protected activity.

If only nursing home facilities enforced all of their policies this rigorously!   Instead of focusing so much attention on a hat, administration should pay more attention to the residents needs and enforcing policies that directly effect the patients in their care.  In any circumstance, a nurse with a hat caring for a resident is better than an understaffed facility neglecting residents.

There are various articles that reported this matter: Journal, JDSurpa, HRMorning, Lexology, and Tribune

The website MedicalXpress had an article discussing the new study called, "Nurses’ Perceptions of Error Reporting and Disclosure in Nursing Homes," published in the January 2012 issue of the Journal of Nursing Care Quality.   The majority of registered nurses who responded said error disclosures are difficult to process in nursing homes.   In NHs, nurses more routinely interact with patients with complex needs, which in turn increases the chance of errors occurring. Nursing errors refer to a nurse’s action that adversely affected, or could have adversely affected, a patient’s safety, quality of care, or both. Examples of nursing errors include lack of prevention (eg, breach of infection control precautions), inappropriate judgment or attentiveness, misinterpreting a physician’s order, or documentation errors.

NYUCN Assistant Professor of Nursing, Laura M. Wagner, PhD, RN, GNP-BC said  "Our research highlights the need for nursing homes to improve communication processes and policies, ultimately rendering a culture of safety in nursing homes."  The authors found that multiple barriers exist that might inhibit disclosure; almost one-third of the respondents were less likely to disclose if they believed they might be sued or reprimanded.

"Although there is increasing attention to disclosing harmful events, there is a significant gap between what is expected and what actually occurs in current practice. The process of disclosing is an ethical and legal obligation that provides essential information to patients and families."

The cover up is always worse than the initial mistake made by the caregiver.
 

Cincinnati.com had an article about a nursing home employee of Alois Alzheimer Center who was arrested for stealing medication from her patients.  Peggy Ballinger faces two counts of theft, deception to obtain dangerous drugs and illegally processing drug documents.

"According to court records, Ballinger falsified drug logs at the facility….to steal the powerful painkillers Percocet and Vicodin and took the drugs while on duty Nov. 7."    Evidence shows that Ballinger was high on the drugs while at work. 

The falsification of drug logs and theft of patient drugs while on the job probably caused residents to be harmed.  There were no fines or penalties for the nursing home for their lack of supervision.  The scenario exemplifies the lack of proper medication control and insufficient supervision of employees at nursing home facilities. 

 

Illinois’ The State Journal Register reported the $2,200 fine issued to North Church Nursing & Rehab for failing to supervise a patient who died from choking on food.  State officials recommended that federal officials level a separate, $7,600 fine against North Church, a 113-bed for-profit facility that previously was known as Golden Moments Senior Care Center.

According to the investigation report, the resident was eating a sandwich unsupervised when she began to choke and passed out.  She was pronounced dead in the Passavant Area Hospital emergency department about 6:45 p.m. Sept. 23.

In a similar incident, the state issued a $50,000 fine against the facility, then known as Golden Moments, for poor care connected with the Oct. 3, 2009, death of Adam Waeltz, a 74-year-old patient who choked on food.

Health Jockey reported a new study showing an epidemic of depression among nursing home workers.  The analysis was done by professionals from the Harvard School of Public Health.  The study titled, ‘Household Food Insufficiency, Financial Strain, Work—Family Spillover, and Depressive Symptoms in the Working Class: The Work, Family, and Health Network Study’ is published in the American Journal of Public Health.  I guess being overworked, underpaid, and underappreciated can lead to depression.

"Financial obligations, worries about being at home without food, frequent thought about issues at home while at work were some of the stressors that contributed to depression among nurses. These variables apparently led to 2 folds increase of depression rates experienced by stressed workers unlike those who did not face such worries. Depression is one of the primary causes of disability and avoidance of work world over. It is also significantly linked to worker turnovers in many organizations."

“The high burden of work-family stress and depression in this group has important public health implications for the workers and their families as well as for the quality of care delivered to nursing home residents,” commented Cassandra Okechukwu, assistant professor of society, human development, and health and lead author.