The Chicago Tribune recently had an interesting article on the increase of male caregivers, mostly because of the increase in alzheimer’s dementia among elderly women.

"In the last 15 years, the number of men caring for loved ones with Alzheimer’s or dementia has more than doubled, from 19 to 40 percent, according to the Alzheimer’s Association. The trend corresponds to the higher number of women over the age of 65 in the U.S. with the disease — 3.4 million, compared with 1.8 million men. Those demographics have changed the tone of local support group meetings by adding a chorus of male perspectives. It has also prompted an outpouring of new books, organizations and online resources for men learning how to be nurturers."

"Certainly there were male caregivers in earlier generations, but the number documented today is probably higher for several reasons, said Harrison, of the National Caregiver Center. The size of the average family has become smaller, so leaving the caregiving to women is not always an option. There is also a greater geographic divide among family members today, sometimes putting children in other states far from aging parents. And perhaps most notably, men are less hesitant to be known as something other than the breadwinner, Harrison said."

McKnight’s had an article on a study that concluded many elderly nursing home residents are not getting enough Vitamin D.  Vitamin D deficiency can contribute to higher rates of falls and fractures in the elderly due to its effects on calcium absorption and bone metabolism.  Physicians advise that those over the age of 70 should take in 800 international units of vitamin D per day

The German study showed nearly all residents had insufficient levels of vitamin D, while more than two-thirds had severely deficient levels.

 

Several recent articles about Medicare have shown a decrease in costs as benefits grew.

In the first full year of the new healthcare law, 3.6 million people in the government Medicare program saved $2.1 billion on prescription drugs in 2011. The savings are one of the first tangible benefits of the sweeping overhaul that the president signed in March 2010.  The Medicare prescription drug provision is designed to gradually phase out a gap in coverage for pharmaceuticals that was included in the Part D program when it was created under President George W. Bush. 

In 2010, beneficiaries who hit the so-called doughnut hole in coverage received a $250 rebate check under a provision of the new law.

In 2011, the law provided beneficiaries a 50% discount on covered brand-name drugs and a 7% discount on generics when they hit the doughnut hole.

That worked out to an average of $604 per beneficiary, according to the Department of Health and Human Services. Those discounts are slated to rise to 75% for brand name and generic drugs by 2020, when the coverage gap will be eliminated altogether.

As the U.S. Senate and House of Representatives begin making crucial budgetary decisions for FY 2013, a new bipartisan national survey conducted for the Alliance for Quality Nursing Home Care by Public Opinion Strategies and Hart Research Associates finds that after hearing that Medicare funds are used to help pay for nursing home care, 82% of registered voters (RVs) oppose reducing Medicare funding for seniors’ nursing home care; 90% say funding for U.S. nursing home care should either "remain the same" or "increase"; 69% support the concept of phasing-in a 2011 Medicare regulation that reduced Medicare funding by 11.1% all at one time.
See articles at L.A.Times, The Wall Street Journal blog, and The Sacramento Bee.

Neuroscientists at Case Western Reserve University School of Medicine have made a dramatic breakthrough in their efforts to find a cure for Alzheimer’s disease.  A recent edition of the journal Science will report on how Professor Gary Landreth and his team discovered that a cancer drug can quickly reverse Alzheimer’s symptoms in animal models. Within 72 hours of administration, the medication halved the number of plaque deposits closely associated with this degenerative brain disease. More, it saw the signs of cognitive and memory deficits disappear within the same short time period.

Bexarotene has been approved for the treatment of cancer by the U.S. Food and Drug Administration for more than a decade. These experiments explored whether the medication might also be used to help patients with Alzheimer’s disease, and the results were more than promising.

Alzheimer’s disease arises in large part from the body’s inability to clear naturally-occurring amyloid beta from the brain. In 2008 Case Western Reserve researcher Gary Landreth, PhD, professor of neurosciences, discovered that the main cholesterol carrier in the brain, Apolipoprotein E (ApoE), facilitated the clearance of the amyloid beta proteins. Landreth, a professor of neurosciences in the university’s medical school, is the senior author of this study as well.

Landreth and his colleagues chose to explore the effectiveness of bexarotene for increasing ApoE expression. The elevation of brain ApoE levels, in turn, speeds the clearance of amyloid beta from the brain. Bexarotene acts by stimulating retinoid X receptors (RXR), which control how much ApoE is produced.

In particular, the researchers were struck by the speed with which bexarotene improved memory deficits and behavior even as it also acted to reverse the pathology of Alzheimer’s disease. The present view of the scientific community is that small soluble forms of amyloid beta cause the memory impairments seen in animal models and humans with the disease. Within six hours of administering bexarotene, however, soluble amyloid levels fell by 25 percent; even more impressive, the effect lasted as long as three days. Finally, this shift was correlated with rapid improvement in a broad range of behaviors in three different mouse models of Alzheimer’s.

This study identifies a link between the primary genetic risk factor for Alzheimer’s disease and a potential therapy to address it. Humans have three forms of ApoE: ApoE2, ApoE3, and ApoE4. Possession of the ApoE4 gene greatly increases the likelihood of developing Alzheimer’s disease. Previously, the Landreth laboratory had shown that this form of ApoE was impaired in its ability of clear amyloid. The new work suggests that elevation of ApoE levels in the brain may be an effective therapeutic strategy to clear the forms of amyloid associated with impaired memory and cognition.

The Science study was co-authored by John R. Cirrito, Jessica L. Restivo, Whitney D. Goebel, Washington University School of Medicine; C.Y. Daniel Lee, Colleen Karlo, Adriana E. Zinn, Brad T. Casali, Case Western Reserve University School of Medicine; Donald A. Wilson, New York University School of Medicine, and Michael J. James, Kurt R. Brunden, Perelman School of Medicine, University of Pennsylvania.

The potential of this research to assist the 5.4 million Americans living with Alzheimer’s disease is immense. I commend Professor Landreth for this extraordinary research, and look forward to learning of additional progress as he takes it to clinical trials.

See article from The Wall Street Journal

 

Nursing home residents with dementia who use average doses of selective serotonin reuptake inhibitors (SSRIs) are three times more likely to have an injurious fall than similar people who don’t use these drugs. The association can be seen in people who use low doses of SSRIs and the risk increases as people take higher doses. The results are published in the British Journal of Clinical Pharmacology.  Falls are a major health problem in nursing home residents with dementia. In nursing homes one-third of all falls result in an injury.

Many nursing home residents with dementia are treated with antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are generally considered the treatment of choice. "Our study also discovered that the risk of an injurious fall increased even more if the residents were also given hypnotic or sedative drugs as sleeping pills," said lead author Carolyn Shanty Sterke, who works in the Section of Geriatric Medicine at Erasmus University Medical Center, Rotterdam, The Netherlands. "Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses," says Sterke.

The incident reports showed that 152 of the 248 residents (61.5%) sustained 683 falls. This corresponds to a fall incidence of 2.9 falls per person-year. Thirty-eight residents had a single fall, but 114 fell frequently. Two hundred twenty falls resulted in injury or death. Of these 10 were hip fractures, 11 were other fractures and 198 were injuries such as grazes, open wounds, sprains, bruises, and swellings. One person died after falling.

"Staff in residential homes are always concerned about reducing the chance of people falling and I think we should consider developing new treatment protocols that take into account the increased risk of falling that occurs when you give people SSRIs," says Sterke.

See also story at USAToday.

More information: Dose-response relationship between Selective Serotonin Reuptake Inhibitors and Injurious falls: A study in Nursing Home Residents with Dementia. Carolyn S Sterke, Gijsbertus Ziere, Ed F. van Beeck, Caspar W. N. Looman & Tischa J. M. van der Cammen. BJCP (2012); DOI: 10.1111/j.1365-2125.2011.04124.x

 

Levin & Perconti’s Illinois Nursing Home blog had a great article on the value and need for video cameras to prevent abuse and neglect in nursing homes.

"Our Chicago nursing home abuse lawyer John J. Perconti was quoted this week in a Chicago Daily Law Bulletin article on the role that video cameras are playing in the courtrooms. The article touched on the effect that the increased use of surveillance cameras might have on the strategies of both plaintiff and defense attorneys. As local residents are aware, Chicago’s use of camera technology to monitor its corners and streets is growing rapidly. It is hard to go anywhere without being recorded by some sort of video device. In fact, while our city has certainly taken advantage of the surveillance tools as of late, we are actually a bit behind the curve. Other large cities (particularly international ones) have been using video cameras in more intrusive ways for years.

Not only is the city itself using these cameras, but many private businesses similarly monitor their surroundings as a safety tool. The captured footage is often crucial evidence when it records the incidents that at the heart of injury lawsuits. For example, our Illinois injury attorney John Perconti discussed a nursing home neglect case of ours involving a resident who fell outside of a senior center, suffering severe injuries that ultimately killed him. Attorney Perconti explained how the video camera mounted by outside an adult day care center caught the entire event.

The recording shows the senior using a walker, walking down a ramp toward a bus. Perconti explained, “He caught the side slope of the ramp and this causes him to fall sideways, striking his head on the pavement.” Perconti went
 

The Louisville Courier Jornal reported the jury’s verdict in a recent two week nursing home neglect trial against Treyton Oak Towers.  The jury awarded $8 million in damages to the estate of a retired surgeon whose legs were broken becuase of neglect.  Dr. David Griffin died less than two months after he was improperly transferred from a chair into his bed causing fractures.  The plaintiffs claimed Griffin was transferred without a lift and by only one nursing assistant, in violation of the nursing home’s care plan, which required two assistants.

The worse part is that Defendants tried to cover up what happened.  Employees were ordered to change medical records to cover the incident up.  This happens all the time in nursing homes. 

The verdict was returned after the jury deliberated for about two hours and included $2 million for pain and suffering, $1 million for violating the state nursing home statute and $5 million in punitive damages.
 

I found an interesting website called Glassdoor where employees including nursing home employees can discuss their workplace environments.  Below is one from an employee of a Kindred facility.

Kindred Healthcare – “Back breaking work, and EXTREMELY stressful environment”
1 of 1 people found this helpful

Kindred Healthcare Respiratory Therapist in Louisville, KY: (Current Employee)

Pros

My co-workers,& patients’ there, still need "someone" who cares and that will help them.
Cons

They say they go by patient accuity, but they don’t. They cram as many patients’ in as they can and sometimes 2 patients’ to tiny rooms where beds aren’t hardly 2 feet apart! They take anybody, whether the patient has been known to abuse staff and also many weighing over 300 pounds, which is hard on staff. It is all about money there! They even stopped having sodas, and milks, kept on floors for patients’ and/or families because of COST! Patients’ must call down ahead for one soda or milk and kitchen is closed at night! Cafeteria hours are horrible for employees! They open for approx. 1 hour for breakfast, which no one has time for at change of shifts. Lunch is only served for about 2 hours through the week and less on weekends. They run out of food. Most employess must bring a lunch or order out to be ensured a meal. Staff goes out with way too many patients! We are then expected to watch patients "closely"(one floor won’t allow sitters and hardly any restraints) who are confused and unrestrained, so that they aren’t falling and pulling trachs out, but no one can keep up with workloads , watching patients, and answering alarms promptly.People who are FULL Codes are allowed to repeatedly pull out vital tubes, and staff must promptly" keep" replacing them in emergent situations.Even with all that, they expect excellence, and ALL work completed without error!If you complain, you are in jeopardy of getting fired for any reason. EXTREMELY STRESSFUL environment for those doing patient care! Management shows no compassion whatsoever. Jobs are hard to come by so people sweat it out, but morale is ROCK bottom!
Advice to Senior Management

Need new management with education in managing people without being cold, and abusive.

Keep reading to see what was said about Fundamental Administrative Services.
 

Read More →

The Rome News Tribune reported on the ongoing trial of George Houser.   The linked article summarizes another administrator testifying about deficiencies cited by state regulators and bills for food and other items that were not being paid.   Greenway testified that lab work could often not be done, garbage sometimes piled up and she and other staff members paid for food because the bills had not been paid on the items.  The former administrator at the facility testified about “tags,” which are deficiencies noted by the state. Once nursing homes are tagged with deficiencies, they must submit a correction plan and a follow-up visit is scheduled to make sure the plan has been followed. Greenway also testified that the Mount Berry facility was tagged twice for a violation involving the Residents’ Trust Fund, which comes from the resident’ Social Security benefits and sometimes from family members. The funds are supposed to be available to residents to use for expenditures.

Houser, the former owner of Forum Healthcare Group, which owned two facilities in Rome and one in Brunswick, is on trial in U.S. District Court in Rome, accused of defrauding Medicaid and Medicare out of $30 million between 2004 and 2007 and willfully failing to pay taxes. 

According to the federal indictment, residents of the Housers’ nursing homes lived in substandard conditions, with broken air-conditioners and leaky roofs, while the couple raked in millions of dollars, purchasing homes, property and expensive cars.  According to the indictment, Houser submitted false or fraudulent claims to Medicare and Georgia Medicaid that were “worthless.”

 

WLBT out of Jackson, Mississippi had a disturbing story of a former employee’s admission of abuse and neglect she witnessed at Brandon Nursing Home and Rehabilitation Center, a for profit nursing home.   Several people contacted WLBT sharing similar stories.

"Brandon Nursing Home and Rehabilitation Center employee who we’ll call "Ann" worked as a certified nursing assistant at the facility for about six weeks.  "While I worked there I reported several cases of abuse," said Ann.  She resigned after repeatedly seeing elderly patients neglected, left for hours in their waste and treated cruelly.  The 30 year old wife and mother said she told her supervisors about the abuses but nothing was ever done.

"I witnessed a gentleman fall out of his wheelchair and I witnessed one of the other aides that I was shadowing pull his shirt up over his head and when she did that his head bounced and hit the floor," said the certified nursing assistant.

Why isn’t this place getting investigated or shut down–the regulatory enforcement is lacking.