Quail Creek Nursing and Rehabilitation in Oklahoma has been in local news because of more abuse and neglect allegations. Ken Capshaw, husband of resident Ann, said that the home refused to call in a doctor to help his wife, whose face and neck were severely swollen. Capshaw called an ambulance, who rushed Ann to the hospital. One of the nurses told Capshaw that Ann would likely have died in the afternoon if she hadn’t been rushed to the hospital. Capshaw said that his wife will not be going back into the facility.

Wes Bledsoe, a citizen advocate, said the state needs to stop ignoring complaints. Dorya Huser, Chief of Long Term Care for the State Department of Health, said that state inspectors do all they can. They conduct interviews, maintain records, and review past records in an effort to improve the situation. Huser said that they have cited the facility. Bledsoe doesn’t think that a citation is enough. Bledsoe is calling for a more thorough investigation of the incident and the facility.

With multiple allegations, complaints, and a citation, the question arises of how far is too far? How many instances of abuse and neglect are necessary before the state does more than simply issue a citation? Bledsoe claims that the state conducts their investigations with blinders on. If it’s not happening in front of them, he says, then it’s like it doesn’t exist.
 

Medical News Today reported the finding that medications are known as nonbenzodiazepine hypnotic drugs, a class of sleeping medications that includes Lunesta, Sonata, and Ambien increase the risk of falls and hip fractures.  The scientists discovered that the risk for hip fracture was greater for the residents taking a nonbenzodiazepine hypnotic drug.  The benefits do not outweigh the risks.

The finding came from new research conducted by experts from Harvard Medical School, led by Sarah D. Berry, M.D., M.P.H.

"It is important to understand the relationship between sleep medication use and injurious falls in nursing home residents," the experts wrote. A previous study demonstrated that nursing home residents with dementia are three times more likely to have an injurious fall when they take drugs to treat depression."

The authors said:
"The risk for hip fracture is elevated among nursing home residents using a nonbenzodiazepine hypnotic drug. New users and residents having mild to moderate cognitive impairment or requiring limited assistance with transfers may be most vulnerable to the use of these drugs."
When prescribing sleeping pills to nursing home residents, doctors should take caution, the researchers added. They concluded :

"Residents, staff, and nursing home administrators need to collaborate to create a culture change within the nursing home that increases daytime activity, improves social engagement, avoids daytime naps, and minimizes awake time in bed for residents. Physicians must also have amore active role to ensure that sleep quality and structure are not impaired by treatable medical or psychiatric conditions and that other sleep disorders commonly seen in the frail elderly (eg, central sleep apnea) are promptly diagnosed and treated."

 

The Tennessean had an article on the report recently released by the state of Tennessee detailing serious complaints about the Imperial Gardens Health and Rehabilitation Center in Madison. The 143 page inspection report uncovered many instances of delays of necessary medication, lack of necessary medication, transcription errors which led to overdosing, under dosing, and giving patients wrong medications. In addition to medication mistakes, there were cases cited in the report detailing lab test results which were not sent to physicians or never completed, contrary to physician’s orders. The report also discloses instances where patients were placed in harm through neglect. In one instance, a patient’s head was stuck between his mattress and bed rail. Another patient wandered undetected outside in near-freezing temperatures, concluding with him being picked up by a passing emergency vehicle near a busy street.
The inspection report is the result of a series of complaints from residents and family members. However, complaints come not only from the patient side, but the care side as well. Some facility staff were so discouraged by the conditions that they immediately transferred. In one instance, a family member reports that a staff member encouraged her to file a complaint because the conditions were so bad. The report cites facility records, discovering that the Administrator was aware the facility was not meeting state standards for staffing. This lack of staffing led to the neglect of everyday necessities, such as showers, meals, and waste removal. It was also cited as contributing to the development of several patients’ pressure sores and a delay in necessary treatment.
This report details the serious neglect occurring at the Imperial Gardens Health and Rehabilitation Center. The 143 page report covers the spectrum of nursing home neglect for the facility which had at the time of this report, 118 patients. Because of this report, the state has effectively shut down the facility, refusing new admissions to the home and beginning the transfer process for the residents. Medicare and Medicaid Services have barred funding for new patients and will cover current residents for only 30 days. Spokesman for Vanguard Healthcare, the owner of Imperial Gardens Health and Rehabilitation Center, said that decertification will begin immediately and that a monitor has already been appointed to oversee patient transfers.
With 2 other Vanguard owned homes in the Nashville area alone, the transfer facilities may still be under Vanguard Healthcare, which requires a concern for those facilities’ conditions of care. Since rampant neglect occurred on Vanguard’s watch at Imperial Gardens Health and Rehabilitation Center, who is to say that it isn’t occurring at the other two facilities? And how will the state of Tennessee move forward with that in mind?
 

Shorewood Patch reported on the lawsuit filed against Hillcrest Nursing and Rehabilitation Center and its owner/management company.  The suit charges that Rush, who is paralyzed on the right side and cannot speak due to a series of strokes, moved to Hillcrest in July 2010. While there, he developed multiple bed sores and became dehydrated.  He developed a pressure sore on his left heel that became infected and resulted in him needing to have part of his leg removed, according to the lawsuit. Rush has since moved out of the facility.

"John was paralyzed to the right side of his body. When he had to have an amputation, it was his left leg – his only means of any mobility and independence. Now he cannot get out of bed by himself and it is very difficult to transport him. Not being able to transport him keeps him essentially trapped in a facility instead of being able to participate in everyday activities like seeing family, going to dinner or a movie.”

After Rush’s family filed a complaint with the state about the incident, the Illinois Department of Public Health cited the nursing home for Type A and Type B violations and fined it $31,600. During the investigation, the agency also found 23 incidents of verbal, sexual, physical or mental abuse between residents at Hillcrest during a five-month period in 2011.

The nursing home has lost its Medicare and Medicaid funding, and is pushing to close the facility by revoking its state license, a state spokesman said last June. Among the problems documented by the state are two suspicious resident deaths within a six-month period, allegations of sexual and physical assaults, and failure to monitor prescription drugs.

 

New America Media had a great article about the proposal to require nursing homes to have a medical doctor onsite at nursing homes.

Jonathan M. Evans is a geriatric physician who teaches "Aging and the Law" at the University of Virginia School of Law.  He published the article “When Long-Term Caregivers Have Ethical Obligations.”  Evans is a proponent of the model of care requiring a nursing home specialist and has been involved in long-term care for seniors for more than 20 years.  “The thing that matters most is being there – being there for patients when they’re sick; being there for families when they’re in need; being there for staff to provide support and ongoing education. You can’t be part of a team if you’re not present.”

"Several years ago Paul R. Katz and his health care-research colleagues at the University of Rochester wrote a journal article about the problem with nursing home physicians. They made a compelling argument for a new model of care."

We contend that rather than accepting a diminished presence of physicians in nursing homes and finding alternative care models, it is time to fully consider, appropriately fund, and test the nursing home specialist model. If nearly half of the baby boomers spend some time in a nursing home, the question ‘Is there a doctor in the house?’ will take on new urgency and meaning.”

 

 

 

Villaspring, a nursing home in Kentucky, will pay $350,000 to the federal government and improve their care after settling a lawsuit over fraudulent charges. The home charged Medicaid and Medicare for services that were never performed; in some cases going against the orders of physicians, neglecting to treat and monitor patients, and being short staffed in their care.

In 2007, Kentucky issued the home a Type A citation, the most severe citation, for the facility’s neglect to treat pressure sores that resulted in an environment of imminent danger, serious physical harm, and death.   This lawsuit settlement has provided not only financial recompense for Medicare and Medicaid spending but has also provided its residents with a commitment to improvements within the institution.

According to the terms of the settlement, the nursing home will hire a third party consultant to help improve the facility. This consultant firm will also be responsible for submitting quarterly reports to the US Attorney’s Office. This settlement is the first of its kind because it demonstrates a commitment not only to justice for those who have been affected by the home, but for justice of those who will be affected. 

See article at Cincinnati.com.
 

The Palm Beach Post reported on Florida’s attempts to protect the corporate decision-makers from accountability for their decisions that affect the care provided at the facility.  In the case of “vicarious liability,” HB 869 says, punitive damages may not be imposed unless “an officer, director, or manager of the actual employer, corporation, or legal entity condoned, ratified, or consented to the specific conduct.”  The bill makes it even more difficult to hold the corporate decision-makers (who make millions from taxpayers) responsible for the neglect and abuse at their nursing homes.  

Advocates for residents warn it’s a bad move in a state with one in five homes on a watch list for safety concerns.  15 more nursing homes recently joined the state watch list, joining some 123 others already on it.

“All this legislation does is immunize corporate decision-makers from any accountability,” said Brian Lee, the state’s former long-term care ombudsman and now the executive director of an advocacy group, Families for Better Care.

Meanwhile, executives who controlled nursing homes in Palm Beach and two other counties face felony charges in a $2.75 million Medicaid fraud case. A Pahokee nursing home paid more than $26,000 for an assistant CEO’s BMW and a Gainesville affiliate paid more than $50,000 for her Cadillac convertible, according to documents supporting the arrests. The Gainesville home is on the watch list.

This additional protection is not needed.   Florida had the most dramatic changes in liability costs in the country, with claims per 1,000 beds dropping by half from 2000 to 2007 and severity falling from $450,000 to $100,000 per claim.

 

The Sacramento Bee reported on the conclusion of the wrongful death and abuse trial against Emeritus Corp.  At the end of the liability phase of the trial, the jury awarded the plaintiffs $3.875 million for Joan Boice’s pain and suffering. That award, however, had been capped at $250,000 by Judge Judy Holzer Hersher under state law that applies to medical malpractice cases. 

The second phase of the trial is the jury hearing evidence related to punitive damages.  The jury decided yes and awarded the family $23,000,000.81.  The 81 cents was for the resident’s age.  A clear rebuke to Defendants harping on her age during the trial.

"It took the panel less than a day of deliberations following two days of testimony to decide what the damages should be in the punitive phase of the trial. The same jury on Monday came back with a finding of liability against Emeritus and found that the Seattle-based corporation acted with malice, oppression and fraud in its treatment of Joan Boice. The woman died in February 2009, three months after she left Emeritus at Emerald Hills in Auburn with bed sores spreading over portions of her body."

Testimony at the trial showed that Emeritus at times had no caregivers on duty during the overnight shift during Boice’s three-month stay at Emerald Hills.
 

 

 

The Star-Tribune reported for the second time in less than a month, state officials have found evidence of neglect by a nursing home worker who failed to try to save a patient who was in distress and died.  In the latest case, a staffer at Benedictine Health Center did not administer cardiopulmonary resuscitation (CPR) after being called to the resident’s room by employees who saw the man, who could not talk, “blink and take a last deep breath,” according to the report released.

It was the second investigation made public recently where an overworked nursing home worker allowed a resident to die without trying resuscitation. Investigators found other problems in the employee’s actions in the Benedictine case. In addition to the failure to administer CPR, the neglectful staff member also failed to contact the man’s doctor about a earlier vomiting episode, as required for any change of condition.