A man in his 80s had to be rescued after falling down a 25-30 ft. slope named North Side.  The man was discovered when a nurse at the nursing home where he lived couldn’t find him in his room.  Rescuers said the man was conscious and alert, but also scared and bruised.  The man is in stable condition at Alleghany General Hospital.

The Centers for Medicare & Medicaid Services has updated survey guidelines regarding nursing homes’ use of antipsychotic medications for dementia care. The interim guidance revises Appendix P and Appendix PP of the State Operations Manual. The Appendix P update includes new surveyor tasks to ensure that survey samples include enough residents who have dementia and who are taking an antipsychotic medication. Updates on Appendix PP include new interpretive guidance related to care of residents with dementia, including medication use. For more information, read the article in McKnight’s.

In a follow-up blog from an older post, Susan Juilfs, the administrator at Pomeroy Care Center from 1983 to 2011 during which a female resident was sexually assaulted, has been found guilty of professional incompetence. See article at Des Moines Register.  Juilfs knew that William Cubbage was a sex offender and didn’t take the precautions necessary to ensure the safety of other residents. The Iowa Board of Nursing Home Administrators is placing sanctions on her, an unusually severe punishment, since the Board rarely punishes administrators for abuse or neglect that occurs in their homes. This case is different because Juilfs knew about Cubbage’s past and told employees not to tell anyone about the sex offenders living in the home. In addition to failing to explain their history, she also failed to protect residents from Cubbage, which resulted in the tragic assault of at least one female resident. An 8 yr old girl witnessed Cubbage fondling a resident in her bed who was screaming ‘No’. The family is suing the home for failing to protect the woman, and they allege that the Iowa Department of Human Services didn’t create a plan for Cubbage to ensure he wouldn’t reoffend and failed to see that he was under proper supervision once he was placed in the home. Des Moines has had a number of sexual assaults in nursing homes, another post on the phenomenon can be found here.

In a recent report in Wisconsin, 40 nursing homes have been listed as having a ‘substandard quality of care.’  See article at WAOW.  This tag comes with additional federal scrutiny on the homes, many of which have a history of violations and citations. Some were even on the list in 2011, marking them as consistently below the line when it comes to quality of care. The substandard homes are being watched more closely by the state and federal authorities, prompting a more immediate response to violations and citations than in the past.

Additionally the homes aren’t allowed to train new CNAs for a period of two years after the listing. The list may be a good thing, resulting in extreme watchfulness and immediate action, but if it is such a strong list to be placed on, how come homes have been on the list more than once?   If authorities responded immediately to violations and citations, and the list was a strong deterrent to providing poor quality of care, then something is getting lost in translation, because homes are staying on the list – not improving, not closing, but maintaining a state of care that is substandard.

Is that where you want your loved one to be?

Documentation has been a growing problem in the healthcare industry especially short-staffed nursing homes.  In an article from Medscape, issues with charting are looked at and explored for potential problems. A nurse posed a question about charting. She detailed how the electronic charting system at her hospital was so cumbersome that many nurses had to stay over their shifts, which necessitates overtime, or they were clocking out and entering notes on their own time so that the charts would be up to date. The problem, she said, is that by the time the notes are entered, the patient’s condition could have drastically changed. Since the system records the time of the notes, this could lead to issues of charting integrity and in some cases, HIPAA violations.

The documentation standard is for charts to be updated within an hour of the assessment or treatment, unless more frequent updates are required, such as for a patient who requires more frequent nurse assessments. Untimely documentation leads to issues of the credibility of those notes. If a patient dies at 8:00 and the nurse enters her notes that he is healthy and well at 8:15, there’s obviously an issue of integrity.

Electronic charting systems, like all newly implemented computer systems, will require some work to become familiar with the program. Maybe the nurses are going through a learning period, and as they work with the program it will be easier to use and easier to timely enter chart notes. If the system is too difficult to work with, nurses are probably not the only ones having problems. If doctors and nurses are both frustrated with the system, then a meeting should be set up with the administration. In either case the situation is going to require time. For right now, it seems inevitable that charting integrity will continue to be a source of concern for many hospitals.

There are a number of phrases that we use to describe when a loved one has died. Passed on, kicked the bucket, bought the farm, met their Maker, was called home, or left us, just to name a few. There are websites dedicated to death euphemisms, all of which were created to ease the pain of losing a loved one.

Stephen Jukes, 56, heard none of those when he called to ask about his mother’s condition. He received a blunt ‘she’s dead.’  The two words together didn’t make sense at first. Stephen had gone on an extended trip to Belgium to oversee construction of a house. The day after he came home from the trip he called the home, asking about his mother’s health. He was brusquely informed that she was dead. When he asked the home for help in arranging funeral plans, he was informed that she had been cremated. Two months earlier. Stephen’s mother had been dead for three months. No one at the home called him.

Stephen and his mother had been close. The transition into the nursing home was heartbreaking for Stephen and his family, but when his mother’s dementia worsened, her doctors recommended round the clock care that Stephen couldn’t give. He placed her in the home so that she would be safe, looked after, and taken care of. Stephen, a loving son, visited his mother in the Landmere Nursing Home every day until he went abroad, which cut off his access to the home.

When asked why no one contacted him when she died and why they had cremated her against her wishes, the home said that they had lost the care plan, which included his number and Mary’s burial wishes. The shock and pain led Stephen to file a suit against the home. He had to quit because of the rising costs, but he recently filed fresh proceedings against the home, stating that it wasn’t about money, it was about raising awareness. See full article at The Daily Mail.

Know when to hold ‘em, know when to fold ‘em, and know when to walk away.

That old adage has been providing people with poker advice for years. Unfortunately, the same adage can be held true for nursing homes. Crescent Senior Care in Weathersby, TX is undergoing plans to sell the facility, and fast. With a list of debts a mile wide, it’s easy to see why the facility is undergoing rapid sale procedures. Companies in the area have filed suit against the home in an effort to receive payment for services provided. As of right now, six companies have filed suit against the home, and the total amount they’re seeking is over $1 million.  The home has been having financial issues, with some employees having trouble cashing paychecks. Because of this, College Park Rehabilitation and Care Center are seeking an emergency change of ownership from the state. If not granted, then Crescent will have to put all their chips on the table, and will likely result in shortchanging the six companies who are seeking judgment. See article at the Weatherford Democrat.

In an investigation by Quebec coroners, their findings say that many nursing home deaths are avoidable. The coroners investigated 27 suspicious deaths from nursing homes between 2006 and 2011. An article by The Montreal Gazette looks specifically at 12 of the cases, which tell a gruesome and sometimes horrifying tale of abuse, negligence, and avoidable and wrongful death. The most common causes of death were burns suffered as a result of scalding hot bath water, asphyxiation because of restraints and bed rails, and exposure to the elements because of unlocked doors and windows.  I don’t recommend reading the article if you’re squeamish.

If you thought planning for retirement was bad, you might want to check out this article from Matt Wallace, an attorney and CPA in Port Huron, MI. His article provides tips and details about Medicare eligibility, and how to plan Medicare costs so that nursing home fees don’t break your bank. He quashes rumors about Medicare that you may have heard, like you have to whittle your assets down to $2000 if you’re single and if you’re married that half of your assets must be spent on the nursing home. He goes into a number of tips such as: know and use your exempt assets like your home, prepay your funeral, and maximize your small insurance policies. He goes into more detail about these and other tips in his article, which was written for families who need help with the complex and complicated Medicare system.