According to Patricia Anne Holcomb and Angela Jourdan, their grandmother, 93 year old Iva Jean Bonds, was sexually assaulted in Evergreen Arvin Healthcare, a nursing home in Southern California. The complaint filed on behalf of Iva details a harrowing evening which is truly horrible in its indications of humanity. May 25, 2013, Iva was sexually assaulted by a male CNA (certified nursing assistant). The assault was so violent that blood pooled in Iva’s vaginal canal.

During the six hours she lay waiting, bleeding internally, she developed blood clots. When Patricia and Angela learned their grandmother was bleeding, they demanded she be sent to the hospital. While there, a surgeon discovered Iva had been raped, and the hospital reported the incident. Sadly, Iva died 18 days after the assault ‘as a result of her injuries’. Evergreen’s staff attempted to cover up the incident by accessing Iva’s medical file without authorization.

Iva’s story, though sad, is not unique. Evergreen has a history of poor patient care, deficient health services, failure to screen staff members, and failure to report incidents of abuse and assault. Patricia and Angela also charge the home with failure to protect their grandmother because the same aide sexually assaulted a male patient just four days before Iva was violently raped.

Though the California Department of Public Health did investigate Iva’s case, they wrote Evergreen a citation and fined the home a mere $20,000 fine. Iva and patients like her are more vulnerable towards predators like the CNA because they are elderly, frail, have poor health, and are nonverbal and immobile, as Iva was. For those who want to prey on the weak, nursing homes are a prime place. This is why it is so important to properly screen staff. As long as there are predatory people in the world, and the authorities refuse to do anything more than slap nursing homes like Evergreen on the wrist with paltry fines, this type of crime, while horrendous, will not be uncommon.
 

 A review by USA Today says over 100,000 health care workers are abusing or dependent on prescription drugs every year. Doctors, nurses, medical technicians, and aides all have important jobs. The safety of hundreds of thousands of people is in their hands at any given moment. What if those hands operating on you were shaky because they hadn’t gotten their fix? Or what if the anesthesiologist putting you to sleep was obsessively thinking about the next time she could get high? What if you weren’t getting the pain medication you needed for a surgery, but you were getting the unexpected surprise of Hepatitis C? While these scenarios may seem unlikely, each and every one has happened.

In the USA Today article and video, multiple health care professionals were interviewed about their drug use and abuse. Each of the above scenarios was detailed in those interviews. These are real nightmares that happened to real people. And with the prevalence of drug abuse in the medical field, the next victim could be you.

 

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 A blogger in Mississippi took photographs of Republican Thad Cochran’s ailing wife who is in a nursing home.  Police charged three more men in connection to the blogger, Clayton Kelly, who created a political video against the longtime senator from Mississippi. Mark Mayfield, an attorney and local tea party leader, and Richard Sager, an elementary school P.E. teacher and high school coach have been arrested for their roles in the political scheme. 

The photo surfaced in a political attack ad on YouTube that aimed to smear Cochran. It is unclear how the photo was used because the ad was removed within hours of being posted. Authorities added felony charges of conspiracy and photo voyeurism to the count of exploitation of a vulnerable adult.

 

 A recent study conducted by the Center for Medicare Advocacy, a nonprofit consumer group, found that surveyors often have difficulty in challenging doctors who frequently prescribe antipsychotic drugs to dementia patients. Nursing home facilities often advocate prescribing these types of drugs to keep elderly residents in a sedative, and often times, a vegative state.

Because of such abuses in these types of drugs, the federal government’s Centers for Medicare and Medicaid Services set up a program in 2012 to attempt to prevent doctors prescribing antipsychotics to nursing home residents.  Since the launching of this initiative, state surveyors have had mixed reviews on its effectiveness.

Often, nursing home facilities are found falsifying records and forcing residents to take drugs that are inappropriate. Doctors who are responsible for the care of these residents now create false diagnoses in attempts to justify the prescribing of these drugs. An elderly person who is prescribed antipsychotic drugs without reason can lead to dangerous changes in their health. This includes: choking, heart attacks, falls, bone fractures, infections, and pneumonia.  See article at The Patriot Ledger.

 The Charleston Post & Courier published a letter from Neah Kelly about legislation to allow video cameras in nursing homes to protect resident and prevent waste and fraud. See letter below:

"The S.C. Senate Medical Affairs Committee’s recent 7-7 vote on legislation to allow residents of nursing homes to install electronic monitoring systems demonstrates a need for more critical analysis of the subject. The news has been inundated with reports on alleged neglect of nursing home residents throughout the nation. No one can argue there is a need to ensure better care and treatment of our elderly.

Many abuse cases that have been in the media were exposed through the use of video cameras that had been placed by family members trying to confirm the safety of their loved ones. This has resulted in residents and family members pressing for more legislation to allow the use of video cameras.

The issue has sparked much discussion and brought with it a multitude of principled questions, which must be discussed when creating and implementing a new policy.

We must not forget that these are places residents call their home, where all their private and personal moments take place.

This should be a place of peace, comfort and security, but some are living out their final days in a desperate torture unable to speak up for themselves.

Those who support the use of electronic monitoring believe that it will end or significantly reduce the instances of cruelty and negligence in facilities and thereby improve the residents’ quality of life and well-being. The use of video surveillance could also eliminate suspicion of any wrongdoing on behalf of the facility.

Those who are opposed to residents’ use of cameras in the nursing home often stress concern that retaining staff will be more difficult, given the scrutiny of electronic monitoring. Another concern is how to maintain the privacy rights of the staff and residents.

These ethical and privacy concerns need to be evaluated against the weighty cost of abuse and neglect. Currently, there are no federal laws that directly address this issue.

Under the Federal Residents Rights regulation, 483.10, residents have the right to self-determination, dignified existence and communication with persons inside and outside the nursing home, and nursing homes must protect and promote these rights.

Texas and New Mexico are the first two states to enact legislation to permit the installation of cameras by nursing home residents. Neither statute allows for covert monitoring.

Until we can be assured that our loved ones placed in care facilities are being properly cared for, the dispute over the use of video cameras is not going away. Nor should it.

Video cameras cannot take the place of proper training and care on behalf of the staff, but they can add to a resident’s sense of security. Protecting the rights of the resident should be of the utmost importance.

The residents have the right to safety, privacy and dignity. According to the Administration on Aging, there annually are more than two million reported cases of elder abuse, neglect or exploitation in the U.S.

It is believed that for every reported case of elder mistreatment or negligence, up to five cases do not get reported. Unfortunately elder abuse happens, but we can all act to protect seniors.

Do not let Senate bill 662 stay undecided. Call for reform, for action. Be a voice. Be an advocate."

Bill Myers from Provider Magazine had an interesting article about dementia and hip fractures.  "A team of researchers crunched data on nearly 46,000 elders’ hip fractures in Ontario between 2003 and 2010 and found that people with dementia accounted for more than four-fifths of hip fractures in long term care centers and nearly one-quarter of hip fractures in the community. Several previous studies have shown that those with dementia who break their hip are more likely to die, and more quickly, than their peers."

The findings were published in the latest edition of the Journal of the American Medical Directors Association.  Researchers found further evidence that those with dementia “are a high-risk group who likely require specialized care processes” after surgery.

 

 The Des Moines Register reported that two Iowa nursing homes run by a former gubernatorial candidate Jerry Rhoads have filed for bankruptcy protection.  All-American Restorative Care of Washington, Ia., and Regency Rehab and Skilled Nursing Center of Council Bluffs are on the federal government’s newly updated list of the nation’s most troubled care facilities. Both have been on the list for 22 months. Throughout 2013, the home was cited for numerous infractions, including failure to meet professional standards, insufficient staffing, unsanitary food service and inadequate infection control.

Under federal regulations, a facility that has been on the list for 18 months can be barred from the Medicaid program, effectively shutting off its primary source of public funding. Both of the Iowa homes, however, continue to collect Medicaid.

Rhoads and both of his Iowa care facilities recently filed for bankruptcy protection. He’s claiming $7.2 million in debt and $889,000 in assets. Among his potential liabilities are five of the six wrongful-death claims filed by the estates of former residents of a third care facility Rhoads once operated, All-American Care of Little Rock, Ark.

Court records indicate some of those wrongful-death claims were dismissed last year after Rhoads wrote to the plaintiffs’ attorneys, stating he had "no insurance for All-American Care" and had "no resources" to pay for any settlements or legal fees. He wrote that the company was "out of business with no assets, no insurance (and) owners who lost money on the venture."

Six months later, in September 2013, Rhoads announced he was running for governor of Iowa as an independent candidate, vowing to fight what he called the state’s "punitive and negative" enforcement of minimum-care standards.

A week later, state inspectors began investigating a June death at the Washington facility. As a result of that investigation, the federal government temporarily banned the home from accepting any new Medicaid-dependent residents and began imposing daily fines against the home until it was able to show compliance with all regulations. Those federal fines eventually totaled $70,750.

In 2012, video recorders at the home captured a resident falling and then lying on the floor for 48 minutes as nearby workers participated in a Christmas party. The resident was subsequently taken to a hospital and treated for a serious head injury.

The home also was cited for failing to perform CPR on a resident who was found in bed with no vital signs. Minutes before, an aide saw the resident breathing heavily and gasping for air and told a co-worker the resident "did not look right." 

 

 Gene Uzawa Dorio, M.D., is a housecall geriatric physician on staff at Henry Mayo Newhall Memorial Hospital and has been engaged as an advocate in many community activities. He wrote a Commentary for SCVNews.com.  Below are excerpts of that article:

"As a geriatric physician, I have visited patients in nursing homes for more than a quarter of a century. (Personally, I have vowed to make sure this stop is not on my bucket list.) Why do so many of my elder senior patients already know about the care rendered at these facilities? Easy. They see their parents, spouses, family members and friends arrive there, never to leave. From a physician’s perspective in our country, hospitals admit the patient, make a diagnosis, start treatment, then triage them out as quickly as possible to save money. Because home care, assisted-living facilities and board-and-care homes are not capable or legally allowed to continue this care, patients have no choice but to go to a nursing home.

Here are the problems:

* Once a patient is admitted to a SNF, continuity of care is lost. Only one doctor sees the patient, and that is once a month. You will not see a neurologist, orthopedist, gastroenterologist, pulmonologist, nor any other specialist once you are admitted, as they do not go to nursing homes. Any ensuing medical problem or complication can easily be missed.

* Nursing homes are underfunded. Not only do they have to jump through the medical and legal hoops of state and federal regulations; they also must budget based upon low Medicare-Medicaid-insurance reimbursement. Sometimes the level and quality of care is minimal.

 

After a 6 week jury trial, the jury compensated the family of a female resident $13.2 million after she was neglected resulting in painful pressure ulcers that caused her death.  The case involved Mary Dwyer, who was admitted to the Alaris Health at Harborview facility in Jersey City for short-term rehabilitation after falling at home and dislocating a shoulder.  Over the course of about three months, the 87-year-old Dwyer developed large Stage IV ulcers, lost 20 pounds, underwent nine wound debridements, two bone shavings and a colostomy — conditions and treatments that  were “unnecessary and preventable.” She died on Feb. 27, 2010. Hundreds of Haborview workers went on strike for three days in 2010 to protest low wages and short staffing. The 180-bed, for-profit facility vigorously denied the charges and refused to accept responsibility.

“With adequate staffing and a properly run facility she would have completed her rehab and gone back home,” reads a statement from her attorneys at Stark & Stark. “Instead, she died an undignified death in pain.

 

 

 The Daily Mirror reported on the horrific but common problem of elderly starvation in long term care facilities.  The article talked to a nursing home assistant who watched residents waste away in front of her because of lack of nutrition and hydration.  The nursing home worker has spoken of witnessing first hand how malnutrition is a major problem in the care of the elderly in nursing and residential homes. The worker claims she has raised her feeding concerns for residents with management but her appeals have fallen on deaf ears. "I’ve raised this with management and nothing’s done about it. It’s being brushed under the carpet,” she alleged.

Several people are known to have died of hunger in Northern Ireland hospitals between 2008 and 2012.  The shaming statistics have sparked growing calls for Health Minister Edwin Poots to take action.  “Staff are constantly raising this as an issue internally and externally but they are not being listened to,” he claimed.