Here’s eye-opening news: Currently, 4.2 million Americans ages 40 and older are visually impaired. Of these, 3 million have low vision. By 2030, when the last baby boomers turn 65, the number of Americans who have visual impairments is projected to reach 7.2 million, with 5 million having low vision.

For the millions of people who currently live or will live with low vision, the good news is there is help.  But first, what is low vision? Low vision is when even with regular glasses, contact lenses, medicine, or surgery, people have difficulty seeing, which makes everyday tasks difficult to do. Activities that used to be simple like reading the mail, shopping, cooking, and writing can become challenging.

low vision

Most people with low vision are age 65 or older. The leading causes of vision loss in older adults are age-related macular degeneration, diabetic retinopathy, cataract, and glaucoma. Among younger people, vision loss is most often caused by inherited eye conditions, infectious and autoimmune eye diseases, or trauma. For people with low vision, maximizing their remaining sight is key to helping them continue to live safe, productive, and rewarding lives.

The first step is to seek help.

“I encourage anyone with low vision to seek guidance about vision rehabilitation from a low vision specialist,” advises Paul A. Sieving, M.D., Ph.D., director of the National Eye Institute (NEI), one of the National Institutes of Health (NIH) and the federal government’s principal agency for vision research.

What is a low vision specialist? A low vision specialist is an ophthalmologist or optometrist who works with people who have low vision. A low vision specialist can develop a vision rehabilitation plan that identifies strategies and assistive devices appropriate for the person’s particular needs. “A vision rehabilitation plan helps people reach their true visual potential when nothing more can be done from a medical or surgical standpoint,” explains Mark Wilkinson, O.D., a low vision specialist at the University of Iowa Hospitals and Clinics and chair of the low vision subcommittee for the National Eye Health Education Program (NEHEP).

Vision rehabilitation can include the following:

  • Training to use magnifying and adaptive devices
  • Teaching new daily living skills to remain safe and live independently
  • Developing strategies to navigate around the home and in public
  • Providing resources and support

There are also many resources available to help people with low vision. NEI offers a 20-page, large-print booklet, titled What You Should Know About Low Vision, and companion DVD, featuring inspiring stories of people living with low vision. This booklet and DVD, among other resources, are available at www.nei.nih.gov/lowvision.

With the aging of the population, eye diseases and vision loss have become major public health concerns in the United States. NEI is committed to finding new ways to improve the lives of people living with visual impairment. Aside from making information and resources readily available, NEI has dedicated more than $24 million to research projects on low vision, including learning how the brain adapts to vision loss; strategies to improve vision rehabilitation; and the development of new technologies that help people with low vision to read, shop, and find their way in unfamiliar places. Research like this will help people with low vision to make the most of their remaining vision and maintain their independence and quality of life.

The Wall Street Journal had an interesting article about surgical errors in hospitals.  Surgery can be risky by its very nature, and the possibility of error or negligence makes it even more so. According to an analysis last year in the journal Patient Safety in Surgery, 46% to 65% of adverse events in hospitals are related to surgery, especially “complex” procedures.  Procedures are still performed on the wrong body part and surgical tools are sewn up in patients.

The consequences of surgical error are huge, both for patient health and hospital finances. A 2012 study by researchers at Johns Hopkins estimated that there are 4,082 malpractice claims each year for “never events”—the type of shocking mistakes that should never occur, like operating on the wrong body part. In nearly 10,000 cases studied, which took place from 1990 to 2010, never events led to death in 6.6% of patients, permanent injury in 32.9% and temporary injury in 59.2%. The total payout in those cases was $1.3 billion.

 

“Given all of the current technology, strategies and tools that are available to prevent these occurrences, it is unacceptable that foreign objects are still being left in surgical sites and that wrong-site surgeries are still occurring,” says Lisa Freeman, executive director of the nonprofit Connecticut Center for Patient Safety.  Many hospitals are participating in the National Surgical Quality Improvement Project, or NSQIP, overseen by the American College of Surgeons and adapted from an effort at Veterans Administration hospitals that helped decrease postoperative death rates by 47% from 1991 to 2006. “All too often, patients are being harmed by preventable complications,” says Clifford Ko, a colorectal surgeon at UCLA and director of NSQIP. Many hospitals don’t collect reliable data on their own adverse events, and “you can’t improve a hospital’s surgical quality if you can’t measure it.”

There’s also a movement afoot to change how some surgeons behave. Often seen as the rock stars of medicine, surgeons can be hard to rein in, resisting efforts to conduct preoperative briefings and being dismissive and curt if not downright intimidating to underlings. According to a study in the American Journal of Surgery in January, they are the specialists most commonly identified as “disruptive physicians,” and their outbursts can shift the focus away from the patient and lead to increased mistakes during procedures and diminished respect from colleagues.

 

ABC Chicago reported that Illinois may become the next state to allow video security of nursing home residents.  The ABC7 I-Team reported last spring that cameras are legal in four states.  Ten months after an ABC7 I-Team investigation of nursing home abuse, legislation was introduced in Springfield that would help family members who want to keep closer watch on their loves ones. Under the proposal, surveillance cameras could be put in the rooms of nursing home patients.

Health care experts and family members of nursing home residents say that surveillance cameras would help keep elderly patients safe, improve the state’s nursing home care ranking, which is near the bottom nationally, and save taxpayer money from being wasted.

The latest Department of Public Health report cites 106 Illinois nursing home residents were victims of theft, abuse and neglect.
“If we can prevent 10 percent, 20 percent, 50 percent of the suffering of these seniors by making sure they are recorded and people know that their actions will be seen, it would be a wonderful thing,” said Rep. Greg Harris (D-Chicago).  Rep. Harris says Attorney General Lisa Madigan asked him to draft legislation. Under the proposed law:

  • Nursing home cameras would have to be visible
  • Resident’s roommates and staff notified in advance
  • Patients would be responsible for paying

“Having eyes on the patients, being able to have a clear record of what goes on, should enable guaranteed better care and it should protect them if they’re concerned that somebody make a frivolous charge,” Rep. Harris said.  Under the law, the state would put up $50,000 for residents who couldn’t afford cameras, recipients to be chosen by lottery.

The New York Times reported changes to the Nursing Home Compare website on CMS.gov.  The federal government announced that it was changing the way it measures nursing homes, essentially adjusting the curve that it uses to rate homes to make it more difficult for them to earn coveted four- and five-star government ratings.  Under the changes, scores are likely to fall for many homes, federal officials said, although they did not provide specific numbers.

“In effect, this raises the standard for nursing homes to achieve a high rating,” said Thomas Hamilton, the director of the survey and certification group at the Centers for Medicare & Medicaid Services, which oversees the ratings system.  Nursing homes are scored on a scale of one to five stars on Nursing Home Compare, the widely used federal website that has become the gold standard for evaluating the nation’s more than 15,000 nursing homes even as it has been criticized for relying on self-reported, unverified data.

In August, The New York Times reported that the rating system relied so heavily on unverified information that even homes with a documented history of quality problems were earning top ratings. Two of the three major criteria used to rate facilities — staffing levels and quality measures statistics — were reported by the homes and not audited or verified by the federal government.

In October, the federal government announced that it would start requiring nursing homes to report their staffing levels quarterly — using an electronic system that can be verified with payroll data — and that it would begin a nationwide auditing program aimed at checking whether a home’s quality statistic was accurate. 

The changes were part of a further effort to rebalance the ratings by raising the bar for nursing homes to achieve a high score in the quality measures area, which is based on information collected about every patient. Nursing homes can increase their overall rating if they earn five stars in this area. The number of nursing homes with five stars in quality measures has increased significantly since the beginning of the program, to 29 percent in 2013 from 11 percent in 2009.

The updated ratings will also take into account, for the first time, a nursing home’s use of antipsychotic drugs, which are often given inappropriately to elderly patients with dementia.

 

IJ Review had the story and video of a resident being abused by caregivers.  In 2012, video evidence surfaced showing a brutal abuse of an elderly woman by two aides at a nursing home in Oklahoma City. Jurors awarded the woman’s family $1.2 million for emotional distress with an additional $10,000 in punitive damages, KOCO reports.

At Quail Creek Nursing and Rehabilitation Center in Oklahoma, two aides shoved latex gloves down the throat of Eryetha Mayberry while she sat helplessly in her wheel chair.  Wes Bledsoe, an advocate for reforms in nursing homes, discussed the harrowing footage:

“In my mind, there’s absolutely no question that these aides had abused other residents before this… This was not the first time that they had ever abused a resident and if it had not been for that camera they would have continued to abuse other residents.”

Lucy Waithira Gakunga and Caroline Kaeseke, the two women caught abusing Mayberry, were found guilty of abuse. Kaeseke is rumored to have fled the country while Gakunga served two years and was subsequently deported for her crimes.

Mayberry passed away less than six months after the abuse took place. She was 96 years old and suffered heavily from dementia and Alzheimer’s disease.

 

The NY Post reported that a settlement has been reached in the seven year case involving a resident who froze to death.  Prospect Park has agreed to settle the wrongful death lawsuit filed by his family for $750,000 — while the home’s half-dozen remaining residents still suffer in freezing temperatures, according to court papers and a lawyer for the judge’s family.  The late Civil Court Judge John Phillips — known in his heyday as “the kung-fu judge” because of his black belt — froze to death in his Prospect Park Residence apartment, court papers state. “Judge Phillips froze to death while confined to an unheated apartment at the defendants unlicensed facility in February 2008,” according to court papers filed by Phillips’ estate in 2010.

“The judge’s wrongful death is not an isolated incident,” said lawyer John O’Hara, who represents the Phillips estate. “He was confined and they were blocking doctors from seeing him and the heat went off and he froze to death seven years ago today. And there are still people freezing in there.”

An elderly woman who currently lives in the facility said the dining room and other common rooms are unheated and that the residents often eat in their rooms so they don’t have to brave the freezing dining room. “It was really bitter cold [at breakfast this morning.] My fingers were like ice. They had a little space heater but it didn’t generate any heat,” said the woman, who didn’t want her name used because she fears retaliation.

 

The Saratogian News reported that a long-time employee and relatives of residents at the former Maplewood Manor nursing home disclose that residents aren’t being fed, bathed and cared for properly since new owners took over on Feb. 1.  The employee states that residents were verbally and physically abused by one of the nearly three dozen temporary agency workers brought in from New York City to fill staffing shortages.  But another person said medicine wasn’t administered in a timely manner to their family member, and that the facility ran out of bibs and wash cloths last weekend. “I watched an aide use disposable paper ones,” the person said. “My family member cried out like it was sandpaper.”  A current long-time employee said patient alarms sometimes aren’t attached, food is simply left with residents that need assistance eating, and residents who previously were changed and put to bed by early evening are still in wheelchairs — wearing urine-soaked diapers — close to midnight. “Since it switched over there’s been a lot of neglect,” the employee said. “I blame it on these agency people and I blame it on Zenith because they weren’t prepared (for the changeover).”

The principal owners of Long Island-based Zenith Health Care Group, Ari Schwartz and Jeffrey Vegh, purchased Maplewood Manor from Saratoga County for $14.5 million. The facility has been renamed Saratoga Center for Rehabilitation and Skilled Nursing Care.  Since the ownership change pay has been reduced from about $21 to $15.10 per hour, that employee healthcare contributions have gone up and that it takes longer to become eligible for sick time and vacations.  One employee resigned this week, in part because the workload had become too great.

 

The Star Tribune reported that a severely disabled resident at Walker Methodist Health Center in Minneapolis was sexually assaulted last December by an employee who had entered the resident’s room at night, according to a state investigation.  A witness reported seeing the alleged assailant moving back and forth in a “thrusting motion” about four times, while the resident was on the bed with bare legs exposed. The witness noticed that the resident’s incontinence product was open on the bed during the assault, indicating that the victim’s undergarments were open.

After being discovered, the alleged assailant “quickly moved back from the resident, placed the resident’s legs back on the bed and replaced the incontinence product.” The witness immediately contacted the night supervisor who removed the alleged assailant from the floor.  Police were called and the alleged assailant was taken to jail and charged with sexual assault, according to the state report.

The Minnesota Department of Health, which investigates reports of maltreatment at nursing homes, cited the individual employee for abuse, but not Walker Methodist.   Reports of abuse and neglect at Minnesota nursing homes have soared over the past four years. The state received 553 maltreatment reports in the 2013 fiscal year, up from 283 in 2010, according to state data.

 

Vox reported on dying in America based on the research by Kaiser Health News, a nonprofit national health policy news service, with support from The SCAN Foundation.  15 years ago, the Institute of Medicine released its seminal 1997 report detailing the suffering many Americans experience at the end of life and offering sweeping recommendations on how to improve care.  It has gotten worse since then.

Despite efforts to build hospice and palliative care programs across the country, the number of Americans experiencing pain in the last year of life actually increased by nearly 12 percent between 1998 and 2010, according to a study released in the Annals of Internal Medicine. In addition, depression in the last year of life increased by more than 26 percent  even though guidelines and quality measures for end-of-life care were developed, the number of palliative care programs rose and hospice use doubled between 2000 and 2009.

Most physicians tend to under-treat pain and other symptoms at the end of life because they don’t recognize them or are hesitant to talk candidly about the process of dying and the pain associated with it, said Dr. Tim Ihrig, a palliative care physician at UnityPoint Health in Fort Dodge, Iowa.

Buffalo News reported that nine months have passed since a hidden-camera investigation led to the arrest of 17 workers at HighPointe.  It was late April and the employees – a registered nurse, seven licensed practical nurses and nine certified nursing aides – stood accused of neglecting a bedridden man under their care.  Each worker at HighPointe on Michigan pleaded guilty and has been sentenced, ending a story that cast yet another critical spotlight on nursing home care across the region.  Initially charged with felony crimes, the defendants ended up pleading guilty to only misdemeanors or violations. With one exception, a nursing aide who went to jail for 15 days, each was sentenced to community service.

As part of their sentences, they are required to take part in a “scared straight”-style program intended to educate other nursing home workers. “They worked in the most difficult, short-staffed unit,” said Charles J. Marchese, a defense lawyer in the case.  Marchese said the workers took the fall for the owners, who failed to provide its staff with the proper training and resources to adequately do its job.

The allegations against the 17 workers revolved around a single patient.  With the help of footage that came from a camera hidden in the man’s room, state investigators accused the nurses and nursing aides of ignoring their responsibilities. They said nurses failed to check on him and dispense pain medication, and aides failed to provide incontinent care and give him liquids.  The workers also faced allegations of falsifying documents to conceal their neglect.