Medical News Today had an interesting article on the new guidelines issued by The American Academy of Orthopaedic Surgeons (AAOS) Board of Directors.  AAOS approved Appropriate Use Criteria (AUC) for treatment and rehabilitation of elderly patients with hip fractures, in addition to postoperative direction to help prevent fractures from recurring.

Hip fractures are one of the most feared injuries in older adults because this trauma creates pain and can force a change in lifestyle or limited mobility. We are providing evidence-based assistance for physicians and patients to determine the best course of action for surgery and follow-up care,” said Robert Quinn, MD, AUC Section Leader for the AAOS Committee on Evidence-Based Quality and Value.

Pinning bones back together using surgical screws versus reconstructing the hip joint through total hip replacement (THR) surgery has long been debated. The AUC criteria rely on peer-reviewed studies and practices to recommend different procedures depending on a patient’s individual indications such as activity levels, bone and joint health, location(s) of the fracture, and whether the break is stable or displaced. The AUC addresses patients age 60 and above with fractures caused by low-impact events.

The AUC panel reviewed 30 potential patient scenarios to create the “Appropriate Use Criteria for the Treatment of Hip Fractures in the Elderly.” Each treatment in each patient scenario is rated “appropriate,” “may be appropriate,” and “rarely appropriate.”  For example, THR is rated “appropriate” for a highly active patient with a non-displaced fracture in the neck of the femur bone. However, the same procedure is “rarely appropriate” for a non-ambulatory patient.

Another example rates reattaching bone with a specific type of screw (sliding hip anti-rotation screws) as “appropriate” for highly active patients with and without arthritis who have a stable fracture of the intertrochanteric crest, located near the top of the femur.

Accompanying the AUC, the AAOS created a “Preoperative Checklist” to assist surgeons and allied medical providers in delivering quality care to patients by completing 12 important initiatives. They include limiting preoperative traction; managing Warfarin, a blood-thinning medication; and discussing the patient’s home environment prior to discharge.

The second AUC, “Appropriate Use Criteria for Postoperative Rehabilitation for Low Energy Hip Fractures in the Elderly,” provides universal recommendations for recovery across elderly patient populations including:

  • Interdisciplinary care to prevent deep vein thrombosis
  • Prevention or management of postoperative delirium
  • Multi-modal perioperative pain management
  • Interdisciplinary management of recovery at rehabilitation and skilled-nursing facilities
  • Home care therapy following discharge
  • Osteoporosis assessment and management.

Supplementing the AUC, a “Perioperative Prevention of Future Fractures Checklist,” emphasizes important follow-up measures to reduce patients’ risk for future injuries. Participation in a fall prevention program, and supplements and medications to improve bone density are among the recommendations.

“It is very important to think ahead to make the right care choices after a fracture is repaired. Not only can this help patients recover, but this also helps prevent fractures from happening again, which is a big problem,” Dr. Quinn said.

AAOS created the AUCs following the 2014 release of the Clinical Practice Guideline (CPG) “Management of Hip Fractures in the Elderly,” which gives a broad overview of care options. In contrast, the AUC provides guidance for circumstances when a specific surgical procedure should be applied.

McKnight’s reported that the federal government has thrown its weight behind whistleblower complaints against skilled nursing chain SavaSeniorCare LLC.  Authorities joined three lawsuits accusing the massive provider of “routinely” billing for therapy services that were either unnecessary or not medically reasonable.  Prosecutors consolidated the complaints, alleging that SavaSeniorCare “exerted significant pressure” on its skilled nursing facilities to meet “unrealistic” financial goals that pushed facilities to disregard patients’ medical needs and provide unnecessary therapy services. 

The government also says SavaSeniorCare delayed patients’ discharges in order to increase Medicare payments, per a Oct. 29 Department of Justice statement.  The three lawsuits were all originally filed by former SavaSeniorCare employees, who claim that the company often submitted false Medicare claims for rehabilitation.  SavaSeniorCare is listed as the nation’s fifth-largest nursing facility company, with more than 24,000 beds.

The lawsuits against it are being handled by the Justice Department’s Civil Division’s Commercial Litigation Branch and the U.S. Attorney’s Office of the Middle District of Tennessee. U.S. Attorney’s offices in Texas and several federal agencies, including the Office of Inspector General, also have taken an active part.

 

WBTW reported the bizarre and tragic death of Virginia Ann Lawton, 69, of Chapin, S.C.  She was killed after a tragic accident in the parking lot of White Oak Manor Nursing facility in Newberry around 3:15 p.m.

Coroner Craig Newton says Lawton was sitting in her car for a very short period of time before she “apparently put the vehicle in reverse gear and then for an unknown reason exited the vehicle and began walking to the back door area.”  Lawton tried to get back into the vehicle after the car began to roll backwards.

Coroner Newton says at that point “Lawton attempted to re-enter the vehicle to put it in park, but while doing so… [she] was knocked to the ground by the open driver’s door.” The vehicle rolled over Lawton, trapping her, according to Newton.

Lawton was taken to Newberry Memorial Hospital and died shortly after arriving. She died due to injuries sustained in the accident, Newton says.

 

McKnight’s reported that the Medicare Payment Advisory Committee recommended Congress freeze market-basket updates for facilities for fiscal years 2017 and 2018. MedPAC pushed for the payment rate freeze, because the level of Medicare payments to SNFs “remains too high.”

The group’s draft also recommends that the SNF prospective payment system be revised, due to differences in Medicare margins that reflect the “systematic biases of the PPS that need to be corrected.” Those biases include PPS’ continued favor of therapy over complex care, and a wide variation in margins that reflects patient selection, service provision and cost control, MedPAC said.

MedPAC commissioners showed support for the SNF draft recommendations, but gave no word on whether it would come up for a formal vote in January, according to Bloomberg BNA.  Although MedPAC may formally recommend the policy to Congress, lawmakers are not obligated to take action.

Other MedPAC recommendations, including a freeze to hospice payments and a cut to Medicare Advantage reimbursements, have been slated to be voted on in January and presented to Congress in March.

The Mercury and ABC both reported the tragic preventable death of Barbara Westcott.  Michelle Sorentino, a care assistant at Vaucluse Gardens Aged Care nursing home, found Westcott trapped between her mattress and bed pole. Ms Sorentino said she was the only member of staff working in The Manor that night.  The facility had about 26 residents, spread over four floors, with a number requiring high levels of care.

Westcott was lying face down with her head and neck stuck between her mattress and bed pole, and with her knees on the floor.  A post-mortem examination determined Ms Westcott had died of position asphyxia, or suffocation. A bed pole is a device that allegedly helps patients get in and out of bed.  Staff at Vaucluse Gardens had been emailed warnings about the dangers of the bed poles.

Ms Sorentino said she thought none of the residents “received the care they paid for” and that she would not put a relative into the aged care facility.  She said she had complained to her management about understaffing, describing it as “unsafe” but was told there would be no change. Ms Sorentino said she had never seen Mrs Westcott use the bed pole, but that it had been there “a long time”.

The inquest heard Mrs Westcott required half hourly checks but nursing staff had told police the last time she was checked was about 8:30pm or 9:00pm on the night she died.  Attending police checked patient charts which did not indicate a check after 2.30pm.  Despite staff being required to check Ms Westcott, the inquest heard the high-needs patient wasn’t checked for at least 2½ hours prior to her death and possibly for up to nine hours.

 

The inquest also heard several documents requested from the nursing home had not yet been provided, including staff rosters and ratios as well as policies and guidelines on the use of bed poles.

 

 

 

GoUpstate reported the $20 million nursing home facility being built by the for profit White Oak Manor chain. The company operates 15 nursing home and independent living facilities with about 2,100 beds and 2,700 employees in the Carolinas.  Spartanburg-based White Oak Management broke ground on a new $20 million nursing home facility on about 18 acres at North Grove Medical Park near Boiling Springs.

Designed by Stuart Barber with McMillan Pazdan Smith Architecture, it will follow a national trend focused on “deinstitutionalizing” nursing home design. The 82,000-square-foot, 132-bed facility will operate as White Oak of North Grove.  “Nothing like this exists in the region to the best of my knowledge,” said Barber, whose father, John Barber, serves as chief financial officer of White Oak Management.

“We are very excited about it,” said Cecil, whose family founded the company in 1964. “This is a very big project for us and we’re happy to be able to do something like this.”  Doug Cecil, president of White Oak Management, said the facility is expected to be completed by late next year.

Site plans filed with the county show the facility will be separated into three X-shaped wings.  Each wing will support two separate “households.” Each household has 21 rooms, along with living rooms and dining spaces. Baths will be replaced by spas. Nurses’ stations will be hidden. There will be a large community room, a beauty shop and several dining places. The facility will be surrounded by landscaped courtyards. Residents will be able to meet up and socialize at different spots.

WJTV reported that Belinthia Ross was convicted for simple assault of a vulnerable person.  Attorney General Jim Hood said the investigation determined that 32-year-old Ross hit an 83-year-old woman at a nursing home. The victim was unconscious and bruised after she was hit.

Judge William E. Chapman III has set the sentencing for February 2016. Ross faces up to five years behind bars and/or a $1,000 fine and was immediately taken into custody.

 

An assisted living resident is accused of sexually abusing another resident and 9 Investigates uncovered documents that show the former director knew about it and tried to cover it up.  Documents said the staff at Seasons by Riviera assisted living facility raised concerns about a dementia patient who they claim was overly sexual. But the state found those claims were ignored.

The report said the man who was the director at the assisted living facility did not do enough to protect the residents.  State officials believe the former director knew the accused attacker was also aggressive toward women at another facility.  A state investigation determined the former executive director falsified records to cover up the abuse by a male patient with dementia.

The report also found the director failed to get the victim immediate medical care and failed to alert authorities. The Agency for Healthcare Administration is revoking the facility’s license and slapping it with a $25,000 fine. The Department of Children and Families is also investigating the abuse and neglect.

Assisted living facilities are required by state law to report suspected abuse or neglect to law enforcement.  The staff here wrote a report about the sexual abuse but state officials said the former director threw it out because it was inappropriate and he did not believe anyone was abused.

 Beachwood Pointe Care Center nursing home and its parent company, Provider Services, will pay $1 million to the family of a resident who died due to the facility’s “negligence and recklessness,” including infected pressure ulcers, a judge ruled. A jury in Cuyahoga County Common Pleas Court awarded Stevens’ estate $560,000 in punitive damages and $440,000 in compensatory damages.

Mary Stevens, a 71-year-old resident, died in 2012 following injuries caused by staff negligence, according to a lawsuit filed by her estate. Stevens also suffered from infected pressure wounds, and sustained “severe” and “fatal” injuries while living at Beachwood Pointe, the lawsuit claims.

According to the lawsuit, the Stevens’ family and physician were never notified of her injuries, and she was “not provided with a safe environment” prior to her death.

 

Fox61 reported the disturbing and reckless indifference shown by Ellis Manor nursing home in Hartford and the Department of Public Health after being informed that a resident was being abused.  In an exclusive interview, Patricia J. told FOX 61 that she first noticed scratches on her mother in 2012 and questioned Ellis Manor staff. “I asked how did the scratches get there,” said Patricia. “They didn’t kind of know. We kind of said, well maybe your mom did it.”

Patricia said she continued noticing a pattern of scratches, even when gloves were placed on her mother’s hands. She said the scratches would stop whenever she would stay overnight in her mother’s room.  Patricia said she mentioned the scratches to a state inspector on site at Ellis Manor in 2013. She was told that “unless I had further proof to show them that she [her mother] was doing it, then there wasn’t no need for an investigation.”

For two more years, Patricia said she continued to question Ellis Manor. In July 2015–still waiting for answers–Patricia said she placed a hidden camera inside her mother’s room, collecting video for six weeks. The video shows Patricia’s mother shoved in her bed and left without oxygen, which she is supposed to be connected to at all times. The video also shows a nurse’s aide spinning her oxygen tubes.

Patricia said after collecting the surveillance video, she began calling the Department of Public Health. “I kept calling and saying, ‘Look, I have something,’” explained Patricia. “’I have facts. I have proof. I need to speak to someone now. Can you have someone call me back? I need to speak to a manager.’ Well, they told me…that that’s not policy and procedure. You send something in writing and we get it in the mail, and once we get it and review it and if it’s something that needs to be investigated, we go out there and we do it.”

Patricia said when she asked for a time frame, DPH told her that after sending in a written request, it would take anywhere from three to six months. Dissatisfied, Patricia said she took the surveillance pictures to Ellis Manor management.

After seeing the images, Ellis Manor took immediate action, firing eight nurses assistants, replacing its administrator and director of nursing and paying closer attention to its operations. “[We are] watching people perform care,” said newly-appointed Ellis Manor administrator Judy Johnson. “We’ve done additional training. We watch. We just have more eyes in place.”

DPH found several violations based on Patricia’s images and following an investigation prompted by Ellis Manor, which had a legal obligation to report Patricia’s complaints to the state.  DPH uncovered 22 violations, including insufficient staffing and reports of residents wandering from the facility.

Patricia also told FOX 61 that the Hartford Police Department is now opening a criminal investigation into her case.

This is a great example of why South Carolina needs to allow video cameras in nursing homes.