Pearce Adams wrote an article for the Independent Anderson Mail about an administrator of an assisted living facility stealing from his residents.  He was arrested on Wednesday and charged with exploitation of a vulnerable adult.

Robert Dunmoyer, 57, was allowed to post a $25,000 bond in Anderson Municipal Court the attorney general’s office made the recommendation, citing Robert Dunmoyer’s "cooperation" with the investigation.   Dunmoyer, former administrator with the Magnolia Residential Care center in Anderson, tricked a 75-year-old resident to give Dunmoyer power of attorney for the man. That step gave Dunmoyer legal authority to handle the man’s bank accounts and investments.

Supposedly, Dunmoyer took responsibility for his actions after he got caught.  He made excuses for his behavior stating that he was having personal problems from a divorce that “created the state of mind” that allowed him to steal and take advantage of his resident. 

Dunmoyer had taken “approximately $100,000 from (the elderly man’s) account with them,” and charged the man $9,500 to handle his stocks, the report states.

Ken Moore, representing the state unit that investigates nursing home and assisted living home crimes, testified that between July 2007 and April, Dunmoyer withdrew $60,000 without the consent of the elderly man.

The discrepancy between the amount mentioned in court and that listed in the incident report was not addressed. Moore said Dunmoyer “told us what he did and why he did it” and was cooperating with authorities.

I stumbled across this article from the New York Times which I found interesting regarding violence against nurses being a serious issue – especially in terms of workplace violence.  It reminded me that in all the talking we do about abuse and neglect of patients, we sometimes forget that nurses and aides, and really anyone providing "front-line" care to patients in a health care setting, are at risk for abuses as well.

The article points out that workplace violence is 12% higher in for nurses and personal care aides than in the private sector, which may not sound like a lot, but certainly seems like a high risk if you work in this field.  The article goes on to say that the most dangerous setting is psychiatric facilities and nursing homes due in part to patient confusion.  However, the author also points out that part of the problem in these settings is the long wait time for services in places like nursing homes and emergency rooms.  This is made worse still by the nursing shortage.

"Nurses say the persistent nationwide nursing shortage is making matters worse, because understaffing increases the risk of violent incidents. And nurses cite the fear of assault as a reason for low morale, especially if they feel that management does not share their concern."

We have to remember that often times, our clients, our family members, our patients (whatever angle you look from) are quite often not the only victims in these situations.  Many times, too many times, the people who provide the care are victims as well – if they don’t have enough support, then they effectively have an increased risk of being harmed.  Interesting, isn’t it – without enough staff, we know the care of the resident’s suffers, but we forget that short staffing affects the staff as well.

I, myself, when working at a nursing home, have been cornered in my office by an elderly lady who was furiously swinging at me.  I was a social worker, the resident was in my office because she had been disruptive all day and the nurse’s simply couldn’t watch after her anymore.  I realized right quick that part of the fear is that they might injure you (its amazing what sort of strength a demented, angry 95 pound woman can have), and part of the fear becomes that you might injure them in trying to protect yourself.

I don’t know what the solution is, but I am reminded again, as I often am, about a discussion with a friend about one way to keep plenty of good staff is to pay them well – pay them to continue to care, pay them to be accountable for the care they provide.  Of course, I know that money is not the absolute solution, but Management types should certainly know that if they have good staff, they should pay them to stay – and while thy’re there, they have to listen to and support them emotionally.  If Management sees their front line staff as just another warm body, then eventually morale becomes such that you have just that, another warm body.

It takes a certain, special kind of person to care for patients of all kinds, nursing home residents included.  The article reminded me that we have to remember that caregivers are sometimes victims as well, and often through no fault of their own.  And, like the residents they care for, they should have some measure of safety as well.  Thoughts?

Online Nursing Home Resource Provided by IQ Nursing Homes.  IQ Nursing Homes announces the launch of their new website, a comprehensive online research tool for nursing home residents and concerned family members.

(EMAILWIRE.COM, July 17, 2008 ) New York – IQ Nursing Homes announces the launch of their new website, a comprehensive online research tool for nursing home residents and concerned family members. A national nursing home directory, up-to-date nursing home news, nursing home deficiency reports, and legal resources for victims of nursing home abuse and elder neglect cases are now just a click away on one easy to navigate site.

With increased life expectancies in today’s society leading to higher numbers of nursing home residents, IQ Nursing Homes recognized the need to create a free, complete online nursing home resource. Careful research is imperative to ensure that the nursing home to which you entrust your loved one’s care is reputable and safe. When you visit IQ Nursing Home’s national directory to locate elder care facilities in your area, you can also check nursing home deficiency reports to make sure the facility you choose provides the best care possible to its residents.

In addition to directories and information, IQ Nursing Homes provides a way for nursing home employees, residents, and their families to combat elder abuse and neglect. These are serious, prevalent problems that can result in physical and emotional suffering. Painful bed sores, broken hips, and even death are among the afflictions the nursing home residents face at the hands of negligent or abusive caregivers. Resources to help individuals recognize and report these problems are available on the IQ Nursing Homes website, including signs and symptoms of abuse and neglect and an anonymous abuse report form.

If abuse is suspected, a free nursing home abuse case evaluation is also available on the site. IQ Nursing Homes has partnered with expert nursing home lawyers and law firms throughout the country with the goal of putting a stop to the victimization of the elderly. By holding negligent and abusive staff members accountable for their actions and making it financially devastating for nursing homes to allow abuse and neglect to occur, this epidemic can be put to an end.

Be IQ Smart. Visit http://www.iqnursinghomes.com/ to learn more.

This press release was issued through GroupWeb EmailWire.Com. For more information on unlimited press release distribution service, go to http://www.emailwire.com

House subcommittee passes nursing home arbitration bill (07/17/08 McKnight’s Long Term Care News)

The House Judiciary Subcommittee on Commercial Law and Administrative Law Tuesday approved the Fairness in Nursing Home Arbitration Act, which would outlaw signing an arbitration agreement as a prerequisite to admission in a nursing home.

Republicans on the subcommittee voted against the measure but came up short in a 5-4 vote. Some members tried to add amendments that would remove some of the sting for nursing homes. Rep. Chris Cannon (R-UT) tried to add language that would exclude physicians and providers in nursing homes from the bill, ensure the bill would not be retroactive, as well as other provisions. All these amendments were shouted down in voice votes.

The subcommittee’s approval moves the bill one step closer to becoming law. Long-term care advocates oppose the legislation, arguing that arbitration agreements allow them to channel limited Medicare and Medicaid resources to providing quality care instead of funding lengthy court trials.  

Of course, no Medicaid or Medicare money actually goes to defending lawsuits since insurance companies pay for the defense of the claim.  What is really needed is a bill that mandates minimum amounts of insurance for each facility–something in the amount of 10% of gross revenues.

I know I’m about a week behind on this one, but I think it’s important.  Jane Gross wrote a piece for one of the New York Times blogs about all the decisions that needed to be made for her mother towards the end of her life.  In the piece titled What I Wish I’d Done Differently, Ms. Gross talks about everything from having a geriatrician to selling her mother’s house, and all the uncertainties in between.

She points out, quite correctly that there’s no way to be without uncertainties in situations like this, but that she would have liked to known prior to making some decisions that ultimately limited the choices they had later in regards to her mother’s care.

Something to think about this afternoon . . .

Article about lawsuit over husband’s fall at nursing home by David Yates, writer for The Southeast Texas Record. 

The nursing home staff found him in a pool of his own blood two years ago.  Clifford Ozen has suffered from seizures and decreased mobility sinc ethat fall.  The Senior Rehabilitation and Skilled Nursing Center in Port Arthur allowed Mr. Ozen to fall from his bed.  His wife, Sharon Ozen, filed suit against the healthcare provider July 9 in Jefferson County District Court.

On July 28, 2006, Sharon Ozen visited her husband at the 199-bed rehabilitation facility.   After leaving the center, Sharon received a call and was advised that her husband was being rushed to the hospital.   "According to Mr. Ozen’s chart, an aide called a nurse because he was found on the floor with his head lying against the frame of the bedside table," the lawsuit said. "Defendant’s staff observed blood on the floor in a puddle, as well as a contusion and laceration to the top of Mr. Ozen’s head."

Since the fall, Clifford Ozen has suffered from seizures and has been bedridden. Upon his admission to the nursing home in January 2006, Clifford was diagnosed with dementia, confusion, wandering and an unsteady gait.   All risk factors for falling.  Nursing home was on notice that he could fall but did nothing to try to prevent him from injuring himself even though his wife consented to the use of restraints and safety devicesto protect him.

"The only safety precautions being utilized for Mr. Ozen were side rails on his bed and geriatric chair," the suit says. "These precautions were used only intermittently. Further, during his stay, he was unable to ambulate himself and had an impaired safety awareness."

Sharon alleges she informed the nursing home staff of her concerns, but the healthcare provider negligently failed to assess her husband’s risk for falling.  The nursing home also allegedly "failed to adequately protect him from falling in light of his confusion, agitation and impaired safety awareness."

Senior Rehabilitation and Skilled Nursing Center is owned by Victoria, Texas-based Regency Nursing & Rehabilitation Centers, Inc.

The New Jersey Courier Post online had an article about how nursing homes’ populations are getting younger.  Below is an excerpt from the article:

At 45, John Eickmeyer is the youngest resident of the New Jersey Veterans Memorial Home on North West Boulevard.  His roommate is 86 and has advanced Alzheimer’s disease. That disparity isn’t unique to the veterans home.

Eickmeyer is one of a growing number of younger residents in long-term care facilities traditionally viewed as places for the elderly.   At the veterans home, the average age of residents is 81.

But, 24 of the home’s 290 residents — or roughly 7 percent — are under age 65.   In December 2003, 12.4 percent of New Jersey nursing-home residents were under age 65, according to the Centers for Medicare & Medicaid Services. In December, 14.3 percent were 65 or younger.
Across the country, 12.3 percent of nursing-home residents were under age 65 in December 2003. Last year, that number increased to 13.9 percent. In all instances, the vast majority of those residents were over age 30.

Health-care experts said the number of younger residents in nursing homes and assisted-living facilities will continue to grow, creating new challenges for administrators who must find ways to provide quality of life for residents who might be a half-century apart in age.

At first, Eickmeyer found it hard to adjust to being lumped in with an older crowd.

"It was culture shock," said Eickmeyer, who grew up in Waterford and lived in Hammonton before moving in to the veterans home.   He and some of the older residents disagreed on things as simple as room temperature.  But, Eickmeyer eventually saw an upside to living with people old enough to be his grandparents.

"Thrown into an environment like that, you listen first," he said. "I figured I could learn a multitude of information from older people, and I did."

"Within the next 10 to 15 years, there will be more of an influx of those who served in Vietnam, Desert Storm and more recent conflicts," he said.

Reach Tim Zatzariny Jr. at tzatzariny@thedailyjournal.com

Heather Johnson was kind enough to write a guest post for the blog.  We thank her for her contribution, and appreciate her expert advice.

How to Pick a Nursing Home for an Alzheimer’s Patient

Any family that’s been afflicted by having a member stricken by Alzheimer’s disease knows how immensely difficult and trying it can be. Many times it’s so hard because the person with Alzheimer’s disease is in perfect physical health. This makes the family so much more hesitant to put the relative in a nursing home because it seems like nothing is wrong and we want to believe that. However, we also know that as the disease progresses they can’t perform the daily activities safely and responsibly. It puts such a strain on the family that eventually the only choice is to look for a nursing home. This brings up the major issue of finding a place that can provide the care we demand. It can be an arduous search and here a few tips to help you as you look for that special place:

1. Staff ratios are of the utmost importance. Alzheimer’s disease patients need more direct care than your standard nursing home. Given the unpredictability of the disease and the actions of the afflicted it’s dire that they receive as much dedicated care as possible. Make sure the facility can guarantee at least a ratio of five patients to one caregiver.

2. Pay attention to the building’s architecture. Many Alzheimer’s disease patients have trouble making sharp corners. They do better with rounded hallways that don’t require sharp turns. All hallways should have hand railings to further assist patients with walking.

3. Group activities are important. Check to see that the facility offers small group activities instead of large ones. Alzheimer’s disease patients react much more favorably to working in groups under four than they do in larger groups.

4. Talk to relatives with family members already in the facility. This is sometimes the best way you can determine if the facility is the right place for your loved one. They will shoot you straight and answer your questions directly and honestly instead of a coordinator who needs to toe the company line and always put a positive spin on the facility’s deficiencies.

5. Discover what kind of experiences the patients can expect. There are many new techniques that some nursing homes offer their patients that help alleviate some of the accompanying discomforts that go hand-in-hand with those who suffer from Alzheimer’s disease. Aromatherapy and experimenting with dimmer lighting are a couple examples of ways nursing home deal with the anxiety that many suffer from on a daily basis.

By-line:

This post was contributed by Heather Johnson, who writes on the subject of Cruise Ship Nursing. She invites your feedback at heatherjohnson2323@gmail.com.

CLARK KAUFFMAN at DesMoinesregister.com wrote an article about a nursing home employee who stole a resident’s cat.  Luckily, the cat found his way back!  The article states that the Iowa nursing home has been cited by the state for numerous problems, including the theft of a resident’s pet cat.

Granger Nursing and Rehabilitation Center, located in Granger in Dallas County, was fined $7,500. Recently, investigators with the Iowa Department of Inspections and Appeals looked into allegations that employees at the home were attempting to get rid of an unnamed elderly resident’s cat.

The woman told inspectors someone had taken her cat and put it outside, although the cat did not run away. Later, the resident alleged, someone at the home took the cat and dumped it along a gravel road. The cat allegedly found its way back to the facility.   According to state records, inspectors interviewed seven employees, all of whom expressed concern that someone at the home intended to put the cat in the facility’s trash bin and kill it.

One worker allegedly told inspectors that the staff had been trying to dispose of the cat. The worker said that one night, while the resident was eating supper, she entered the resident’s room, placed the cat in a box and took it home for safekeeping. The worker said she intended to keep the cat only until she felt it could be safely returned to the nursing home.

Based on that worker’s statement, state officials cited the home for taking a resident’s property.

The Granger home has been cited for numerous other problems in recent months. Inspectors have alleged that:

A worker stole a resident’s pain medication for her own use. The worker allegedly took the resident’s Imitrix, a costly drug that is prescribed for the treatment of migraine headaches. The resident’s insurer had paid for the drug at a rate of $26 per tablet. The worker told inspectors she took the pills at the suggestion of the director of nursing. The director of nursing told inspectors she knew of only one instance in which the worker used the resident’s medication. She acknowledged that she did not report the theft to police or to state inspectors.

• As inspectors watched, a resident who was totally dependent on employees for assistance with eating was given little or no help with breakfast. At one point, the resident motioned to workers, pointing to a cereal bowl. One worker stopped and put milk and sugar on the cereal but then walked away. Twenty minutes later, the resident reached for a worker as she passed, but the worker only paused and walked away with the resident still pointing at his or her plate. A few minutes later, the resident was wheeled out of the dining room with most of the food untouched. At lunch, workers again failed to assist the resident with eating.

• One resident was mistakenly given double the amount of prescribed insulin for diabetes treatment.

• The home was cited for failing to ensure that residents had ready access to drinking water and for inadequate infection control.

• Inspectors watched workers walk through urine while providing care for one resident.

• One resident walked out of the home and was later seen by a passer-by crawling along the shoulder of a nearby highway. The passer-by alerted workers at the home, who picked up the resident and took him to a hospital for evaluation.

The Granger home has 61 residents. Federal records indicate residents of the home receive, on average, 18 minutes of daily care from a registered nurse, which is half the average of all Iowa nursing homes.

A recent Cornell University study reports aggression is commonplace in nursing homes–between residents themselves and between residents and employees of the nursing home.  Verbal and physical abuse is more common than the industry acknowledges. In an online report with McKnight’s Long Term Care News, the study documents many observations made at a city-based nursing home which found at least 35 different types of abuse, with screaming being the most popular. Physical violence included pushing, punching, and fighting.

The report also referenced another two-week study wherein researchers found that 2.4 percent of nursing home residents have been victims of physical aggression; 7.3 percent claimed they were verbally abused. A third report discussed an investigation in which 12 nurse observers found 30 incidents of aggression between residents in one eight-hour shift. Victims were most commonly male and often had “wandering cognitive processing problems.”

A report released earlier this year by the Congressional Government Accountability Office (GAO) revealed a widespread “understatement of deficiencies,” that included malnutrition, severe bedsores, overuse of prescription medications, and nursing home resident abuse in the nation’s nursing home inspection reports. The report stated that nursing home inspectors routinely ignore or minimize problems that pose serious, immediate patient threats.

Facilities are generally only inspected once a year by overworked and underpaid state employees. Federal officials sometimes attempt to validate state inspector work by joining them on visits or conducting follow-ups. It was in a follow-up that the GAO discovered the state missed at least one serious deficiency in 15 percent of all inspections. Worse, in nine states, inspectors missed serious problems in over 25 percent from 2002 to 2007.

There are 16,400 nursing homes with over 1.5 million residents nationwide; approximately one-fifth of the homes were cited for serious deficiencies last year. “Poor quality of care—worsening pressure sores or untreated weight loss—in a small, but unacceptably high number of nursing homes, continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said. Taxpayers spend about $72.5 billion annually to subsidize nursing home care and facilities must meet federal standards to participate in Medicaid and Medicare, which covers over two-thirds of its residents, at a cost of over $75 billion annually.

Unfortunately, nursing home abuse tends to be underreported because individual homes do not take elder abuse seriously and residents fear embarrassment, injury, even incapacitation for speaking up.