There is a great discussion on abuse in nursing homes that I found here.

Nursing Home Abuse is on the rise even though less people are entering nursing homes with debilitating conditions according to recent data. The true number is probably much higher but The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of abuse. There are nearly 1.4 million Americans that are living in nursing homes right now.

Unfortunately, a nursing home is not always the place of respite and healing it should be. According to the National Center’s study, 57% of nurses’ aides working in long-term care facilities admitted to witness, and even participating in, acts of nursing home abuse. The report sites systemic problems within the nursing home industry, like inadequate pay for workers and chronic understaffing, as contributing to the epidemic of abuse.

Neglect is the most common form of abuse. Residents in soiled beds and clothes, or those suffering from bedsores and frozen joints are most likely victims of neglect. Indications that a patient is over or under medicated can also signal neglect.

About 2500 cases of physical abuse or rape are reported each year.

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 A lawsuit against a Fort Smith-based nursing home company can proceed as a class-action suit, the Arkansas Supreme Court ruled this week.

The court affirmed a decision to grant class-action certification to a suit alleging Batesville Nursing and Rehabilitation Center failed to live up to contractual and statutory obligations to take care of the basic daily needs of hundreds of residents.

The suit, filed in 2005 by Annette Thomas, names the nursing home and its parent company, which was known in 2005 as Beverly Enterprises, as defendants. Beverly changed its name to Golden Horizons last year following its purchase by Golden Gate National Senior Care.

The suit alleges between Sept. 13, 2000, and June 30, 2004, the nursing home failed to care properly for 489 residents by, among other things, failing to provide adequate staffing and failing to provide a clean, safe living environment.

Attorney Philip Bohrer of Baton Rouge, La., argued the case did not include personal injury claims, but rather claims involving issues such as understaffing which would have affected all residents of the facility. Granting class-action status was preferable to "having 400 individual trials on the same issue and the same evidence," he said.

Bohrer also said many of the plaintiffs are elderly and unaware of their rights and would not be able to file individual claims against the company.

In its decision Thursday, the Supreme Court said the plaintiffs showed the case met the criteria for class-action certification. The justices agreed with Harkey the defendants would benefit from class-action status.

"A class action is clearly a more efficient way of handling a case where there is a predominating, common issue to be resolved for all 489 class members. A class action is also fair to both sides in this case, as it is a vehicle for all class members to have their claims heard, and Beverly will not have to defend against the same assertion of liability in a multitude of different lawsuits," Justice Robert Brown wrote.

 Police are investigating claims that a 91-year-old woman was raped at a nursing home.

The director of The Life Care Center says once they learned of the allegations on June 4, they immediately called the Department of Social and Health Services, Federal Way Police and the woman’s guardian.

Police say the rape happened about a month ago.

The family of the woman has removed her from the facility. The alleged rapist has been placed on leave during the investigation.

I wonder if they did a criminal background check or if they asked the suspect to undergo a polgrapg examination.

Here is an article about a nursing home company indicted in 2004 for the death of a resident.
Life Care Centers of America Inc. was finally indicted in the preventable death of an elderly woman whose body was found in her overturned wheelchair at the bottom of the front stairway of an Acton facility.

Life Care Centers of America Inc., which owns and operates the Life Care Center of Acton, was charged with manslaughter, abuse and neglect of a long-term care facility resident, and making a false Medicaid claim in connection with the death of 74-year-old Julia McCauley on April 17, 2004.

Attorney General Martha Coakley said that beginning in 1999, a physician had ordered McCauley to wear a device called a WanderGuard, which would set off an alarm and lock the doors of the facility if she approached them. The order also required nursing home staff to check the device daily to ensure it was functioning properly.

On the day she died, McCauley went through the front entryway of the Life Care Center and fell down the stairs. She was not wearing the WanderGuard device. 

The corporation will face a maximum fine of just $1,000 on the manslaughter charge, and no corporate official faces prison time.

I saw a great article discussing the process of choosing and entering a nursing home.  The article tells the story of a woman who scouted nursing homes with a home-like setting where the staff-to-resident ratio was low.

More than 5 million people in the United States receive some form of daily care, according to Joseph L. Matthews, a California attorney who specializes in elder law and is the author of "Long-Term Care: How to Plan and Pay for It."

More than 2 million people older than 65 are in some type of nursing facility or other residential care facility at a cost of between $30,000 and $150,000 each per year, according to Matthews.

One out of four of those nursing-home residents stay in a facility for longer than a year, and 10 percent stay for more than three years.

Medicare covers the first 20 days of care at 100 percent. After that, a 20 percent co-pay is required for the next 80 days.  Some supplemental Medicare insurance will pick up the co-pay, but patients without that coverage could find themselves paying $130 or more per night for the remaining 80 days, Honig said.

While Medicaid will cover the cost of nursing home, residents have to spend down their assets to qualify, she said. But the spouse still living at home can keep residential property, a car and a limited number of other assets. 

The Center for Medicare & Medicaid (CMS) is the component of the Federal Government’s Department of Health and Human Services that oversees the Medicare and Medicaid programs. 

Medicaid and Medicare dollars are used to cover nursing home care and services for the elderly and disabled. State governments oversee the licensing of nursing homes. In addition, State have a contract with CMS to monitor those nursing homes that want to be eligible to provider care to Medicare and Medicaid beneficiaries. Congress established minimum requirements for nursing homes that want to provide services under Medicare and Medicaid. These requirements are broadly outlined in the Social Security Act (the Act). The Act also entrusts the Secretary of Health and Human Services (DHHS) with CMS, a DHHS Agency, is also charged with the responsibility of working out details of the law and how it will be implemented, which it does by writing regulations and manuals.

CMS contracts with each State to conduct onsite inspections that determine whether its nursing homes meet the minimum Medicare and Medicaid quality and performance standards. The State conducts inspections of each nursing home that participates in Medicare and/or Medicaid about once a year.  The State also investigates complaints about nursing home care.

During the nursing home inspection, the State looks at many aspects of quality. The inspection team observes resident care processes, staff/resident interaction, and environment. Using an established protocol of residential rights, the team interview a sample of residents and family members bout their life within the nursing home, and interview caregivers and administrative staff. 

Depending on the nature of the problem, the law permits CMS to take a variety of actions; for example, CMS may fine the nursing home, deny payment to the nursing home, assign a temporary manager, or install a State monitor. CMS considers the extent of harm caused by the failure to meet requirements when it taken an enforcement action. If the nursing home does not correct its problems, CMS terminates its agreement with the nursing home. As a result, the nursing home is no longer certified to provide care to Medicare and Medicaid beneficiaries. Any beneficiary residing in the home at the time of the termination are transferred to certified facilities.

I saw this story in a Pittsburgh paper.  I can’t believe they gave probation to a nurse who lied, changed medical documents, and covered up the circumstances of neglect that caused the death of a nursing home resident. 

What kind of deterrent is this?

Kathleen Galati who was a nursing home supervisor was sentenced to only five years’ probation.
She pleaded guilty in March to perjury, false swearing, criminal conspiracy, and tampering with evidence in connection with the October 2001 death of Mabel Taylor, 88, at Ronald Reagan Atrium I Nursing and Rehabilitation Center.

Allegheny County Common Pleas Judge David R. Cashman also banned Galati from working in health care during her probation.  So in five years she can go back to covering up neglect in nursing homes!

Atrium head Martha Bell helped cover up the death of Taylor, who died after wandering outside on a cold night.  Bell was convicted of involuntary manslaughter and health care fraud and sentenced to at least seven years in prison.

There is a new product called QuietCare which is a home monitoring system that tracks a resident’s health, and alerts designated neighbors by e-mail or phone when something is wrong. 

The QuietCare monitoring system can keep up with meals and medications, and to alert others if he has had a fall or other emergency.

In an industry that is becoming proactive, QuietCare focuses on keeping aging or disabled people at home longer. Everything from computerized medication dispensers to concierge health-care managers aim to give the elderly and disabled the assistance they need to stay independent and safe.

With the cost of nursing home care skyrocketing and baby boomers reaching retirement, the country is facing an expensive health-care bill. Nursing homes are already crowded, and at a cost of $6,000 to $6,500 per month in Central Florida, providing round- the-clock nursing home care to an increasing number of seniors could be back-breaking for the nation’s health-care system.

There certainly is no shortage of products designed to help seniors and caregivers.

AT&T offers home video monitoring, or so-called nanny cams, that some people are using to keep a watch on elderly relatives.

LifeAlert — known for its marketing slogan "I’ve fallen and I can’t get up!" — markets emergency-button systems. Other companies offer similar personal emergency-response systems as well, with prices ranging from $200 to more than $1,500, plus monthly monitoring fees.

If taking medication is an issue, Guardian Medical offers a pill dispenser that can be programmed to dispense medication at certain times, and provide alerts by phone if pills are missed.

Movie explores love, life and Alzheimer’s Disease in nursing home setting.

A new movie, “Away From Her,” is set in a nursing home and examines a couple’s struggle with Alzheimer’s Disease as well as love within the context of life and aging.   An Ontario couple who has been married for over 40 years decides to seek nursing home placement for the wife (played by Julie Christie) after she wanders away from home.

For the first time in the five decades of their relationship, they are forced to undergo a long separation since the nursing home has a “no-visitors” policy for the first 30 days of a resident’s stay so they can adjust to their new surroundings. When the husband visits after the adjustment period, he is devastated to find out that not only has his wife seemingly forgotten him, she has transferred her affections to another man. The other man, also a nursing home resident, is mute and wheelchair-bound. The husband then starts spending time with the male resident’s wife, played by Olympia Dukakis. Dukakis’ own mother had Alzheimer’s Disease.

Source: www.npr.org, May 16, 2007; http://www.imdb.com/title/tt0491747/

People with Alzheimer’s disease experience an acceleration in the rate of cognitive decline after being placed in a nursing home according to a new study by the Rush Alzheimer’s Disease Center. The observational study involved 432 older persons with Alzheimer’s disease.  

On average, cognition declined at a gradually increasing rate for all participants. During the study period, 155 persons were placed in a nursing home, and placement was associated with a lower level of cognition and more rapid cognitive decline.

"The findings suggest that experience in day care may help individuals with Alzheimer’s disease make the transition from the community to institutional residence," said study author Robert S. Wilson, PhD, a neuropsychologist at the Rush Alzheimer’s Disease Center.

The authors considered the possibility that nursing home placement is simply a sign of increased severity of Alzheimer’s disease. Yet, the nursing-home-related increase in cognitive decline was observed even after simultaneous control for cognitive and noncognitive indicators of dementia severity at the time of nursing home entry.

"The findings suggest that the transition from the community to a nursing home is particularly difficult for people with Alzheimer’s disease and that those planning for their care should consider the possibility that experience in adult day care programs may help prepare affected persons for institutional living," said Wilson.

See article here