The Pittsburgh Post-Gazette had an interesting article about the danger of entrapment in bedside rails and restraints after prominent Pittsburgher Robert Frankel’s recent accidental strangulation from entrapment in bed rails at the Charles Morris Nursing and Rehabilitation Center nursing home highlighted a danger that has concerned regulators and consumer advocates for years.  Mr. Frankel, a businessman, arts patron and father of a state legislator, was pronounced dead of accidental asphyxiation from “compression of the neck” after being found on the floor of his room. A state Health Department inspection report said he was “lying with his body on the floor and his neck between the air mattress and the side rail.”

Are they too dangerous or a necessary safety intervention?  The risk of injuries from bed rail use, particularly in the case of dementia patients like Mr. Frankel, has been among the issues cited in a successful effort over the past two decades to reduce a variety of dangerous restraints that restricted nursing home residents.  The FDA, which regulates hospital beds as a medical device, counted 531 rail-related deaths from 1985 to 2013, the most recent period in which it did an analysis.

The safety movement has been driven primarily by the goal of enhancing the dignity and independence of residents, who were once often tied to their beds or wheelchairs. However, other interventions don’t necessarily achieve their goal of enhanced safety including bed rails and alarms attached to beds or patients’ clothing.  Those include placing adjustable beds low to the floor, using protective padding beside the bed and having staff learn and follow residents’ patterns for needing assistance getting to the bathroom.  The only truly effective intervention is proper supervision which can only be achieved with adequate staffing.

Even when portable bed rails and hospital bed rails are properly designed to reduce the risk of entrapment or falls, are compatible with the bed and mattress, and are used appropriately, they can present a hazard to certain individuals, particularly to people with physical limitations or altered mental status, such as dementia or delirium,” the U.S. Food and Drug Administration reports on its website.

The state report on Mr. Frankel’s death said the nursing home was using rails not to protect him from falling out of bed, but to help him in repositioning himself due to his physical limitations. Such use of side railings is better accepted by consumer advocates, because their purpose is then as an “enabler” serving to promote independence of residents, but facilities are still supposed to ensure safety.  For dementia patients, in particular, rails can be hazardous from attempts to climb over them, as well as the entrapment issues. They can fall from greater heights and incur more serious injuries, most notably to the head.

As part of a comprehensive update of nursing home regulations adopted in 2016, the federal Centers for Medicare & Medicaid Services became more restrictive on use of full side rails. Residents must be assessed for risk of entrapment beforehand and steps must be taken to ensure that beds and rails are properly designed for use with one another, avoiding dangerous gaps.

 

Ashton Place Health and Rehabilitation Center nursing home has been hit with record fines after inspectors found widespread neglect resulting in actual harm to multiple patients including one who died after transfer to a hospital showed widespread wounds with maggots that apparently had gone untreated.  A male patient who was admitted to the home on July 26 of this year with no visible wounds ended up being transferred to a hospital for ulcers and ultimately died on Oct. 11 where hospital staffers found maggots in wounds that appeared to be untreated.

The 98-page inspection report cites multiple cases of patients suffering actual physical harm due to failure to follow a physician’s orders, failure to administer prescribed drugs and failure to inform physicians’ of their patients deteriorating condition.  According to the report, the home’s medical director stated, “I have support, no direction. I have talked (to them) about the staff they have here. I don’t have much confidence in them.”

The fines totaling $50,000 were imposed on the 211-bed nursing home.  In addition to the fines Tennessee Health Commissioner John Dreyzehner ordered a rare freeze of any new admissions to the facility and appointed a monitor to oversee its operations.

Neglect and poor care was also detailed for other patients, including a female patient suffering from ovarian cancer whose worsening condition was not reported to her doctor. She died on Oct. 24.

 The report was highly critical of managers at the facility and noted that top officials contended they were unaware of the problems reported by direct care staffers.  What is worse?  Knowing of a problem and ignoring it or not even being aware of what is going on at the facility?

See article at Commercial Appeal.

Time reported the story of Catholic nun Sister Irene Morissette, a resident of Chateau Vestavia, an assisted-living facility near Birmingham, Ala.   Sister Irene told a staffer that she was raped in her bed.  What added insult to injury was her inability to sue the facility that failed to keep her safe.

Morissette told police that someone held her 5-ft. 2-in., 140-lb. frame to the bed by her shoulders. She recalled the “terrible experience of being penetrated,” according to a recorded police interview reviewed by TIME. “I was so scared,” she said. “She was afraid to call anyone,” an examiner wrote later, “because she was afraid that the assailant would be the one to come back to her room.”

“Police and medical records paint a disturbing scene. Police investigators found two semen stains in Morissette’s bed and blood on the “inside rear area” of her green-and-pink-flowered pajama bottoms, which had been shoved underneath the mattress. A sexual-assault examiner at a local hospital reported that Morissette had sustained multiple abrasions inside and outside her vaginal canal, wounds that could be consistent with rape. “The genital exam was very painful for the client,” the examiner’s report said.”

“After a criminal investigation by local police failed to produce enough evidence to identify a suspect in the alleged attack, Morissette’s family tried to file a civil suit against Chateau Vestavia, alleging everything from negligence to outrageous conduct. They felt there was plenty of evidence to back up those charges. The semen on the nun’s bedsheets was enough to suggest sexual contact, and Morissette, because of her dementia, could not legally consent to any sexual act. But none of it would see the light of day in a courtroom.”

When Morissette first came to Chateau Vestavia, she had signed the facility’s standard admissions contract. Buried in pages of terms and conditions was what is known as a pre-dispute binding arbitration agreement. By signing it, the elderly nun gave up her Seventh Amendment right to trial by jury and any right to bring a civil suit against Chateau Vestavia or its then parent company, Trinity Lifestyles Management, for any reason and at any time in the future.

More than a million other elderly Americans may have waived away their rights in the same way Morissette did.  More than half the 2.5 million Americans in nursing homes or senior living centers are likely bound by them. Legal advocates who work on behalf of seniors estimate that as many as 90% of large nursing-home chains in the U.S. now include arbitration agreements in their admissions contracts.

With arbitration, there is no courthouse, no judge and no jury. There are no requirements to follow state or federal rules on procedure, and effectively no appeals process. Whatever the arbitrator decides is almost always final.

 In June, the Trump Administration proposed a new rule that would allow nursing homes to require residents to sign arbitration agreements as a condition of admission to a facility: either sign it or find somewhere else to live. With the number of elderly Americans projected to double over the next 30 years, mandatory arbitration clauses in nursing homes will likely affect millions of people. Which means some may find themselves in the same private system of dispute resolution that Morissette and her family fell into.

“This is blatantly a sellout to the big CEOs and the Wall Street guys,” says Kenneth Connor, a self-described conservative and a South Carolina trial attorney.

As for Sister Irene’s case, Reed Bates, one of Chateau Vestavia’s lawyers, argued ridiculous theories to defend the failures of the nursing home.  He argued that Sister Irene was lying and had not bee raped.  Bates then argued that the traumatic vaginal abrasions were caused by Sister Irene’s masturbation.  Bates then offered speculation that the semen stains on the nun’s bedsheets got there while being laundered or handled by staff.  Ridiculous.

The arbitrator sided with the facility claiming Chateau Vestavia was not accountable. Neither the assisted-living facility nor Trinity Lifestyles Management would be required to compensate Sister Irene nor issue an apology.  And with that, the case was closed.

As a final indignity, Morissette’s family was handed a bill for roughly $3,000 to cover the cost of renting the Marriott room where the arbitration had taken place.

The Age published an article on recent deaths caused by untreated flu.  The fatal flu outbreak at St John’s Village nursing home caused the death of 10 residents and two others from respiratory illness.  The government investigation blames serious management failures–it took days after infections began in August for management to report the outbreak.  By the time they did, 16 residents and eight staff were already sick.

In response, the St John’s Village nursing home accepted the resignation of its own former acting care services manager and referred him to his professional body for potential sanction.

The Clarion Ledger reported the settlement between the Department of Justice and a Georgia nursing home and its management company for “grossly substandard care”.  Hyperion Foundation, the owner, and AltaCare Corp., the management company, agreed to pay $1.25 million to resolve allegations of Medicare and Medicaid fraud for failing to provide care at Oxford Health and Rehabilitation nursing home.

The poor quality and lack of staff caused serious health issues including pressure ulcers, dehydration, malnutrition, and falls according to the government investigation.  I hope the DOJ continues to investigate the adequacy of the services provided to nursing home residents to increase quality and to rid the industry of the waste, fraud, and abuse that is so common.

 

 

 

CBS12 Investigates uncovered reports of true horror stories happening at nursing homes across the country that should have been reported to law enforcement.  These cases include life threatening falls, starvation, even sexual assaults that were not reported.

 “We found that CMS, the Centers for Medicare and Medicaid Services didn’t have adequate controls in place to detect these potential instances of abuse or neglect,” said Curtis Roy, Assistant Regional Inspector General for Audit Services, OIG.

“CMS acknowledged that that they are not doing the data match to identify cases of neglect,” added Roy. “They also acknowledged that they have not identified any instances of nursing home staff not reporting cases as required.”

The audit found 38 cases that were so bad, by law the nursing homes were required to contact local law enforcement. But, they didn’t do it.

CMS must initiate protocols to adhere to a long-standing federal statute that requires nursing homes to report abuse cases to police and other state agencies immediately or risk fines of up to $300,000.

“They don’t care about those fines,” explained attorney Joe Landy. “It is business as usual. It is cheaper to pay those fines to keep these facilities understaffed with people that are not properly trained while they make record setting profits.  “It exposed what is a long-standing problem in Florida,” said Landy. “It exposed a nursing home that was making a huge amount of money with no accountability whatsoever.”

WFLA had an article about the horrific neglect and abuse suffered by Willie Johnson at the hands of the caregivers at Habana Health Care Center owned and operated by Consulate Health Care. His daughter Tonya Baker said her elderly father is living in poor conditions and shared photos to prove it.  “Not taking care of my dad, not feeding my dad, going in there finding my dad, wet Pampers, Depends, not being changed,” she said.

johnson 2

“My daddy’s not getting the care that he’s paying for to stay in that facility,” Baker told me.  Baker has filed five complaints with the State’s Agency for Health Care Administration about the nursing home. Four out of five times, they found the nursing home violated its own rules or law. But despite the state’s involvement, Baker says problems persist.

“I also went in there and had them take my daddy’s air conditioning out the wall because he had a lot of mold in there, in the air conditioner and in the air conditioner wall,” explained Baker.

The photos include one where he has a busted lip. Baker said the facility told her he was punched by a roommate. Another photo shows her father with a gash on his forehead after a fall in the shower.

johnson 4

 

News Channel 20 had an article detailing the problem in Illinois nursing homes but it applies to most other states too.  The most recent audit by the Inspector General’s Office of Health and Human Services says Illinois has the highest number of nursing home neglect incidents in the U.S.  Unfortunately, at least 40 percent of these incidents go unreported to local authorities.

 

The Japan Times reported a good example of what happens when a nursing home is understaffed and the caregivers get burnt-out from being overworked.  Hisashi Minakawa, a caregiver at a Tokyo nursing home was arrested over the murder of an 83-year-old resident at the facility in August, the police said.  Minakawa admitted to the killing, the police said. The victim, Kan Fujisawa, “repeatedly wet the bed and I couldn’t stand it anymore,” Minakawa was quoted by the police as saying.   Fujisawa suffered Parkinson’s disease and could not control his bladder.

The killing took place in the early hours of Aug. 22. According to the police, Minakawa lost his temper after Fujisawa wet the bed multiple times the previous night. He strangled Fujisawa, threw him into a bathtub and drew hot water, according to the police.  Minakawa had been working a night shift with another worker on the night of the homicide but was alone with Fujisawa in the bathing facility.

Prior to his arrest he told the police he found the victim dead after he was away tending to an emergency call within the nursing home. But there was no record of such a call, according to the police.  The police launched the murder investigation after spotting evidence of strangling — a broken bone in Fujisawa’s throat.

Wood TV reported that Yahira Zamora, an employee at Crystal Springs assisted living facility, will spend six months behind bars in connection to the freezing death of an 85-year-old woman.  Zamora appeared in court for sentencing in the October 2016 death of Kathryn Brackett.  Brackett had Alzehimer’s disease. She walked out of the assisted living facility and froze to death outside.

A second worker – Denise Filcek – was also charged in Brackett’s death. She pleaded guilty to one count of intentionally placing false information on a health chart.  Zamora pleaded no contest to second-degree vulnerable adult abuse for allowing Brackett to get outside unnoticed. She admitted she heard an alarm go off, but never checked the door.