WFTV in Florida had an article about a nursing home allowing one of their residents to fall NINE times from a her wheelchair.  This is neglect.  Why didn’t they try a safety device like a tray or belt?  I wonder if they were given her the right amount of medication or if they were using the medications as a chemical restraint?   Hopefully the family will get some answers during the lawsuit. 

The falls caused Ruth Boelke to prematurely die. The nursing staff failed to follow the doctor’s orders and best safety practices by failing to use a safety device to prevent Ruth from falling out of  her wheelchair.   The home’s director said it did call her doctor a few days before she died and sent her to the hospital. The family claims the nursing home should have called for help sooner.

Santa Cruz Sentinel has an article about the tragedy that is all too common for many nursing home residents.  Nursing homes fail to train on what DNR status means, and far too often simple care is not provided that would save a resident’s life.  Below are excerpts from the article.

The Tragedy: On Sept. 11, 2007, a 71-year-old woman with cancer was transferred to Pacific Care Manor, a nursing home in Capitola. Just prior to her admission, the woman’s doctor noted that her patient was lucid and responsive and "could have years to live." Most importantly, the patient had also expressed a desire to live.

Shortly after her admission, the woman began refusing food, water and any treatment. Within two days, she was screaming and combative. On day three, the nursing staff suggested that lab work be ordered to determine the cause of the resident’s distress. The facility’s director of nursing overruled the suggestion because "once we know what is going on then we will have to treat her." Instead, the nursing director asked the facility doctor to prescribe pain medication and a "do not resuscitate" order. The doctor complied and, despite the woman’s documented opiate intolerance, he prescribed a Fentanyl patch, Haldol, morphine. He also wrote an order for "no CPR, no hospitalization." His patient cried out "you are all going to kill me" after the forcible administration of the prescribed medications. On Sept. 16, just five days after her admission, the resident died. 

All residents of nursing homes have the right to grant or withhold consent to any proposed treatment.  Residents have the right to refuse or consent to treatment and to receive all information relevant to making their treatment decisions. Providing such information is part of any responsible nursing home’s assessment and care planning process. Federal regulations also reaffirm residents’ rights to informed consent and to refuse treatment.

Regardless of a resident’s mental capacity, no facility may administer treatment unless the resident has agreed or has been specifically adjudicated incompetent by a state court judge. Even after a court has determined that a resident is incompetent, it must make additional findings before terminating a resident’s right to refuse treatment. Without a court order, the provision of any treatment over a resident’s express refusal is a violation of several residents rights and is criminal battery.

Similarly, doctors cannot order "Do Not Resuscitate" orders without the written authorization of their patients. For DNR orders, designated health care agents may sign for the patient. However, doctors may not unilaterally impose DNR orders without a resident or resident representative signature.

Nursing homes throughout California are accustomed to interposing their notions of a resident’s best interests over the expressed wishes of their residents. The Department of Public Health and resident advocates have been generally weak in preventing this illegal conduct. Hopefully, the tragedy in Capitola will serve as a warning to both facilities and advocates about the deadly consequences of disregarding residents’ critical rights to direct their own treatment.

Anthony Chicotel is an attorney for the California Advocates for Nursing Home Reform in San Francisco.

 Warren Wolfe of the Star Tribune in St. Paul, Mn. wrote a great article on the overuse of medications in the nursing home population.

Thousands of nursing homes nationwide are using powerful antipsychotic drugs to quiet disruptive people with mild dementia — at times a step that’s easier and cheaper than training staff to fix the problem.   The practice is alarming Medicaid officials so they ordered state nursing home inspectors to crack down on it. 

The Food and Drug Administration requires some to carry a "black box warning" that they heighten risk of death for older patients, a warning that it might extend to all antipsychotic drugs. They also increase the risk of confusion and falling.   The drugs often are prescribed whether the resident is psychotic or not.

Antipsychotic drugs have become the No. 1 drug paid for by Medicaid, which regulates and pays for nursing home care.  It’s easy to understand why an overworked and burnt out nurse might want a resident drugged as a chemical restraint.  However, unless the resident is combative because of a mental illness such as paranoia, there’s always a better way to control disruptive behavior in someone with dementia than with drugs, said John Brose, a Minneapolis psychologist who consults at more than 100 nursing homes, including Hopkins.

"Usually, that person is trying to communicate something — I’m too cold, too hot, constipated, frightened, tired, thirsty," he said. "Figure that out, then deal with the real problem."

WHEC-TV ran a story about a neglected resident who sued a nursing home for pressure ulcers, bedsores, and gangrene at Blossom South Nursing and Rehabilitation Center.  The nursing home is already facing nearly $150,000 in fines from the state for other deficiencies.

Resident Ruby Myers’ right leg was amputated after gangrene had set in.  Myers broke her leg last September. Doctors put her leg into a brace that apparently caused severe pressure ulcers and open sores. The circulation in the leg was stopped.  The woman also suffered from bedsores.

D.A. Mike Green has decided to defer to the state health department for possible action but no penalty has been decided yet.   Over the last three years, Blossom South had 70 standard health deficiencies, while the statewide average was 16. And deficiencies related to "actual harm" or "immediate jeopardy" were 10 for Blossom South, compared to just one for the state average for a nursing home.

South Florida Sun-Sentinel.com has an article from Violette King, president of Nursing Home Monitors, a non-profit, all-volunteer advocacy group for nursing home safety about improper discharges and evictions of residents from nursing homes.  She encourages the media to put a spotllight on the injustices that occur daily in nursing homes throughout the country because the exposure will hurt the profits and therefore will deter bad behavior.

Long-term care facilities spend a lot of money to make sure that their beds are full. They know very well that bad publicity translates into the anathema of empty beds. Legislation to require facilities to give a reason for discharge should be spurred on by the media to add more protective measures. Legislators are under immense pressure from the many long-term care lobbyists who swarm their offices.

Involuntarily discharging a resident can lead to serious setbacks and even death from what is known as "transfer trauma." There are only three acceptable reasons for evicting a resident: The facility can no longer meet the resident’s needs, the resident or Medicaid has failed to pay the bill, or the resident is a danger to him/herself or to others. The burden of proof should always be on the facility to prove its case, which should be done at a proper hearing where legal assistance is provided for residents who cannot afford an attorney.

Good profits and lack of oversight lead to far too many unscrupulous characters going into the nursing home industry. When a resident or the family complain about needs that are not met as agreed, the facility all too often asks them to leave.  Threat of eviction has a chilling, silencing effect on families who usually have no other choice for placement.

In many of our neglect and abuse cases, the victim is unable to testify regarding the bad care because of dementia or death.  I read an article today about a man who is competent and speaking up for his rights and the rights of others at the facility where he lives.  Mr. Crawley is a competent 48 year old man who resides at Sunrise Rehabilitation & Care in Marion, N.C.   "I am not being treated like, I feel, as a human being," said Crawley. 

Crawley became a paraplegic as a result of a car wreck in 1982. His 81-year-old father, Joe Crawley Sr., can no longer take care of him and he started living at Sunrise Rehab on Oct. 15. For the first two weeks there, the staff didn’t give him a bath or shower.  "I don’t know what is going on here," he said. "It seems like they make a lot of errors in simple things."

Crawley said his elderly roommate will talk incoherently and constantly yell about having to urinate, and, rather than listening to him, the staff will shut the door. With the heater running, that makes the room get hot for both Crawley and his roommate. He said he has called the nurse’s station to have the door opened but is ignored.

His sister said the staff once left a feces-soiled blue pad on his wheelchair for more than two hours. His father, who visits him twice a week, found it and thought his son had had an accident. He bagged up the soiled pad and took it to the nurse’s desk.  "That’s an unsanitary condition and that’s neglect," said Pilgrim.

Crawley said he’s confined in his bed 21 hours a day.   This will increase the likelihood of developing pressure ulcers. 

Crawley added he’s paying $879 a month to stay at Sunrise Rehab, which leaves him with just $30 out of his monthly disability check. He wishes he could go someplace else.

"I don’t know if they think I am incoherent or lost my faculties or don’t know what is going on," he said. "But I do know what is going on. I need more than anything to be transferred to a place that deals with wound care."

"They are neglecting the people," said Buckner. "That is why there is a waiting list at Autumn Care."

The official Web site for Medicare contains information about nursing homes across the nation. The site states that Sunrise Rehab had 11 health deficiencies, which are above the state and national averages. One of the deficiencies included failure to "write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents’ property."  Another deficiency found on May 10 by inspectors was failure to "give professional services that meet a professional standard of quality."

In addition, inspectors found on Aug. 30 that Sunrise Rehab failed to "make sure that residents are safe from serious medication errors" and it also failed to "make sure that the nursing home area is free of dangers that cause accidents."

See full article here.

Here is an article about a tragic case where a nursing home failed to supervise residents who ended up walking away from the facility and was killed in a car accident.  For the second time in six weeks, a resident of the Dover Woods health care facility has been struck and killed by a car. 

Township officials expressed frustration at their inability to come to an agreement over safety measures for the facility’s residents with its owners, the Erez Health Care Realty Company LLC of Lakewood.

A meeting had been scheduled for mid-January, but it was canceled it because the company wanted its corporate defense lawyer to appear. No new date has been scheduled.   The facility doers not seem concerned that two of their residents have died as a result of their failure to properly supervise their residents as they are required and paid to do.

In December, police were called to Dover Woods for more than 37 incidents ranging from residents wandering along the highways picking up cigarette butts to the harassment of customers at a nearby shopping center.   The Police Department has responded to the facility 27 times this year.

Texas Attorney General Greg Abbott has filed a lawsuit against a Fort Worth assisted living center, claiming its manager threatened residents with a hammer, withheld food and locked some of them out of the building at night.  See full article here.

Abbott says the alleged abuse took place at the Oasis Village assisted living facility, located in Fort Worth’s Polytechnic neighborhood. A district judge issued a temporary injunction against the owner of the facility, God’s Intercessory Prayer Warriors Ministries, Inc., and its manager, Bertha McCoy.

According to state inspectors from the Department of Aging and Disability Services, at least five residents at the facility have complained that McCoy abused them. Some residents said she took the mattresses from their beds and forced them to sleep on metal bed frames, as punishment for soiling their sheets. They also said she locked them out of the building overnight. State inspectors also found evidence that McCoy hit several residents and threatened some with a hammer.

Inspectors reportedly found a hammer in McCoy’s office during a recent visit.

The state has filed suit against Oasis Village with the facility facing a punishment of up to $10,000 per penalty.   All of the residents at the facility have been relocated.

The Naplenews had a frightening article about a recent lawsuit that chronicles severe neglect of a resident. 
Sophie Arvigo moved into Lakeside Pavilion Nursing Home in Naples.  After several years there, her care and treatment took a dramatic turn for the worse.

There was neglect that led to painful and humiliating medical problems, and traumatic injuries that resulted from physical mishandling by staff.   The family contends nursing home staff dropped Arvigo from a Hoyer lift, a sling-like device to move immobile individuals, and wasn’t taken for X-rays until two days later despite outcries of pain.  She suffered an impacted hip fracture that was not recognized by the staff despite numerous signs and symptoms of a broken bone.

She was injured a second time while being wheeled in her wheelchair and a third time while being moved again in a Hoyer lift.   The complaint said the nursing home staff and administrators were negligent by failing to protect Arvigo against injuries and for failure to properly hire, retain and supervise nurses who were qualified and capable of treating her as expected in the nursing profession.

The nursing staff failed to address Arvigo’s numerous bouts of dehydration and severe weight loss, numerous urinary tract infections, respiratory infections, bed sores and odorous drainage from her left ear, among other medical conditions.

The complaint also says the nursing home failed to notify a doctor about the significant changes in Arvigo’s condition and failed to follow doctor’s orders for her treatment, including monitoring her changes.

The Chicago Tribune has a story about the suspicious deaths possibly caused by morphine overdose at a nursing home.  McHenry County prosecutors acknowledge the suspicious deaths at the Woodstock Residence nursing home in Woodstock have been difficult to pursue.  Three bodies were exhumed last year, and tissue samples were sent to a Pennsylvania lab for analysis.

The bodies of three others whose deaths investigators consider suspicious could not be examined because they were cremated.  Alissa Nataupsky, administrator of the Woodstock Residence, has denied any wrongdoing at the home and has said the investigation was triggered by a former employee.

When Cole, 78, died in September 2006, the cause of death was listed as pneumonia. Cole had been living at the Woodstock Residence for two months.

If lab results do not conclusively show that morphine overdoses caused the deaths of the three former residents whose bodies were exhumed, a grand jury might be used to further investigate the case, a law enforcement source said.