The WYDaily reported the tragic death of a nursing home resident from a preventable improper transfer, and the family’s search for answers and justice.  Lee Cleveland Scruggs, the executor of the estate of Fannye Doris Holden Scruggs Rorer, is suing Williamsburg Landing in a neglect lawsuit, stating the home was, at times, negligent in their care of Rorer.  Court documents allege Rorer fell “at the hands of” staff on April 15, 2016, while being transferred from her bed into a hoyer lift. The lift is used for mostly or completely immobile patients.  Rorer died eight days after her fall.

“At all pertinent times, Fannye was a helpless, mentally compromised, one-eyed amputee with inter alia limited communication ability, who was totally dependent on defendant… for her basic activities of daily living … and everything else,” according to a civil complaint filed in the Williamsburg-James City County Circuit Court.

According to court documents, Rorer was a resident patient at Woodhaven Hall at Williamsburg Landing from April 2011 to April 23, 2016, when she died.  In those five years, the family paid over $600,000 for her care, the complaint said.

The complaint cites multiple surveys completed by the Virginia Department of Health in 2015 and 2016 which cited the nursing home for safety violations, including not immediately notifying a doctor when a patient fell, not developing an “appropriate” care plan for another patient, and more.  The complaint states Rorer was injured at least six times during transfers using a hoyer lift in the months leading up to her fall and death.

Rorer was dropped around 5:40 a.m. April 15, 2016, while being transferred out of her bed by a single nursing assistant. Employees later told Rorer’s family the transfer should have been made by two people, the complaint states.  X-rays after the fall showed Rorer had multiple compression fractures on her lumbar spine.

 

The State reported that a Lexington County jury has found Lexington Medical Center Extended Care guilty of gross negligence in the death of one of its residents.  Jurors compensated the family of Samuel B. Cunningham $450,000, including $200,000 for Cunningham’s pain and suffering, medical and funeral expenses, and $250,000 for the family’s mental shock and suffering, wounded feelings and loss of companionship.

Cunningham was admitted to the facility at 815 Old Cherokee Road in Lexington on April 29, 2013, at age 81. He was suffering from dementia and was legally blind.  The family alleged that Cunningham often was found by his family soaked in urine, unclean and lacking in oral care.  Nursing home records showed Cunningham suffered 26 falls. He was found on the floor 19 times without anyone seeing him fall. On one occasion, he was found on the ground outside the building with multiple ant bites.

“We were heartened by the jury’s verdict and hope that it will provide incentive for the facility to get its act together and start treating its residents with the dignity and care that they deserve.,” Ken Connor, the Cunningham family’s attorney, said in a news release.

The suit alleged improper care; on one occasion, Cunningham fell and required a hip replacement at Lexington Medical Center, which also operates the nursing home.

Cunningham also developed bed sores because of improper care, and was not properly fed. He also developed pneumonia, which was not addressed in a timely fashion by the nursing home.

On July 1, 2015, Cunningham was admitted to Lexington Medical Center suffering from multiple areas of skin breakdown, malnutrition, dehydration and infections, the suit claimed. He was unable to recover from his decline and died two weeks later at Agape Hospice House in Columbia.

WFAA had an interesting article discussing the problem of short-staffing and chemical restraints at nursing homes.  This article was Part 4 of WFAA’s continuing investigation of nursing home abuse and neglect. (See Parts 12 and 3 ).  The ongoing WFAA investigation into Texas nursing homes has already revealed questionable practices in the hiring of criminal caregivers – and now WFAA has uncovered inappropriate and unnecessary drugging of residents.

In effort to cut costs, troubled nursing homes may drug the elderly rather than hire needed staff. The practice has been dubbed “chemical restraints.” It’s a practice of using powerful drugs to sedate or quell agitated, disruptive or violent patients.  When a facility is chronically short-staffed, often the staff will administer medications that sedate the residents so the residents are easier to take care of for the overworked and burnt-out caregivers.  In the latest report, called “Drugged and Dying,” News 8 investigative reporter Charlotte Huffman found that 96 percent of Texas nursing homes admit they’re giving drugs to residents who don’t need them.

According to the FDA, unnecessary use of antipsychotic medication kills 15,000 nursing home patients every year. Of all the drugs used as chemical restraints, antipsychotics are the most widespread and may be the most dangerous.

The federal government has previously caught drug manufacturers improperly promoting their antipsychotic drugs for use in nursing homes. (See here and here.)

Before nursing homes can give residents antipsychotics, new federal guidelines require doctors to diagnose them with at least one of three mental illnesses, the most common being schizophrenia.  A WFAA analysis of nursing home data shows that, after this new rule, the number of residents diagnosed with schizophrenia has skyrocketed 26 percent.  Schizophrenia develops in a patient’s early 20s, not later in life, experts say.

Various healthcare officials and advocates, when reached for comment, have found WFAA’s findings troubling:

“There’s no doubt that it raises a big red flag,” said Amanda Fredriksen, AARP Texas director of advocacy and outreach. “It’s pretty disturbing when people are that motivated to drive their numbers down to falsify medical records or to make up diagnoses. But to the extent that that’s happening, that’s a real serious issue.”

Dr. Daniel Pearson, head of psychiatry at Methodist Hospital, questions a first-time schizophrenia diagnosis of an elderly nursing home resident. He said such a diagnosis, especially to sedate, may be inappropriate, and possibly dangerous.  “Does that surprise me? No. Are those diagnoses legitimate? Probably not,” Dr. Daniel Pearson told WFAA.  “If you are using it just to keep people quiet, there are significant risks that are associated with that…increased risk of cardiac death, increased risk of falling, breaking a hip,” added Dr. Pearson, who spent a decade as a psychiatrist in nursing homes.

About 70 percent of a nursing home’s expenses are staffing,” said attorney Ernest Tosh, who handles nursing home lawsuits. “So, if they can cut back on staffing, they can directly increase their profitability.”

Last year, the state of Texas warned nursing home administrators about inappropriately drugging residents.

That same watchdog created this brochure to inform nursing home residents about the dangers of them being inappropriately drugged.

Here is a link to federal government regulations dealing with medication administration and monitoring – see p. 505.

Watch a 2011 U.S. Senate hearing on antipsychotic drug use in nursing homes.

 

 

 

 

The New York Times had an interesting article on how the Dutch are helping elderly residents from falling.  Falling can be a serious thing for older adults. Aging causes the bones to become brittle, and broken ones do not heal as readily.  The Dutch, like many elsewhere, are living longer than in previous generations, often alone. As they do, courses that teach them not only how to avoid falling, but how to fall correctly, are gaining popularity.  The classes are designed for people over 65.

There is the “Belgian sidewalk,” a wooden contraption designed to simulate loose tiles; a “sloping slope,” ramps angled at an ankle-unfriendly 45 degrees; and others like “the slalom” and “the pirouette.”  The obstacle course was clinically devised to teach them how to navigate treacherous ground without having to worry about falling, and how to fall if they did.  In order to learn, the students start by approaching the mats slowly, lowering themselves down at first. Over the weeks, they learn to fall.  Hundreds of similar courses are taught by registered by physio- and occupational therapists across the Netherlands.

 

 

PennLive reported the $250,000 verdict after the jury found a nursing home was at fault for the death of an 85-year-old resident.  The family of Bruce Dove had filed suit against the United Church of Christ’s Sarah A. Todd Memorial Home in Carlisle.

Dove had five children, now adults, some of whom were there throughout the trial, and it was the circumstances of his February 2014 death at the nursing home that spawned the lawsuit, filed in 2015.  According to the complaint and testimony at trial, the incident occurred like this:

On Feb. 5, 2014, Dove was in his wheelchair, waiting, near the entryway to the dining room, for dinner to be served. A supervising registered nurse asked another registered nurse to push him into the room.  But the second nurse pushed his wheelchair fast and recklessly down the hall toward the dining room without giving Dove warning or attaching footrests – a violation of safety standards. This motion flung Dove from his wheelchair. He hit his head on the floor and broke his neck.  The nurses rolled him over — failing to immobilize him — placed him back in his wheelchair and then moved him into his bed.

Dove suffered cervical spine fractures of the C1 and C2 and an odontoid fracture with displacement, as well as neurological damage. He died the following day.

“It was very important to my clients that the truth come out,” attorney Michael Kelley said. “They had been told early on that he just fell out of his wheelchair. They never believed that.”  The two nurses involved had been fired after the incident, which Kelley said was among the strongest pieces of evidence against the home.

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.

 

Fox 8 reported that police are investigating a suspicious death at Concord Care and Rehabilitation Center in Ohio after a confrontation between two nursing home residents.  Police Detective Joe Rotuno said Richard Cain, 65, was found unresponsive in his room at Concord  around 7 p.m. Thursday.  Rotuno said Cain’s roommate, who is 63 and usually in a wheelchair, told staff Cain was lying on the ground, and he believed he was dead. Staff then found Cain clutching a chunk of his roommate’s hair and called police, according to investigators.

The roommate told officers that the pair had argued over whether to close the room door when Cain began choking the roommate, according to Rotuno. He said the roommate reported he then punched Cain in the stomach, causing him to fall backward and hit his head.

Rotuno said both roommates suffered from mental health and other issues, and that staff reported the roommate had a history of anger issues. He said they had gotten into arguments in recent weeks.  “We’ve heard there’s been a lot of verbal altercations between the two,” Rotuno said. “Our suspect does have a history of being what we would call ‘angry’ at the facility, having issues with other residents, having issues with other staff.”

“If his roommate had to defend himself, I don’t blame him at all. I blame the nursing home and staff for not paying attention,” said Bonnie Cain. “They’ve been in several verbal confrontations weeks prior and nobody’s done anything about it. Why couldn’t you separate them?”

She said she wants justice and more training for nursing home staff.

“Every time I close my eyes I see my dad, and it’s just so heartbreaking,” Cain said. “Why couldn’t something be done? Maybe my daddy would still be with me today.”

 

 

The Pittsburgh Post-Gazette reported the tragic and preventable death of Pittsburgh businessman Robert Frankel who died from asphyxiation from an incident in which his neck was trapped in bed rails.  Mr. Frankel died late Sept. 17 at the nursing home from what the medical examiner deemed at the time accidental asphyxiation, “due to compression of the neck.” The Charles Morris Nursing and Rehabilitation Center has discontinued using such railings in response, according to a Pennsylvania Department of Health report.

“Based on review of facility policy and documentation, clinical records and staff interview, it was determined that the facility failed to identify a hazard created by the use of side rails resulting in the death,” the report said.   The report said that at 11:30 pm. on Sept. 17, “a nurse aide was performing first rounds to check on the residents and found Resident R1 (Health Department inspection reports do not identify individuals by name) pulseless and without respirations, lying with his body on the floor and his neck between the air mattress and the side rail.” A nursing supervisor pronounced him dead at 11:40.

 

Kayla Evans at Reviews.com wrote to me asking to share research her team at Reviews.com conducted regarding senior safety and medical alert systems. It is a valuable research for caregivers and family.

With millions of seniors ending up in the ER due to falls each year, Kayla and her team recognized that medical alert systems can be key for contacting help when accidents occur in the home. After over 100 hours of research and hand-testing, our guide outlines which factors will help families and seniors choose the right system for their needs: http://www.reviews.com/medical-alert-systems/

To find the best modern-day medical alert system, they spent over 100 hours talking with elder-care experts, digging into service agreements, and hand-testing the top contenders. They collected 68 medical alert devices that run on cellular-enabled base stations and that connect you to an independent central monitoring center.

Not all personal emergency response system (PERS) devices connect you directly with a monitoring system where employees are trained to assess what help to send. Some operate more like long-distance walkie-talkies that either connect you to your designated emergency contact or alert 911 automatically. Those medical alert systems are better suited for an extra layer of security when you’re walking through the office parking garage at night.

The technology advancement of PERS devices is incredible, but for this review, they looked solely at their most basic function: Press a button, get help. The caregiving experts suggested that simpler medical alert systems may be less flashy, but they’re the best place to start.

The Telegram reported the Aug. 7 death and cover-up of Walter E. Haddad.  State and federal agencies investigated the suspsicious circumstances surrounding the death of Haddad who died after he fell and hit his head, and nursing home staff covered up the fall rather than send him to the hospital.

The report said that after hearing a loud thud about midnight on Aug. 6, a certified nurse assistant and a licensed practical nurse found Mr. Haddad lying on the floor and they put him back in his bed.  No assessment by a registered nurse was done. The CNA told investigators that he did not report the fall, as required by the facility, because the LPN had asked him not to.

“However, staff did not complete a thorough clinical evaluation or neurological assessment on (Mr. Haddad), which resulted in a delay of transfer to the hospital for evaluation of possible injury,” investigators said in the report.

Mr. Haddad’s daughter, Lorna Haddad, took issue with the report. She said staff should have been more careful because they knew that her father, who helped found the nursing home, had a history of falls. The retired accountant had moved into the nursing home last year, after Parkinson’s disease left him prone to falls. She said notification of his fall risk was posted throughout his area of the facility.

“I think the report is meaningless,” she said. “The fact that he didn’t have an alarmed bed or an alarmed chair is alarming.”

The report in general said professional standards of quality were not met because of the actions or inactions of the staff.  Every time a patient falls, injury or not, they’re required to call the physician and the patient’s family.

The morning after he fell, Mr. Haddad told several staff about the incident. The only thing that they did was to give him Tylenol. When Mr. Haddad’s family came to visit, he told them that he had fallen the night before and hit his head. Staff told the family that there was no report of a fall and that Mr. Haddad may have been mistaken or confused. When his speech became slurred and he complained of neck pain, he was taken to the trauma unit at UMass Memorial Medical Center, where he died.