Forbes had an article on a company called EarlySense.

“One company, EarlySense, is bringing skilled nursing facilities into the digital age through a practical and inexpensive approach. For several years, its contact-free patient monitoring systems have been used by hospitals to continuously track respiratory rate, heart rate and movement. The technology is a direct response to the challenges hospitals face in monitoring non-critical (non-ICU) patients—tracking their care status and preventing costly falls and pressure ulcers. With monitor bells ringing frequently, over time, nurses can develop alarm fatigue. Standard bedside equipment becomes the “machine that cried wolf”—making nurses less likely to respond to alarms they hear all day. This is exactly where continuous monitoring steps in.”

“Real-time alerts show 43% fewer patient falls, 64% fewer pressure ulcers and 86% fewer code blue events. A statistical analysis estimated that institutions using EarlySense leveraged the data and far-less-frequent alerts to save more than 550 lives, 800 falls and more than 45,000 hospitalization days in 2016.”

The key takeaway: improved care and reduced costs.

EarlySense technology is also user-friendly. Nurses can view the data at the bedside, nursing station or on a tablet, and receive alerts in real time.

JAMA Network had another article on the overuse and abuse of anti-psychotics in nurisng homes.  In May 2011, the Office of Inspector General (OIG) released a widely publicized report, “Medicare Atypical Antipsychotic Drug Claims for Elderly Nursing Home Residents,” revealing that 83% of atypical antipsychotic drug claims were prescribed for nursing home residents without a US Food and Drug Administration (FDA) indication, and that 88% of claims were related to use in residents with dementia, for whom antipsychotics are associated with an increased risk of mortality as specified in the FDA black box warning.

“Despite long-standing and widely recognized concerns about safety and efficacy, antipsychotic agents, including older “typical” agents (ie, haloperidol and chlorpromazine) and newer “atypical” agents (ie, quetiapine, risperidone, and olanzapine), have been commonly used to treat behavioral and psychological symptoms of dementia.”

This Viewpoint describes a national initiative of the Centers for Medicare & Medicaid Services (CMS) focused on the use of antipsychotics in nursing homes. These efforts have led to a 33% relative reduction (from 23.9% to 16.0%) in the prevalence of antipsychotic use among long-term nursing home residents over the past 5 years.

Percentage of Long-Term Nursing Home Residents Receiving Antipsychotic Medication, 2011-2016

Several media outlets including the Post & Courier and the NY Post have reported the tragic and preventable death of Bonnie Walker.  Walker was found in a retention pond behind the facility, with “multiple sharp and blunt force injuries” consistent with an alligator attack.

Staff at the Brookdale Senior Living center in Charleston failed to supervise her and lost track of Bonnie Walker on July 27, 2016 and didn’t discover her missing until seven hours later, according to the wrongful death suit filed by her granddaughter, Stephanie Walker Weaver. The suit claims Brookdale failed to adequately monitor Walker or conduct a timely search.

Walker had a history of wandering at night and sleep-walking and the facility knew she needed supervision to be safe.  Investigators believe Walker slipped down a steep embankment and fell into the pond right before the gator struck. Weaver reportedly stumbled upon her remains while searching the area with relatives.

She “was shocked and horrified to find the remains of her grandmother’s body floating in the pond where it had been dismembered by an alligator,” the suit says.

“Defendants’ conduct was so extreme and outrageous as to exceed all bounds of decency and must be regarded as atrocious and utterly intolerable in a civilized community,” the suit says.

“This was a horrifying, lamentable series of events that, with the exercise of reasonable care, we maintain could have easily been avoided,” explained Weaver’s lawyer, Ken Connor.

“The complaint really speaks for itself,” he said. “You can just imagine how horrified Ms. Weaver was by the scene that she was confronted with.”

Weaver’s filing on Monday marks the third time Brookdale has been sued in the past seven months, the Courier reports. At least two of those suits allege wrongful death, as well.

 

 

The Burlington Free Press reports a lawsuit filed against Pillsbury Manor South alleging violations including bed height, insufficient staffing and failure to re-examine the best type of bed conditions. The estate of Patricia Calmer who died at Pillsbury Manor South in November is suing the facility and its former owners, alleging negligence led to the resident’s death.  The family’s lawyer called it “an unnecessary and untimely death.”

Calmer was discovered in her room at the home in the early morning of Nov. 3, 2016, with her head trapped between her bed rail and an air mattress.

According to the lawsuit, the facility was in violation of a number of state regulations at the time.  A number of these violations were noted during a site visit five days after Calmer’s death in a report filed by the Division of Licensing and Protection through the Vermont Department of Aging and Independent Living.

 

 

Reuters reported that more than 20,000 people living in U.S. nursing homes experienced serious injuries to the face last year, mainly from falling and hitting hard surfaces or while getting in and out of bed, a recent study suggests. Face injuries can be particularly serious for elderly people because they can affect vital functions like speech, swallowing, sight, and even breathing, said Dr. Peter Svider, a researcher at Wayne State University School of Medicine in Detroit, Michigan.

Nursing homes programs focused on fall prevention should concentrate more on averting these injuries that can cause considerable pain and disability, the research team writes in JAMA Otolaryngology – Head and Neck Surgery.  SOURCE: bit.ly/2n8c8jI JAMA Otolaryngology – Head and Neck Surgery, online March 16, 2017.

Nursing homes can reduce the risk of falling by doing exercise or physical therapy and getting their vision checked, while paying greater attention to fall risks during their patient assessments, and offering adequate fall prevention interventions.

Between 2011 and 2015, they found that 109,795 people over age 60 and living in nursing homes required emergency room care for face injuries. Half of the patients were over age 84 and 65 percent were women.

For each incident, the study team noted where on the face patients were hurt and how they sustained the injury.

The most common wounds were deep cuts or skin tears, which made up over 44 percent of all injuries. A similar proportion of patients experienced other soft-tissue injuries, including bruises on the skin or in deep tissues and the tearing off of patches of skin including eyelids or ears.

Bone fractures accounted for nearly 13 percent of injuries. More than two thirds of these breaks were to the nose, and the next most common fracture site was the eye socket.

The injuries were most often the result of falling and hitting structures like the floor, countertops, doors or cabinets, representing 57 percent of injuries.

Getting in and out of bed was the second most common source of injury, accounting for 23 percent.

“Falls are a tremendous source of disability in older adults,” said Hilaire Thompson, a professor at the University of Washington School of Nursing in Seattle.

“Older trauma patients are more likely to experience a longer hospital stay, increased number of complications, higher costs of care and a higher likelihood of dying for any specific injury than younger adults,” Thompson, who was not involved in the study, said by email.

“Facial injuries are underappreciated,” Thompson added, “as they may accompany other sometimes more severe injuries and are therefore overlooked.”

 

 

 

 

KARK investigative reporters had an incredible expose on a recent case in Little Rock, Arkansas.  “In this KARK exclusive, Working 4 You delves into the death of Clara Hoyt, the laws on what nursing homes are required to report and who is held accountable when facilities aim to keep families in the dark on suspected neglect that leads to death.”  The Coroner’s office bypassed an autopsy after police reported no signs of “criminal or suspicious activity.”  But the family got a call a day later from a whistleblower who told here that Clara’s death at Pleasant Valley Nursing and Rehabilitation could have been prevented.

Clara Hoyt died at 68 years old. The nursing home told her daughter Hillary that Clara died from natural causes triggered by the distress of falling out of bed.

“They said she wiggled her way out of bed, panicked, and scared herself to death and gave herself a heart attack,” Hillary said.
When Hillary saw her mother an hour after getting the call, she says Clara was back in bed and a sheet had been wrapped around her neck.
“They told me it was for when rigor mortis sets in they don’t want your mouth to fall open,” she said. “I thought it was odd, and something inside me told me to take a picture of her there. I’m so glad that I did.”
The whistle-blower told the family that Clara actually died “caught between the mattress and possibly the wall” Hillary said.  The results of a private autopsy proved Clara Hoyt had died from positional asphyxiation. Her air flow was cut off, which was consistent with her head being caught between the mattress and the bed rail.
The nursing home never reported the death to the coroner’s office nor did the nursing staff inform the coroner’s office that it might have resulted from suspected neglect or abuse. The nursing home did finally report Hoyt’s death to the Office of Longterm Care nearly two weeks afterward, after the coroner’s office contacted them for interviews for its investigation. Arkansas law requires nursing homes to notify the coroner’s office of deaths resulting from suspected maltreatment.
Regulations require incidents, accidents and unusual deaths to be reported immediately but no later than 24 hours. Pleasant Valley did neither. The coroner determined that between 3 and 5 a.m. Clara fell out of bed; her head wedged in the gap, and when she was finally found, she didn’t have a pulse and was turning blue
Is there any way someone is hanged on a bed rail without neglect?” KARK asked attorney Shawn Daniels.
“I just don’t see how. We see corners being cut all the time in nursing homes. If you look at the shift sheets, you can see they were understaffed, and if they had been properly staffed and checking on her regularly because of that risk, she might be alive right now and we wouldn’t be here.”

UPI reported on a new technological gadget that could save lives in nursing homes.  To prevent nursing home residents from falling or otherwise injuring themselves, an alert system involving lights, alarms and call buttons lets certified nursing assistants, or CNAs, know a resident needs assistance.

In an effort to speed up the time it takes from a resident calling for help and that help arriving, scientists at Binghamton University have developed a smartwatch app to alert nursing home CNAs wherever they are at a facility, with the hope of providing better service and preventing injuries.

 The concern is in the amount of time it takes for CNAs to respond to calls for help especially when short-staffed. If a resident needs to use the restroom, after a certain period of time they’ll just stand up to go by themselves — but if they are not strong enough, they’ll fall, which can cause injuries or worse.

According to the design, published in the journal Human Aspects of IT for the Aged Population, the scientists combined the existing safety systems at nursing homes, which often include call lights, chair and bed alarms, wander guards, call-for-help options and others — into a single app.

The system requires CNAs to sign in, where they receive a display specific to their assignments. If a resident calls for help or triggers an alert, a notification shows up on the screens of all staff members, including those assigned to the resident.

Photo by John Brhel/Binghamton University
 “The alert message is more informative than the existing system and, at the same time, it will help nurses to prioritize,” Li said. “We will mark or highlight alarms from residents who are actually assigned to whoever is using the app.”

The constant monitoring and connectedness of the system, allowing CNAs to always be plugged in, could help make nursing homes safer.

“The CNAs are exited about this idea and they are interested in this device,” said Haneen Ali, a researcher at Binghamton University. “They would like to see the adoption of new technologies in their working environment because all of the problems in their current situation.”

USA Today had an interesting article about a new report on balance and aging. “Loss of balance, it turns out, is not just a problem for the oldest old.  Instead — like strength, agility and muscle mass — balance tends to start declining in midlife.”

As we grow older, all of us lose some of our ability to balance leading to falls.  This knowledge allows us to recognize our limitations and prevent falls.  However, elderly resident who suffer from dementia, delirium, or other cognitive issues may not be aware of their limitations and safety precautions.  That is why nursing homes must supervise, care plan, and monitor the effectiveness of the fall prevention interventions used.

The  new findings, published in Journals of Gerontology: Medical Sciences, shows a decline earlier in life than many might suspect, says Miriam Morey, a researcher at Duke University School of Medicine. While all the scores fell from the youngest to oldest age groups, scores on the balance and sit-and-stand tests were the first to fall, starting in the 50s, say Morey and co-author Katherine Hall, an assistant professor of medicine at Duke.

About one-third of adults over 65 fall each year, according the Centers for Disease Control and Prevention. While there’s less fall data on younger adults, studies suggest that at least one in 10 falls each year. Most are not seriously injured, but broken bones and head injuries from falls land about 700,000 people in hospitals each year, the CDC says.

“Balance is not just a matter of how well the vestibular system of the inner ear is working. Declines in strength, flexibility, vision, touch and mental functioning can all contribute to balance problems, says Peter Wayne, an assistant professor of medicine at Harvard Medical School.”

“Balance is a very complicated process,” he says. But improving it can be simple, the experts say. Here are a few tips:

• Practice standing on one foot, challenging yourself to increase the duration. You can do it on line at the grocery store or while brushing your teeth. If that’s too difficult at first, start by using a chair back or bathroom counter for support. If it’s easy, try raising your foot higher or holding it out to the side. For extra challenge, try standing on a throw pillow or closing your eyes.

• Try heel-to-toe walking, as if on a balance beam.

• Practice getting in and out of a chair without using your hands.

• Exercise while standing on a wobble board or Bosu ball (an inflated rubber disc on a stable platform).

• Try tai chi or yoga. The evidence that tai chi can improve balance is especially strong, and studies show it is quite safe for people of all ages and fitness levels. In a typical class, a series of movements is performed in a slow, graceful flow, accompanied by meditative deep breathing.

 

ABC News had an interesting article about the decline in the use of alarms as a means of fall prevention.  The change is part of a nationwide movement to phase out personal alarms and other long-used fall prevention measures in favor of more proactive, preventative care. Without alarms, facilities need staff to better learn residents’ routines and accommodate their needs before they try to stand up and do it themselves.

We’re putting alarms on residents so we can forget about them,” said Jenna Heim, director of nursing at Oakwood Village Prairie Ridge.

The use of bed and chair alarms proliferated in the 1990s, when physical restraints were banned, and are intended to go off when a resident’s weight shifts, indicating they may be trying to stand without assistance. But a growing body of evidence indicates alarms and other measures, such as fall mats and lowered beds, do little to prevent falls and can instead contribute to falls by startling residents, creating an uneven floor surface and instilling complacency in staff.”  As we all know, an alarm is only as good as the caregiver responding to it.

 

About 1,800 older adults living in nursing homes die each year from fall-related injuries, according to the Centers for Disease Control and Prevention. Research shows a reduction in falls at multiple long-term care facilities that discontinued the use of the alarms and tailored fall prevention for individuals — things like altering bathroom schedules, room rearrangements or more mental stimulation.

Going alarm-free isn’t yet possible for every nursing home, but it’s generally becoming a best practice as nursing facilities work to create the most home-like setting for people who live there, according to John Sauer, executive director of LeadingAge Wisconsin, a network of nonprofit long-term care organizations.

An alarm system doesn’t prohibit falls,” Sauer said.

McKnight’s had a great article by Eleanor Feldman Barbera, PhD, author of The Savvy Resident’s Guide. Barbera is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

As McKnight’s Staff Writer Emily Mongan points out in “Depression treatments may increase risk of falls in SNF residents, study shows,” a psychosocial treatment for depression increased the likelihood of resident falls. Barbera spoke with Suzanne Meeks, Ph.D., first author of the study, to discuss the problem and the results of her research.

Meeks and her colleagues studied the impact of the Behavioral Activities Intervention (BE-ACTIV) on depressed nursing home residents. They determined that the risk of falls in the treatment group was six times that of the control group, a statistically significant number.

Meeks told me all treatments for depression, including medication and behavioral interventions, increase the chance of falls. When an individual is no longer depressed, he or she has more energy to stand and walk, thus creating more opportunities to fall. If depression has immobilized them for some time, deconditioning may exacerbate the problem.

Meeks points out that more than 81% of her research subjects in both treatment and control groups were receiving antidepressants, suggesting that the behavioral intervention activated the residents more than the medication.

It’s important to treat people for depression despite the increased risk for falls because, as Meeks states, “depression is a fall risk.” Other researchers have found that the risk of falls increases when an individual has more of the following risk factors: depressive symptoms, antidepressant use, high physiological fall risk, and poorer executive function. Any two of these risk factors increase the likelihood of a fall by 55%. Participants with three or four risk factors were 155% more likely to fall — 155%!

The BE-ACTIV intervention

The BE-ACTIV model was quite successful in reducing depression, Meeks and her colleagues found, as described in an earlier article about their work. Study subjects in the 10-week treatment group were encouraged and assisted to participate in pleasant activities such as regularly scheduled group programs, in-room crafts and self-care such as haircuts. Compared to the “treatment as usual” control group, BE-ACTIV was “superior … in moving residents to full remission from depression.”

In addition, there was this particularly noteworthy point: “Staff did not report spending more time with the residents than they had before the intervention, but 86.4% reported improvement in their relationships with the residents.”

This is notable for a number of reasons: First, the intervention didn’t require extra staff time, which is always at a premium. Second, having more pleasant relationships with residents improves workers’ experiences on the job, which reduces turnover. And third, when residents have better interactions with staff members, they are less likely to be depressed.

Mitigating the risk of falls

If depression can contribute to falls and treating depression can also lead to falls, this creates a dilemma that can be addressed by using the following recommendations:

Increase awareness of fall potential. Meeks and her coauthors encourage clinicians and researchers to be aware of the increased risk of falls as residents become less depressed and more active. Those in other LTC roles, such as nurses, aides and recreation therapists, can be directed to more closely monitor a resident whose depression is abating and to use the techniques listed below.

Teach the residents about fall prevention. Many elders can benefit from knowing that they’re at increased risk for falls as they become more active. They’re likely to appreciate the opportunity to self-monitor and will be more motivated to participate in the subsequent suggestions.

Refer for rehabilitation services. A resident who is starting to become more active after a period of inactivity may be helped by a stint in rehab to strengthen areas of physical weakness and reduce the likelihood of falling.

Promote attendance in activities like tai chi. Recreation programs such as tai chi, exercise groups or balloon volleyball can simultaneously improve physical functioning while enhancing mood. Follow the lead of the BE-ACTIV program by including several of these pastimes on the recreation calendar each week and encouraging residents to attend.

Both falls and depression are significant health risks for elders in long-term care and, as the findings of the study show, they should be treated in conjunction with one another.