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.

Reuters had an article about a new study that indicates seniors living on their own may have a greater risk of fractures when they’re less mobile and less able to manage daily tasks without help, but in nursing homes the opposite may be true.  Among nursing home residents, risk factors for fracture included the ability to walk independently, wandering the halls, dementia and diabetes, the study found.

“In the community, individuals that need more assistance with mobility often have multiple health problems that place them at greatest risk for fracture,” said lead study author Dr. Sarah Berry of the Institute for Aging Research and Harvard Medical School in Boston.

“In the nursing home, all residents have health problems, but there is a tremendous variation in the ability of these residents to move independently,” Berry said by email. “Frail nursing home residents that are still mobile and independent have opportunity to fall, whereas residents that require extensive assistance have less opportunity to fall and fracture.”

Nearly 10 percent of hip fractures in the U.S. occur among nursing home residents, researchers note in The Journals of Gerontology: Series A. More than one-third of nursing home residents who fracture a hip will die within six months, and many others who were mobile before the fracture will become completely disabled.

Among residents who survive hip fractures, infections and pressure ulcers, or bed sores, are common, leading to functional decline and diminished quality of life.

Even if mobility might carry an increased fracture risk for nursing home residents, the fix isn’t staying in bed, said Dr. Joe Verghese, director of the Albert Einstein Jack and Pearl Resnick Gerontology Center in Bronx, New York.  That’s because being immobile is associated with an increased risk of blood clots, malnutrition and death for elderly people.

To prevent falls, bright lighting during the day and night lights after dark can help boost visibility, said Jean-Michel Brismee of Texas Tech University Health Sciences Center in Lubbock. Removing rugs that might slip, placing hand rails in showers and tubs, and keeping walkers and canes within easy reach can also help, Brismee said in an email.

The Gerontologist reported that a new study regarding fall occurrence during a nursing home (NH) to community transition. This study sought to examine whether the presence of supports and services impacts the relationship between fall-related risk factors and fall occurrence post NH discharge.  Falls are a major source of morbidity and mortality among older adults.

“Fifteen percent of participants fell within 30 days of NH discharge. Factor analysis of fall-related risk factors produced three latent variables: fall concerns/history; activities of daily living impairments; and use of high-risk medications. A supports/services latent variable also emerged that included caregiver support frequency, medication management assistance, durable medical equipment use, discharge location, and receipt of home health or skilled nursing services. In the SEM model, high-risk medications use and fall concerns/history had direct positive effects on falling. Receiving supports/services did not affect falling directly; however, it reduced the effect of high-risk medication use on falling (p < .05).”

King5 had an article about fall prevention in nursing homes.  Any facility accepting residents must assess residents to determine their fall risk.  Understanding the cause helps prevent falls. Alternative interventions are necessary if the resident has dementia and lacks safety awareness.

“So, the key is preventing injury and that takes a little detective work on the part of the staff. They have to figure out just when a resident falls; can routines be changed to prevent falls? It may be as simple as more supervised trips to the bathroom.”

The best interventions include lowering the bed; raising side rails in bed; placing a safety mat next to bed; using a pressure alarm; but the best intervention is adequate staffing to safely supervise the residents.

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.”