First Cost News reported the tragic and preventable neglect of Annie Hurley at San Jose Health and Rehabilitation Center.  Annie was transferred to the hospital with a large infected Stage 4 pressure ulcer and a fever of 104.  Annie’s daughter, Paris, questions the level of care her grandmother was given at the nursing home.

“The way the sore looks is awful,” says Paris Hurley. “It’s almost like her body is rotten.”  She adds there’s no way the staff there could’ve missed the huge sore – not just based on its size, but also the visceral smell. It was so ugly, Paris explains, the Emergency Room doctor was stunned.

“He said this is the worst case he’s ever seen in his life,” Paris says.

“And she had no response,” Paris says.

Family members maintain she deserves the best of care and now they don’t believe she received it.  “We trust the caretakers, the nurses, to take care of our family members every day and they don’t,” Paris says.

 

The Casper Star Tribune reported the settlement between SavaSeniorCare d/b/a Poplar Living Center and resident Gilbert Arellano.  The lawsuit involved a facility employee driving a van into the blind resident standing near the curb waiting for a ride in March 2014. Arellano was knocked to the ground, and injured.  The nursing home did not have someone stand with Arellano while he waited for his ride on the handicap ramp and the man was unable to avoid the danger himself because he is legally blind, the suit says. The suit alleges the facility failed to meet the legal standard of care because it is understaffed, did not accompany Arellano to the curb and allowed an employee to “negligently operate” a company van.

Since the incident, Arellano has had pain and numbness in his right arm.  The amount of the settlement reached on Nov. 1 could not be disclosed because of a confidentiality agreement.

The suit also alleges that SavaSeniorCare, the company that owns the Casper nursing home, kept staff numbers low and didn’t adequately train employees to save money, thus endangering the residents. That allegation is repeated across many of the other lawsuits. The Centers for Medicare and Medicaid Services also cited Poplar Living Center for understaffing the facility.

According to its website, SavaSeniorCare operates more than 230 nursing homes across the country, including two more in Wyoming: Cheyenne Healthcare Center and the Sheridan Manor.

“The nursing home’s settlement was the most recent conclusion to six wrongful death or personal injury lawsuits filed against it in the last six years. Repeated inspections by the Centers for Medicare and Medicaid Services also detail a pattern of understaffing, improper care and unsafe building conditions.”
The facility is on the Special Focus Facility list that needs close monitoring because of a “history of persistent poor quality of care.”   Inspection records show a pattern of the for-profit Sava nursing home failing to employ enough staff to keep residents safe, take care of residents who showed signs of depression and investigate complaints of neglect.
Improper wound care is repeatedly cited in the reports. The presence of pressure ulcers is an indicator of neglect and short-staffing.  One resident arrived at the facility in January 2015 without any wounds but developed open sores on her buttocks and legs in March.  The nursing home administrator told inspectors in January, “I’m nowhere near where I want to be in terms of staffing,” according to the agency’s Jan. 15 report.  According to a March 2015 report, there were many nights where only one nurse and one nurse’s assistant were in the building to care for more than 100 residents — many of whom require assistance to use the bathroom and navigate other simple tasks.

The reports repeatedly note that the nursing home fails to adequately record, investigate and resolve complaints about living conditions.  Residents who needed help using the bathroom reported they often waited long periods of time — sometimes up to eight hours — before they were taken to the restroom. One resident wandered the halls of the facility just after 8 p.m. March 29, 2015, with urine-soaked pants for at least 25 minutes before being helped.

Residents also told inspectors that the food served was inedible. A district manager who sampled a meal of steak and noodles also said the food was “not palatable,” according to the reports.

Families of previous residents have sued Poplar Living Center at least six times in the past six years alleging that negligence led to the death and serious injury of their loved ones. The nursing home settled four of those suits for undisclosed amounts and one is still ongoing.

McKnight’s had a great article on the Centers for Disease Control and Prevention’s recent report on sepsis in Vital Signs.  Sepsis is a complication caused by the body’s overwhelming and life-threatening response to infection. It can lead to tissue damage, organ failure, and death. Sepsis is a medical emergency.

Many clinicians are missing the signs of sepsis according to the Centers for Disease Control and Prevention.  In a Vital Signs report published, the CDC found that 7 out of 10 people with sepsis had either recently used healthcare services or had chronic diseases that required frequent medical care. Nearly 80% of patients develop sepsis outside of the hospital setting.

Those statistics mean healthcare providers play a “critical role” in recognizing sepsis early on, and protecting people from infections that can lead to the condition, the CDC said. That role is even bigger for long-term care providers, since adults age 65 years and older and those with chronic medical conditions are more likely to get sepsis.

When sepsis occurs, it should be treated as a medical emergency,” said CDC Director Tom Frieden, M.D. He urged families, doctors and nurses to watch and ask “could this be sepsis?”

The CDC urged providers to follow infection control requirements, educate patients and families about sepsis, act fast if symptoms are identified and know the signs and symptoms.

Healthcare providers can

  • Prevent infections. Follow infection control requirements (e.g., hand hygiene) and ensure patients receive recommended vaccines (e.g., flu and pneumococcal).
  • Educate patients and their families. Stress the need to prevent infections, manage chronic conditions, and seek care if signs of severe infection or sepsis are present.
  • Think sepsis. Know sepsis signs and symptoms to identify and treat patients early.
  • Act fast. If sepsis is suspected, order tests to determine if an infection is present, where it is, and what caused it. Start antibiotics and other medical care immediately. Document antibiotic dose, duration, and purpose.
  • Reassess patient management. Check patient progress frequently. Reassess antibiotic therapy 24-48 hours or sooner to change therapy as needed. Be sure the antibiotic type, dose, and duration are correct.

The agency is also taking steps to increase awareness of sepsis among clinical professionals, aligns infection prevention, chronic disease management and antibiotic use, and develop sepsis tracking programs to measure the impact of successful interventions.

 Graphic: Healthcare providers are key to preventing infections and illnesses that can lead to sepsis.

RightWingNews reported the disturbing story (and disgusting photos) of a nursing home resident.  The sickening story of neglect was reported about a woman in the care of Landsdowne Care Home.   Anahita Behrooz discovered that her 91-year-old mother, Mahbubeh Ghadimabadian, was being terribly mistreated.

The daughter explained how the staff didn’t turn her mother over nearly enough, and this did end up causing terrible and painful bedsores. The most disgusting part of this case of neglect is that the poor old woman’s foot was literally rotting away and definitely did not receive the proper medical attention.  Hit the above link to see video and photo.

 Beachwood Pointe Care Center nursing home and its parent company, Provider Services, will pay $1 million to the family of a resident who died due to the facility’s “negligence and recklessness,” including infected pressure ulcers, a judge ruled. A jury in Cuyahoga County Common Pleas Court awarded Stevens’ estate $560,000 in punitive damages and $440,000 in compensatory damages.

Mary Stevens, a 71-year-old resident, died in 2012 following injuries caused by staff negligence, according to a lawsuit filed by her estate. Stevens also suffered from infected pressure wounds, and sustained “severe” and “fatal” injuries while living at Beachwood Pointe, the lawsuit claims.

According to the lawsuit, the Stevens’ family and physician were never notified of her injuries, and she was “not provided with a safe environment” prior to her death.

 

The Joliet Patch reported the preventable death of Sylvia Raucci at Fairview Care Center of Joliet nursing home.  The Cook County Record reports that Rosemarie Barry, administrator of the estate of Sylvia Raucci, filed a lawsuit against the facility, citing neglect and multiple violations of the Illinois Nursing Home Care Act.

According to the suit, Raucci was accepted into Fairview in August 2013. Her physician instructed the care center to turn Raucci every two hours and ordered a specific cream to be used on her to prevent her from getting bedsores. The chart indicates the care was never provided.  Two open sores were noted by the care center, but no documentation says they were ever treated.

The complaint states that Raucci was transferred to Presence Saint Joseph Medical Center with a Stage two pressure sore to her sacrum and a Stage four pressure sore to her coccyx causing hypotension and dehydration on Sept. 20, 2013.  Nine days later, Raucci died.  Fairview had a duty to ensure Raucci was properly cared for, and to prevent the development of bed sores.

The Indy Channel and Call 6 reported the tragic case of Tim Johnson. Navy Veteran Johnson died in a Columbus hospital Oct. 11, 2014, at the age of 43 as a result of sepsis and cardiac arrest after spending four years at the Seymour Crossing nursing home operated by American Senior Communities.  See Police investigating possible neglect at nursing home.  Tim Johnson battled rheumatoid arthritis and other health issues.

State inspection reports and police records obtained by Call 6 Investigates raise questions about whether the nursing home neglected Johnson.  Following the death of Johnson, the Indiana State Department of Health/federal Centers for Medicare & Medicaid Services (CMS) conducted an investigation and inspection at Seymour Crossing on November 3, 5 and 6, 2014.

The report shows on October 4, a staffer went to check on Johnson and found him lethargic, disoriented, whimpering and saying ‘please.’  Johnson ended up in the hospital with bed sores and wounds on his body.  The Intensive Care Unit nurse at the hospital noted Johnson was unkempt, unclean and had a very strong smell. “(The right arm dressing) was saturated and foul…smelled like it had been there a while and we were all wearing masks,” an ICU nurse told investigators. Johnson’s family took pictures of the wounds, too graphic to show, including one on his right arm so deep it went down to the bone and muscle.  Johnson developed an infection complication known as sepsis, went into cardiac arrest, and was taken off life support at the age of 43.

“You put your loved one in there and you expect them to be taken care of,” said Rebekah Klaus, Johnson’s sister.  Klaus tries to remember her brother, a Navy veteran, for how he lived, not how he died.  “He loved his daughter, he loved his family, he loved animals, he loved life in general,” said Klaus. “He couldn’t walk, that’s the reason he was at the Crossing,” said Klaus. “His knees wouldn’t go.”  “I have cried every single day for a year,” said Klaus. “I still look at those pictures. I still go out to that graveyard every day and it haunts me.”

The state/federal investigation found Seymour Crossing failed to provide necessary care and services, and noted a deficiency in “Provide Care/Services for Highest Well Being.”  Seymour Crossing paid $7,897.50 in fines in 2014, according to CMS, however the fines were not connected with the death of Tim Johnson. The fines were related to a prior inspection at Seymour Crossing that found four deficiencies including failing to maintain an odor free environment and failing to respect the dignity of patients.

 

McKnight’s reported that HSR: Health Services Research has found that one of the leading indicators of hospital readmission in nursing homes is the prevalence of pressure ulcers. HSR’s research found that quality measures like pressure ulcer rates could affect hospital readmission rates regardless of county. Nursing homes with long term residents with pressure sores were more likely to readmit residents to hospitals. The acuity of the residents also affected whether the facility had higher readmit rates. Other quality measures weren’t found to be good predictors of readmission. Overall, HSR found that the majority of reasons patients are readmitted to the hospital are for reasons beyond their control, including nursing home care. Pressure ulcer prevalence was found to be a good predictor of readmission. Readmission rates will affect skilled nursing facilities’ payments in 2018, according to a law passed last year.

NJ Online had a great article about protecting loved ones from elder abuse quoting esteemed nursing home advocate/attorney Saul Gruber.  Our senior citizens are the heart of the population, but are often times forgotten when placed into long-term care facilities.

“The nursing homes get to a point where they are trying to make money and the biggest expense is labor, so that’s where they make cuts,” Gruber said. “Understaffing is the biggest problem. The employees are OK, but they can only do so much. If they are told to feed eight people at each meal, but those eight turn into 14, it’s tough.”

Federal guidelines were first put into place in 1987, Gruber said.  “Everything was put on paper,” he said. “Everything they had to do to maintain patient care. They know what they’re supposed to do. The problem is they aren’t doing it.”

Signs of elder neglect or abuse

Bed sores – Pressure ulcers or bedsores occur when a patient is not being moved often enough and not being fed a proper diet, according to Gruber. “We see those a lot,” he said of neglect cases. “I call them rotting, smelly holes in someone’s back.”

FallsGruber said it is the staff’s responsibility to do whatever is necessary to prevent falls. “There are a lot of things they can do,” he said. “If they fall out of bed, be sure the bed is near the wall. Use rails. If person seems to fall at 3 a.m., maybe take them to the bathroom at 2:30 a.m. so they don’t have to get out of bed. They are supposed to try to prevent falls. Prevention is key.

Strange smells – Gruber suggests conducting a “smell test.” “Bad smells are a give-away for many different issues,” he said. “Even if it’s a very antiseptic feel and smell, it’s not really a home, and what is that smell covering up?”

Tips

Care assessments – When a patient is admitted to a long-term facility, staff members are required to perform a “care assessment.” “They should be assessed so the staff knows what they need, what problems they have, and how to care for them,” Gruber said. “These assessments need to be done all the time because patients change.” Care assessments look for a patient’s “red flags” – such hazards as falling due to instability, pressure ulcers due to lack of movement, choking, and malnutrition.

“Then they are supposed to make up a care plan – it’s not magic,” Gruber said. “What are they at high risk for? And here’s what to do to prevent these issues and care for the patient.”  Then, that plan must be utilized faithfully.

“If a care plan is put into place to prevent falling and the patient continues falling, the staff can’t just say ‘oh well.’ They have to do more,” he said.

Be familiar with the staff – Gruber said, once your family member is settled, get to know the staff members who will be caring for your loved one.

“When you put someone into a facility, you have to become friendly with the staff because they will tell you what’s happening,” he said.

Vary your visitation – If a patient is being neglected or abused, staff members may pay attention to when the the family comes in and be sure that the situation looks perfect.

“Go visit at different times of the day,” Gruber said. “Don’t always go at 3 p.m. and don’t tell them when you are coming, and just see what’s happening.”

Check online – Gruber said medicare.gov publishes reports on the performance of each of the approximately 300 nursing homes throughout the state.

“Each nursing home has to be inspected a minimum of once per year,” he said. “It’s called a survey. They pull random charts, and interview staff and families, to make sure doing what they are supposed to be doing.”  These reports can show you what areas a facility has had problems with.

“When picking, look online at reports,” Gruber said. “If you think you don’t like a nursing home, don’t go there. If you’re already there and think something is wrong, it probably is.”  Gruber said the most import aspect is being present.

“You’ve got to be there,” he said. “some families are afraid that if they raise trouble, then when they are not there, their loved one won’t be cared for properly. Let (staff) know you will know if they neglect the patient.”

He said one of the most difficult parts of his job is dealing with a family’s guilt.

“I’ve sat here with clients crying, saying, ‘Why did I put my mom there? I knew it was bad and now she’s dead,'” Gruber said.