The Conversation reported on the epidemic of resident to resident assaults in nursing homes.  Many preventable deaths in nursing homes are a result of aggression between residents. This most commonly occurs in people with dementia, their research has found.  Published in the Journal of the American Geriatrics Society, they examined records for all resident-to-resident aggression-related deaths among nursing home residents reported to a coroner in Australia between 2000 and 2013.

Their study examined the frequency and nature of resident-to-resident aggression resulting in the most severe outcome – death. In their analysis, almost 90% of residents involved in resident-to-resident aggression had a diagnosis of dementia. Three-quarters had a history of behavioral problems, including wandering and verbal and physical aggression, which are common symptoms of dementia.

The rising global prevalence of dementia, particularly in the nursing home population, means aggressive behaviors between residents will increasingly be an issue. Two high-level reports on elder abuse in aged care in Australia have recommended better reporting systems so we can understand and prevent all such deaths in nursing homes.

Resident-to-resident aggression is an umbrella term that includes physical, verbal or sexual interactions that are considered to be negative, aggressive or intrusive. These behaviors can cause serious physical harm or psychological distress.

The prevalence of aggression between nursing home residents is difficult to determine. Recent research estimates at least 20% of nursing home residents in the US were involved in such incidents.

Most incidents appeared to be unprovoked, or were triggered by communication issues or a perceived invasion of personal space. Importantly, only one of the 18 studies reported a single death as the result of physical resident-to-resident aggression.

Our research found most exhibitors of aggression (85.7%) were male. The risk of death from aggression between residents was twice as high for male as for female residents. Those who exhibited aggression towards other residents were often younger and more recently admitted to the nursing home than their targets.

Incidents commonly involved a “push and fall”. Seven (25%) related deaths resulted in a coronial inquest, but criminal charges were rarely filed.

However, this is likely to be just the tip of the iceberg as there is much potential for underreporting and misclassification of resident-to-resident aggression deaths. We have limited data on how often incidents of aggression between residents in Australia occur but do not result in death.

WNCN reported that Natalia Mikhailovna Roberts has been accused of stealing medication.  Warrants state Roberts worked as a nurse for Lake Emory Post Acute Care in Inman.  Lake Emory is owned and operated by the national for profit chain Fundamental Long Term Care.

Authorities say there were 78 doses of Oxycodone for a patient when there should have been 96 doses. Warrants state Roberts “intentionally…omitted information” required for records keeping.

Records showed another patient was missing 124 doses of Hydrocodone on June 17, another arrest warrant states.

Roberts is charged with theft of a controlled substance and two counts of violating drug distribution laws by the S.C. Department of Health and Environmental Control.  A temporary order of suspension has been issued for Roberts by the S.C. Department of Labor, Licensing and Regulation.

It is unclear if she was using the pills or selling them to make money.  The investigation into why the facility failed to notice the missing opiods is ongoing.

The St. Louis Dispatch reported the tragic and preventable wrongful death of Donna Chapman who caught fire and suffered fatal burns in May while smoking a cigarette in her wheelchair.   On May 13, a member of the staff wheeled Chapman onto the patio, then left her alone to smoke a cigarette before dinner. Chapman somehow ignited her clothing and was found ablaze by an attendant.

“I am burning alive, I am burning alive,” Chapman kept saying, according to an investigative report from the Missouri Department of Health and Senior Services.   She suffered third-degree burns to her scalp, chest, neck and shoulders.

Chapman died May 15, two days after she caught fire while smoking unsupervised on a patio at NHC HealthCare. Her son, Dean Chapman filed the wrongful-death suit Oct. 23.

The suit claims the nursing home improperly left the disabled woman alone while she smoked without a special burn resistant apron that was supposed to protect her from ashes and dropped cigarettes. The suit also says the nursing home failed to adequately assess her ability to smoke unsupervised and detect changes in her mental and physical condition.

Chapman had dementia, and because of her paralysis, limited use of her legs and left arm. She was a longtime smoker. The nursing home performed eight “smoking assessments” for her between 2012 and March 17, 2017, the suit says. All of the assessments determined she could smoke without supervision, despite concern expressed by staff in October 2016 and the discovery of burn marks on her clothing in February, the suit adds.

In March, the nursing home did tell Chapman she had to wear a special smoking apron to protect her from hot ashes and dropped cigarettes. Despite concerns that her dementia was worsening and that burn marks continued to be found on her clothes, she was put on the back porch alone on May 13 without a smoking apron, the suit says.

Peimann, the nursing home administrator, told the Post-Dispatch in May that Chapman’s death was “a bad accident.”

David Terry, an attorney for Dean Chapman, said: “For a nursing home to provide a safe environment for its residents, there must be enough staff members to properly supervise the residents and the staff needs to be sufficiently trained to meet the needs of each resident. We believe in this case the NHC facility failed to do that.”

CNBC reported that Trump’s new tax plan removes an important deduction for nursing home residents.  The Republican bill would repeal the medical expense deduction, which allows people who spend more than 10 percent of their income on out-of-pocket health costs to write them off.

The cost of living in a nursing home can easily run up to tens of thousands of dollars per year and wipe out the savings of elderly residents who are paying out of pocket. The deduction can be an important offset to taxes those Americans would owe on their retirement savings distributions.

“It tends to be mostly … older people who do not have long-term care insurance, and end up in a nursing home,” said Richard Kaplan, a professor who specializes in tax policy and elder law at the University of Illinois College of Law.  “For people who are receiving long-term care and are paying for it themselves, this is going to be a huge deal,” said Kaplan.

“This would be a joke if the consequences weren’t so serious,” said Brad Woodhouse, campaign director of health-care advocacy group Protect Our Care, in a statement. “Republican leaders are determined to raise health-care costs for middle-class families who need it most — in this case people with high medical costs or those paying for long-term care.”

 

Public Opinion had an interesting article on how the nursing home industry is changing for the Baby Boomer generation.  ““The entire senior living industry is in the midst of great change right now,” Menno Haven CEO Hugh Davis said. “The post-war generation, those born between 1945 and 1965, is the largest population wave this nation has ever seen, and they are now at retirement age and looking for senior living communities in waves. This shift is causing the entire industry to look at their products and services. These folks have grown up very differently than their World-War-II-era parents, and they have different wants and expectations.”

The need for short-term rehabilitation services such as physical therapy, occupational therapy and speech therapy has increased. The goal is to prepare people to return home after a hospital stay for acute illness, traumatic injury or elective surgery.  Local retirement communities already are moving to “small houses,” an innovative model for assisted living. The concept balances social interaction and privacy; with residents sharing a kitchen, living room and meals at a family-style dining room table.

Industry research shows these environments reduce anxiety, medication use and confusion in memory care residents.

Next Avenue had an interesting article on how 4 states have lowered nursing home admissions. Nursing home care is the most expensive form of long-term care. According to the 2017 Genworth Cost of Care report, a private room in a nursing home now costs an average of $97,455 per year. A semi-private room runs more than $85,000.

“If you are hospitalized at age 65 or older, there is a one in five chance you will be discharged to a nursing home.   Certain states — like Minnesota, Maine, Oregon and Connecticut — have implemented policies that lower the chances of getting “stuck” in a nursing home, said Wendy Fox-Grage, a senior strategic policy advisory with the AARP Policy Institute and co-author of “State Strategies to Reduce the Risk of Long-Term Nursing Home Care After Hospitalization.”  The new report, released Oct. 6, highlights some of those innovative policies.

Minnesota: ‘Return to Community’

Minnesota uses “community living specialists” to work with older adults to get them back to their communities. The community living specialists, who are nurses or social workers, assist the nursing home to identify new residents who may want to return home. Then, after the residents return home, the community living specialists follow up with them to make sure they are getting the services and support they need over the following months.

Another Minnesota initiative lauded in the report is its Performance-Based Incentive Payment Program. This program rewards nursing homes with incentive payments for designing projects to lower their numbers of long-term residents.

Oregon: Downsizing Nursing Homes

Oregon does a better-than-average job of keeping people out of nursing homes by providing services in the community: just 3.3 percent of state residents age 85 and older live in nursing homes. (The national average is 9.5 percent, according to the AARP report.)

A 2013 law provided a financial incentive for nursing homes to buy another facility and then take the excess capacity out of use — a process known as “buy and close.” Some providers have diversified into hospice care, assisted living, home health and independent living, the report said.

Connecticut: Home Care for Older Adults

Connecticut’s Home Care Program for Elders provides financial assistance for home care services so older adults can delay or avoid going to a nursing home. There are varying levels of service depending on a person’s financial resources, but unlike other programs, those who don’t qualify for Medicaid are not automatically excluded.

The services may include housekeeping, companion services, home-delivered meals, a personal emergency response system, adult day care, assisted living, mental health counseling and minor home modifications. Family caregivers can receive payments of between $42.58 and $107.06 per day.

The program “represents a significant state investment in the delivery of home care services to people who, despite being at risk for nursing home admission, do not qualify for Medicaid,” the report said.

Maine: Getting to People Early

Maine has been working since the 1990s to limit nursing home admissions to the people who most need them, according to the report. It does that, in part, by mandating medical assessments before admission. Maine also provides prospective residents and their families with a “community plan of care,” which gives information about services they may be able to use instead of going to a nursing home.

The program also provides individuals with a service plan that has estimates of how much the home care services will cost. The service plan doubles as an authorization for payment by Medicaid, if the person qualifies, or the state-funded home- and community-based care services program.

 

 

 

The Chicago Sun Times had an article about the excessive cost of long term care.  Long-term care costs are surging again and the most expensive option — a private nursing home room — may soon top $100,000 per year.  This is shocking considering the epidemic of abuse and neglect in the nursing home industry.

The median cost of care increased an average of 4.5 percent this year, according to a survey released by Genworth Financial. The cost of home health aide services rose 6 percent, to $21.50 an hour. Private nursing home care now costs more than $97,000.

“Long-term care can impose a crushing financial burden on individuals or families in part because Medicare, the federal health coverage program for people over age 65, provides limited help. That can force people who don’t have private coverage to spend down their assets until they qualify for the government’s health insurance program for the poor, Medicaid.”

 

Reuters had an interesting article about a recent study showing that nursing home care is increasingly being delivered by specialized nurses and physician assistants instead of medical doctors.  “One of the problems is that many nursing homes have no regular doctors, since it is not a requirement,” Dr. Mitchell Katz, director of the Los Angeles County Health Agency told Reuters Health by email. “Most nursing home patients have a private doctor who signs the orders for the nursing care, but it is at an office where they may not be able to get to the nursing home on a regular basis.”

“In the past decade, the number of doctors in nursing homes has dropped as the number of “skilled nursing facility specialists” has almost doubled, the researchers report in JAMA Internal Medicine.”

The research team found that the proportion of physicians who had ever billed for care delivered in these facilities fell from 13.7 percent to 9.8 percent. Although the number of physicians classified as skilled nursing facility specialists rose from 1,496 to 2,225, that represented an increase from just 0.3 percent of all physicians to 0.5 percent.

WSPA reported on the new $41 million 108-bed facility to house honorably discharged vets, paying about $34 per day.  County leaders decided on a location, but aren’t revealing where the 35 acre property is going to be.  The state is building three new veterans nursing homes, including one in Cherokee County.  According to the United States Department of Veterans Affairs, a 2014 survey found more than 100,000 Vietnam War veterans in South Carolina.

“We need to do everything we can to make sure our veterans are taken care of,” said Cherokee County Veterans Service officer Todd Humphries.

The facility will come from federal and state funding. Humphries says it would also bring almost 200 jobs to the area.

“There will be doctors, nurses, dieticians – all sorts of medical staff and non-medical staff,” he said.

Once the federal dollars start rolling in, county officials hope to break ground as early as 2019.

While many senior citizens sleep less than younger adults, they actually need the same amount of sleep in order to stay healthy. Continue reading to learn more about seniors and sleep.

Studies have shown that 13% of men and 36% of women who are age 65 or older require at least 30 minutes to fall asleep. This inability to fall asleep quickly (if at all) is often coupled with frequent waking throughout the night. While it is true that sleeping patterns change as we age, it is important that senior citizens get the amount of sleep they need to stay healthy.

How Much Sleep Do Senior Citizens Need?

The average person needs seven to nine hours of sleep per night to perform at their best. Though many senior citizens get less sleep than the recommended amount, they actually still need these critical hours of rest.

While the specific amount of sleep needed varies from person to person, it does not change as we age. In other words, if you required 7 hours of sleep in your mid-twenties, you will likely need a similar amount of rest for the remainder of your life. So, while many senior citizens may seem spry, despite rising before dawn, there may be a plethora of underlying issues. Read More →