11Alive wrote another article about the SavaSeniorCare facility in Atlanta where a decorated World War II veteran died while gasping for air and begging for help as the SavaSeniorCare caregivers were seen on a hidden video, laughing.  The DeKalb County District Attorney may file criminal charges against nursing home staff for not responding appropriately while one of their residents slowly died in front of them.

Dempsey died while begging for assistance inside the Northeast Atlanta Health and Rehabilitation Center. Video shows he yelled “help” numerous times and pressed his call button half a dozen times. It took nursing home staff about an hour to call 911.

In November, the Brookhaven Police Department launched a criminal investigation into 89-year-old James Dempsey’s death after an 11Alive Investigation uncovered hidden camera video and court depositions of nursing home staff who responded to the World War II veteran.

The SavaSeniorCare facility is Northeast Atlanta Health and Rehabilitation. 11Alive obtained both videos in 2017 through public records requests after the family filed a lawsuit.  Police say 11Alive’s story was key to re-opening the investigation. “It was very instrumental…because there was information in the news report that you guys aired that our detectives had not seen yet,” said Gurley.

One of the nurses seen in the video is Wanda Nuckles, who worked the night Dempsey died. In a court deposition, the nursing supervisor testified under oath that she rushed to the room and started CPR on Dempsey and did not stop until paramedics arrived.  That is clearly not true.  The video shows she did not start CPR immediately. The video also shows her starting and stopping CPR numerous times, only picking up right just before paramedics arrived.

At one point, the hidden camera video caught nursing home staff laughing while they tried to fix his oxygen machine when Dempsey had already stopped breathing.  Last year, operators of the nursing home, Sava Senior Care, took 11Alive to court in an attempt to stop the video from getting released. Attorneys for Sava even attempted to appeal to the Georgia State Supreme Court, but withdrew its appeal after a lower court already released the video to 11Alive.

The Atlanta Journal Constitution confirmed that arrest warrants have been issued for three nursing home employees accused of repeatedly ignoring a World War II veteran’s pleas for help. A grand jury indicted the women — Loyce Pickquet Agyeman, Wanda Nuckles and Mable Turman — four years after James Dempsey was found dead in his room at the SavaSeniorCare facility.

Agyeman, a former licensed nurse, was charged with murder and neglect to an elder person, Jones said. Nuckles, also a former licensed nurse, was charged with depriving an elder person of essential services. Turman, a certified nurse assistant, was charged with neglect to an elder person. All face concealing a death charges.

WSPA, my hometown local news, reported on the prevalence of physical restraints in South Carolina nursing homes.  South Carolina restrains your loved ones at three times the national average.  Only one state physically restrains patients more often, and some local facilities rank among the worst in the nation.  There are numerous safety devices that can be used for safety that do not place residents in harm’s way.  Under a combination of state regulations and federal law, physical restraints can’t be used unless a doctor specifically authorizes it, and that authorization has to be renewed every 24 hours.

WSPA told the story of Charles “Eddie” Fowler who died from “positional asphyxia” or choked to death, strangled by the medical restraints that bound him to his wheelchair.  “He was all by himself,” Charles’ sister Deborah Cranford said. “Don’t know if he was calling for us, don’t know how he felt…he had to feel so alone.  They think he slid down from what the coroner said and the harness was strangling him the whole time,” she said.

State and federal regulators have tried for decades to eliminate the kinds of restraints that Cranford said killed her brother.

No place in the Upstate restrains a higher percentage of it’s patients than the Ellenburg Nursing Center in Anderson.  On average, about 11 percent of the patients at the nursing center are restrained each year, which is 10 times the state average and 26 times what you’d expect nationwide.  And at times, the numbers are a lot worse than that.

At Woodruff Manor in Spartanburg County, staff physically restrained more than 11 percent of its patients in the last three months of 2016.

Jason Blalock is a certified nursing assistant and up until last month worked at Lake Emory Post Acute Care.  “They would have like a seat belt wrapped around them that’s bolted to the back of the wheelchair, and wrapped around with an alarm on the back.”

Blalock said he was fired from Lake Emory Post Acute Care after he filed abuse complaints with the state.

We asked him, “how long would somebody be restrained like that?”

“For hours at a time,” Blalock said.

“For hours at a time?” we asked. “You saw for hours at a time patients restrained to their wheelchair?”

“Yes,” he said.

KPCC reported the latest data from the federal Centers for Medicare & Medicaid Services, known as CMS, regarding the percentage of long-term nursing home residents being given antipsychotic drugs dropped from about 24 percent in late 2011 to under 16 percent last year. Decreases were reported in all 50 states, with the biggest in Tennessee, California and Arkansas.  However, 16 percent is still way too high.

“Given the dire consequences, it should be zero,” said attorney Kelly Bagby of the AARP foundation, which has engaged in several court cases challenging nursing home medication practices. Bagby contends that the drugs are frequently used for their sedative effect, not because they have any benefit to the recipients.

Experts and advocacy groups — including the Washington-based Center for Medicare Advocacy and AARP Foundation Litigation — say even the lower rate of antipsychotic usage is excessive, given federal warnings that elderly people with dementia face a higher risk of death when treated with such drugs. Some nursing homes are finding other medications that sedate their patients into passivity without drawing the same level of scrutiny as antipsychotics.

Analyzing the latest government data, Human Rights Watch estimates there are now about 179,000 people in nursing homes who get antipsychotics every week without having a diagnosis for which the drugs are approved.

“Antipsychotic drugs alter consciousness and can adversely affect an individual’s ability to interact with others,” the new report says. “They can also make it easier for understaffed facilities, with direct care workers inadequately trained in dementia care, to manage the people who live there.”

The report also says that nursing homes, in violation of government regulations, often administer antipsychotic drugs without obtaining consent from residents or the relatives who represent them.

Hannah Flamm, the report’s lead author, said the recent data showing a decline in antipsychotic usage demonstrated how extensive the overmedication problem had been. In an interview, she said the lower numbers don’t impress her.

Would you want to go into nursing home if there’s a one in six chance you’d be given a drug that robs you of your ability to communicate?” she asked. “It’s hard for me to applaud the reduction when it’s inexcusable to ever misuse these drugs.”

Advocacy groups contend that federal enforcement of medication regulations has been too lax and will only grow more lenient as President Donald Trump’s administration pursues an agenda of deregulation.

“They’re helping the industry, not the patients,” said attorney Toby Edelman of the Center for Medicare Advocacy:

 

CNN had a great article on the new Human Rights Watch report, “‘They want docile:’ How Nursing Homes in the United States Overmedicate People with Dementia.”  “Children complained about parents who were robbed of their personalities and turned into zombies. Residents remembered slurring their words and being unable to think or stay awake. Former administrators admitted doling out drugs without having appropriate diagnoses, securing informed consent or divulging risks.”  The under-staffing of nursing homes is a major factor of such over-medication.

The 157-page report estimates that each week more than 179,000 people living in US nursing facilities are given antipsychotic medications, even though they don’t have the approved psychiatric diagnoses — like schizophrenia — to warrant use of the drugs. Most of these residents are older and have dementia, and researchers say the antipsychotic medications are administered as a cost-effective “chemical restraint” to suppress behaviors and ease the load on overwhelmed staff.
What’s revealed in this report echoes the findings of a CNN investigation published in October. The CNN story described how one little red pill, Nuedexta, was being misused and overprescribed in nursing homes. What’s more, CNN learned that this overuse benefited the drugmaker to a tune of hundreds of millions of dollars, largely at the expense of the US government. The CNN report prompted an investigation into a California-based pharmaceutical company.
The Food and Drug Administration has not deemed antipsychotic drugs an effective or safe way to treat symptoms associated with dementia — including dementia-related psychosis, for which there is no approved drug. In fact, the FDA cautions that these drugs pose dangers for elderly patients with dementia, even doubling the risk of death, the report shows. Other possible side effects outlined in the report include an onset of nervous system problems that may cause “severe muscular rigidity” or “jerking movements,” as well as low blood pressure, high blood sugar, blood clots and other problems.
There are plenty of ways to deal with dementia-related symptoms or behaviors that don’t involve pharmaceuticals, the report lays out. Improvements can be achieved through providing activities, reducing loneliness, creating routines, encouraging relationships with familiar staff members, offering exercise and promoting programs like music therapy and pet therapy.
The government has long-recognized the problem of overusing antipsychotic medications and is required to monitor the use of such drugs, the report shows. In fact, in 2012, the Centers for Medicare & Medicaid Services established the National Partnership to Improve Dementia Care in Nursing Homes in acknowledgement of this issue.  “The US government pays nursing homes tens of billions of dollars per year to provide safe and appropriate care for residents,” said Hannah Flamm, a New York University Law fellow at Human Rights Watch. “Officials have a duty to ensure that these often vulnerable people are protected rather than abused.”

The Department of Justice issued a press release related to the sentencing of a nursing home employee who embezzled over $80,000.  Veneford Blankenship was sentenced to a year and a month in federal prison, announced United States Attorney Mike Stuart. Blankenship previously pleaded guilty to mail fraud. She was also ordered to pay $81,486.15 in restitution.

Blankenship worked at a nursing home in Princeton as the Business Office Supervisor where she oversaw the financial operations. Her duties included sending patient invoices, recording deposits in the nursing home’s accounting program, and depositing checks into the nursing home’s operations account. The nursing home also had another bank account, which allowed residents to collect funds that were occasionally spent on dinner, outings, and small events for residents. While the nursing home’s parent company received bank statements for its operations account, the parent company did not receive any statements for the other bank account.

Blankenship admitted that in June 2015, she began secretly diverting residents’ payment checks. Instead of depositing these checks into the operations account, she deposited the checks into the other bank account. She then wrote checks to herself from the other account, forging the signatures of the two individuals with signature authority. She hid her crime by writing false memos on the checks and indicating that the withdrawals were for legitimate nursing home purposes, when in reality she took the money for herself. She also falsely updated the nursing home’s accounting program to indicate that the residents paid invoices and that the nursing home received funds that she had stolen.

 

 

U.S. News reported that Veneford Blankenship, a nursing home employee in West Virginia, has been sentenced to one year and one month in federal prison in an embezzlement case.  Blankenship was sentenced for mail fraud in federal court in Charleston. She also was ordered to pay more than $81,000 in restitution.

Prosecutors say Blankenship was the business office supervisor at a Princeton nursing home and admitted to diverting residents’ payment checks into a bank account. She then wrote checks to herself, forging the signatures of two other individuals.

The Duluth News Tribune and Twin Cities Pioneer Press had articles on the tragic death of a resident at Bethel Care Center. When a St. Paul nursing home resident’s ventilator tube became detached and sounded an alarm during a worship service at the facility last summer, there weren’t any nursing staff around to help, according to a report by the Minnesota Department of Health.  Staff didn’t notice the detached tube for an hour, at which point it was too late to save the resident, the report said.

According to the Health Department:

Around 2 p.m. on July 16, 2017, the resident was brought to a church service in the nursing home. His ventilator was functioning properly. Two minutes later, his ventilator alarm sounded. A pastoral staff member claimed to hear the alarm, but he or she had previously been instructed to ignore it. About an hour later, the same staff member noted poor color in the resident and called for help.

Nursing staff arrived, reconnected the tubing and called emergency services. At 3:36 p.m., emergency medical services pronounced the resident dead.  The resident’s cause of death was listed as asphyxia due to disconnection of the ventilator tubing. The resident physician said he had recently examined the man and thought it unlikely he would have died otherwise, the report said.

 

The Daily Report reported on the recent nursing home verdict in Valdosta, Georgia where a jury compensated the family of a neglected resident with a $7.6 million verdict after the man died from complications of a bowel obstruction he suffered at Heritage Healthcare at Holly Hill nursing home.  The key issue was a lack of appropriate medical staff at the facility the night 71-year-old Bobby Copeland began vomiting and complaining of a distended abdomen in October 2012. When Copeland’s symptoms became obvious, the only medical staffer was a licensed practical nurse, who called an off-site physician assistant to ask whether to send Copeland to an emergency room less than a half-mile away.  The physician assistant allegedly said no and ordered some tests, but it was only the next day that Copeland was taken to the hospital, where he died hours later.  Had a registered nurse been available, she could have performed a skilled assessment of his symptoms and mental faculties. The nursing home had a policy of only using LPNs at night.

By the time Copeland got to the emergency room at South Georgia Medical Center, he was showing signs of having aspirated fecal matter in his lungs, and his stomach was severely distended.  Copeland died about 12 hours after arriving at the hospital.

Heritage Healthcare at Holly Hill is operated by Lowndes County Health Services, a division of the PruittHealth chain of nursing homes.

The jury found the nursing home liable for both ordinary and professional negligence and apportioned only 20 percent of the fault to the facility, with the rest divided among four nonparties.  The family offered to settle for $600,000 or $650,000 under Georgia’s offer of settlement statute, by which a party that declines a settlement offer and then loses at trial by at least 25 percent more than the rejected offer may have to pay the winning party’s attorney fees from the date of the offer.

The jury took about three hours to award $7.5 million for the value of Copeland’s life and $121,200 to his estate for pain and  suffering, medical and funeral expenses.

The panel allocated 20 percent of the liability to the nursing home, 35 percent apiece to the physician assistant and medical director, and 5 percent apiece to South Georgia Medical Center and the ER doctor.

 

Skilled Nursing News had some depressing news to report on nursing home caregiver wages.  “Hourly wages for nursing home employees who provide direct care and services tend to be lower than wages for the same job titles in assisted living facilities and continuing care retirement communities, recent survey findings show. But salaries for leadership titles and director positions did not follow the same trend.”  So management staff–all of which receive higher salaries in nursing homes on average than they do in assisted living facilities–are getting paid more but the actual caregivers get less despite having more responsibilities and work!  No wonder nursing homes have trouble keeping staff.

Certified nurse aides (CNAs), resident assistants, medication aides, activity aides, housekeeping staff, laundry staff, and maintenance, transportation and dining services staff all take in lower hourly wages at nursing homes than at assisted living facilities, the survey shows.

A staff nurse (RN) in a nursing home makes an average of $27.84 per hour versus a staff nurse in an assisted living facility, who makes $29.39 per hour — or roughly 5.6% less per hour, according to data released in the 20th annual Assisted Living Salary & Benefits Report, published by Hospital & Healthcare Compensation Service (HCS) this week. The comparable hourly wage in a CCRC was $28.90.

Licensed practical nurses (LPNs) in nursing homes make 6.8% less per hour than their assisted living counterparts, at $21.56 per hour versus $23.13 per hour in ALFs.

Several key players in the skilled nursing mergers-and-acquisitions space identified wage pressures as a key issue for providers in 2018, as the stable economy gives workers more choices and bargaining power.

Findings of the survey were collected from 602 respondents throughout the U.S., with data effective October 2017. The report is published in cooperation with LeadingAge and supported by the National Center for Assisted Living (NCAL).

The Sun Sentinel reported the trauma suffered by first responders to Hollywood Hills Rehabilitation Center after Hurricane Irma. Many are still haunted by the dying nursing home residents they tried to save as they sweltered in a building with no air conditioning.  Some reported that it was cooler outside the nursing home than inside where the residents struggled to breathe in the heat.

“In a span of about three hours on Sept. 13, the Hollywood firefighter/paramedic and fellow crew members treated two critically ill residents. They had trouble breathing and registered body temperatures of 107.5 degrees. When the paramedics returned to the Hollywood Hills Rehabilitation Center for a third time that day, they found the head nurse performing CPR on a dead male patient.

The lack of care that these people were experiencing and just the conditions they were experiencing,” Wohlitka said. “In all honesty, this call is still very much haunting.”

Wohlitka and other fire-rescue workers who responded to the nursing home testified in court. This is the first time the rescue workers who responded to the nursing home where 12 ultimately died have publicly given their accounts of what they saw during those deadly pre-dawn hours.  It was part of a series of hearings this week to determine whether the nursing home should be allowed to re-open. The nursing home is challenging the state’s move to revoke its license.

After finding the dead man, the crew decided to check out other residents. Wohlitka said he noticed a woman inside her room looked “unwell” from where he stood in the hallway. He tried to figure out if she was OK, but nursing home staff insisted they had already done their round of checks.  “I attempted to enter the room and evaluate her and I was stopped by a Hollywood Hills staff member who basically told me that they had just done rounds and everybody was fine,” he testified. “I asked her, ‘Are you sure? That woman doesn’t look good’ and she said, ‘No, she just looks like that.’

“I just felt bad for that woman,” Wohlitka said. “You beat yourself up and maybe I should have told that facility member ‘no,’ but an RN is higher than a firefighter and a paramedic. We had no reason to doubt her.”

But eventually the paramedics did doubt the competency of the nursing home staff.  “I believe that they were panicked, that they were overwhelmed by the amount of patients that we were deeming critical,” Parrinello testified.

 

As she tried checking on patients’ vital signs, she said the head nurse told her that his staff had already done that. Parrinello testified that at this point she doubted the staff had been truthful about their assessment of patients. She said she told the head nurse: ’Well, you told me that before and now we have multiple deceased patients. So, with all due respect, I don’t trust your judgment and we’re going to check everyone ourselves.’

Ultimately, a dozen residents died from heat exposure and the medical examiner determined their deaths to be homicides.

Said Wohlitka, the firefighter/paramedic: “The uncomfortable heat alone was unbearable for myself, I won’t speak for anybody else. I was very uncomfortable inside the facility; I can only imagine what somebody who wasn’t able to go outside or get out was dealing with. I think it’s pretty evident… it just wasn’t safe.”